Cuomo Loosens Reins on NPs, PAs, and More

Cuomo Loosens Reins on NPs, PAs, and More

As New York state climbs the steep face of its COVID-19 curve, Gov. Andrew Cuomo (D) issued an executive order vastly widening the scope of practice for some healthcare providers and absolving physicians of certain risks and responsibilities.

Among the order’s provisions:

  • Eliminating physician supervision of physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists, and others
  • Enabling foreign medical graduates with at least a year of graduate medical education to care for patients
  • Allowing emergency medical services personnel to operate under the orders of NPs, PAs, and paramedics
  • Allowing medical students to practice without a clinical affiliation agreement, and lifting 80-hour weekly work limits for residents
  • Granting providers immunity from civil liability for injury or death
  • Suspending usual record-keeping requirements
  • Allowing several types of healthcare professionals — including NPs, PAs, nurses, respiratory therapists, and radiology techs — with licenses in other states to practice in New York. However, physicians were not specifically included in the order, as the Department of Health and Human Services has not yet issued the necessary regulation
  • Suspending or revoking hospitals’ operating certificates if they don’t halt elective surgeries

The order, which remains in place through at least April 22, was met mostly with applause, though with some hesitation around work-hour limits.

C. Michael Gibson, MD, of Harvard, called it “stunning in both the breadth and depth of recommendations” on Twitter.

Shariq Shamim, MD, described it as a “great move,” with the exception that trainee work hour limits shouldn’t be scrapped: “They are already working equivalent to 2 [full-time employees] without Chinese-style PPE. More hours = more risk of exposure,” he tweeted.

Art Gianelli, president of Mount Sinai Morningside hospital in New York City, told MedPage Today that his team is “grateful to the governor for throwing the regulations out the window right now. He’s encouraging us and enabling us to do what we have to do to get through this. It’s the right thing to do.”

John Puskas, MD, chair of cardiovascular surgery at Mount Sinai Morningside, agreed that the steps are the right ones given that New York City “hasn’t flattened the curve adequately to avoid a big wave crashing. We’re really going to feel it in the next 2 or 3 weeks.”

“If simultaneously with that, we lost a meaningful number of healthcare providers to home quarantine, then we’d have a shortage not just of ventilators, but of people to run them and care for patients,” Puskas said.

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today

How Do You Deal with A Patient’s Death?

How Do You Deal with A Patient’s Death?

Death is a natural part of life but that doesn’t make it any easier. Intensive care nurse Rhianna Ferial says that, “as healthcare professionals, we are there for people and their families during the final moments. This can be hard emotionally, so it’s important to recognize and find ways to deal with your feelings.”

Watch the video or read the transcript below [edited for length] — and use the comment tool to let us know how you deal with patient death in your own work.

Rhianna Ferial: Hi, everyone. Today, I wanted to have a little nurse talk, a sit-down talk, and I wanted to talk about dealing with patient death. I want to tell you about my first experiences with patient death, my experiences since then in some ways that I think help coping with patient death and dealing with your grief or your emotions over the situation.

I honestly think the most stressful and emotionally taxing part of dealing with patient death is being there for their families, and this is something that’s very important. I feel like we don’t get enough education or practice with this part because we’re there for treatment and I know how to take care of patients. I know how to do ACLS. I know what to do to save them. But when we can’t save them, what comes after that is dealing with the family while they say goodbye to their loved one. We’re there with them afterwards while they’re grieving.

That’s the hardest thing for me in my career. It was the hardest thing for me to get used to from the beginning, and I always thought the actual scenario of trying to save somebody or them passing away would be the hardest. For me, it’s actually the emotional part of dealing with the remaining family members who are just grieving and so upset.

My #1 piece of advice in dealing with the families is it’s okay to be silent. I always used to feel like I need to say something when a tragic situation was going on. I was in the room with a family who’s saying goodbye to their dead loved one and I felt like I should be saying something or talking to them, trying to console them, but there’s nothing you can really say to help them. There’s nothing you can say to take their pain away. Sometimes just being there, handing out tissues, trying to hand out waters or anything you can to just make them a little more comfortable is all you can do.

Sometimes people just need a hug. Not everybody is a hugger, but sometimes family members just want you to be there with them. Sometimes they need a hug, a shoulder to cry on, and you can be that person. You don’t always need to be saying something. Don’t be scared of saying the wrong thing. Don’t be worried that you’re not saying enough. Honestly, there is no right answer here, and all you can do is what feels right. Oftentimes, for me, I found that that’s silence and waiting for them to start talking. If they talk and initiate and want to have a conversation more about what’s happening, I’m there and I’ll talk to them as well.

The second piece of advice I have… and these are in no particular order. I’m not saying one of these is more important than the other. But the second thing I would say is please try not to blame yourself and try and find things wrong with what you did when somebody dies in your care. We’ve tried everything we can to save somebody. We’ve given blood and ACLS, done CPR, done everything we can think of, tried to save this person, and they just couldn’t make it. Their body couldn’t handle it, and it was just time for them to go, even though it doesn’t feel like it’s time and doesn’t feel like it’s right. There’s nothing that you could have done, not one thing specifically that you could have done or changed what you did, or change the timing is something usually that would have saved that person.

There’s too much, too many factors going on, so try not to blame yourself, try not to replay scenarios over and over again in your head blaming yourself. I know a lot of newer nurses or younger nurses that are dealing with death for the first time tend to do that. I’ve had people tell me they do that. I’ve done that in the past before, too. Just realize that that’s not a productive way to deal with your feelings, and it’s just going to make you feel worse.

This kind of leads me into the third thing that I wanted to talk about and that is don’t compare your feelings to how other people are feeling during this situation. Everybody processes situations and feelings and emotions differently. Just because one nurse is extremely upset and one doesn’t seem to be upset at all does not mean that either one of them is dealing with the situation in the wrong way. We all just handle things in our own unique ways. Obviously, you need to be able to keep it together during the situation. You can’t really be functioning during the code or like a mass transfusion protocol or any kind of dire situation if you’re completely overwhelmed and upset. If that’s happening during the situation, obviously that’s another issue that needs to be addressed, but I’m talking about afterwards.

Take things at your own pace, deal with things how you feel like you need to deal with them. If you’re upset and you need to go in the bathroom or the break room and cry for a second, do that and don’t think there’s anything wrong with that. If you’re not upset and you feel like you can go right into your next patient’s room and provide them with care, and you feel like you need to keep going, keep yourself busy, do that as well. There’s no right answer here. Everybody deals with it differently. I just wanted to say that because often in healthcare there’s this kind of vibe that you shouldn’t get upset about things. You should keep a wall up. You shouldn’t get upset about patients or situations. You should kind of just move on to your next task. That’s not always the case.

The fourth thing I wanted to say is something that has really helped me in the past and continues to help me is find an outlet for yourself, whether that be working out, whether that be crafting, whether that be continuing education, something that you can focus on and spend your time on that’s for you. This isn’t just with patient death, but with stress in general. Having something for you is very helpful, something productive that makes you feel good, which makes you feel like you’re getting stuff done and you can put your mind and soul into and really focus on that.

Now, the last piece of advice I have, I think it would be tip #5, is to talk with others, whether this be your co-workers who are there with you during the incident or whether this be a therapist or a counselor, or somebody who can help you deal with your feelings. Obviously, don’t violate HIPAA if you’re not talking to your co-workers who were there in the situation, but you can talk about situations without giving details. If you need to see a therapist or a counselor, do not feel bad about that. Sometimes you need somebody objective to talk to who’s very neutral and can just give you advice and just be there for you to listen and you don’t feel like is judging you.

Talking to your co-workers can be great, too, if you have good co-workers and just depending on the situation. If you come home and you just had a really bad day, you lost a patient, something horrible happened, don’t be afraid to tell your family that you’re just really not feeling good and you had a bad day at work. You don’t need to go into detail or make it gruesome for them or tell them anything specific. Maybe you just need to go take a bath or listen to some music or read a book or go sit in your room by yourself for a little while, but oftentimes they’ll be very understanding of this. I’m sure they know your job is stressful. Just don’t be afraid to vocalize when you need a little you time.

That’s it for my tips for dealing with death. Obviously, there’s many more things you can do. That’s just kind of some things that I found that are helpful. I hope they were helpful to you guys as well. If you have any tips or things that you do to help you cope with loss, please leave them in the comments below because people who have dealt with stuff before can help new nurses, new health care workers who are just now dealing with it for the first time. By sharing your feelings and experiences, you can really help lift them up and help them realize that they’re not going through this alone.

Young NP Student is in Recovery After 5-Month Coma

Young NP Student is in Recovery After 5-Month Coma

By Judy George, MedPage Today

April Braker, a 30-year-old registered nurse, was four classes away from completing her master’s degree and on her way to becoming a nurse practitioner. It was May 2018 and she had just started a new job at Rush University Medical Center’s emergency department in Chicago when she started feeling odd.

“I had just finished orientation at Rush,” she recalled. “I started having weird symptoms — headaches at first, then headaches with fever. I thought I had meningitis.”

She went to a community hospital for testing, then went home. When her symptoms persisted, she went to another hospital. “I called a stroke alert on myself, and one of my good friends responded,” she recalled. “I managed to get admitted to the neurology floor. Within a week, I rapidly declined. I lost my ability to breathe. I spontaneously went into a comatose state.”

Diagnosing what caused Braker’s coma took a while. Figuring out how to bring her out of it took much longer.

Diagnosing April’s Coma

Concerned that Braker had no diagnosis, a clinical friend found a paper about anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis, an immune-mediated disease that can strike young women. When Braker’s cerebrospinal fluid tested positive for NMDA receptor antibodies, she was transferred to Stephen VanHaerents, MD, an epileptologist and specialist in autoimmune encephalitis at Northwestern Medicine in Chicago.

Anti-NMDA receptor encephalitis can be tricky to diagnose, VanHaerents explained. “It’s essentially a condition in which the immune system attacks the brain.”

First described in 2007, anti-NMDA receptor encephalitis is rare — its incidence is estimated to be 1.5 per million people per year — and is 4 times more prevalent in women than men.

Patients develop a constellation of symptoms that vary depending on the stage of the disease. “The presentation can be different from patient to patient, but commonly include psychiatric symptoms and neurocognitive deficits,” VanHaerents said. In the weeks before Braker became comatose, for example, her family reported she was uncharacteristically agitated, forgetful, even paranoid.

Known triggers of NMDA receptor autoimmunity include tumors — usually ovarian — and herpes simplex encephalitis. About 80% of patients improve with immunotherapy and, if necessary, tumor removal.

Braker was not one of those patients. “She was comatose when she came to Northwestern,” VanHaerents said. “We put her on EEG and saw she had several seizures.” VanHaerents also observed that Braker had a very specific EEG pattern for anti-NMDA encephalitis known as extreme delta brush.

“We stabilized her, treated the seizures, and began immunotherapy,” VanHaerents recalled. “We also looked for any potential neoplasm, which we found.” Braker turned out to have a right ovarian teratoma, which was removed. She underwent multiple sessions of steroids, plasmapheresis, and intravenous immunoglobulins — all with no response.

Finding the Right Medication: A Detective Story

No anti-NMDA receptor encephalitis treatments have been approved by the FDA, but clinicians tend to follow general guidelines, VanHaerents noted. When first-line immunotherapy didn’t work, he turned to two second-line treatments, the anti-cancer agents rituximab (Rituxan) and cyclophosphamide, to try to wake Braker.

“There’s a big risk with patients like this,” he noted. “The longer they stay in a coma, the more we worry about problems that could come up in the ICU. They could develop infections, especially if you’re suppressing their immune system.”

But even with rituximab, cyclophosphamide, and additional plasmapheresis, Braker remained comatose.

VanHaerents kept searching for an answer, calling colleagues around the country. He found case reports demonstrating how bortezomib (Velcade), a drug approved for multiple myeloma, had been used to treat several refractory cases of anti-NMDA receptor encephalitis. “Bortezomib is a proteasome inhibitor; it predisposes both short- and long-term plasma cells to apoptotic death,” VanHaerents explained

At least two case series had been published about severe encephalitis patients who had been treated with the drug in Germany, including one in JAMA Neurology and one in Neurology.

Then VanHaerents heard about another case at a large academic U.S. hospital. They told him their patient started to wake up after bortezomib therapy. “Their ‘n of 1’ was good,” he said.

“I had to convince our pharmacy and our critical care team that I wanted to try this medication based on these cases,” he recalled. “They agreed. And so we did.”

And it worked.

Braker received her first dose of bortezomib on August 9, 2018. A few weeks after starting bortezomib and 5 months after she first became comatose — she began to wake up.

“She was sort of there, but not really there,” VanHaerents said. “She was very agitated, very combative.”

On Sept. 18, VanHaerents tested Braker’s spinal fluid for NMDA receptor antibodies and “there wasn’t even a detectable titer at that point,” he said. “The bortezomib really got rid of it.”

Emerging from Coma with ECT

By mid October, Braker could breathe on her own, but her recovery was still in its early stages. “She still was incredibly agitated and shockingly strong for someone who had been in a coma,” VanHaerents said. “She pulled out her tubes and had to be restrained several times.”

In some patients who experience severe catatonia with anti-NMDA receptor encephalitis, electroconvulsive therapy (ECT) can help, VanHaerents noted. Working with Northwestern psychiatrist Lisa Rosenthal, MD, Braker started having “an amazing response” to ECT, he said. “She became more comfortable and began smiling. These were things she wasn’t doing before because she was so agitated.”

After her second ECT session, she began to speak and follow simple commands. She continued ECT 3 days a week for a total of 10 sessions; her cognitive status waxed and waned, but she showed progressive improvement.

“I think bortezomib woke her up and got her brain working,” VanHaerents said. “But ECT really sped up her recovery.”

She started eating and drinking and with therapy, she regained much of her previous function. By April 2019 — almost a year since she first sought treatment for her symptoms — her IQ was in a normal range. “She’s obviously very intelligent and is working very hard to get back to 100% but even at the level she’s at now, she’s functioning very well,” VanHaerents said.

On the Path to Recovery: “I’m at 95%”

Braker’s case illustrates how treating anti-NMDA receptor encephalitis depends on many disciplines, he added. “This disease requires a lot of collaboration,” he said. “Most patients start out in a psychiatric facility because they appear mentally ill. And once they’re diagnosed correctly, it requires a huge team effort to figure out how to best care for them.”

Not every patient with anti-NMDA receptor encephalitis ends up in a coma and for those who do, bortezomib and ECT do not always work. But for April Braker, these treatments helped her reclaim her medical career.

Last summer, Braker audited the last class she had taken before she became ill. “I wasn’t ready to go back to graduate school full force, but I joined the class discussions, took the exams, and ended up doing well,” she said. She officially re-enrolled in school this past September and plans to finish her master’s degree in May.

“It felt natural to get back to school,” she said. “I’m not completely myself; I’d say I’m at 95%. But I’m pretty sure that eventually, I’ll be better.”

Originally published in MedPage Today

New RN Survey Results: Nurses a Little Grayer, Slightly More Diverse

New RN Survey Results: Nurses a Little Grayer, Slightly More Diverse

The U.S. nursing population has grown a bit more diverse in recent years, but most RNs are still white and female, according to a national survey from the Health Resources and Services Administration — and the average age is creeping upward.

According to the 2018 National Sample Survey of Registered Nurses (NSSRN), close to 4 million licensed RNs in the U.S. were working as of Dec. 31, 2017, representing a 29% increase from the NSSRN’s 2008 findings.

The report also showed that almost three-quarters of nurses are non-Hispanic white, and that about nine in 10 are women. Also, the current RN population is “graying” — the 2008 survey reported that 44.7% of RNs were over age 50; the 2018 NSSRN survey put that percentage at 47.5%.

The NSSRN findings are in line with what the American Nurses Association (ANA) expected, said Cheryl Peterson, MSN, BSN, vice president of nursing programs for ANA.

But, she added, “I think we would all say that we are disappointed that we didn’t see more of an increase in the diversity of nursing between 2008 and now. We have to look again at… why people of color are not choosing nursing as a profession.”

The NSSRN identified a slight change in the proportion of minority RNs, driven primarily by an increase in Hispanic nurses. Specifically, 10.2% of RNs in the 2018 survey were Hispanic, 7.8% non-Hispanic black, 5.2% Asian, and 1.7% multiracial. Racial and ethnic minority groups accounted for 26.7% of all RNs who responded to the survey.

Healthcare needs to remove barriers to recruiting more nurses in communities where they are underrepresented, Peterson stressed, and “not just Hispanic and African American, but Native American as well as Asian and Pacific Islander and Alaska natives.”

In terms of men entering the RN workforce, the 2018 report found that male RNs made up 9.6% of the total population, a slight bump from 7.1% in the 2008 NSSRN survey.

Scott Kelnhofer, executive director of the American Association for Men in Nursing, said the organization was “encouraged” by the rise in the percentage of men in the profession.

“We anticipate the percentage will continue to grow in the coming years, based on the increasing number of men who are pursuing nursing degrees around the country, and as more men realize the benefits of entering a profession where there is such a high demand for a skilled and diverse workforce,” Kelnhofer wrote in an email.

The U.S. nursing population has grown a bit more diverse in recent years, but most registered nurses (RNs) are still white and female, according to a national survey from the Health Resources and Services Administration — and the average age is creeping upward.

According to the 2018 National Sample Survey of Registered Nurses (NSSRN), close to 4 million licensed RNs in the U.S. were working as of Dec. 31, 2017, representing a 29% increase from the NSSRN’s 2008 findings.

The report also showed that almost three-quarters of nurses are non-Hispanic white, and that about nine in 10 are women. Also, the current RN population is “graying” — the 2008 survey reported that 44.7% of RNs were over age 50; the 2018 NSSRN survey put that percentage at 47.5%.

The NSSRN findings are in line with what the American Nurses Association (ANA) expected, said Cheryl Peterson, MSN, BSN, vice president of nursing programs for ANA.

But, she added, “I think we would all say that we are disappointed that we didn’t see more of an increase in the diversity of nursing between 2008 and now. We have to look again at… why people of color are not choosing nursing as a profession.”

The NSSRN identified a slight change in the proportion of minority RNs, driven primarily by an increase in Hispanic nurses. Specifically, 10.2% of RNs in the 2018 survey were Hispanic, 7.8% non-Hispanic black, 5.2% Asian, and 1.7% multiracial. Racial and ethnic minority groups accounted for 26.7% of all RNs who responded to the survey.

Healthcare needs to remove barriers to recruiting more nurses in communities where they are underrepresented, Peterson stressed, and “not just Hispanic and African American, but Native American as well as Asian and Pacific Islander and Alaska natives.”

In terms of men entering the RN workforce, the 2018 report found that male RNs made up 9.6% of the total population, a slight bump from 7.1% in the 2008 NSSRN survey.

Scott Kelnhofer, executive director of the American Association for Men in Nursing, said the organization was “encouraged” by the rise in the percentage of men in the profession.

“We anticipate the percentage will continue to grow in the coming years, based on the increasing number of men who are pursuing nursing degrees around the country, and as more men realize the benefits of entering a profession where there is such a high demand for a skilled and diverse workforce,” Kelnhofer wrote in an email.

The U.S. Census Bureau in partnership with the National Center for Health Workforce Analysis periodically conducts surveys that examine race, age, gender, educational attainment, and other key characteristics of the nursing workforce. The first survey was conducted in 1977.

More than 50,000 active RNs completed the 2018 survey (online or on paper). The sample was randomly selected from licensure records provided by the National Council of the State Boards of Nursing, and sorted by state, license type, and other demographics in order to determine the appropriate sampling rate from each state. The response rate was 50.1% (49.1% weighted).

Aging Workforce

In the current survey, mean age of survey respondents was 47.9, up from an average of 47.0 in the 2008 NSSRN survey.

Employers who aren’t paying attention to which of their RNs are nearing retirement could find themselves “in a world of hurt,” Peterson said, and may have to reconsider how they can keep RNs in direct patient care for longer.

She said that one strategy would be to rethink traditional nursing work schedules: “Are we so wedded to 12-hour shifts that we can’t reduce to [8-hour shifts], or look at other staffing patterns that might better suit a nurse who is older?”

It’s also important that employers attract younger RNs to their facilities while the more experienced nurses are still available to teach them, she said.

Education and Experience

Almost 64% of nurses said they earned a bachelor’s degree or other higher degree, with 19.3% reporting that they earned a graduate degree. But that leaves 29.6% of RNs whose highest level of education was an associate degree, and 6.4% whose highest attainment was an RN diploma.

“The complexity of healthcare is such that it warrants a higher level of education than even probably a diploma, but those programs are out there… they are part of the house of nursing and we support that,” Peterson said.

She noted that the 2011 Future of Nursing report stated a goal of having 80% of nurses earn a baccalaureate degree by 2020, Peterson noted. Still, while it’s unlikely the workforce will hit that mark this year, “we’ve made significant progress,” she said.

The current report also found that 11.5% of all RNs earned a graduate degree and an advanced practice certification versus 8.1% reporting the same in 2008.

The 2018 survey showed that registered advanced practice nurses (APNs) made up about 11.5% of the nursing workforce. A relative handful of RNs, 5%, received their training outside the U.S.

Telehealth

Telehealth technologies were available to 32.9% of RNs in 2017 and, of those, 50.3% report using some version of telehealth “in their primary nursing position.”

Provider-to-provider consults made up 54.4% of telehealth use and calls from nurses to patients made up about 50%.

Peterson said the rise in telehealth is not surprising. “We see the National Quality Forum, and some of these value-based purchasing plans, that are really …placing value — including monetary value — on follow-up phone calls, [and] follow-up televisits to patients after they’ve left the hospital,” she said.

Peterson said she expects to see more reliance on telehealth with the increasing use of technologies such as wearables.

“I think this is where nursing has the capacity to do … some really good work,” she said, “being able to appropriately and adequately advise patients” by leveraging algorithms and their own critical thinking to provide guidance and feedback to patients outside the office.

Salaries

Full-time RNs earned a median salary of $73,929; the median for part-time RNs was $39,985.

There was a significant gap between male and female for median full-time earnings, with male RNs earning $79,928 per year and female RNs earning $71,960, according to the survey results.

Peterson said that she has not heard any complaints from nurses about a pay disparity. “I think it’s more about career choices,” she said: male RNs tend to work in places where there is a salary differential, such as emergency departments, ICUs, and in management.

by Shannon Firth, Washington Correspondent, MedPage Today

Originally published in MedPage Today

House Hearing: More Research Needed on Health Effects of Cannabis

House Hearing: More Research Needed on Health Effects of Cannabis

WASHINGTON — Healthcare providers don’t know enough about cannabis to talk with patients about the potential risks and benefits, witnesses said at a mid-January House Energy and Commerce Health Subcommittee hearing.

“We need to have much more education with respect to how the use of marijuana products can negatively impact or help someone,” said Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA). “The problem is we do not have sufficient evidence that could help us mount those programs in a way that’s actually required. At this point, I don’t feel the evidence is sufficient to say, ‘We’re going to recommend that this product should be used by this patient.'” For example, elderly patients who take marijuana-containing products may be on a lot of other medications, and little is known about potential interactions between marijuana and prescription drugs. “So I do believe in the importance of expanding our knowledge so we can develop educational training programs that are based on knowledge, not on anecdote.”

Making it Easier to Research Cannabis

Rep. John Sarbanes (D-Md.) noted that a 2015 survey of healthcare providers concluded that the providers “perceive a knowledge gap related to cannabis dosing, treatment plans, and different areas related to cannabis products, so providers themselves realize the need for research and expertise to be developed in this area.”

The hearing was held to discuss six bills on cannabis, several of which were aimed at making it easier for researchers to obtain cannabis for research purposes. Currently, the only cannabis legally available for research comes from a single farm housed at the University of Mississippi, and researchers who want to use it must get permission from three agencies: the FDA, the Drug Enforcement Administration (DEA), and the NIH. “We need to figure out a way to take advantage of different producers of cannabis plants to evaluate the diversity of products out there, as opposed to limiting us to the Mississippi farm,” said Volkow.

Rep. Kurt Schrader (D-Ore.) agreed. “The sad part is we’re not testing the right stuff,” he said. “I fail to understand why we have one bloody facility that is the sole nexus for research and analysis of CBD [cannabidiol] products. It seems to me we ought to be testing products on the marketplace.” Subcommittee chairman Anna Eshoo (D-Calif.) agreed. “I don’t understand why the three agencies before us can’t get this done,” she said, referring to NIDA, the FDA, and the DEA, which all had officials testifying at the hearing.

The Cannabis Research “Catch-22”

Several subcommittee members expressed frustration over what they called the “Catch 22” problem that cannabis researchers face. “They can’t conduct cannabis research until they can show cannabis has a medical use, but they can’t demonstrate cannabis has a medical use until they conduct research. It doesn’t make sense,” said Eshoo.

“You’ve got to help us figure out how we’re going to get out of this Catch 22,” Rep. Debbie Dingell (D-Mich.) said to the witnesses at the hearing. “This lack of knowledge poses a public health risk.”

One issue with conducting research on marijuana is its classification as a Schedule 1 drug; these are substances deemed to have no medical value and have a high potential for abuse, and their availability is highly restricted. Several bills the subcommittee is considering, including the Legitimate Use of Medicinal Marijuana Act, the Marijuana Freedom and Opportunity Act, and the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, would either downgrade marijuana from a Schedule 1 drug to a Schedule 2 drug, which has fewer restrictions, or remove it from the drug schedule altogether.

Rep. Michael Burgess, MD (R-Texas), the subcommittee’s ranking member, said the latter “is going too far,” adding that “using our congressional authority to override this may be a dangerous move, especially given the lack of research.”

So far, only one marijuana-related drug has been approved by the FDA: Epidiolex, which contains cannabidiol, was approved in June 2018 for treating a rare seizure disorder in patients ages 2 and over.

Diverse Testimony from Both Sides of the Aisle

Both the witnesses and the subcommittee members seemed divided on marijuana’s potential harms and benefits for patients. Volkow mentioned research showing that cannabis exposure during pregnancy was associated with low birthweight and preterm delivery, and added that it was also linked with episodes of psychosis. She also said that there was some evidence that cannabis may be useful in treating spasticity, multiple sclerosis, and pain, “but otherwise there is little benefit for other indications for which patients are using it.”

Rep. Morgan Griffith (R-Va.) said that his support of medical marijuana began some years ago when he learned that people were smuggling marijuana into a Virginia hospital to help a terminally ill father who wanted to be feeling well enough to spend time with his 2-year-old son. Years later, when he told that story at a high school town hall, one student raised his hand and said, “They did that for my daddy too.”

“These communities were 20 years apart, 30 years apart, yet doctors were turning a blind eye to allow marijuana to be brought into the hospital because they recognized that for those patients who are dying, that was the only way they would get relief and get the nutrients they needed to spend a little more time with their children,” Griffith said.

Rep. Greg Gianforte (R-Mont.) said he was opposed to efforts to “make any Schedule 1 drug legal without adequate research.” Instead, “we should focus on combating addiction,” he said.

by Joyce Frieden, News Editor, MedPage Today

Originally published in MedPage Today

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