Bipartisan House Cannabis Decriminalization Bill Passes Initial Committee Vote

Bipartisan House Cannabis Decriminalization Bill Passes Initial Committee Vote

Cannabis and politics are at an intriguing crossroads as we creep ever closer to the next election year. Politicians must decide how to position themselves on the hot-button issue of cannabis legalization. Many potential legalization bills have been proposed in the House of Representatives but very few have ever made it out of committee. National legalization bills have a history of facing intense scrutiny in the houses of Congress. There are a number of reasons for this but the vast differences in political opinions of members of Congress makes compromise on any bill, let alone one about a hot button issue like cannabis legalization, very difficult.

However, on Wednesday, November 20th, a new bill that would decriminalize cannabis nationally, allow states to make their own laws on full-scale legalization, and create the potential for expunging criminal records related to cannabis arrests passed in the House Judiciary Committee.

Chances of the Bill Passing

Though it is tough to envision a cannabis bill actually seeing the light of day, there is hope for this most recent iteration. The bill already has 50 co-sponsors, bipartisan support from notable pro-cannabis legalization Republicans like Matt Gaetz of Florida, and passed the House Judiciary Committee with a vote of 24-10. It is always encouraging when Republicans and Democrats can agree on legislation, especially when it comes to a potential cannabis legalization bill. Recently, the House of Representatives passed the SAFE Banking Act with bipartisan support. The bill allows for cannabis businesses to bank safely and discreetly. Its passage shows the willingness of Congressional Republicans and Democrats to work together to pass a cannabis bill.

The House cannabis bill is undoubtedly an exciting moment for those in the legalization movement. As promising as the bill seems, it is unlikely that it will be passed without major changes. It may pass the Democrat-controlled House of Representatives, but will face an intense battle in the Republican-controlled Senate. As unlikely as the bill’s passage is, those investing in the cannabis industry seem to believe the bill has a chance to become a part of American law soon.

Impact On The Cannabis Industry

As news of the forwarding of the house cannabis bill was announced, cannabis company stocks soared. The three biggest cannabis stocks, Canopy Growth, Tilray Inc., and Aurora Cannabis all saw prices rise between 8% and 15% on Wednesday, according to Reuters. Investor excitement is palpable, but some experts warn about the long term future for the House cannabis bill. Alan Brochstein, managing partner at New Cannabis Ventures, cautioned that the bill is, “such an early step in a long process that there are no near-term implications for cannabis stocks.”

The merits of the House cannabis bill will likely debated for the next few months. Changes will be made and votes will be cast before anything is set in stone. Whether or not this iteration of a legalization bill becomes law is unknown, but the fact that some politicians continue to fight for cannabis legalization is tremendously promising.

Border Flu Shot Protest: 4 Docs arrested

Border Flu Shot Protest: 4 Docs arrested

Four physicians and two others protesting their inability to vaccinate migrant detainees at the U.S. Customs and Border Protection (CBP) headquarters here were arrested last Tuesday for failing to comply with federal orders to disperse.

They were held for about an hour, according to some of those who were arrested.

The two groups of protesters — about 60 people in total — had gathered in two driveways leading to CBP headquarters for about an hour when one of the groups received a warning from federal officials that if they stayed in the driveway, they would be arrested, said Marie DeLuca, MD, an emergency room physician from New York who was one of those arrested. Some of the members had blocked the driveway by laying down across the road while others chanted, “No more death.”

“We stayed peacefully in the driveway entrances of their building and said that if they weren’t going to let us in to vaccinate against the flu, we were going to remain. They didn’t let us. Instead they chose to arrest members in one of the two groups,” DeLuca said.

She said her hands were secured behind her back with zip ties by officials from the Department of Homeland Security (DHS) as she and the other protesters were led into a conference room and told to wait. After about an hour following the protest, they were issued tickets with a court date for “failure to comply with the lawful direction of federal police officers or other authorized individuals,” and then released, she said.

A San Diego Union-Tribune reporter posted a video of some of those doctors being arrested.

At about 2 p.m. Tuesday, DHS’s press secretary tweeted a picture of the protesters and said, “Of course Border Patrol isn’t going to let a random group of radical political activists show up and start injecting people with drugs.”

Sen. Elizabeth Warren (D-Mass.) also tweeted a link to a video of the protesters, saying that “Children are dying in CBP custody due to the flu. Refusing to administer flu vaccines is neglectful and cruel.”

Other doctors arrested, who were part of the group Doctors For Camp Closure, included Mario Mendoza, MD, a former anesthesiologist who now lives in New York City and runs the organization Lifeundocumented.org; Hannah Janeway, MD, an emergency room physician in Los Angeles who helps run the Refugee Health Alliance; and Mathieu De Schutter, a pediatric hospitalist from San Luis Obispo, California. The non-physicians arrested were Rebecca Wollner of Jewish Action San Diego and Matthew Hom, a graduate student from Cerritos, California, who works with the group Never Again Action.

On Monday, the physicians began their three-day vigil and protest of federal immunization policies at the gate of the detention center in San Ysidro at about 11:30 a.m. They stayed until about 4:30 p.m. with no response despite repeated requests. Tuesday’s action took place nearby at the Chula Vista CBP headquarters.

DeLuca said the doctors and their supporters planned to return Wednesday to try one more time to administer the 120 influenza vaccines they brought with them for the detainees. They say it’s important for public health, not just to protect these detainees, but also everyone else they come in contact with.

Members of the groups chanted slogans and carried banners and signs calling on federal officials to let them administer the vaccinations to those inside. The vaccines were purchased with financial donations.

Originally published in MedPage Today.

Climate Change Awareness: The Role of Health Providers

Climate Change Awareness: The Role of Health Providers

As trusted professionals in the eyes of the public, health providers are considered stewards of public health and safety.

A view of Hong Kong smog from Victoria Peak.
A polluted morning in Hong Kong.

Health providers are ethically bound to advance health holistically, and with climate change, this means translating information into advocacy. The effects of climate change call for the many roles that medical providers take on: first responder to disaster, risk educator of patients and public, and — in an almost exact reenactment of Florence Nightingale’s work — defender of clean water, nutritious food, and sanitation.

The scope of climate-related effects on human health is simultaneously as broad as global drought and as specific as increased incidence of skin cancers. Health providers are uniquely positioned to address the health implications of climate change, providing education within the context of direct patient care and speaking with authority on policy decisions that affect public health.

Climate Change and Human Harm

Health providers warn that climate change can cause or increase the severity of a range of dangerous respiratory ailments.

Scientists are still working to understand the full impact of climate change on human health; however, there are existing studies that show severe effects on human health as a result of environmental hazards. According to the National Institutes of Health, there are several key areas of concern regarding climate and health, and many opportunities for health providers to offer prevention and education.

THREATS TO RESPIRATORY HEALTH

Implications: Lung disease, allergies, and asthma will be worsened by longer allergy seasons and deteriorating air quality.

Health Provider Recommendations: Support staying inside on poor air quality days and remind vulnerable populations to adhere to medical treatment plans and medication.

VECTOR-BORNE DISEASES

Implications: Ticks and mosquitoes will be more active for longer and range farther.

Health Provider Recommendations: Encourage people to use bug repellent when outdoors or in any areas with insects. Monitor and record reports of disease outbreaks. Inform others about signs and symptoms of diseases and when to call a health care provider.

WEATHER-RELATED ILLNESS AND INJURY

Implications: Extreme temperature fluctuations affect outdoor laborers, children, pregnant women, and older adults and can cause pulmonary and cardiovascular problems and dehydration. In addition, increased particulate matter, ozone concentrations, and extreme weather events may trigger stress and respiratory issues that lead to heart disease.

Health Provider Recommendations: Educate about the risks of heat exposure. Ensure access to air conditioning for vulnerable or older adults and homeless populations. Also, encourage people to drink enough water throughout the day and not just when they feel thirsty.

MENTAL HEALTH AND STRESS DISORDERS

Implications: Extreme weather can be destructive to property and quality of life, often resulting in the loss of homes, belongings, and loved ones. Prolonged exposure to these stressful experiences can manifest psychologically as people try to navigate grief and loss with interrupted access to care.

Health Provider Recommendations: Encourage others to speak openly about their grief to reduce stigma. Identify gaps in mental health literacy and teach patients about signs and symptoms of mental health risks. In addition to educating, refer at-risk patients to a mental health provider as soon as possible.

Spreading the Word About Disaster Preparedness and Dangers

One result of climate change is more frequent and more powerful natural disasters, like hurricanes. Pictured are specialists testing the flooded river during Hurricane Harvey
Flooding after hurricane Harvey

In a 2018 World Health Organization report on climate change and health,  experts state that “globally, the number of reported weather-related natural disasters has more than tripled since the 1960s.” For this reason, it’s essential that health providers inform their communities about disaster preparedness and dangers. The best time to get involved is before a disaster; therefore, it’s critical for providers to leverage any one-on-one time with patients to address holistic health and emergency concerns. Special attention should be paid to those who may be vulnerable in the wake of disasters. For example, this could include people with chronic conditions, physical disabilities, or respiratory diseases; infants and children; pregnant women; and older adults.

Thin Ice: The Life-Threatening Effects of Climate Change

Air Temperature Change

  • Increase in heat exhaustion
  • Spread of disease vectors among animals, insects, and people

Air Pollution

  • Increased movement of airborne allergens and diseases
  • Higher risk of respiratory illness  
Climate change affects pets, too. Rescued dogs from Hurricane Harvey are being treated by volunteer health providers.
Volunteer care providers treat pets rescued after hurricane Harvey.

Extreme Weather

  • Chronic stress
  • Geographic displacement
  • Loss of loved ones and pets

Water Temperature Change

  • Changes to coastal ecosystem health that will affect food supply and erosion
  • Increased likelihood of extreme precipitation, drought, or flooding
  • Water contamination due to harmful chemicals and pathogens

Food Security

  • Malnutrition, especially for prenatal or early childhood development
  • Exposure to pesticides and toxic contaminants
  • Increase in harmful algal blooms

Source: Health Effects of Climate Change.  U.S. Department of Health and Human Services, 2018. Accessed April 23, 2019.

All health providers are important voices in preemptively educating patients about disaster preparedness, but nurses specifically make up a crucial part of disaster response.

More than 20,000 licensed and student nurses serve the Red Cross in a variety of roles — some as first responders and CPR educators and others as supervisors and organizational managers.

While the effect of climate-related health issues increases alongside the shortage of nurses and other medical providers, there’s great reason for all providers to advocate for change.

A Rising Tide Lifts All Boats: Advocacy for Climate-Related Health Policy

Nurses and other health providers are advocating for climate action.
Alliance of Nurses for Healthy Environments at September 2019 rally in D.C.

Climate change may be politically polarizing, but illness and injuries seen by first responders and health providers are concrete outcomes and can translate into loss of life on a global scale.

In a 2018 report on climate change and health that accounted for continued economic growth and medical progress, the World Health Organization stated that “climate change is expected to cause approximately 250,000 additional deaths per year between 2030 and 2050.” These fatalities are projected to come from the following climate-related health complications:

— 38,000 due to heat exposure in older adults

— 48,000 due to diarrhea

— 60,000 due to malaria

— 95,000 due to childhood undernutrition

Health providers can draw awareness to this dire need for attention at the policy and community levels. They can also share firsthand experience and research. This is an ethical duty that can result in widespread support of strong public health programs and climate justice.

How to Get Involved in Climate and Health Policy

In addition to in-person education with patients, health providers can do a variety of things to spread awareness about climate and health policy in their communities:

Leverage social media. Share articles with verified, evidence-based information on social channels. Use hashtags related to climate and health that make your posts easier to find. For example, #ActOnClimate, #Go100Percent, #Renewables, #SaveThePlanet, and #ClimateChange.

Continue your education. Request or attend an educational presentation from a trained professional, then collaborate with community organizations to educate people in your area. Volunteer with climate- or policy-focused organizations to gain perspective.

Participate in civic engagement. Call your representatives to let them know whether you support specific legislation. And always, vote in local and national elections.

Organizations for Further Reading or Involvement

If you are a health care provider looking to learn more about climate and health policy, you may wish to visit the websites of these organizations.

Citation for this content: [email protected], the online DNP program from the Simmons School of Nursing

Stanford Study Finds no Link Between Immigrant Health Coverage and In-Migration Rates

Stanford Study Finds no Link Between Immigrant Health Coverage and In-Migration Rates

Extending insurance coverage to immigrant children and pregnant women did not appear to influence whether they crossed state borders (known as in-migration) to acquire care, according to survey data.

Among 36,438 lawful permanent residents with children, the average in-migration rate 1 year before public health insurance was expanded to cover immigrants was 3.9% and 1 year after the implementation, the rate remained essentially unchanged at 3.7%, reported Vasil Yasenov, PhD, MA, of the Immigration Policy Lab at Stanford University in California, and colleagues.

Similarly, among 87,418 women of reproductive age, the in-migration rate 1 year before expansion was 2.7% and 1 year after it was 4.6%, the team wrote in JAMA Pediatrics.

“No Discernable Association” Between In-Migration and Insurance Expansion

“If an expansion of health insurance coverage was associated with in-migration to another state, the probability of in-migration would have increased in the treatment group compared with the control group,” the researchers wrote. “There was no discernable association between the in-migration from any state among the treatment group relative to the control group and public health insurance expansion.”

The authors compared the group of immigrants with children with a control group of lawful permanent residents without children. The proportion that migrated among immigrants without children was slightly higher before and after expansion (4.0% and 5.9%, respectively), but not significantly different from immigrants with children, Yasenov and his team reported.

Meanwhile, among a control group of post-reproductive women, the rate of in-migration was 3.5% and 3.9% in the years before and after expansion, respectively, which was also not significantly different than the group of women of reproductive age, the researchers added.

“We hope policy makers concerned with spiraling costs and people flooding in from other states will have the evidence they need to make a decision when thinking about extending public healthcare benefits for legal immigrants in the U.S.,” Yasenov told MedPage Today.

Findings Indicate Immigrants are Fleeing Violence and Corruption, Not Chasing Health Coverage

As of 2016, immigrants with children were covered by public insurance in 31 states and pregnant immigrants were covered in 32 states. Many Democratic candidates for the 2020 election support extending healthcare to undocumented immigrants, a policy that has been suggested will increase the flow of immigration within the U.S.

These null findings make sense in the context in which most U.S. immigration takes place, wrote Jonathan Miller, JD, of the Office of the Massachusetts Attorney General in Boston, and Elora Mukherjee, JD, of the Immigrants’ Rights Clinic of Columbia Law School in New York City, in an accompanying editorial.

Namely, many people coming to the U.S. are fleeing from violence or political corruption in their home countries, and “do not seek refuge in the [U.S.] because of potential access to healthcare,” Miller and Mukherjee said.

“Making it easier for immigrant communities to connect to and seek care from physicians will not radically shift migration patterns. Instead, allowing access to the basic human right of health care shows a common commitment to human decency for all who are in the [U.S.],” the editorialists stated.

Immigrants Sampled Were Below 200% of Fed Poverty Thresholds

For this study, data were collected from individuals residing in the U.S. from 1 to 6 years — but who were not born in the U.S. and were not citizens — from the American Community Survey. Notably, the sample was restricted to individuals who were below 200% of the federal poverty thresholds to identify people who would qualify for public insurance if it were extended, the authors noted. Immigrants on student visas, veterans, or those married to U.S.-born citizens were excluded because they qualify for other healthcare benefits, the team added.

The data were controlled for personal characteristics like age, race/ethnicity, and marital status, as well as things that varied by state and time such as cash assistance and economic conditions.

In total, 208,060 immigrants — mean age of 33 years, 47% of whom were female — were included. About two-thirds were Hispanic (63%), and the in-migration rate among the entire sample was 3%.

“Near-Zero” Likelihood

Overall, the likelihood that lawful permanent residents would migrate to a state where public health insurance has been expanded to cover immigrants was practically zero before and after expansion was implemented (percentage change from -1.21 to 1.78), the authors reported.

The likelihood was also close to zero among lawful permanent-resident women of reproductive age when compared with a control group of lawful permanent-resident post-reproductive women (percentage change from -1.20 to 1.38).

In a model specifically looking at whether public health insurance expansion would bring in migrants from a neighboring state, no association was found between policy implementation and the rates of in-migration of immigrants with children (–0.03 percentage points, 95% CI –0.5 to 0.44) or pregnant women (–0.02 percentage points, 95% CI –0.48 to 0.09), the researchers reported.

The primary limitation of the study, they said, was the inability to account for time-varying factors that could undermine the analysis, and it was also not possible to isolate states among the border and determine whether there was an association between in-migration and health policy specifically in these states. Lastly, the investigators said, the association was not analyzed among county-level or city-level programs.

The study was funded by the Stanford Child Health Research Institute.

The authors and editorialists reported having no conflicts of interest.

Primary Source

JAMA Pediatrics

Source Reference: Yasenov V, et al “Public health insurance expansion for immigrant children and interstate migration of low-income immigrants” JAMA Pediatrics 2019; DOI: 10.1001/jamapediatrics.2019.4241.

  • Secondary Source

JAMA Pediatrics

Source Reference: Miller J, Mukherjee E “Health care for all must include everyone” JAMA Pediatrics 2019; DOI: 10.1001/jamapediatrics.2019.4247.

by Elizabeth Hlavinka, Staff Writer, MedPage Today

This story was originally published by MedPage Today.

Will “Produce Prescriptions” Show Healthy Returns?

Will “Produce Prescriptions” Show Healthy Returns?

Federal, private funders bet food-as-pharmacy programs will deliver healthcare cost savings

When low-income patients with high blood pressure fill their “produce prescriptions” at certain New York City pharmacies, they walk away with $30 in vouchers to spend on fresh fruits and vegetables at the city’s farmer’s markets.

The city’s “Pharmacy to Farm Prescriptions Program” has reached more than 1,000 hypertensive SNAP recipients since it launched in 2017, and has grown from 3 to 16 participating pharmacies. It is set to report outcomes data next year.

The program is supported in part by a grant from the U.S. Department of Agriculture (USDA), which is poised to make an even bigger impact on the food-as-pharmacy programs that have been growing in popularity. The 2018 Farm Bill established a national Produce Prescription Program that sets aside millions in grants each year.

With diet-related illnesses like heart disease and obesity costing hundreds of billions of dollars each year in the U.S., other funders are also expecting a healthy return-on-investment (ROI) in these programs, which means more initiatives like New York City’s may find the means to thrive.

Not Just for SNAP Recipients

USDA has been supporting projects to increase healthy food consumption among SNAP recipients since 2014, under the Gus Schumacher Nutrition Incentive Program (GusNIP, formerly the Food Insecurity Nutrition Initiative). The bill now guarantees GusNIP can administer $25 million in produce prescription grants—not just for SNAP-based programs—for the fiscal year beginning in 2018, jumping to $45 million for the 2019 fiscal year and rising to its cap of $56 million in 2023. The first grants will be awarded in October.

The Local Food Hub in Charlottesville, Virginia, currently receives funding from local businesses and philanthropies, but has applied for a federal grant. Its Fresh Farmacy program provides low-income patients who have chronic disease with produce from local farmers. Participants pick up their “shares” every other week during the growing season.

“We have seen first-hand the impact of incorporating healthy food to manage weight, maintain healthy blood glucose levels, and reduce the risk of diabetes complications,” said Patricia Polgar-Bailey, a nurse practitioner at the Charlottesville Free Clinic, which participates in Fresh Farmacy.

Non-Profit and Private Sectors Pitch In

Federal dollars aren’t the only way to keep food-as-pharmacy programs afloat. Wholesome Wave, a non-profit that was co-founded by Gus Schumacher, has been supporting produce prescription projects since 2010.

Wholesome Wave gets money from philanthropies and corporate partners – including Target, Chobani, and Humana, to name a few – to foster such programs.

“There are non-profits and private-sector supporters trying to prove the model in the interest of getting insurers and the healthcare industry to really step up,” said Julie Peters, director of programs at Wholesome Wave.

An example of the organization’s support: it’s putting money into a produce prescriptions pilot for diabetes at Community Health and Wellness Partners (CHWP) in Logan County, Ohio, which is also supported by state and federal dollars.

Healthy Food = Healthier Lives

Once a month, participants attend nutrition classes taught by staff dietitians, and subsequently receive vouchers for up to $120, depending on family size, to purchase produce at local grocery stores or farmer’s markets.

Among those who have completed three months of classes, HbA1c has already declined 0.6 percentage points on average, said Jason Martinez, a clinical pharmacist at CHWP who has analyzed preliminary data from the program.

Will these improvements translate to reduced healthcare costs? That has been the case at Geisinger Health System’s Fresh Food Farmacy initiative. The program focuses on patients with type 2 diabetes who experience food insecurity. In addition to 15 hours of disease and nutrition counseling, participants get enough healthy food for 5 days of the family’s weekly meals.

Over 18 months, participants’ HbA1c levels fell 2.1 points on average, compared with declines of 0.5-1.2 points for those taking two or three medications only. Along with improvements in weight, cholesterol, and hypertension, that has translated to an 80% drop in healthcare spending for 37 of about 200 participants who were insured by Geisinger, according to early data.

“We know the cost of the program, all-in, for the food and the clinical care is around $2,500, so it’s reasonable to assume that there’s an ROI that we would experience with that,” said Allison Hess, vice president of health and wellness at Geisinger. She’s hopeful that ROI will convince insurance companies “to potentially fund this as part of a benefit package.”

Similarly—albeit hypothetically—a recent simulation study of Medicare and Medicaid recipients predicted that providing a 30% subsidy on fruits and vegetables would prevent nearly 2 million cardiovascular events and save almost $40 billion in annual healthcare costs.

This story was originally posted on MedPage Today.

Expert: Forget Detox for Substance Use Disorder

LAS VEGAS — There’s a lot more to substance abuse disorder than physical dependence, which means that acute detox treatment by itself isn’t an effective therapy, a researcher said here.

The real key, said Debra Gordon RN, DNP, of the University of Washington in Seattle, in a talk here at the annual PAINWeek conference, is establishing a relationship with patients so that behavioral changes can be implemented.

Withholding opioids from patients with substance use disorder will not cure their addiction, she said. Moreover, providing them with opioids will not necessarily worsen their addiction and may help them accept behavioral therapies.

“There is no evidence that detoxing someone in an acute situation or hospital setting is going to impact that disease,” Gordon said in a presentation. “In fact, the evidence seems to be they will be more at risk for using at their discharge and having an overdose, some of that being in the prison system, but you see that in hospitals too.”

Patients with substance use disorder continue to use drugs despite recurrent problems in their social, workplace, or familial spheres that occur because of their use. Many take multiple substances and have underlying mental health disorders, both of which need to be screened for, Gordon said.

These patients have a higher pain threshold and the prevalence of chronic pain is also much higher in patients with drug abuse disorder. As such, using the Numeric Rating Scale (NRS-11) to define their pain will be insufficient, and providers should determine whether the source of pain is acute, chronic, or related to the patient’s addiction.

Clinicians should also anticipate that patients with substance abuse disorder may have had negative experiences with the healthcare system previously, Gordon said, and asking open-ended questions without judgment may mitigate feelings of shame or fear that prompt them to withhold information.

Seemingly obvious physical comforts, like turning off the lights or keeping a room quiet, also go a long way as well, Gordon said. Cognitive behavioral therapy can also help patients change their perception of pain and help with sleep, mood, and anxiety issues co-occurring with substance use disorder.

Still, some patients may not be willing to change, and others may try to use within the hospital. When encountering patients who deny having a problem, or who recognize the disorder but are unwilling to change, providers should focus on helping them transition out of the hospital when the time comes and providing naloxone emergency overdose kits to patients who may return to illicit drug use.

“Failure to engage in treatment is not a failure,” Gordon said. “It’s part of the process and it’s part of the disease.”

But despite the treatment options available for patients with substance abuse, some providers may be unaware they exist, or may be unsure of what they are authorized to provide, Gordon said.

“There are barriers in the healthcare system in terms of the way we’ve traditionally been trained and traditionally work in silos, and to care for this population we have to really have a team approach,” Gordon told MedPage Today. “It’s one thing to say stuff on paper and another to try and find out how it works in the real world.”

This story was originally posted on MedPage Today.

Listen to the Chapter Podcasts for Jonas and Kovner's Health Care Delivery in the United States


Gain a better understanding of the current state of the US health care system and how it might impact your work and life.

You have Successfully Subscribed!