Posts Tagged ‘depression’

Be Part of the Mental Health Solution

March 29th, 2013

Students can’t be academically successful when they’re battling anxiety, depression, substance abuse and other common conditions.  Nearly 50% of lifetime mental disorders begin by the mid-teens.  That’s why we’ve launched a partnership with Kognito Interactive to educate middle and high-school teachers how to recognize signs of depression and other mental health disorders that have the potential to lead to low academic achievement, violence or even suicide. At Risk for Middle School Educators and At Risk for High School Teachers are hour-long, avatar-based online training programs where teachers, administrators and staff learn to recognize and help when a student’s behavior and appearance may be a sign of psychological distress, such as depression, anxiety or substance abuse. 

When equipped with the appropriate knowledge on how to handle sensitive situations, teachers and staff have a better chance of success in connecting the student with help.  At-Risk simulations are the first online trainings available to provide realistic and risk-free role-play exercises in identifying, speaking with, and referring troubled youth.  Developed with input from teachers and some of the country’s leading authorities on youth suicide prevention, At-Risk helps connect students to treatment early on- which is critical to improving mental health outcomes. 

This professional development opportunity is free and available to high schools and middle schools in Arizona.  It only takes an hour to complete, doesn’t need to take away from class time, and comes with a certificate of completion.  It can also be paused and restarted without having to start from the beginning.  To take the training…  sign in at the following links for Middle School and High School.

 

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New M2 Petitions on Horizon Again

January 23rd, 2013

Last January we accepted petitions from the public to add PTSD 1; PTSD 2; Depression; Migraines; and Generalized Anxiety Disorder to the list of conditions that qualify patients to receive a Medical Marijuana Registration Card.  Because my guiding principle for making the decision was to use science and research to make the decision, we contracted with the U of A College of Public Health to do an evidence review of published scientific studies to help us to make a more informed decision.  You can see the UA’s analyses for Depression; Generalized Anxiety Disorder; Migraine Headaches; and Post Traumatic Stress Disorder (PTSD) on our petition website.   Our literature review found limited scientific evidence to document whether Cannabis is helpful or not for the petitioned conditions or that support permanently adding the petitioned conditions to the statutory list of qualifying debilitating conditions identified in the Act.  In short- I didn’t approve the petitions last year because of the lack of published data regarding the risks and benefits of using Cannabis to treat or provide relief for the petitioned conditions. 

The AZ Medical Marijuana Act requires us to periodically accept petitions to add new medical conditions- and we are once again accepting petitions to add new debilitating medical conditions this week (January 25 – 31) on our petition website. Our medical team will meet after January 31st and will be providing me with an initial analysis regarding whether any petitions we receive meet the screening criteria…  and we’ll be using the UA College of Public Health to review the scientific literature for any that pass the screening test.  Assuming we receive qualified petitions, I’ll need to make a final decision by July 2013.  Our website shows folks how, what, where, and when to submit petitions.

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M2 Petition Decision

July 19th, 2012

The voter approved list of conditions that already qualify patients for an AZ Medical Marijuana Registration Card (with a doctor’s certification) includes any of the following: any chronic or debilitating disease or medical condition (or its treatment) that causes severe and chronic pain, severe nausea, severe and persistent muscle spasms, wasting, or seizures, cancer, glaucoma, HIV, Hepatitis C, ALS, Crohn’s disease, agitation of Alzheimer’s disease.  The AZ Medical Marijuana Act also requires us to periodically accept petitions to permanently add new medical conditions to the list of conditions that qualify folks for a card.  

We accepted petitions from the public to add new medical conditions back in January.  Folks submitted numerous articles as a part their petitions for PTSD 1; PTSD 2; Depression; Migraines; and Generalized Anxiety Disorder.  We also received lots of informal comments regarding adding PTSD; Depression; Migraines; Generalized Anxiety Disorder and General comments.  We also heard in person testimony from dozens of folks at our public hearing in May.

Because my guiding principle for making the decision was to use science and research, we contracted with the U of A College of Public Health to do an evidence review of published scientific studies to help us to make a more informed decision.  You can see the UA’s analyses for Depression; Generalized Anxiety Disorder; Migraine Headaches; and Post Traumatic Stress Disorder (PTSD) on our petition website.   The UA used the GRADE methodology to evaluate the quality of the studies looking at the benefits and harms of using Cannabis to treat or provide relief for the conditions that were petitioned to add to the list of qualifying conditions for a Medical Marijuana Registration card.  Also, our ADHS Medical Advisory Committee reviewed and analyzed the data and provided me with recommendations earlier this week.

We heard and received a host of moving stories from the public both on-line and during our a public hearing in May.  Many of the commenters and folks that testified self-reported that they believe Cannabis provided relief for the petitioned conditions.  However, our literature review found limited scientific evidence to document whether Cannabis is helpful or not for the petitioned conditions or that support permanently adding the petitioned conditions to the statutory list of qualifying debilitating conditions identified in the Act.  In short- I didn’t approve the petitions because of the lack of published data regarding the risks and benefits of using Cannabis to treat or provide relief for the petitioned conditions. 

However, some of the petitioned conditions (such as migraine headaches) already qualify patients for a medical marijuana registration card if they cause severe and chronic pain, severe nausea, severe and persistent muscle spasms, wasting, or seizures.

Whatever you think of the decision, just know that our team and I really took an objective and close look at the scientific evidence before making this decision.  And remember, the Act provides for a judicial review of this decision and a continuing petition process.  In fact, we’ll be accepting petitions again next week.

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The Scientific Literature Gradient

July 18th, 2012

Medicine and public health have relied on peer-reviewed published scientific literature to help guide progress in patient treatment and public health interventions for decades- even centuries. For example, when we did the fact-finding to inform our decision about whether to add the petitioned conditions to the list of disorders that qualify for AZ medical marijuana cards- we (and the UA) turned to the scientific literature. Within the scientific literature- there are different categories of research designs that each have their strengths and weaknesses. 

Studies to assess the effectiveness of an intervention (like whether Cannabis is an effective treatment for depression) can have an Experimental or Observational design. For example, a randomized and controlled experimental study selects participants at random and places them in the intervention or control group and then follows up on the subjects over time to assess any differences in outcomes. Experimental studies generally provide the highest quality and most reliable results. 

An Observational study isn’t really experimental- rather, it’s a study that looks at natural variation regarding an intervention (or exposure) and looks at differences in outcomes among people or populations. Controlled observational studies can look at before and after conditions. For example, a cohort observational study can look at populations prospectively, retrospectively, or as part of a time series. Observational studies can also be of case-control or cross-sectional design. Observational studies can also simply look at a series of cases and look at interventions and outcomes without a control group. 

In general, the highest quality studies use the experimental approach and include a randomized design. Studies in the category can be very high quality if there is little bias and confounders are identified and controlled for… and if the study is large. Observational studies are generally of lower quality- although they can be quite useful if they limit bias, are consistent, direct, and control for confounding factors. The lowest quality study is what’s called a case series with no controls. Often, case series studies are simply observations made by clinicians- but without control groups… and they usually don’t control for confounders or bias.

 Anyway- you get the idea… scientific studies are absolutely critical to helping the public health system design interventions, make policy decisions, and measure results. Published scientific literature allows us to use science to inform our policy decisions and interventions in an objective way- increasing the likelihood that the public health system makes a positive impact in people’s lives.  Understanding what makes a published scientific study strong and compelling is critical to sorting through the published scientific literature for the types of strong studies that make for solid foundations for policy and intervention decisions. 

My post tomorrow will summarize ways to evaluate the quality and reliability of various kinds of studies.

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Medical Condition Petition Status

July 6th, 2012

The AZ Medical Marijuana Act requires us to periodically accept petitions to add new medical conditions to the list of conditions that qualify folks for an AZ Medical Marijuana Registration Card.  In January, we accepted petitions from the public and had a public hearing in May.  Folks submitted numerous articles as a part their petitions for PTSD 1; PTSD 2; Depression; Migraines; and Generalized Anxiety Disorder.   We also received lots of informal comments regarding adding PTSD; Depression; Migraines; Generalized Anxiety Disorder and General comments.

We also contracted with the U of A to review published scientific studies related to marijuana use and the petitioned conditions.  You can see the UA analyses for Depression; Generalized Anxiety Disorder; Migraine Headaches; and Post Traumatic Stress Disorder (PTSD) on our petition website.  Our ADHS medical team will be meeting within the next week or so and will be providing me with their analysis and recommendations.  The ultimate decision rests with me,  the Director, and I have a decision deadline in late July.

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What’s Debilitating?

April 20th, 2012

The voter approved language in the AZ Medical Marijuana Act directs us to periodically accept and evaluate petitions to add new debilitating medical conditions.  We’ve made it through the first phase of considering whether to add 4 new debilitating conditions… 1) Post Traumatic Stress Disorder; 2) Generalized Anxiety Disorder; 3) Migraines; and 4) Depression.  You’ll be able to give us your thoughts about these four conditions at a public hearing next month (May 25th from 1 – 4 p.m. at our State Lab).  You can read the information we already have about these four starting next week.

If we decide to add PTSD or any other debilitating conditions, we want to make sure we’re on solid medical ground.  I’m heading down to a conference in Tucson next weekend where physicians can get Continuing Medical Education credits for learning about medical cannabis.

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State Comparison of Substance Abuse and Behavioral Health

August 10th, 2011

A new report is out that provides a state-by-state comparison of a wide range of behavioral health issues. Every state has to deal with some significant challenges with mental illness and substance abuse.  For example, among people 12 and older, Alaska’s current illicit drug use rate more than double that in Iowa (13% versus 5%), yet Iowa was among the top 10 states when it came to binge drinking (28%).

 The report was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and provides valuable insight to state public health authorities and service providers on the scope and type of behavioral health issues affecting their states. The report uses the combined 2008 and 2009 National Surveys on Drug Use and Health (NSDUH ), which is drawn from interviews with more than 100,000 persons from around the country, and provides a state-by-state breakdown along 25 different measures of substance abuse and mental health problems, including illicit drug use, binge drinking, alcohol and illicit drug dependence, tobacco use, serious mental illness, and major depressive episode. Other notable findings include:

  • Fewer people in many states perceived that cigarette use can be risky. Between the combined years 2007-2008 and 2008-2009 the perception of great risk from smoking one or more pack of cigarettes a day decreased in 14 states among those aged 12 to 17; in 31 states among those aged 18 to 25 and in 9 states among those 26 and older.
  • Current illicit drug use dropped among adolescents aged 12 to 17 in 17 states between 2002-2003 and 2008-2009; no increases in current illicit drug use occurred in any state in this age group over this time period.
  • While the District of Columbia had the nation’s highest rate of past year alcohol dependence or abuse for those 26 or older (8.1%), it had the lowest rate among persons aged 12 to 17 (3.0%).
  • Utah had the lowest rate of current marijuana use (3.6%) while Alaska had the highest rate (11.5%).
  • Between 2007-2008 and 2008-2009 11 states showed declines in past year cocaine use among persons aged 12 or older (in alphabetical order — Arizona, Arkansas, Georgia, Indiana, Kentucky, Maryland, Minnesota, Ohio, Oregon, Tennessee and Virginia).
  • Rhode Island had the nation’s highest rate of adults aged 18 or older experiencing serious mental illness in the past year (7.2%), while Hawaii and South Dakota shared the lowest rate (3.5%)

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Medical Marijuana Public Comments

January 7th, 2011

So far, we’ve received well over 1,300 comments on the Informal Draft Rules that we posted December 17.  Our first comment period ends today.  We’ll be reviewing the comments and revising our initial draft over the next couple of weeks.  We’ll be releasing new draft rules for public comment on Monday, January 31, kicking off our next comment period (which will go through February 18).  After that, we’ll craft the final Rules and publish the finished package on March 28.

The following issues are generating the most comments:

  • The definition/requirements for patient-physician relationship;
  • Adding additional medical conditions including mental illness, PTSD, fibromyalgia, depression, etc.;
  • The fee structure (especially for patients with limited income);
  • The 25 mile limit for patient/caregiver cultivation (which is actually in the Initiative, not the rules);
  • The requirement that dispensaries cultivate 70% of their own product;
  • The processes for approving dispensary registration certificate;
  • The requirement that dispensaries have a medical director;
  • The qualifications for medical directors (e.g. allow other medical professionals including a pharmacist, naturopathic physician, homeopathic physician, family nurse practitioner, physician assistant, or registered nurse to be the medical director);
  • The 2 year residency requirement for dispensary applicants; and
  • The requirement that cultivation facilities be licensed in association with a dispensary (which is actually in the Initiative).

Overall, the comments so far have been constructive and many have been positive and support much of the overall language in informal draft rules.  All the comments on the informal draft rule are part of the public record and will be available for review on our hub 203 website (with personal identifiers removed) by next Wednesday.

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Mental Health ED Visits

August 3rd, 2010

Did you know that nearly 1/8 of all emergency department visits in the US are because of a mental disorder, substance abuse problem or both? A new federal report found that depression and other mood disorders accounted for 43% of behavioral health visits, 26% were for anxiety disorders and 23% involved alcohol-related problems. These data are from AHRQ News and Numbers in their Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007 report.

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