Archive for the ‘General’ category

Director’s Decision: Cannabis & Palliative Care for PTSD

July 9th, 2014

Web PTSDLast December I denied a petition to add Post Traumatic Stress Disorder (PTSD) to the list of debilitating medical conditions that qualify people for an Arizona Medical Marijuana Registration Card.  I denied the petition because, at the time, I believed there was a lack of scientific evidence to document whether Cannabis is helpful or not to treat or provide palliative care for PTSD.

The Petitioners appealed my decision to the Arizona Office of Administrative Hearings earlier this year.  A few weeks ago the Administrative Law Judge ruled that: “…  the Appellant’s appeal is granted and that PTSD is added to the list of debilitating conditions for which marijuana may be dispensed”.

Among the reasons why Judge Shedden issued a recommendation that was different than my decision was that our Rules invite petitioners to submit information other than peer-reviewed data with their petition…  and I primarily considered the presence or absence of peer-reviewed data in my December decision.  Also, during the March hearing the Petitioners referred to a manuscript (at the time yet to be published) that found an association between Cannabis use and PTSD symptom reduction in some patients.  That article was subsequently published in the Journal of Psychoactive Drugs (March 2014).  In other words, the information presented by the Petitioners at the hearing and the subsequent published study provided evidence that marijuana may be helpful in the palliative care of PTSD in some patients.

Therefore, today I issued a Director’s Decision that will authorize the use of marijuana (under AMMA) for patients that are currently undergoing conventional treatment for a diagnosis of PTSD.  Physician certifications would be valid only for palliative care of PTSD symptoms (not treatment).  Certifying physicians will be required to attest that they have reviewed evidence documenting that the patient is currently undergoing conventional treatment for PTSD before signing the medical marijuana certification.

The implementation date of this decision will be January 1, 2015.  This allows a few months for certifying physicians, dispensary medical directors, and dispensary agents to develop policies and procedures and educational materials required by our Rules.


Take Charge of Your Own Treatment

July 9th, 2014

Businessman with laptop computerWhen you shop for a new car, phone or camera, you have lots of information about your choices.  But when it comes to choosing the right medicine or the best health- care treatment, clear information can be hard to find.  Let’s face it, if you don’t get the best possible information about your treatment choices, you might not make a good decision about your treatment.

That’s where HHS’ Agency for Healthcare Research and Quality’s Effective Health Care Program comes in.  The Program’s mission is to help folks make more informed treatment choices.  Topics on their website range from integrating existing systematic reviews of current research to publishing treatment protocols.  They use something called Comparative Effectiveness Research to build the consumer information…which uses research to identify new and emerging clinical interventions.

Comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options.  The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.

For example, someone with high blood pressure might have more than a dozen medicines to choose from.  Someone with heart disease might need to choose between having heart surgery or taking medicine to open a clogged artery.  Info on the Effective Health Care Program website is available on the pros and cons of all the options so that you and your doctor can make the best possible treatment decision for you or someone in your family.

An AZ Monsoon Staple: the Scorpion

July 8th, 2014

Desert Hairy Scorpion (Hadrurus arizonensis).My wife has been disturbed by the number of scorpions she’s seen around our house and garage over the last couple of weeks which has inspired me to do this scorpion post.  Arizona has more than 56 species of scorpions but the bark scorpion is the biggie.  Since you live in the bark scorpion’s territory, you probably have them around or maybe even inside your house or garage too.  The Arizona Poison and Drug Information Center and Banner Good Samaritan Poison & Drug Information Center answer thousands of calls every year about scorpion stings.  Last year they recorded 10,000 scorpion stings in Arizona.  Each year there are about 200 kids in Arizona that need intensive medical treatment.

A recent study by the Banner Good Samaritan Poison and Drug Information Center showed that 33% of scorpion stings happen in the bedroom, 24% in the living room, and 6% in bathroom.  Males tend to get stung more than females and the most common sites of stings are of course hands and feet.

Scorpion stings are super painful but usually don’t require special medical treatment.  Washing the sting area and using a cool compress along with over the counter pain medication handles the injury. The pain and numbness can last several days.  Sometimes a scorpion sting causes severe symptoms that require fast and expert medical care.  Symptoms to look for are difficulty breathing, uncontrolled jerking, drooling and wild eye movements.  Small kids are the highest risk group for severe reactions.

OK… but what should you do in scorpion season?  Here are some simple precautions:

  • Seal cracks at the bottom of your exterior doors;
  • Roll back bed linens and check for scorpions before getting into bed;
  • Shake clothes and shoes before putting them on;
  • Keep clothes off the floor;
  • Move furniture and beds away from the walls;
  • Wear shoes when outdoors, especially at night around swimming pools;
  • Be especially careful of wet/damp towels in the bathroom and pool area; and
  • For infants: move the crib away from the wall and take off any crib skirts that reach to the floor.

While scorpions get into your house, that’s not their natural habitat.  Their natural habitat is in your yard, in bushes, brick wall cracks and in landscaping like that loose brown stuff on palm trees.  Some people say that their scorpion problems are worse after people do yard work which messes up the scorpions natural habitat.

The key to keeping them out of your house is to seal the cracks at the bottom of your doors and keep things like doggie doors shut this time of year.  The bottom line is that the monsoon is the harvest season for scorpions so stay on the lookout.

New Return on Investment Calculator

July 7th, 2014

budgetplanIconHHS’ Agency for Healthcare Research and Quality just released the Asthma Return-on-Investment (ROI) Calculator for exploring potential financial returns from quality improvement and disease management programs for populations diagnosed with asthma. The tool provides estimates based on an analysis of 52 research studies on improving asthma care and what those studies imply for cost savings.

Another return on investment tool accessible via the Agency for Healthcare Research and Quality website is the Center for Health Care Strategies ROI Forecasting Calculator. This Forecasting Calculator provides value by determining the impact investments in program interventions may have on improving health outcomes by understanding the relationships among the intervention, the target population, service utilization, program costs, and discount rates.

These tools pair well with the CDC’s Chronic Disease Cost Calculator.  In addition to providing state-level estimates of medical expenditures and absenteeism costs for asthma, the CDC Version 2 tool can be employed to address other chronic diseases such as arthritis, cancer, cardiovascular diseases, depression, and diabetes.

Combined, these three cost estimate/return-on-investment tools may assist public health departments in capturing the effect the investments they make in public health prevention programming have on improving population health.

Mankind’s Nemesis- the Mosquito

July 3rd, 2014

fight-the-biteSummer’s here, and we know what that means…West Nile virus season. West Nile virus is most commonly spread by the bite of an infected mosquito. However, not every mosquito can carry West Nile virus. There are 40 different species of mosquitoes in Arizona, but only 2 transmit West Nile virus (WNV) to humans effectively, Culex tarsalis and Culex quinquefasciatus (try saying that 3 times fast).

The more we know about what they like to eat and where they breed, the better our prevention measures can be to stop the transmission of West Nile virus. Both species like to feed on birds and humans between the hours of dusk and dawn, and they like to lay their eggs in waters ranging from waste water areas to bird baths, old tires, or any container that holds water. If the water evaporates (or is poured out) before the eggs hatch or the larvae complete their life cycle, then they die.

Last year, we didn’t have very many West Nile virus human cases compared to previous years. However, about 80% of people infected with West Nile virus do not develop any symptoms and those cases don’t get counted. 1 in 5 people who catch West Nile virus will develop a fever and possibly other flu-like symptoms. Less than 1% of people who are infected with West Nile virus will get neurological symptoms.

The most severe form of the disease, called West Nile neuroinvasive disease is rare.  Last year Arizona was one of the states with higher rates of the most severe form. The risk of developing the neuroinvasive form of West Nile virus greatly increases with age. For the younger people, less than 1 in 700 will develop neurological symptoms, but it’s 1 in 50 in people over 60.  Underlying health conditions such as hypertension, diabetes, cancer, and renal disease can also increase the risk of developing the more severe form. About 10 percent of people who do develop West Nile neuroinvasive disease will die. This is why avoiding mosquito bites, mosquito-proofing your home, and eliminating breeding sites for mosquitoes is so important. Fight the bite, Arizona.

Summertime is Salmonella Season in AZ

July 2nd, 2014

salmonellaturtleUsually when you hear about Salmonella, you think about food poisoning.. but salmonellosis is also a zoonotic disease – one spread between animals and humans. Salmonella (which gets its name from the Daniel Salmon head of the USDA in 1885) is a bacteria that causes fever, diarrhea, and stomach cramps, usually within 3 days of eating or getting the germs into their mouth. For the most part, people get better and just need to rest and drink lots of fluids.

Besides contaminated food, salmonellosis has been associated with handling snakes, salamanders, lizards, frogs, turtles, chicks, ducklings, hamsters, mice, fish, hedgehogs… pretty much anything a young child would like to have has a pet.

Three of five current multistate salmonellosis clusters/outbreaks with 295 cases are related to such pets. Arizona has at least one case in each of these clusters.

When a pet is infected with Salmonella, the germ gets on their bodies, on cages, in the water, on the soil, and everything else it touches. When kids kiss, cuddle and hold these pets, or clean their cage or aquarium, they can get the germs in their mouth, nose and on hands. Children younger than 5 and those with a poor immune system are at highest risk of catching the disease. Hand washing after touching, grooming, or cleaning cage/aquarium/terrarium is the best way to prevent this infection. More information is available on the CDC Healthy Pets Healthy People website.

FDA Extends E-cigarette Regulation Comment Period

July 1st, 2014

Hand with electronic cigaretteIn April the FDA released proposed regulations for electronic cigarettes and asked for your input.  Last week it extended the comment period by 30 days. The proposed rule focuses on FDA’s regulatory approach to electronic cigarettes and other tobacco products, proposed options for the regulation of cigars, pathways to market for proposed deemed tobacco products, and compliance dates for certain provisions, among other issues.

The proposed new regulations wouldn’t restrict or ban the sale of fruit and chocolate flavored e-cigarettes that some believe are designed to attract and hook young people. They also wouldn’t restrict TV advertising or online sales. People and organizations can submit comments electronically through
August 8.

Interactive Map of Arizona Licensed Facilities

June 30th, 2014

mapNavigating the vast number, type, and location of licensed facilities just got easier. Our GIS team developed a terrific interactive website that can help you find information about a specific facility or facility type in the State. The ADHS Licensed Facilities application features Long Term Care Facilities, Hospitals, group homes for folks with developmental disabilities, Residential, Medical, Childcare, and even Pharmacies. A simple zoom and click feature provides you information on the type, address and contact information.

The Map to Care in AZ can help you find licensed facilities in your area.  It also gives licensed facilities a new view on their region to network and partner with others, especially for public health emergency preparedness planning. Additional resources include Arizona Health Matters with data information about the community to help planners, policy makers, and the community learn about health issues and identify improvements.

Reducing the Painkiller Body-Count

June 27th, 2014

WomanandDoctorAcross the country prescription painkillers take out way more people than heroin and cocaine combined…  and the story is the same in Arizona.  Last year more than one person died almost every day in our state from prescription opioids… and more people died from painkiller overdoses than car crashes.  In January, I blogged about how we’ve joined the Association of State and Territorial Health Officials challenge to reduce prescription drug abuse and deaths 15% by 2015.

We’ve been working with partners from the Arizona Prescription Drug Misuse and Abuse Initiative to develop strategies to reduce prescription drugs deaths. One of the most effective ways to tackle the problem is to reduce the amount of drugs available – there are too many drugs in people’s hands. The Arizona Prescription Drug Monitoring Program shows almost 524 million painkiller pills prescribed in Arizona every year (almost 100 per person per year).  In 2011 we ranked 5th highest in the country for prescribing opioids.

To confront the challenge, we hosted a summit in March to gather input from doctors, pharmacists, hospitals and many more healthcare partners to define guidelines for prescribing opioids.  We finished the draft guidelines this week and are looking for the public and professionals input before we finalize them. The guidelines address prescribing for the treatment of chronic pain that isn’t tied to cancer or someone who is dying and for treatment of acute pain – like after surgery or an injury.  We hope you can time some time to review and give us your feedback by July 12th.

Also, when we overhauled our licensing rules, we included a provision for many types of licensed healthcare facilities to have a policy about prescribing controlled substances to reduce chances of substance misuse. Those go into effect next week.

I want to thank everyone for their help in creating the guidelines - especially Sheila Sjolander- who has been providing tremendous leadership in this effort.

Training Improves Outcomes

June 27th, 2014

trainingImproving health outcomes at licensed healthcare facilities in Arizona requires 2 main ingredients.  Having regulations and encourage continuous quality improvement (which is now complete) and providing our licensed facilities with the information they need to implement practices (in accordance with the regulations) to execute positive change.

Now that we’ve finished developing the new regulations, it’s time to build the knowledge base so facilities can use those new regulations to improve care.  To that end…  three of our Licensing Bureaus (Medical, Long Term Care, and Residential Living) have been busy conducting combined provider and surveyor trainings and attending association meetings.  Literally hundreds of key staff from dozens of different types of institutions have been participating in the trainings- which focus on the practical nuts and bolts of how (and why) to comply with and use the new regulations to improve outcomes.

During the past couple of months our providers have learned about our new outcome based regulations…  with the ultimate goal of improving compliance, reducing enforcement, and improving public health outcomes.  This approach to licensing supports the public health vision of “Health and Wellness for all Arizonans.”