Final Medical Marijuana Rules will be Released Monday

March 25th, 2011 by admin 38 comments »

We’re finished making our policy decisions regarding the final medical marijuana rules, and our rules team will be spending Friday and probably part of the weekend crossing the T’s and dotting the I’s on the final medical marijuana rules.  We’ll be releasing them on our website first-thing on Monday morning.  We’ll also be having a media conference at some point later that day.  We’ve developed a long set of Frequently Asked Questions to help prospective qualified patients, caregivers, dispensary applicants and physicians understand the final set of rules.  While the final rules will be posted on Monday, the actual law takes effect at the start of the business day on April 14.  We expect to be ready to go on the 14th.

We believe the final rule package accomplishes most of our objectives which include:

  1. ensuring convenient access for folks with debilitating medical conditions identified in the Initiative;
  2. ensuring access to the medication in rural Arizona;
  3. clear expectations regarding criteria for medical marijuana certifications;
  4. a way to ensure physicians write certifications for medical use;
  5. a fair, effective, and orderly way to award dispensary licenses this year and in future years;
  6. clear medical, administrative, inventory, and security expectations for dispensary operation;
  7. reasonable compliance and enforcement provisions;
  8. a clear method for adding debilitating medical conditions over time;
  9. efficient administrative oversight designed to minimize cost; and
  10. reasonable fees that will cover the costs of implementing the program.

Over the last few months we have carefully examined medical marijuana programs in other states, reviewed more than 3,000 comments from the public on our 2 draft rule packages, and used the full range of expertise and creativity among our staff to develop what we believe is a responsible set of regulations that will ensure the near-term and future success of the program.  Thanks for all the hard everybody!

New National Public Health Indicator Tool

March 24th, 2011 by admin No comments »

HHS launched a new web portal providing important health and health care indicator data.  The Health Indicators Warehouse represents a vast collection of health and health care indicators like determinants of health, health care access, cost, quality, and use.  Health indicator can be searched for specific populations, places, political jurisdictions, and geographic areas. The Warehouse includes nearly 1200 health indicators derived from over 170 different data sources.

MY Fest 4

March 23rd, 2011 by admin No comments »

The 4th Annual MY Fest is scheduled for Saturday, April 23, 2011 from 11 am to 4 pm.  This exciting event has once again been planned and produced by members of Magellan Youth Leaders Inspiring Future Empowerment (MY LIFE) Arizona. The MY Fest youth festival will be at the Tempe Beach Park again this year and will feature live music, break dancing crew competition, entertainers, artists, food, youth groups and a variety of youth and family-based Valley organizations offering information, resources and services.  We’re looking for volunteers to help staff our table at this exciting event.  Last year more than 2,500 people, the festival and gave youth and families the opportunity to get involved and learn about employment, volunteering, youth programs and other community activities. If you are interested in volunteering, please contact Serena Lozano at 364-4630 or via e-mail at serena.lozano@azdhs.gov

Trace Levels of Iodine- 131 from Japan Detected in AZ

March 22nd, 2011 by admin 1 comment »

As I mentioned in my blog last Friday computer models developed by the international community and the federal government suggested that very low levels of radiation were crossing the Pacific Ocean late last week and that there could be very small increases in natural radiation in North America including Arizona this week.  All the models suggested that the levels would be very low and of no health consequence, but nevertheless measurable by the sensitive instruments that already exist and routinely test for radiation all the time.  It pretty much happened like that this week.

The Arizona Radiation Regulatory Agency (ARRA) monitors radiation levels in the state as a function of its oversight of the Radiation Measurements Laboratory and their responsibilities providing ongoing surveillance near Palo Verde Nuclear Generating Station west of Phoenix.  Trace amounts of Iodine-131 radioactive material from Japan were found by their sensors this week as part of their routine testing system that uses very sensitive instruments.  The amount of additional radiation that they’re detecting is very small and of no public health significance.  The incremental increase (above natural background) is less than 0.1millirem” compared with average background radiation levels of 100-300 millirems per year.  They expected to see a slight increase in detectable radiation because of the still unfolding emergency in Japan and because the monitoring instruments are so sensitive.

Here’s Monday’s monitoring data from the instruments as well as a landing page for future readings.  Monday’s readings for Iodine-131 ranged from 0.24 pCi/M3 (pico-Curies per cubic meter of air) to 3.6 pCi/M3 which is way lower than the federal Protective Guideline Value for Iodine-131 of 1,000 pCi/M3.  As I mentioned last Friday, we’re advising folks not to take potassium iodide because it’s completely unnecessary and could be harmful to some people as it can cause allergic reactions, abnormal heart rhythms and nausea.

A New Best Practice for Suicide Prevention

March 22nd, 2011 by admin 1 comment »

SAMHSA’s Suicide Prevention Resource Center has added At-Risk for High School Educators to its Best Practice Registry for suicide prevention programs. At-Risk is an online interactive training simulation designed to prepare teachers to identify, approach, and refer students exhibiting signs psychological distress including depression, anxiety, and thoughts of suicide. Users assume the role of a high school teacher and engage in simulated role-play conversations with emotionally responsive student avatars exhibiting signs of depression, anxiety, and suicidal ideation.

The virtual students are capable of visually and verbally expressing emotions in reaction to users’ decisions during the conversation, effectively replicating real life interactions. Users learn motivational interviewing techniques such as framing open-ended questions and using reflective listening to effectively broach the topic of psychological distress, motivate the at-risk student to seek help, and avoid common pitfalls, such as attempting to counsel the student or diagnose the problem. Texas and New York have already adopted this program to train over 70,000 educators in their states.  You can read more about this announcement here, and you can view a narrated walkthrough here.

NAMI Report

March 21st, 2011 by admin No comments »

The National Alliance on Mental Illness released a report this month that included policy recommendations for states to consider including educating the public, families and peers about mental illness and incorporating behavioral health screening into primary care.  The good news is that we’re on the mark here in Arizona as we’ve already begun to implement most of the national recommendations.

This spring we began rolling out Mental Health First Aid, which is an evidence-based public education program designed to teach non-professional people about mental illness.  The program teaches a five-step process to assess a situation, select and implement appropriate interventions, and help a person in crisis or who may be developing the signs and symptoms of mental illness.  We’ve also taken steps to integrate behavioral and physical healthcare by hosting the Arizona Integrated Models of Care in Behavioral Health and Primary Care Forum which brought together people from the behavioral and community health fields.

We’ve also creatively found other ways to increase of peer support organizations participation, developed greater transparency for consumers to choose treatment options that are best for them with our on-line dashboard, opened opportunities for consumers to help transform the behavioral health system with our Raise Your Voice forums, and released a toolkit on Integrating Culturally Diverse Communities into Planning for and Responding to Emergencies.

Japanese Radiological Emergency

March 18th, 2011 by admin 3 comments »

All of us are exposed to natural radiation on a daily basis. It mostly comes from space (called cosmic rays) as well as natural radioactive materials found in the soil, water and air.  People can also be exposed to radiation from human-made sources like X-ray machines.

Radiation doses are usually measured in units called milli-Sieverts.  On average, people are exposed to approximately 3.0 milli-Sieverts per year.  Most of this (80%) is from naturally-occurring sources (i.e. cosmic radiation) with the rest coming from the medical use of radiation.  If a nuclear power plant doesn’t work properly (as is the case right now in Japan), radioactivity may be released into the surrounding area by a mixture of products generated inside the reactor (“nuclear fission products”). The main fission products are radioactive cesium and iodine.

We’re working with our federal and local partners and 3 of our state agencies to keep close tabs on the radiological situation in Northern Japan.  Most of the radiation is dissipating rapidly in the environment (because of distance and the short half-life of the elements released).  The international community and the federal government have been doing some modeling and some of the models suggest that very low levels of radiation is crossing the Pacific Ocean.  The models suggest that there could be very small increases in natural radiation in North America including Arizona in the coming days.  The levels would be very low and of no health consequence, but nevertheless measurable by the sensitive instruments that already exist and routinely test for radiation all the time.  For example, if the situation in Japan would continue as-is for several weeks, the total exposure in N. America would be comparable to the amount of radiation that you would get flying from AZ to New York (about 0.04 milli-Sieverts- or about a 1% increase from average annual background).

The EPA posted a new Japanese Nuclear Emergency website today, which includes a daily data summary.  Today’s update shows that the US’s radiation air monitors showed typical fluctuations in background radiation levels today.  As I mentioned earlier, the models suggest that there could be slight increases in the coming days.

Between the state and federal agencies monitoring the situation, we’re confident that there would be no health consequences to the people in Arizona.  But, there are stories that some folks are buying potassium iodide (which saturates your thyroid with iodide) because they’ve heard somewhere that it would provide some benefit (it doesn’t under the current circumstances).  We’re concerned that people are taking medication that they don’t need and could create problems for themselves.  That’s why we put out a notice to the folks of Arizona today suggesting that they not take potassium iodide supplements because:

  1. It’s not necessary because of what’s happening in Japan and provides no benefit;
  2. It can be dangerous to people with allergies to iodine, shellfish or who have thyroid problems; and
  3. Taken inappropriately, it can have serious side effects including abnormal heart rhythms, nausea, vomiting, electrolyte abnormalities and bleeding.

There have even been some calls to some poison control centers over the last couple of days from folks that have taken potassium iodide thinking it would be a good idea (it’s not).

For more information on the emergency in Japan, including answers to some frequently asked questions, visit the Arizona Emergency Information Network (AzEIN) website at www.azein.gov email questions to azein@azdema.gov

Palo Verde Nuclear Generating Station Full-Scale Exercise

Our preparedness team recently participated in a federally evaluated Palo Verde Nuclear Generating Station Full-Scale Exercise to test our response to a simulated radiation contamination at Palo Verde.  The exercise simulated an event whereby people, food or drinking water could become contaminated because of a release of radioactive materials into the atmosphere.  During the exercise we practiced and successfully tested our capabilities to coordinate with other agencies in responding to this type of incident.  Our focus under the response plan included the providing contamination control measures to protect the public from eating or drinking any contaminated food or water, guidance on the health effects of radiation exposure, distributing potassium iodide (there is a stockpile here in the state and nationally), coordination with the CDC, and support for local public health agencies and hospitals.  Here’s a link to our Emergency Response Plan including our Radiological Response Plan.

AZ Bills Related to Marijuana

March 16th, 2011 by admin 42 comments »

Controlled Substances

A few years ago, an Arizona law was passed that established a Controlled Substances Prescription Monitoring Program which requires pharmacies and medical practitioners who dispense Schedule II, III, and IV controlled substances to a patient, to report prescription information to the Board of Pharmacy on a weekly basis.  The purpose of this legislation is to improve the State’s ability to identify controlled substance abusers and refer them for treatment, and to identify and stop diversion of prescription controlled substance drugs in an efficient and cost effective manner that will not impede the appropriate medical utilization of licit controlled substances.  Despite the passage of the Arizona Medical Marijuana Act, marijuana remains classified as a Schedule I controlled substance- but because of the way the Act was written, physicians would have no way of checking the database for their patient’s marijuana use as a Qualified Patient.

House Bill 2585 would require the Board of Pharmacy’s controlled substances monitoring program database controlled substances monitoring program database to include people that have a medical marijuana card issued by ADHS.   If the bill passes and is signed, we would share the data regarding who our Qualified Patients are (for marijuana use) so that doctors have access to that information before making a decisions about how to manage their patient’s medical condition- just like they can with other controlled substances.

Impairment

Another Bill being evaluated is House Bill 2541, which addresses some gaps in current statute around the employer employee relationship.  Under Arizona Medical Marijuana Act, the existence of marijuana metabolites does not mean that employee is under the influence of marijuana.  House Bill 2541 does a few things to help employers be able to navigate the change in law.  Most significantly, the bill more clearly defines the term “impairment” with a set of symptoms similar to what we would all commonly understand.  Things like slurred speech, the inability to walk, appearance, and strange behavior are outlined as impaired.  This is pretty much what a police officer looks for when doing a field sobriety test for a suspected DUI.  It also clarifies that an employer can take action against an employee who is impaired at work.

Another part of the bill defines a new term called a “safety-sensitive position” which is exactly what it sounds like, a job that could impact the safety of the public or other employees.  Things like operating heavy manufacturing equipment would fall under this category.  The importance of this definition is that the law also allows employers to exclude employees from performing safety-sensitive jobs if they believe the employee is engaged in current drug use.

Lastly, the bill also helps protect employers from legal action by defining “good faith” and outlines some ways that an employer can act in good faith when determining if an employee is impaired.  This bill goes a long way towards helping employers keep the job site safe and gives them clear direction when they have an employee that is a medical marijuana card holder.

Mental Health First Aid Rolling

March 15th, 2011 by admin No comments »

The first round of Instructor Training for Mental Health First Aid was completedin Tucson and our efforts are already paying huge dividends.   23 new trainers graduated from the intensive 5-day training program and are now certified Mental Health First Aid Instructors!   The new trainers include peers, family members, behavioral health providers, T/RBHA staff, Pima Community College and Cochise College employees, community health center providers, a faith-based leader, and a person from the Veteran’s Administration system.   We’re scheduling 2 more of these 5-day Instructor Training courses for the coming months and dozens of the 12-hour community training classes as well.  Our goal is to get thousands of Arizonans trained to:

  1. assess a situation;
  2. select and implement appropriate interventions; and
  3. help a person in crisis or who may be developing the signs and symptoms of mental illness.

Cross-cutting Marijuana Team Hitting on All Cylinders

March 14th, 2011 by admin 8 comments »

Under the provisions of the Arizona Medical Marijuana Act we had 120 days to get the entire program up and running.  A short timeframe for this complex program (to say the least).  That gives us until close of business on April 13, 2011 to have everything ready.  That means we’ll need to finish the Rulemaking (our goal is March 28), including finishing the regulatory system for approving, renewing, and revoking the registration of qualifying patients, designated caregivers, nonprofit dispensaries, and dispensary agents.  We also need to be finished with the development of a sophisticated information technology system that’ll track a whole host of data, including on-line application systems for patients, caregivers and agents.  The on-line applications will be ready for testing next week.  By the way, the applications for qualified patients, caregivers and agents will be 100% electronic with no-walk in traffic.  There are dozens of moving pieces right now, but pretty much everything is on track

We released our first “Notice of Intention to Bid” to find a contractor for secure registration cards and printer equipment today.  The idea is to find a vendor for the next year that will provide the cards, printer equipment, accessories, installation, technical support, training and equipment maintenance for the cards that we’ll be issuing for qualified patients, caregivers and dispensary agents.  We’ll be paying for this service with the card application fees that we’ll be collecting starting next month.  The bid is called ADHS11-00000543 on Procure AZ and it closes Friday, March 18 at 3 p.m.