Pennsylvania Nurse 2019 Pennsylvania Nurse 74.1 - Page 10

marijuana (Greenberg, 2017). This poses a challenge for honest reporting, documenting, and consistent fee structures. Act 16 does require detailed record keep- ing but does not address the inability to use federally insured financial institutions. Also, there is no cap on the per-dose price of medical marijuana; Act 16 only specifies that if the Department of Revenue feels that the cost is escalated, they can cap the maximum price for six months. Expenses related to the mari- juana business are not tax deductible (Nix & Knight, 2016) and all sales are exempt from Pennsylvania state sales tax. However, there is a 5% excise tax im- posed on all growers intended to fund research, law enforcement, and expenses incurred with regulation (Medical Marijuana Act, 2016). able with no standard means to measure outcomes and no alignment with current evidence-based practice recommendations. Medical marijuana cures no disease; many of the conditions have episodic or inconsistent symptom presentation making it diffi- cult to measure impact and efficacy accurately. Ethical considerations in decision making need to address risk vs. benefit, equality of access, long-term impact on health, and self-efficacy. There is insuffi- cient standardized data published to date to address these issues adequately. The research currently avail- able is qualitative and unable to be generalized due to the plethora of uncontrolled extraneous variables. Much of the data is opportunistic by presentation for emergency care, and there is no structured research following up long-term use Ethical considerations in to determine valid implica- decision making need to ad- tions and patient outcomes (Heard et al., 2017). dress risk vs. benefit, equali- Contingencies for the use of medications in the workplace are not applicable to sub- stances determined to be il- legal at the federal level, and employers do not have to ac- ty of access, long-term impact commodate for its use (Hear- High consumer demand is ing & Bowles, 2017; Phillips the result of individuals on health, and self-efficacy. et al., 2016). Employers searching for solutions to There is insufficient stan- may be placed in a tenuous medical issues and of media position regarding monitor- saturation of the benefits dardized data published to ing employees for abnormal of marijuana, despite the date to address these issues behavior and financially bur- lack of valid data and low dened by payment for drug publicity regarding ad- adequately. screening if it is indicated. verse events. Research has Restrictions on employment demonstrated that tradi- activities are listed if “blood tional media and internet levels are more than 10 ng/mL” (Act 16, 2016, p. 14). are utilized more than healthcare professionals to The degree of impairment can be variable, and with seek medical information (Suri, Majid, Chang, & the short half-life of marijuana, accurate testing can Foo, 2016). Patients are more likely to seek medical be challenging (Sutton, 2017). The lack of specific- marijuana if they feel that conventional methods ity in state employment regulations creates difficulty are not controlling their disease or if they see it as determining what is considered impairment in rela- an alternative treatment that may be more effective, tion to performing jobs safely, and when termination less costly, or better tolerated (Virgil, Stith, Adams, is justified. & Reeve, 2017). Due to these factors, attempts to amend with more stringent criteria or rescind Act 16 would most likely be met with negative public outcry. Policy Outcomes The escalation in use of illegal marijuana may be due Decision-making priorities should be determined by to increased population acceptance and support of population benefit and safety. The lack of evidence- legalization (Dvorak et al., 2018). based practice recommendations and the availability of other, legal therapeutics make it very difficult to determine if medical marijuana is positively impact- Global Comparisons ing any quality of life measures at a population level. There is no payer coverage for this medication as The benefit of Act 16 to the population is question- a Schedule I narcotic and it is still considered an Issue 74, 1 2019 Pennsylvania Nurse 8