Pennsylvania Nurse 2019 Pennsylvania Nurse 74.1 - Page 9

estimated to be less than one year or diagnosed with a serious medical condition as listed in Table 1 (Medi- cal Marijuana Act, 2016). Many of these conditions are not tracked; overall population benefit is indeterminable. However, it has been reported that 10,000 people have initiated the application for registration as users in Pennsylvania as of January 2018 (Murphy, 2018). This represents 0.08% of the population based on census reports (Pennsylvania Department of Health, 2016). The Act will also impact the family or social sup- port system of patients with those conditions. Other groups of interest include the medical community, legal representatives, law enforcement, marijuana le- galization groups, employers, gun control and rights organizations, and government organizations and officials. The most recent issue being addressed is the Second Amendment and the right to keep and bear arms. One of the questions on the application to purchase firearms lists marijuana as an illegal substance and prohibits users to own firearms (Bresswein, 2017). Senate Resolution 253 and House Resolution 656 both recommend that gun rights should be main- tained by those who use medical marijuana (Penn- sylvania General Assembly, 2017-2018). Both the Pennsylvania State Police and the Bureau of Alco- hol, Tobacco, Firearms, and Explosives are against the legal possession of firearms if using medical marijuana because there are no exceptions for use in federal law (Bresswein, 2017). Diversity, Social Justice, Ethical Interests Issues that are not being addressed by the Penn- sylvania legislature include adverse effects that are being identified and published in literature since enactment of Act 16. There has been a rise in visits to emergency departments resulting from marijuana use, particularly related to neurotoxic symptoms in both children and adults, somnolence that is not treatable with naloxone, and hyperemesis unrelieved by ondansetron (Heard, Marlin, Nappe, & Hoyte, 2017). Incidence may be underreported due to reluctance to seek medical care if marijuana is obtained through non-legal channels. It is also difficult to discern if a legitimate legal medical marijuana user is supple- menting with an illegally obtained supply that has the potential for contamination and additives. The users may not be willing to disclose that informa- tion. Increased use of medical marijuana has led to some ability to track adverse events that may be associated, such as sudden cardiac death in the young (Fischbach, 2017). Additional concerns arise regarding children of pa- tients who use medical marijuana with second-hand smoke exposure, maternal milk transmission, and inadvertent access to foods prepared with medical marijuana (Greydanus & Merrick, 2016; Heard et al., 2017; Paramore & Paramore, 2017). Several studies report the adverse behavioral and neurocognitive developmental problems that arise with exposure in childhood (Ananth et al., 2018; Belendiuk et al., 2015; Greydanus & Merrick, 2016; Nathan, Clark, & Elders, 2017; Paramore & Paramore, 2017; Wang & Cataldo, 2016). The indications for use listed in Act 16 include chronic conditions that have incidence beginning in childhood such as autism, epilepsy, and sickle cell anemia. Implications of neurologic child- hood development issues are an unknown factor and have the potential to negatively impact population health and the ability of these children to lead nor- mal, productive lives as adults. Research has demonstrated that chronic marijuana use can cause dependence with associated adverse behaviors and withdrawal that can be equivalent to heroin withdrawal (Greydanus & Merrick, 2016). Chronic use in addition to nicotine use has been demonstrated to permanently change the metabolic pathways leading to the escalated need for the drugs, particularly in the adolescent brain providing some evidence to support that it may be a gateway drug (Wang & Cataldo, 2016). Marijuana has been demon- strated to cause impairment of abilities required to safely drive (Santaella-Tenorio et al., 2017). Metabol- ic clearance rates vary tremendously depending on the manufacturing and method of consumption (Sut- ton, 2017). These variations complicate the ability to develop standardized recommendations for use. Other considerations that have not been addressed by the legislature include that it is illegal for federally insured banks to accept funds raised from the sale of Issue 74, 1 2019 Pennsylvania Nurse 7