- Created: 20 March 2014
Michigan has added the first new condition for medical marijuana since the Act went into effect in April 2009. After being passed by new conditions panel it was officially approved by LARA on 3-14-14. This is the result of more than a year of work on the part of two panels, scores of live and written testimonies, and countless hours of work by many individuals.
What is PTSD?
There are Six Diagnostic Criteria for PTSD:
- The person has been exposed to a traumatic event involving death, bodily injury and experienced feelings of fear or helplessness.
- The event is relived again and again.
- The person seeks to avoid things that remind them of the event or withdraws.
- The person is hyper-vigilant, angry, or has exaggerated startle responses
- The symptoms continue longer than one month after the event.
- The symptoms impair the patient socially or interfere with normal function.
- Acute PSTD has a symptom duration of less than 3 months, Chronic PTSD is more than 3 months.
How Can Cannabis Help PTSD?
Most treatments for PTSD currently revolve around what is called ‘cognitive therapy’- Basically patients are led on exercises and discussions to ‘think through the problem’ in the individual and group setting. Part of the treatment involves sharing experiences with others with similar experiences and working towards replacing the exaggerated fear responses with more healthy coping mechanisms. Therapy can last for years and involve medication to help with depression.
Medical marijuana can interfere to some extent with cognitive therapy and provides an escape from the distressing thoughts. While it may prolong the treatment duration, it can in many cases provide a needed break in the stress, improve the quality of the patient’s life in the short term, and may prevent catastrophic complications such as suicide, violent behavior and relationship problems.
Denali Healthcare is taking the position that the patient should have input into their therapy for PTSD. In some cases, patients can tolerate intense cognitive and other traditional therapies, in others the patient may require immediate relief of symptoms. We feel this is best determined on a case by case basis and the patient should have a say rather than be ‘told’ they must limit themselves to specific treatments.
While PTSD is traditional viewed as a disorder of combat veterans, any traumatic experience- exposure violent death in an automobile accident, loss of a child, assault/rape, and physical/psychological abuse are examples of civilian cases of PTSD. The photo for this article depicts the 1982 drowning death of a child that affected the 19 year old EMT at the left of the image to this day.
What is the Denali Healthcare Standard for Certification for PTSD?
The diagnosis of PTSD is serious and life altering. It may affect the insurability and employability of the patient for life. It may result in disability determinations. It cannot and should not be diagnosed by non-mental health professionals, and certainly should not be diagnosed based on a single meeting in a hotel or dispensary clinic for the purposes of obtaining a medical marijuana card. It MUST involve follow up to protect the patient from potentially life threatening complications- To give someone a diagnosis of PTSD and walk away is akin to telling them they just had a heart attack and wishing them luck as you walk out of the room.
Accordingly, the Denali Healthcare Standard for the Certification of Patients with PSTD is as follows:
- The diagnosis MUST be formally made by a mental health professional according to the standard of care- by appropriate criteria and over a series of evaluations. The mental health professional making the diagnosis must have arranged for follow up with a treatment plan and appropriate safety measures.
- Patients MUST have documentation of the diagnosis IN HAND when requesting certification. We will not request records or in any way make the diagnosis ourselves. Appropriate records include, but are not limited, letters from their therapist, medical records supporting the diagnosis, and/or a disability determination of any percentage for PTSD.
- Denali Healthcare will administer a standardized screening test for PTSD as part of the patient record (if PTSD is the only qualifying condition claimed).
Our Concerns about PTSD as the sole criteria for a certification.
The use of PTSD as the sole criteria for certification carries with it the risk the ‘low standard’ clinics will attempt to use a single evaluation by a ‘checklist’ of some sort to make the diagnosis (especially by non-mental health providers) simply to qualify the patient to pay for a certification. This carries with it several risks.
- PTSD could become viewed as a ‘sham’ condition simply used to qualify the patient for a card. This disrespects those that truly suffer from the condition and decreases the seriousness of the disorder.
- If PTSD is diagnosed and not properly followed up, people could die. There are 18 suicides a day on average in veterans due to complications of PTSD, not to mention broken homes and lives. If it is identified, it must be followed up.
- Once ‘labeled’ with the diagnosis of PTSD, patients face lifelong problems obtaining life insurance and possibly health insurance. If they can, it may be at a higher premium than their demographic peers. It may limit their employability, ability to own firearms, and a host of other issues.
- In the event a patient applies for disability, the discovery by the hearing officer that the diagnosis was made by a non-mental health professional to obtain a medical marijuana card may not turn out well for an otherwise deserving patient.
The addition of PTSD to the qualifying condition list is a huge advance for medical marijuana patients, and it may save lives. It carries with it a high potential for abuse and must be applied carefully by qualified providers and certification physicians. Denali Healthcare is more interested in the safety and well-being of our patients than their certification fees, so we will adopt a conservative and well documented approach to the use of PTSD as the sole criteria for medical marijuana certification.
We encourage all high standard clinics to adopt and publish similar criteria.