Post-Traumatic Stress Disorder Approved as New Condition for MMJ


PTSD Added as a Qualifying Condition




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:

symptoms of ptsd

The Symptoms of PTSD

  1. The person has been exposed to a traumatic event involving death, bodily injury and experienced feelings of fear or helplessness.
  2. The event is relived again and again.
  3. The person seeks to avoid things that remind them of the event or withdraws.
  4. The person is hyper-vigilant, angry, or has exaggerated startle responses
  5. The symptoms continue longer than one month after the event.
  6. The symptoms impair the patient socially or interfere with normal function.
  7. 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:

  1. 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.
  2. 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.
  3. 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.


Denali to Offer On Line Follow Up


Denali Healthcare offers On Line Follow Up

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Follow up is essential for a bonafide doctor/patient relationship

At Denali Healthcare we are constantly working to protect patients based on the latest court decisions- Most recently concerning the need for follow up after the certification as a measurement of the bonafide dr/pt relationship. We have always offered free, in person follow up with the doctor.  Now patients can complete the requirement for follow up ON LINE and help us with some research into the demographics of medical marijuana in the process.

Follow up provides us with:

  1. Feedback on the effectiveness of our recommended treatment
  2. Useful demographic data for studies on the use of Medical Marijuana in Michigan
  3. Essential records for you medical chart that will be needed in a Section 8 Defense
  4. Makes sure our records are up to date

If you don’t have time to schedule a formal follow up appointment with us, all you need to do is click this button and we can update your chart…

Submit your follow up to us by clicking this button SUBMIT YOUR UPDATE

Follow Up Couldn’t be Easier!

We are currently working on a study of the demographics of Michigan Medical Marijuana Patients- Recently the state put out some misleading statistics concerning the distribution of conditions, we want to find the true numbers of patients certified for each of the approved conditions.  We believe that the state only counted one condition per patient- a card holder with cancer and nausea would be counted as ‘nausea’, we want to count both and need data to do it.

Based on recent court decisions, we at Denali Healthcare feel there will be a large number of Section 8 cases in the coming year.  Not only will the data we are collecting help patients, but the charted follow ups from the on line forms will be critical in the defenses of individual patients.

After you complete the form, it will be added to your chart.  Thank you for your help!


DOJ on Federal Vs State MMJ Laws

 By Michael Komorn,

link to original article

Attorney General Eric Holder informed the Governor’s of Washington and Colorado that the Justice Department will not interfere with the states’ laws which permit the use of marijuana for recreational purposes. This is a huge win for marijuana activists, and big step away from the War on Drugs.

Related: Uruguay Sets Price of Marijuana at $2.50/Gram

The AG sent a memo to the country’s 94 Attorney Generals which outlined what types of activities will still be targeted by the DOJ, highlighting 8 major points that the DOJ still aims to prevent. The 8 points are:

  • the distribution of marijuana to minors;
  • revenue from the sale of marijuana from going to criminal enterprises, gangs and cartels;
  • the diversion of marijuana from states where it is legal under state law in some form to other states;
  • state-authorized marijuana activity from being used as a cover or pretext for the trafficking of other illegal drugs or other illegal activity;
  • violence and the use of firearms in the cultivation and distribution of marijuana
  • drugged driving and the exacerbation of other adverse public health consequences associated with marijuana use;
  • growing of marijuana on public lands and the attendant public safety and environmental dangers posed by marijuana production on public lands;
  • preventing marijuana possession or use on federal property.

These 8 points are still quite broad, and prosecutors across the country could interpret many of them in ways that would favor their decision to prosecute. However, they will no longer be able to use sheer-volume of sales as the sole justification for charging and individual or entity with a marijuana crime.

Related: Sentencing Commission to Review Minimum Sentencing Guidelines

Though the Obama Administration had said on numerous occasions that federal agents would not interfere with states’ where marijuana use is legal to some capacity, US Attorneys have ignored this call for tolerance and gone ahead with prosecutions of marijuana growers and users, regardless of the directives from Washington.

Related: AG Holder’s Opinion Already Affecting Marijuana Cases

Now that the Attorney General has come out and said that the Federal Government will not interfere with the laws passed in Colorado and Washington, the Governors, and people, of those states can finally exhale knowing that a Federal Lawsuit will not be coming their way.


What the new law requires for certification (April 2013)

Everyone is all a buzz about the changes in the MMMA that took effect the first of April.  Really, they don't affect certifications as we have done them to any great extent.  In fact, they confirm that what we have done since the beginning was the right way to do it.

For starters, we require medical records to document your condition.  This is no different than the state requiring a copy of your medicaid card to qualify for the discounted rate, we have to have proof that you have a condition and are being treated in some way for it.

The conditions that qualify patients for medical marijuana are very clear.  Certain diseases such as cancer, glaucoma, and crohn's pretty much automatically qualify, and confirmation of the diagnosis is all that is needed.  Diseases and/or their required treatment that produce certain symptoms such as seizures (caused by epilepsy/head trauma/etc), nausea caused by reflux or migraines, and chronic pain caused by disk disease or arthritis are examples of symptoms caused by a particular disease or injury.  Any condition that directly results in one of these qualifying conditions would qualify the patient, but we need to see documentation of the disease and evidence you are being treated for the symptom.  


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