Pubdate: Wed, 14 Nov 2012
Source: Arizona Republic (Phoenix, AZ)
Copyright: 2012 The Arizona Republic
Author: Yvonne Wingett Sanchez


Pediatrics Group Raises Red Flag About Effect on Fetuses, Seeks Changes to Law

Arizona pediatricians are concerned that the state's 
medical-marijuana law is being used to treat the ailments of pregnant 
women, potentially harming fetuses.

Members of the Arizona chapter of the American Academy of Pediatrics 
want to stop the practice and point to one incident in which a mother 
in labor told hospital officials that she had received a 
medical-marijuana card during pregnancy and had been using the drug.

The mother later told her baby's pediatrician, Kara Tiffany, that a 
physician who was aware of her pregnancy recommended the marijuana. 
The mother showed the pediatrician her 
medical-marijuana-certification documents, which indicated that a 
naturopath made the marijuana recommendation.

"I was appalled," Tiffany told The Arizona Republic, adding that the 
mother told her the naturopath researched marijuana use during 
pregnancy and "thought it would be OK."

Recommending marijuana to pregnant women appears to be legal under 
Arizona's medical-marijuana law, passed by voters in 2010.

The law allows people with certain debilitating medical conditions -- 
such as severe nausea, chronic pain and cancer -- to use marijuana. 
Patients must obtain a recommendation from a physician and register 
with the state, which issues identification cards to qualified 
patients and caregivers. Patients can obtain up to 21/2 ounces of 
marijuana every two weeks.

Program rules require physicians to perform a physical exam, a review 
of a year's worth of medical records and a review of a state database 
that tracks certain prescription-drug use. Physicians are not 
required to ask patients if they are pregnant.

"It's totally up to their physician," said Department of Health 
Services Director Will Humble, who oversees the state's 
medical-marijuana program. "If the physician signs off on a series of 
attestations that we ask for, then, by our rules, that's a 
certification for medical marijuana."

A woman's decision to use medical marijuana while pregnant, even if 
she has a card, could affect her parental rights, however.

Depending on the physician and the hospital, state Child Protective 
Services is contacted if use of certain substances -- such as 
marijuana, alcohol and other drugs -- is suspected, said Susan 
Stephens, medical director for the health plan that covers children 
in the state's foster-care program. In those instances, CPS can open 
an investigation and immediately visit the child in the hospital and 
the home to assess his or her safety.

No one tracks the number of pregnant women who may have received 
recommendations for medical marijuana.

Physicians and the lobbyist for the Arizona chapter of the American 
Academy of Pediatrics said the issue has lit up the organization's 
LISTSERV, with other physicians who say they, too, have encountered 
pregnant women obtaining medical-marijuana recommendations.

The Arizona chapter plans to work with lawmakers to introduce 
legislation in the coming session that, if approved, would prevent 
pregnant women from receiving recommendations for marijuana; require 
physicians who recommend marijuana to ask patients if they are 
pregnant; and require women to submit to pregnancy tests when seeking 

Such changes would require approval by a supermajority of the 
Legislature because it would alter a voter-approved law and a 
revision of program rules by state health officials.

The group also wants lawmakers to earmark a portion of money raised 
through the program to pay for developmental testing on the effects 
of marijuana on babies and breast milk. The effects of marijuana on 
fetuses are unclear; studies have contradicted each other on the 
effects, such as low birth weight and memory problems.

"All women need to be informed that the effects of marijuana on a 
developing baby are not known, and, therefore, it should not be 
used," said Sue Braga, executive director of American Academy of 
Pediatrics' local chapter. "This is an unintended consequence of this 
law -- I want to believe --and it needs to be corrected."

Karen O'Keefe, director of state policies at the Marijuana Policy 
Project in Washington, D.C., said none of the 18 states and 
Washington, D.C., with medical-marijuana laws explicitly ban pregnant 
women from obtaining marijuana recommendations.

Andrew Meyers, campaign manager for the organization that got the 
program on the Arizona ballot, said "it was never intended that 
pregnant women would access the program." He said supporters 
approached the drafting of the law with the idea of trusting 
physicians to make appropriate medical decisions for patients.

"I cannot imagine that an ethical physician would not consider the 
well-being of a fetus if a pregnant woman was seeking a 
medical-marijuana card," Meyers said. "If this is a serious problem 
. it's something that needs to be worked on."

But Meyers said the best way to approach the issue is through 
education at the licensing-board level -- not through legislation.

Medical regulatory boards are typically at the forefront of such 
issues. In Colorado, for example, a doctor last year surrendered his 
medical license after the state's medical board accused him of 
failing to meet expected standards of care because he did not perform 
a physical exam on a patient, review her medical history or ask if 
she was pregnant before recommending marijuana. At one point, the 
doctor disputed whether using marijuana during pregnancy was harmful, 
according to public records.

The Arizona Naturopathic Physicians Medical Board, which regulates 
naturopaths in Arizona, has not received complaints related to the 
practice of recommending the drug to pregnant women, Deputy Director 
Gail Anthony said. Naturopaths, according to a new state report on 
the program, are the physicians who most often recommend medical 
marijuana to patients.

The Arizona Medical Board regulates pediatricians, obstetricians, 
gynecologists and all other medical doctors and has had one case 
involving a pregnant woman who was recommended medical marijuana as 
well as prescribed opioids, which are clinically known to be 
dangerous to fetuses, Executive Director Lisa Wynn said. Ultimately, 
the doctor was disciplined for prescribing the OxyContin.

"It goes against the standard of care for a doctor to prescribe 
narcotics to a pregnant woman," Wynn said. "However, the standard of 
care for recommending medical marijuana is evolving ... as well as 



A medical-marijuana dispensary in Glendale will be the first in 
Arizona to be inspected by state health officials and could soon be 
up and running if it passes.

Department of Health Services Director Will Humble said surveyors 
will check everything from security to inventory control and medical 

"If they're ready like they say they are, they could be up and 
running on Friday," he said.

Surveyors will inspect a Tucson dispensary next Tuesday.

State law prevents health officials from revealing the identities of 
those seeking to open dispensaries. State health officials have 
issued 97 dispensary-registration certificates, giving them the 
opportunity to sell marijuana and operate cultivation sites to grow it.

The law does not limit how much marijuana-dispensary operators can grow.

Some who have received dispensary-registration certificates have told 
The Arizona Republic that they are waiting to move forward with 
inspection requests until a Maricopa County Superior Court judge 
settles a challenge to the state's medical-marijuana law.
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