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Arizona Cannabis Nurses Association vs. Humble 

The legal wrangling over PTSD and medical marijuana continues with new complaint filed against Department of Health Services

Back in July, folks with the Arizona Cannabis Nurses Association were undeniably happy with an administrative judge's recommendation that the state allow post-traumatic stress disorder on the list of qualifying conditions for those who apply for a medical marijuana patient card.

Well, that was July. Last week, the AZCNA filed an appeal in Maricopa County Superior Court against the Arizona Department of Health Services and its director Will Humble to challenge the language used in how patients can claim PTSD status. They also want cards issued sooner than Jan. 1, 2015.

"When a cancer patient applies for a patient card, no one asks them if they are in chemotherapy as treatment in order to qualify," said Kenny Sobel, AZCNA attorney.

What's different for those with PTSD unlike cancer patients, is that Humble is asking that they show they are undergoing some form of treatment beyond using medical marijuana for relief of their symptoms.

Sobel said that Humble's decision to treat PTSD patients differently than other medical marijuana qualifying patients violates their constitutional rights. The other issue for AZCNA is that those who supported their petition more than a year ago, such as veterans, as well as sexual abuse and domestic violence victims, have to wait more than five months before they can apply for their patient cards.

"There's a crisis going on right now," Sobel said. "Veterans are committing suicide at an alarming rate and those, particularly using the Phoenix VA, aren't able to get the care they need."

When Humble responded to the administrative judge's decision, he explained that when he first denied the AZCNA petition on Jan. 14, 2014, he did so because he felt there was a lack of scientific evidence backing medical marijuana's use for PTSD, but that during the hearing, AZCNA provided evidence that had just been published—namely a March 2014 article published by the Journal of Psychoactive Drugs that showed a connection between marijuana and palliative care for PTSD patients.

Humble's decision to go with the admin judge's recommendation included a requirement that certifying docs attest that the patient is undergoing "conventional treatment for PTSD," before signing the patient card certification.

According to AZCNA's latest appeal, nothing in the state statutes on medical marijuana "suggest or implied that the Director has any authority to treat a newly added debilitating disease or medical condition any different from the debilitating conditions listed in the original Act."

Humble told the Tucson Weekly that he feels unfairly attacked by Sobel at the moment and wonders if AZCNA recognizes three outcomes can happen from their appeal. First, the judge will look at evidence and case law and rule that Humble made his decision within the boundaries of the state statute and his discretion as ADHS director.

"I think that's what will happen," Humble said.

"But theoretically the judge could override and say that I must make it for both palliative care and treatment ... but the other that could likely happen is that the judge could send it back to the agency, to me, and say that my statutory authority allows me to give a thumbs up or down on the administrative judge's decision."

Which means, according to Humble, that PTSD as a qualifying condition could just go away and AZCNA or another organization would have to start their petition process all over again.

Humble said he made the decision that marijuana be used for PTSD patients as a palliative care, not treatment, because there is no evidence that it cures PTSD, but relieves symptoms. The medical marijuana law states palliative or treatment, but not both, "not or/and."

"When it came time for making a final decision, I had to make one I could live with professionally," Humble said. The rule that a patient be undergoing treatment isn't how AZCNA is interpreting it to the media, he said. Conventional treatment doesn't have to be prescription drugs or psychiatric care, but a range of treatments, from counseling, group therapy, simple directions from a physician to do medication or take walks or learning coping skills. "Something beyond smoking pot."

The petition process that began last year also included petitions for generalized anxiety disorder, depression, skin cancer and migraine headaches. Humble rejected those, too, and PTSD was the only conditioned championed in the appeal process.

"Sobel has made it sound like I advocate for shoving pills down people's throats. That's not true," Humble said. "I honestly believe I did what was responsible using my own professional judgment public health wise and it stays true to the statute."

Humble said that with or without the PTSD designation, he understands that since the state began issuing patient cards physicians have been signing certifications for those with PTSD under chronic pain—that PTSD can cause chronic pain. "We've approved those cards," he said.

Depending on what happens with Sobel's appeal, Humble said his staff is moving forward, designing the new patient card form that will be available to upload by Jan. 1, and sending information to certifying physicians on PTSD.

"A period of time is needed to help dispensaries and physicians get up to speed and give IT time get new forms ready. Those were the reasons for the Jan. 1 start. That's the kind of thing I've done my whole time as director with other areas. Time allows us to do things responsibly," he said.

Of course, Sobel disagrees. His clients, he said, believe there is no logical and rational reason to delay PTSD suffers from applying for patient cards now that is it listed as a qualifying condition.

"Cancer is not curable. Cannabis provides a palliative benefit since there's no real cure," Sobel said, adding that Humble needs to treat PTSD patients the same. If conventional therapy has a wide interpretation, "then perhaps the director should have put it in writing."

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