Sept. 6, 2019: National Advocacy Update


U.S. Surgeon General Jerome Adams, MD, has released an advisory on marijuana use and its impact on the developing brain. The advisory is in response to high rates of marijuana use among pregnant women and young people, widespread and growing access to increasingly potent marijuana, and a mounting body of evidence of harms.

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The advisory notes that, for pregnant women, marijuana is the most commonly used illicit drug. Between 2002 and 2017, marijuana use among pregnant women doubled. Marijuana is also the third most commonly used illicit substance in adolescents, behind alcohol and e-cigarettes. While among young people the perceived harm of marijuana is decreasing, the advisory states that the potential for harm is actually increasing. The advisory underscores that science shows young people who regularly use marijuana are more likely to show a decline in IQ and school performance, are more apt to miss classes and drop out, and are more likely to attempt suicide. The science also shows that marijuana use during pregnancy can affect the baby's brain and also result in lower birth weight, a marker for early death and disability.

In response to the advisory, the AMA issued a press release, which commends the surgeon general for his warning about the harmful health effects of cannabis use by pregnant women and youth and expresses the AMA's strong support for this effort. The AMA has long discouraged cannabis use by youth, pregnant women and women who are breastfeeding. The AMA has also called for research to determine the consequences of long-term cannabis use in these populations and commends the surgeon general's call for more research.

The AMA is strongly criticizing a proposed Department of Health and Human Services (HHS) rule that would do away with Affordable Care Act (ACA) protections for LGBTQ people, women, immigrants, minorities and other patients.

"This proposal marks the rare occasion in which a federal agency seeks to remove civil rights protections," AMA Executive Vice President and CEO James L. Madara, MD, wrote in a sharply worded letter (PDF) to HHS Secretary Alex Azar. "It legitimizes unequal treatment of patients by not only providers, health care organizations, and insurers, but also by the government itself—and it will harm patients. Such policy should not be permitted by the U.S. government, let alone proposed by it."

The proposal perverts the nondiscrimination provisions included in the ACA by drastically limiting nondiscrimination protections despite decades of case law recognizing these protections.

The rule concerns the ACA's section 1557, which was designed to help people experiencing barriers to care, including LGBTQ people, minorities, patients who speak limited English, and patients seeking reproductive health care.

The administration proposal "is contrary to the intent and the plain language of the law," Dr. Madara wrote. "It will negatively affect patients by drastically limiting the scope of health plans to which the nondiscrimination provisions apply, thereby eliminating coverage protections for certain individuals, such as transgender people, women, LGBTQ people, and individuals living with HIV."

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