John Kroneck, MA, LPC, CPC-R

Transcription

1 John Kroneck, MA, LPC, CPC-R Cherry Street Health Promotion Services PO Box 836, 129 E main, Stanton MI JohnKroneck@CherryHealth.com Certified Prevention Consultant - R Licensed Professional Counselor Certificate # P-C0036 License # Education: 1977 ~ Central Michigan University, Mt. Pleasant, MI. Bachelor of Science; Public Health Education, Psychology (minor) ~ Central Michigan University, Mt. Pleasant, MI. Master of Arts; Patient and Public Health Education with an emphasis in Substance Abuse Prevention ~ Central Michigan University, Mt. Pleasant, MI. Master of Arts; Counseling and Personal Development. Work Experience: 1985 Present ~ Montcalm County Health Promotion Coordinator (Substance Abuse Prevention) Cherry Street Services, Inc ~ Part time faculty at Central Michigan University; Counseling and Special Education Department ~ Public Health Educator. Mid-Michigan District Health Department, Stanton, MI. Current Professional Committees: Michigan Certification Board for Addiction Professionals Prevention Committee, 2001 to Present Michigan Prevention Association Medical Marijuana Task Force Chair May 2011 to Present Regional Substance Abuse Advisory Council 2009 to Present. Publication: Reiki Energetics: Energetic Theories & Practices for Healing & Wellness Balboa Press, 2012 Sample of Volunteer and Professional Affiliations: Psi Chi (Psychology Honorary), , officer. Eta Sigma Gamma (Health Honorary), , officer. Society for Public Health Education, Board officer Montcalm Heart Unit, President Montcalm Area Hospice, Co-founder, Board President, Big Brothers Big Sisters of Montcalm County, ; Board President, Michigan Prevention Association, 2009 to Present. Threshold Academy Public Charter Elementary School 2004-Present; Board President, 2009-Present In December 2010 was named Preventionist of the Year for the Riverhaven Substance Abuse Coordinating Agency Region.

2 The Michigan Experience A prominent legislator publically supported the initiative. News coverage was limited and did not have an appreciation for the potential problems of the specific ballot initiative. Attempts to address the facts were met with an attitude of, Why would you deny people who are critically ill pain relief? In November, 2008, the voters of Michigan approved a ballot initiative that made it legal to use marijuana for medicinal purposes, under prescribed circumstances. Over 60% voted in favor of the initiative. 1

3 222,413 original and renewal applications received since April 6, ,483 patient registrations issued. 22,550 applications denied most due to incomplete application or missing documentation. Patients must suffer from a debilitating medical condition, defined as: (a) cancer, glaucoma, or positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), hepatitis C, amyotrophic lateral sclerosis, Crohn's disease, agitation of Alzheimer's disease, or nail patella. Patients must suffer from a debilitating medical condition, defined as: (b) a chronic or debilitating disease or medical condition or its treatment that produces one of more of the following: (i) cachexia or wasting syndrome; (ii) severe and chronic pain; (iii) severe nausea; (iv) seizures, including but not limited to those caused by epilepsy; or (v) severe or persistent muscle spasms, including but not limited to, those which are characteristic of multiple sclerosis; or 2

4 Patients must suffer from a debilitating medical condition, defined as: (c) any other medical condition or treatment for a medical condition adopted by the department by rule. (NOTE: To date, the department has not added to the list by administrative rule.) Registered caregivers must be 21 or older. Patients under age 18 must have the consent of their parent or guardian responsible for medical decisions. The parent or guardian must be the registered caregiver of the minor patient. The youngest patient we have was five years old at the time the card was issued. A physician must state in writing that the patient has a qualifying debilitating medical condition and that medical marihuana may mitigate the symptoms or effects of that condition. There must also be an relationship between the patient and physician. The physician must be licensed in the State of Michigan. 3

5 The MMMP has 15 days to review an application to make sure it is complete and all parts are current. If the application is complete, the registry identification card will be issued within 5 days after the MMMP verifies the information on the application. If the review is not completed within 20 days, the registry identification card will be considered issued. The caregiver can acquire 2.5 ounces of usable marihuana and grow up to 12 marihuana plants for a qualifying patient. The caregiver may assist up to 5 patients. The marihuana grown as a caregiver must be in an enclosed and locked facility. Other than limiting the caregiver to growing up to 12 plants per patient, inventory controls are not addressed in the law. 4

6 (1) Undertake any task under the influence of marihuana, when doing so would constitute negligence or professional malpractice. (2) Possess marihuana, or otherwise engage in the medical use of marihuana: (a) in a school bus; (b) on the grounds of any preschool or primary or secondary school; or (c) in any correctional facility. (3) Smoke marihuana: (a) on any form of public transportation; or (b) in any public place. (4) Operate, navigate, or be in actual physical control of any motor vehicle, aircraft, or motorboat while under the influence of marihuana. Sec. 4. (a) A qualifying patient who has been issued and possesses a registry identification card shall not be subject to arrest, prosecution, or penalty in any manner, or denied any right or privilege, including but not limited to civil penalty or disciplinary action by a business or occupational or professional licensing board or bureau, for the medical use of marihuana that does not exceed 2.5 ounces of usable marihuana and 12 marihuana plants kept in an enclosed, locked facility. 5

7 Basically the same for a Primary Caregiver. Basically the same for a physician. Basically the same regarding providing marihuana paraphernalia. Eight of the 10 states with the highest percentage of past month marihuana users are states with medical marihuana programs. Five of the top 10 states with the highest rates for new youth marihuana initiates (ages 12 17), are states with medical marihuana programs. The access to and perceived harm of using a drug relates to the extent of its use. Teens who believe marihuana is not harmful are six times likelier to smoke marihuana than teens who believe marihuana is very harmful. Percentage of students in Montcalm County who reported their parents felt marihuana use to be wrong or very wrong as reported in the MiPHY survey. 9 th graders: = 94.4% = 89.8% 11 th graders: = 90.5% = 90.4% Percentage of students in Montcalm County who used marihuana during the past 30 days, as reported in the MiPHY survey. 9 th graders: = 12.9% = 15.4% 11 th graders: = 16.4% = 15.9% 6

8 A MM user does not need to inform employers of use of MM. A MM user may not place others at risk. NO legal limit of THC in the blood has been set, thereby, identifying a safe level of use. What s it mean? A business that has a worker who is using MM (knowingly or unknowingly?) faces higher liability exposure regarding the creation of an unsafe work environment for employees and the general public. Compassion Clubs opened up throughout Michigan. To help people learn how to use MM. To support people with their MM regime. To provide a legitimate resource where caregivers and patients could meet. How our local Compassion Club helped people: They have times that they teach people how to use MM. They will dose as a group. After dosing they wait one hour before leaving. They provided a physician service. For $200 an individual could meet with a physician for the purpose of receiving certification from the physician. If the State refused to issue a card, the individual would have his/her $200 returned. 7

9 How our local Compassion Club helped people: They arranged for a doctor to provide services. This doctor has a plane and flies around Michigan working at different Compassion Club sites. They set up a process by which the Club would buy the overgrowth from growers and then sell this to MM card holders. Each municipality was left on their own to address the aftermath of the new medical use of marihuana law. Legal proceedings have taken and are taking place all over the State. Most popular approach by municipalities has been passing a moratorium to study the impact on public safety. Most approaches by municipalities have included denying the establishment of a business club within 1,000 feet of schools, daycare, churches and other places children may gather. People were surprised by how the law was enacted. Many times the words are spoken; Even though I voted for this, this isn t what I voted for. I thought this would be treated like any other medication and distributed through the pharmacy. I certainly didn t expect people to be sitting together sharing their medications. 8

10 Walmart fires an employee and had to defend its actions in court. Drug enforcement teams have yet to run into anyone who follows growing laws. There are more plants than allowed, the growing is not in a secured facility, etc. Cards issued to college students and high school age teens are increasing. Even law enforcement officers may not access information from Licensing and Regulatory Affairs except to verify that the card number is valid. (HIPPA concerns) Registration cards do not have a picture ID included. Recent ruling from the court states that if the individual has seen the doctor but not yet applied for a card, they are protected by the law. There is a new ballot petition being circulated to legalize the use of marijuana for anyone over 21 years of age. 1. Assessment and Data Gathering: Identifying the concerns in measurable terms in addition to anecdotal reports. 2. Articulate Clear Statement of Concerns: Clear articulation to focus in on concerns of primary interest. 3. Developing Messages: Provide consistent messaging throughout this campaign. One to three primary messages, with secondary messages identified, as well. 9

11 4. Education of Membership: To be effective, all members need to be aware of the plan, be provided the tools, and be aware of opportunities to take action. Membership also needs to be empowered to educate the public and law makers related to the concerns and primary messages. 5. Development of an Advocacy Network: Our membership, their respective organizations, and local coalitions are key allies in developing this network. 6. Education of the General Community: One of the most powerful means of informing the public is one to one. We look to our Advocacy Network to be involved in education within their respective communities. Having a clear and consistent message is critical at this stage. 7. Education of Elected Officials: Elected officials have repeatedly indicated that they look to organizations such as MPA and local coalitions for accurate information and articulation of the issues of concern. Established relationships with elected officials adds credibility to the message. 1. INDUSTRY STANDARDS There are many unclear polices and guidelines in the current Michigan Medical Marihuana Law. Because lack of clarity may be easily exploited for purposes not in the public s best interest, there is a significant potential regarding a diminishing quality of life, related to health and safety, in our communities. The Michigan Prevention Association proposes that industry standards must be created to 1) protect the health and safety of the community, and 2) establish policies and norms in our communities that are supportive of healthy environments within which our children live. 10

12 2. COMMUNITY/ECONOMIC COSTS Medical marijuana laws have allowed for the creation of formal and informal marijuana dispensaries responsible for meeting the marijuana demands of medical marijuana card holders. As a result, there has been an increase in crime and violence at these dispensaries and in the communities where they are found. Residents of these communities feel less safe and are concerned about all of the negative consequences the distribution of medical marijuana is having on their communities. Michigan residents need to learn from the mistakes made elsewhere and prevent them from occurring in our state. 3. ECONOMIC DEVELOPMENT Communities in Michigan are suffering, factories are closing and people are leaving the state to find work elsewhere. Cities are finding ways to diversify their economies. The Michigan Prevention Association believes that communities across Michigan should responsibly redevelop businesses. Medical Marihuana grow shops and dispensaries are a strain on our communities, they divert precious public safety resources and their presence decreases the perception of harm from marijuana usage among our youth. MPA believes that cities and townships should create strong standards to avoid this negative economic development. 4. FRAMING THE MESSAGE / PERCEPTION OF HARM The Michigan Prevention Association (MPA) recommends scientific, research based facts about marijuana use and related issues, be a basic element in any discussion, including the alleged benefits of marijuana use as medicine and pain management. Additionally, MPA has concerns regarding the rise of marijuana cultivation, sales, exchange, availability to youth, and consumption in Michigan communities related to the passage of the Michigan Medical Marihuana Law. 11

13 A. Control the conversation: Determine your message and keep your focus there. Acknowledge other points when appropriate but segue back to your message. This is NOT a debate it is about communicating prevention messages and protecting the public s health. B. Your audience is your largest voting block(s) not the medical marihuana proponents. Know your audience; the older farming community have been using what works forever. C. Talk about exposure to and increased risks in the environment our children are attempting to navigate. availability, relationship to school failure, etc. D. Talk about INDUSTRY STANDARDS designed to limit access by youth and protect the public health. this is not the way medicine is prescribed, produced or distributed. Production safeguards, dosing guidelines, inventory control, second hand smoke, use of motor vehicle while using MM, etc. E. The prevention message must have a curb appeal stronger than helping dying people avoid pain. F. Voters will not read and analyze the proposal they will vote on impressions, i.e. compassion vs. zealots vs. common sense life experiences. G. Voters trust certain people in their life circles these could be partners. Medical professionals. Religious leaders. Sitting legislators. 12

14 H. Identify your natural allies those who have the most at risk should the proposal pass. Parents and Grandparents Chambers of Commerce (business liability exposure) Business Associations (particularly construction, manufacturing, and small businesses). Schools (early onset has relationship to poor school performance).??? John Kroneck, MA, LPC, CPC Montcalm County Coordinator, Health Promotion A Branch of Cherry Street Health Services PO Box 836, 129 E. Main, Stanton MI voice, fax JohnKroneck@CherryHealth.com 13

15 The (Michigan) Board of Medicine and the Board of Osteopathic Medicine and Surgery has adopted the following statement to clarify the standard of care applicable to the evaluation of an individual for the purpose of certification to use marihuana for any medical condition: Generally accepted components of a full medical evaluation to determine suitability and appropriateness for recommending treatment of any kind, including certification for medical marihuana, include: a hands on physician patient encounter full assessment and recording of patient s medical history relevant physical examination review of prior records of relevant examinations, treatments and treatment response including substance abuse history receipt and review of relevant diagnostic test results discussion of advantages, disadvantages, alternatives, potential adverse effects and expected response to treatment development of plan of care with stated goals of therapy monitoring of the response to treatment and possible adverse effects creation and maintenance of patient records documenting the information above communication with patient s primary care physician when applicable 14

16 The Boards expect that these medical encounters would be completed at permanent locations that enable the patient to return for follow up, consultation or assistance as needed. A physician failing to meet generally accepted standards of practice when certifying a patient to use marihuana for a medical condition may be found to be practicing below the acceptable standard of care and therefore may be subject to disciplinary action. John Kroneck, MA, LPC, CPC Montcalm County Coordinator, Health Promotion A Branch of Cherry Street Health Services PO Box 836, 129 E. Main, Stanton MI voice, fax JohnKroneck@CherryHealth.com 15

17 MPA Medical Marijuana Task Force Medical Marijuana Law Concerns The tree diagram is a pictorial representation of the concerns of the Medical Marijuana Task Force of the Michigan Prevention Association. The branches represent the different community sectors that are affected by the law. The leaves represent the concerns we have for each of the different sectors: Green leaves affect 1 sector Orange leaves affect 2 sectors Yellow leaves affect 3 sectors Red leaves affect 4 or more sectors Following are the branches* (different community sectors that are affected by the law), with the leaves (the concerns we have for each of the different sectors) listed below them. Youth/Schools 1. Access in homes by children (affects 5 sectors) 2. Decreased perception of harm MM is defined as medicine (affects 4 sectors) 3. Health Effects (affects 8 sectors) 4. Safety Concerns (affects 8 sectors) 5. Increasing # of college and high school students with MM cards (affects 2 sectors) Adults/Parents 1. Access in homes by children (affects 5 sectors) 2. Decreased perception of harm MM is defined as medicine (affects 4 sectors) 3. Health Effects (affects 8 sectors) 4. Safety Concerns (affects 8 sectors) 5. Increasing # of college and high school students with MM cards (affects 2 sectors) Community 1. Access in homes by children (affects 5 sectors) 2. Decreased perception of harm MM is defined as medicine (affects 4 sectors) 3. Health Effects (affects 8 sectors) 4. Safety Concerns (affects 8 sectors) 5. Harm created in specific community (affects 2 sectors) 6. Street value of 2.5oz is approximately $1,000 (affects 3 sectors) 7. The location in the community of a private grower/dispensaries (affects 4 sectors) 8. Keeping the community informed of changes to the MM law (affects 3 sectors) October 4, 2011

18 Law Enforcement/Government 1. Access in homes by children (affects 5 sectors) 2. Decreased perception of harm MM is defined as medicine (affects 4 sectors) 3. Health Effects (affects 8 sectors) 4. Safety Concerns (affects 8 sectors) 5. Harm created in specific community (affects 2 sectors) 6. Street value of 2.5oz is approximately $1,000 (affects 3 sectors) 7. The location in the community of a private grower/dispensaries (affects 3 sectors) 8. Keeping the community informed of changes to the MM law (affects 3 sectors) 9. Marijuana is still against federal law and is classified as a Schedule 1 drug (affects 2 sectors) 10. MM growing is illegal in federally subsidized housing (affects 1 sector) Businesses 1. Safety Concerns (affects 8 sectors) 2. Health Concerns (affects 8 sectors) 3. Business policies insufficient to address the liabilities MM law could cause (affects 1 sector) 4. Multi housing units and MM growing? (affects 1 sector) 5. Location in the community of dispensaries (affects 4 sectors) Patients/Caregivers 1. Safety Concerns (affects 8 sectors) 2. Health Concerns (affects 8 sectors) 3. The location in the community of a private grower/dispensaries (affects 4 sectors) 4. Street value of 2.5oz is approximately $1,000 Concerns with the Law 1. Back up in processing applications 2. No picture on identification cards 3. No registration of caregivers 4. Transporting marijuana 5. Drugged driving 6. Employees with MM cards 7. Doctor regulation 8. Qualifying diseases for receiving a MM card * Youth/Schools combined. Healthcare has been incorporated throughout. October 4, 2011

19 MICHIGAN PREVENTION ASSOCIATION KEY STATEMENTS OF CONCERN REGARDING THE MICHIGAN MEDICAL MARIHUANA LAW JUNE 5, 2012 Michigan Prevention Association (MPA) members work in communities across Michigan to improve health and productivity and reduce harm caused by the addictive and early use of substances. Families, schools, communities, and individuals have indicated a need for accurate, scientific information on marihuana use. Currently, the marijuana* industry is framing recreational drug use as medicinal use, discussing marijuana as a medical treatment of disease/injury, and claiming the use of marijuana to be a safer even harmless alternative to prescription drugs. The Michigan Prevention Association s Medical Marihuana Task Force (MMTF) has reviewed the Michigan Medical Marihuana Law (MMML), held conferences, entered into dialog with other agencies and communities, and researched factors related to the implementation of the MMML. Out of this process, the MMTF identifies the following four key concerns of most critical interest regarding prevention of marijuana abuse and promoting safe and healthy communities. INDUSTRY STANDARDS There are many unclear polices and guidelines in the current Michigan Medical Marihuana Law. Because lack of clarity may be easily exploited for purposes not in the public s best interest, there is a significant potential regarding a diminishing quality of life, related to health and safety, in our communities. The Michigan Prevention Association proposes that industry standards must be created to 1) protect the health and safety of the community, and 2) establish policies and norms in our communities that are supportive of healthy environments within which our children live. COMMUNITY/ECONOMIC COSTS Medical marijuana laws have allowed for the creation of formal and informal marijuana dispensaries responsible for meeting the marijuana demands of medical marijuana card holders. As a result, there has been an increase in crime and violence at these dispensaries and in the communities where they are found. Residents of these communities feel less safe and are concerned about all of the negative consequences the distribution of medical marijuana is having on their communities. Michigan residents need to learn from the mistakes made elsewhere and prevent them from occurring in our state. ECONOMIC DEVELOPMENT Communities in Michigan are suffering, factories are closing and people are leaving the state to find work elsewhere. Cities are finding ways to diversify their economies. The Michigan Prevention Association believes that communities across Michigan should responsibly redevelop businesses. Medical Marihuana grow shops and dispensaries are a strain on our communities, they divert precious public safety resources and their presence decreases the perception of harm from marijuana usage among our youth. MPA believes that cities and townships should create strong standards to avoid this negative economic development. FRAMING THE MESSAGE / PERCEPTION OF HARM The Michigan Prevention Association (MPA) recommends scientific, research-based facts about marijuana use and related issues, be a basic element in any discussion, including the alleged benefits of marijuana use as medicine and pain management. Additionally, MPA has concerns regarding the rise of marijuana cultivation, sales, exchange, availability to youth, and consumption in Michigan communities related to the passage of the Michigan Medical Marihuana Law. For further information, contact a MPA member in your community or the MMTF Chair, John Kroneck at JohnKroneck@CherryHealth.com, , or Health Promotion Services, PO Box 836, Stanton MI ~~~ SEE 2 ND PAGE FOR SPECIFIC CONCERNS ~~~ i.e. as reflected by the data reported in the Michigan Profile for Healthy Youth survey. *When referring to the MMML, the formal spelling, marihuana, is used. Otherwise, the common spelling, marijuana, is used.