Because the very mention of marijuana use, OTC contraceptives and firearms can draw impassioned debate and questions about where organizations stand on each issue, the AAFP has created or updated policies to explain its stance on these topics, the logic behind that position and what types of evidence-based research might better inform decisions about these important public health concerns.
The AAFP's newly created policy on marijuana updates its 1989 stance and is broken into two sections: medical and recreational use.
Regarding medical use, the policy reads: "The AAFP recognizes that there is support for the medical use of marijuana but advocates that usage be based on high-quality, patient-centered, evidence-based research and advocates for further studies into the use of medical marijuana and related compounds."
Furthermore, the policy adds, "The AAFP requests that the FDA change marijuana’s classification for the purpose of facilitating clinical research. This process should also ensure that funding be available for such research."
- In the first of three updated policies, the AAFP advocates that decisions about medical marijuana use be based on patient-centered, evidence-based research and suggests further studies into the use of medical marijuana and related compounds.
- Secondly, the AAFP supports OTC access to oral contraception.
- Finally, the AAFP supports increased research "into all areas of how gun violence affects public health including, but not limited to, research into the epidemiology, prevention, safety and risks related to gun violence in the United States."
"Marijuana, along with heroin and LSD (lysergic acid diethylamide), is currently classified as Schedule I, which is reserved for those drugs with the highest potential for abuse and no current accepted medical use," said Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division. "Because of this schedule (classification), there are major restrictions to using it in research, which has been limited. Lowering it to Schedule II, which would put it with opioids and amphetamines, would ease these restrictions."
The policy goes on to say, "The data on effectiveness of medical marijuana is limited and of poor quality. Randomized controlled trials of marijuana treatment compared to placebo or another therapeutic agent need to be done to prove its effectiveness as well as its safety."
Frost told AAFP News that she realized medical marijuana is a divisive issue. But she also argued that AAFP members want to provide their patients with effective therapies. "More research will allow family physicians to have better-informed discussions with their patients," she said.
The medical marijuana policy concludes by acknowledging that some states have passed laws approving the medical use of marijuana, but noting that the AAFP does not endorse such statutes. The policy further encourages members to be knowledgeable about laws governing marijuana use in their states and to "consult with their state medical boards for guidance regarding the use of medical marijuana."
As for recreational marijuana use, the Academy policy opposes such use and adds, "The AAFP recognizes that several states have passed laws approving limited recreational use of marijuana but advocates for further research into the overall safety and health effects of recreational use as well as the effects of those laws on patient and societal health."
OTC Oral Contraceptives
Approved by the Board of Directors in July, the AAFP's policy on OTC contraceptives states, "The AAFP recognizes that unintended pregnancies are a major public health concern, accounting for approximately 50 percent of U.S. pregnancies. Access and cost are commonly cited reasons why women have gaps in contraceptive use or do not use contraception."
"We support over-the-counter availability of (oral contraceptive pills), but believe that contraception should be affordable and accessible to all women who want it," Frost said. "Oral contraceptives cost $15 to $50 per month, which would put them out of reach for many women if not covered by insurance."
The policy continues, "While oral contraceptive pills (OCPs) are widely considered to be safe and effective medications, they continue to require a prescription for use, further restricting access. The AAFP recognizes that though contraindications to these medications do exist, women have been shown to correctly self-identify contraindications to use when using a standardized checklist."
Many physicians aren't aware of the available evidence and, therefore, have safety and continuity concerns, according to Frost. "The evidence shows that women can self-screen for contraindications to OCPs, and that it does not prevent them from seeking primary care," she said. "And we already know that OCPs pose less of a risk than pregnancy does."
The policy concludes, "The AAFP supports over-the-counter access to oral contraception without a prescription. Under the Patient Protection and Affordable Care Act, private insurance must cover all contraceptive methods approved by the FDA. The AAFP supports insurance coverage of oral contraceptives regardless of prescription status in all insurance plans."
The caveat here is that the Burwell v. Hobby Lobby Stores Inc. Supreme Court decision opened the door for private (not just religious-based) companies to opt out of contraceptive coverage, Frost said. "The AAFP supports insurance coverage for all forms of contraception," she said. "We also believe that medical decisions should be evidence-based and made between the physician and patient, not made by the business owner based on their personal beliefs."
Firearms and Safety Issues
The AAFP's policy on firearms safety states, "The AAFP recognizes firearm-related deaths, injury and violence as a significant public health problem. The AAFP supports increased research into all areas of how gun violence affects public health, including but not limited to, research into the epidemiology, prevention, safety and risks related to gun violence in the United States."
"Research needs to be done on what strategies are most effective in reducing gun violence," Frost said. "This is a divisive issue, but in order to decrease gun violence in this country, we have to have evidence about what works and what doesn't."
The policy continues by noting the AAFP "supports strong research regarding how gun laws and regulations have affected or will affect rates of injuries, deaths and suicides," along with other efforts to evaluate the effectiveness of regulations, interventions and strategies to prevent injuries and fatalities caused by firearms. Support for "strong and robust enforcement" of existing federal, state and local statutes pertaining to the manufacture, sale and possession of guns is also included in the policy.
More states have passed gun-control laws since the Sandy Hook Elementary School tragedy in Newtown, Conn., according to Frost. "We know that the states with the strongest gun laws have the lowest gun death rates, but research needs to be done to better understand this relationship (what laws/restrictions are most effective)," she said, adding that she knew this type of research was currently in the works but didn't have specifics.
Noting that the policy also calls for prioritizing efforts to enforce current laws on illegal gun trafficking at the federal, state and local levels, Frost observed that most shootings in this country are committed by people "who obtained their weapon through 'gun trafficking.'"
"It is currently very difficult for law enforcement to prosecute traffickers."
The policy concludes by saying that the Academy strongly supports legislation that restricts children's unsupervised access to firearms and ammunition and opposes private ownership of weapons designed primarily to fire multiple (more than 10) rounds quickly.
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