Mass. Moves To Adjust Controversial Medical Marijuana Testing Standards

There are currently four medical marijuana dispensaries open in Massachusetts — in Salem, Brockton, Northampton and Ayer. But patients aren’t able to buy the full 10 ounces every 60 days that is allowed by state law because most of the marijuana grown by these facilities is not passing state testing standards, which dispensaries say are too strict and not realistic. Now the state is proposing a fix.

“With this new … approach, we’re able to specify the amount of exposure and the intended use, similar to what you’d see on a bottle of Tylenol.”

– Marc Nascarella, director of the environmental toxicology at DPH

Revised draft testing standards released Friday by the Department of Public Health (DPH) propose changing the amount of marijuana — and in turn possible contaminants — regulators expect heavy users to consume.

The current assumption is up to 1 ounce a day. That’s a lot of marijuana — in the range of 40 joints, depending on the size. If you smoke 40 joints a day you’re much more likely to inhale a dangerous amount of lead, mercury or arsenic than if you smoke 12 to 15 joints a day, which is what the state would assume (using a very rough ounce to joint translation) under the new proposed standards.

To be more precise, the state’s revised standards are based on the assumption that patients would inhale or ingest 0.35 ounces a day, or 10 grams.

“The department is shifting away from a worst case risk assessment style approach and more to a pharmaceutical industry based approach,” said Marc Nascarella, director of the environmental toxicology program at DPH.

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‘Sundowning’: Why Hospital Staffs Dread Nightfall, And How To Help Seniors Avoid It

By Dr. David Scales

The elderly woman had been normal all day, my colleague told me, tolerating it well when a tube was placed in her bladder to measure her urine. But that evening, she was found wandering the hospital halls yelling in Italian, carrying her urine bag under her arm thinking it was her purse, traumatized that hospital staff were trying to take it away.

Another night in the hospital, a female Sri Lankan colleague saw an elderly man who was convinced she was a Nazi soldier. Reassurances and even a plea from the doctor — “How could I be a Nazi? I have brown skin!” — could not persuade him otherwise. The next day the patient was back to normal, incredulous when told about what transpired the night before.

An 80-year-old man — I’ll call him Bill — came to our emergency room after a fall. He seemed fine and his tests were negative, but his family wanted him admitted over night for observation. That evening, he began shouting out, repeatedly wanting to get up and walk to the bathroom (forgetting he had just gone). Our calming efforts only riled him up more.

This erratic nighttime behavior is called “sundowning.” Staff in hospitals and nursing homes always worry what will happen as twilight approaches. As the sun sets, many elderly patients can change drastically: They can become extremely confused, agitated, not know where they are, and even hallucinate. In other words, they exhibit signs of delirium, a confused state that can lead them to do things they otherwise wouldn’t.

Ulrich Joho/Flickr

Ulrich Joho/Flickr

Thankfully, not every elderly patient sundowns, but when one does, it can be emotionally traumatizing for everyone. To be confused or hallucinate, or to see a relative acting out in irrational ways, is frightening and destabilizing. Yet, sundowning seems to be extremely common. So, what is it? Why do people sundown? And what can you do to minimize the risk of sundowning in yourself or a close friend or relative?

Experts agree that confusion and agitation are more common in the evening and at night. But there is surprisingly little scientific consensus on what sundowning actually is.

The debate is in how much sundowning and delirium are related. Some experts think they’re the same thing, others separate but related entities.

It’s hard to study sundowning without a clear definition and diagnostic criteria. Experts can’t even be sure how often it happens. A recent review found a rate of anywhere from 2.4 percent to 66 percent. Continue reading

Walsh Proposes 21 As Legal Age For Tobacco Sales In Boston

In this March 2013 file photo, cigarette packs are displayed at a convenience store in New York. Later in 2013, lawmakers in New York City voted to raise the cigarette-buying age from 18 to 21. Mayor Marty Walsh wants to do the same in Boston. (Mark Lennihan/AP, File)

In this March 2013 file photo, cigarette packs are displayed at a convenience store in New York. Later in 2013, lawmakers in New York City voted to raise the cigarette-buying age from 18 to 21. Mayor Marty Walsh wants to do the same in Boston. (Mark Lennihan/AP, File)

The age requirement for tobacco sales would rise from 18 to 21 in the city of Boston, under a proposal out Wednesday from Mayor Marty Walsh.

If the plan is approved by the city Board of Health, Boston would become the second major city in the United States, after New York City, to increase the legal age for tobacco sales. Continue reading


A Tale Of 2 Hospital Visits: How The Cost Of Care Can Vary Dramatically Depending On Where You’re Treated

After receiving almost the exact same care at two different hospitals, a patient we're calling Nancy was stunned when she received both bills on the same day. (AP file photo)

After receiving almost the exact same care at two different hospitals, a patient we’re calling Nancy was stunned when she received both bills on the same day. (AP file photo)

The stomach cramp and nausea began one hot Friday evening in August, midway through a vacation on Martha’s Vineyard. The next morning, nearly doubled over in pain, a patient who we’ll call “Nancy” walked gingerly into the emergency room at Martha’s Vineyard Hospital.

Nancy is a 55-year-old former nurse who would prefer not to use her real name because she works with the hospitals in this story.

Even Nancy, who spends hours every day focused on health care costs, would gasp when she saw the bill for this visit.

In the ER, a doctor poked at Nancy’s tender belly and took blood for tests and a urine sample. The doctor ordered a CT scan of Nancy’s abdomen and pelvis, using contrast. It showed bulges, inflammation and thickening in Nancy’s colon. The diagnosis: uncomplicated diverticulitis. Nancy filled a prescription for an antibiotic, took some Advil, and felt better after a few days on a clear liquid diet.

Five weeks later, the diverticulitis monster invaded Nancy’s intestines again. This time she went to an urgent care center closer to home, run by Beth Israel Deaconess Medical Center (BIDMC). A doctor there ordered the same single CT scan of the abdomen and pelvis, again with contrast.

Nancy says the care she received at both places was great. But a month later, when she received the bills and her insurance company’s explanation of benefits for both visits on the same day, she was stunned.

The explanation of benefits show Blue Cross had paid Martha’s Vineyard Hospital almost seven times what it paid BIDMC’s urgent care center for the same CT scan — $3,888.76 vs. $574.97. Continue reading

Clinicians Petition Boston Children’s Hospital To Preserve Prouty Garden

A 65-foot dawn redwood tree slated for removal if the plans to build on the site of Prouty Garden proceed. (Jesse Costa/WBUR)

A 65-foot dawn redwood tree slated for removal if the plans to build on the site of Prouty Garden proceed. (Jesse Costa/WBUR)

Seventy clinicians from Boston Children’s Hospital have sent hospital administrators a petition imploring them to “reverse course” on plans to demolish Prouty Garden, a healing garden that was gifted to the hospital 60 years ago.

The petition calls Prouty Garden a “precious asset,” an “enduring therapeutic resource” and a testament to the hospital’s commitment to compassionate care.

The doctors, nurses and nurse practitioners who signed the petition say they’ve been left out of the hospital’s decision to construct an 11-story clinical building on the site of the garden and build other smaller, green spaces throughout the property.

Dermatology program director Dr. Stephen Gellis helped organize the petition.

“You cannot replace [Prouty Garden] with indoor gardens or with the [outdoor] garden they’re planning,” Gellis told WBUR. “It’s just depressing. I think so many people have gotten joy from the garden and solace.”

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Mass. Medical Society Calls For Changes To Key Provisions In Baker’s Opioid Bill

The head of the Massachusetts Medical Society (MMS) is calling for lawmakers to change two key provisions in a bill that Gov. Charlie Baker says is needed to fight the state’s growing opioid addiction epidemic.

The Joint Committee on Mental Health and Substance Abuse held a hearing on the legislation Monday, during which MMS President Dr. Dennis Dimitri urged changes to two controversial proposals: limiting first-time opioid prescriptions to a three-day supply, and letting hospitals hold addiction patients against their will for up to three days while trying to place them in treatment.

Testifying before the committee, Baker defended the proposals, saying they are necessary to stem the problem.

“For some patients in the throes of this addiction, the choices may be between a jail cell, a coffin or treatment through this proposed process,” Baker said. “I choose the latter over the other two.”

According to a press release, MMS President Dimitri testified that the involuntary commitment proposal “cannot work without access to treatment resources and post-hospitalization care.”

Dimitri also said that involuntary commitment “could further exacerbate” the problem of emergency department overcrowding “without actually benefiting patients.”

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Who Is Overdosing In Boston And When

A call goes out to 911. Sirens scream through the streets.

Boston EMS responded to 135,040 calls last year. More than 2,000 of them (2,038 to be exact) were patients with narcotic related illness (NRI), based on the observations of an EMT.

The vast majority involved heroin. Pleas for help with an overdose were a small segment of EMS calls. But the upward trend is “just striking,” said Boston EMS Superintendent in Chief Brendan Kearney.

(Click to enlarge)

(Click to enlarge)

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You Hate Leaf Blowers, Your Neighbor Uses Them: How One Town Seeks Middle Ground

(GBaile/Wikimedia Commons)

(CBaile/Wikimedia Commons)

About five years ago, Jamie Banks noticed that the whine of gas-powered leaf blowers around her home in Lincoln, Massachusetts, had grown from an occasional burst of nearby noise to a frequent, high-decibel din that could last for hours, several days a week.

She would wake up to the engine roar, she says, step outside and observe landscape workers wielding four or five blowers, raising a 30-foot-high miasma of dust that commuters would skirt as they walked to the nearby train station in the town center.

“At my home it had become a 360-degrees surround-sound situation,” she said. “It was ubiquitous.” And it was all year round, Banks added, the machines used not just for leaves but to clear parking lots and driveways, gutters and planting beds. Even to blast snow off roofs.

A health care researcher with a Ph.D, Banks began looking into the health effects of the fine dust, exhaust pollution and noise caused by leaf blowers, and found causes for concern — including a clear recommendation against using gas-powered leaf blowers and lawn equipment from the American Lung Association.

In 2012, Banks teamed up with Robin Wilkerson, a Lincoln garden designer who worried not just about the noise and dust and carbon footprint of leaf blowers, but also about their impact on the land.

“People were scouring their land of valuable organic matter,” Willkerson said, and then often replacing it with dyed mulch from Louisiana. “It just seemed like lunacy.”

Something needed to be done, they both decided.

At this point in the story, which has played out in many towns and cities around the country, a big fight ensues. Residents who hate the blowers try to get the machines banned. Landscapers, landlords and homeowners who use the blowers fight back. The neighbor-vs.-neighbor battles often grow heated, as they have recently in the big Boston suburbs of Newton and Brookline.

And often, the attempts to regulate lose. Some California towns banned leaf blowers back when they were new in the 1990s, but blower use has been growing enormously, and relatively few towns have blocked them or successfully enforced limits.

In New England, where leaf-peeping season is now routinely followed by leaf-blowing season, no town has passed an outright ban, though a few have imposed restrictions.

First-World Problems

First-world problems, you might say. And you might be correct. Lincoln, a gorgeous New England hamlet of old stone walls along winding, wooded lanes, is one of the richest towns in the U.S., with median annual household incomes topping $100,000. The leaf blower issue naturally tends to arise in affluent suburbs where people can afford landscapers and increasingly seek a manicured look.

But it can surface just about anywhere there are trees and blowers, and it doesn’t seem trivial if it’s happening where you live or (try to) work.

No less a literary personage than James Fallows of The Atlantic, who has become very vocally active against leaf blowers, argues that the issue speaks to big concepts about collective versus private life. A trenchant New Yorker article on the mother of all leaf blower regulation fights in California found that it became “a referendum on what it means to be a neighbor.”

As Banks and Wilkerson learned more about the battles over bans around the country, they decided to pursue a more positive path in Lincoln.

They started in 2012 by forming a citizen group, Quiet Lincoln, to spread word about the issue. The next year, in 2013, they asked their fellow citizens at Lincoln’s Town Meeting to approve a study panel. And thus, the Lincoln Leaf Blower Study Committee was formed.

No landscaping companies joined, but the panel did include members from the Department of Public Works, which uses blowers, and the Rural Land Foundation — which owns a small collection of stores and offices in the town known as the “mall,” and employs landscapers to maintain it — along with residents.

The committee surveyed the town to get a sense of people’s feeling about leaf blowers, and found that 46 percent of respondents were bothered by the noise and 37 percent by the dust and air pollution.

“We recognized the importance of education if we were to get town support around this issue,” Banks said. “This is a problem that affects some individuals and not others, so it’s very hard to get broad-based support.” Continue reading

Massachusetts Doctor On The Power And Limitations Of Narcan

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

An educational pamphlet and samples of naloxone, a drug used to counter the effects of opiate overdose, are displayed at a fire station in Taunton. (Elise Amendola/AP)

A common treatment for anyone who overdoses is the drug naloxone, also known as Narcan.

Naloxone is touted as an invaluable tool in the battle against heroin and other opiate overdoses because it can temporarily reverse the effects and restore breathing. But some doctors warn that naloxone is not a cure-all and has some limitations.

Dr. Ed Boyer, chief of the Division of Medical Toxicology at UMass Memorial Medical Center in Worcester, joined Morning Edition to explain. Continue reading