December 4, 1998

The APA Assembly approved a new practice guideline on delirium at its meeting last month in Washington, D.C., and approved a statement affirming physicians' right to free speech related to the recent debate over medical marijuana.

The 66-page "Practice Guideline for the Treatment of Patients With Delirium" was assembled by a work group chaired by Paula Trzepacz, M.D. It now awaits action by the Board of Trustees at its December meeting.

If approved, it will be APA's 10th set of practice guidelines. (The others are on eating disorders, major depression, bipolar disorder, substance use disorders, psychiatric evaluation of adults, Alzheimer's disease, panic disorder, schizophrenia, and nicotine dependence.) Three additional guidelines are under development, dealing with geriatrics, psychiatric aspects of HIV/AIDS, and borderline personality disorder.

The Assembly approved an action paper asking that the final phase of guideline development be modified so that members of the Assembly and the Commission on Psychotherapy have access to early drafts of guidelines. The proposal also now goes to the Board of Trustees.

The proposal further asks that the guidelines process be altered so that an ad hoc group from the Assembly would have an opportunity to decide on final wording and incorporate comments from the Assembly prior to a vote by the full Assembly. Although there is currently provision for input from an ad hoc group from the Assembly, that group is appointed only after the Assembly approves a guideline.

The Assembly approved a freestanding statement related to the medical use of marijuana. The statement was originally intended as a modification of the APA "Policy Guideline on Medical Use of Marijuana."

The new statement reads, "Effective patient care requires the free and unfettered exchange of information on treatment alternatives; discussion of these alternatives between physicians and patients should not subject either party to criminal or professional sanctions."

The measure was a response to threats from the federal Office of National Drug Control Policy to sanction physicians who provided a written recommendation for marijuana to patients under the terms of California's Proposition 215. Marijuana cannot, technically, be "prescribed" because it remains unavailable through pharmacies. Proposition 215, approved in November 1996, was designed to protect physicians who wrote recommendations or discussed its risks and benefits with their patients. State law allows patients to possess marijuana legally if they have a written recommendation from their physician. This November, voters in Alaska, Oregon, Nevada, Washington State, and the District of Columbia approved similar measures, although Congress used a technicality to prevent the results of the District's ballot from being released. Arizona voters reaffirmed a 1996 vote approving medical use of marijuana and specifically rejected a legislative requirement that would have barred physicians from recommending marijuana until the drug is approved by the Food and Drug Administration.