Medical marijuana, role of the nurse, professional organization

[hotflashion]

It would be nice if we could have an intelligent and professional discussion about this topic without a whole lot of judgement going on. I tried to find an appropriate topic before stating a new one but many (most? all?) of them have been closed.

Right up front I'd like to say that federal law and state law clash on the use of marijuana in a medical contex, so there's no need for anyone to state that again. Also, the action of any state's Board of Nursing is unknown, and should be researched by those who have questions. (So, call them and ask! And let us know what you've been told.) If you know of documented cases of license suspension or revocation, provide links to verifiable information, but please, no scary stories without facts.

I started by Googling the question "What is the role of the nurse in a marijuana dispensary?" My state is one of the ones that recently approved medical marijuana use and will soon be accepting applications for dispensaries. It's an occupational setting I would consider, so I am interested in hearing from nurses who work in dispensaries or clinics.

[Anna Flaxis, BSN, RN]

I think that until the DEA removes marijuana from Schedule 1 designation and the FDA approves the smoking of marijuana as a medical treatment, then Nursing as an institution is hardly any more responsible for relegating marijuana to CAM status.

But to me, that's beside the point. I don't think of "CAM" as a dirty word. I don't think things have to be mainstream or FDA approved to have value in the health care milieu.

[xoemmylouox, ASN, RN]

Unfortunately I don't see a role for a nurse in a dispensary unless they are a NP. I cannot remember the name of it, but a few years ago I had a patient who received a marijuana supplement. He was hospice and was Rx'd it for BID dosing for anorexia. It worked great. When he took them his appetite was much better, his anxiety was decreased, and was a lot more social.

[jadelpn, LPN, EMT-B]

There are lots of medications for pain. Methadone comes to mind. It is generally thought of to be a alternate to heroin use. However, it is a legit medication for pain. I have seen it work wonders in terminal to end of life care.

There is Oxy, Vicodin--and legit for pain control, they can and are abused.

I truly believe that if one has chronic pain issues, one has to be able to function. If one is terminal and end of life and one would like to smoke pot til the cows come home, honestly, why would this be an issue?

I also know that there's THC in pill form. This has been used for some time in terminal care.

The role of a nurse is function, pain control, and advocacy. I am not into mj as a recreational drug of choice, much like any other medication that is abused. My issue with becoming involved in a dispensary would be a nurse would somehow have to police this too much. On the other hand, there are strict regulations. However, there are for other pain control drugs as well. I could see a nurse's place in a clinic. But a dispensary that gives "x" amount of mj to a patient with a prescription is crossing a pharmacy line that I am not sure I would want to cross.

Additionally, I am unclear on where the mj is coming from. How can one be sure of the purity, and if my teenage days are clear what "type" of mj one is talking about. They all can be different "strengths" and can be grown in entirely different ways. So unless I know what I am giving, to be able to educate accordingly on side effects (multiple phone calls about paranoia, "I think I am dying" would just about be the worst thing to deal with) then I am not sure I would want involvement on such a unregulated regulated system.

Drug seeking patients are everywhere, legit consumers are also everywhere--a dispensary would be no exception. However, to have a situation where there's no practioner, no pharmacist, no one but the nurse is taking too much responsibility--when in most states anyone can start a dispensary who has the money to, but the nurse would have the entire responsiblity from there.

[FineAgain]

Studies have shown that smoking remains the preferred method of administration, especially for the ability to titrate the dose. The oral medication lacks some of the cannabinoids that make the medication more effective. More studies need to be done on vaporization and oral methods of administration. Unfortunately every time someone wants to do an effective study, the federal government puts the skids to it.

As to the abuse, there is widespread abuse of many otherwise effective medications for pain control. I had an oncologist recently tell me that he was against the use of marijuana because it was a legal way to get high. I think it is a lot less harmful than the ones he prescribes. Just my humble opinion.

[BlueDevil,DNP, DNP, RN]

I have a lot of patients that use MM and even more that lack a qualifying diagnosis and therefore use the non-medicinal variety, lol. I don't have a problem with it, frankly. I do have one problem with medical mj in theory, and that is that it probably artificially raises prices. Never having bought any, I have no idea.

Disclaimer: since I don't believe mj should even be illegal, I think the entire argument about legalizing it for medicinal purposes is foolish. I have never used any product stronger than a 30 year old single malt, and would be highly unlikely to use mj in most any circumstance I can think of) There is no rational reason for it to be illegal, and schedule I is completely beyond the pale.

Speaking specifically on the topic of marijuana as a therapeutic modality, I don't prescribe it because I don't offer chronic pain management. My policy is to manage acute pain for up to 90 days. For any condition likely to require treatment beyond 90 days, or was not anticipated to last beyond that but in fact does, I refer to pain management specialty. I have and will continue to refer people to providers who do prescribe medical mj. Any of my patients seeking it more than likely have a specialty provider that can address the underlying issue. If not, I refer appropriately. I doubt that medical mj has any more place in primary care than does methadone. Are there people for whom methadone is appropriate? Of course. That doesn't mean they should be managed in primary care for said condition. I feel the same way about medical mj. The underlying condtion, whatever it may be, warrants referral out of primary care, and for that reason I don't see myself prescribing it, though I do support it's use.

Clear as mud?

[yarmada]

I want to weigh in on this topic. I live in Pennsylvania and our state has not yet adopted the law for use of medical marijuana however I have followed this topic for a very long time and I can only hope that PA will follow those states who have approved. Who are we or anyone for that fact to pass judgement on something that has been proven helpful to patients in various degrees of disease? The fact that this was originally classified under a schedule I drug in no way should overshadow the fact that we are now learning the benefit of this plant. YES it IS a plant! Something that grows in the soil. Something that has now been instrumental in helping to a greater degree people all over the world. Dr. Gupta came out and recently said, "Hey, I made a mistake...I am sorry. I have changed my opinion on the benefits of this plant." I intend to advocate and support this to the fullest.

[Guest372004]

Did we forget something here? This is not about dispensing meds. There is no way a RN is needed in a medical marijuana store.

Eventually, maybe not in my life time, but eventually this herb will be legal in the entire U.S. and then it will become legal for recreational use. Police do not want to deal with someone who has a small amount for personal use. Better to spend the time where it is needed.

[darlink]

In hospice, I've seen pts get much benifit from marijuana. Our mds do not prescribe it though we can prescribe Marinol. Our pts are usually pretty upfront with us as we dont judge and want whats best for them regarding comfort. California has clinics but Feds try to shut them down.

[msslim]

You all shoould watch the documentary by Dr. Sanjay Gupta called Weed. It came on CNN on 8-11-13 but you can probably find it online or catch a rerun. It was very interesting, showing how marijuana basically helped save a 5 year old little girl's life in Colorado and helped some other people with their health conditions. They explained the chemical breakdown of it and how it affects the brain, etc.

[Guest372004]

I live in Ca and they seem to move the clinics around. I am a RN in an upscale acute hospital. Maybe it is different here in Ca? Or maybe people are more upfront with their marijuana use? I have had patients who tell me it helps and I have co workers with cards for their pain issues, and then I know of at least 15 recreational users inc MD's who are employees. Again, maybe being in Ca puts a different spin on this.

[kalevra, BSN, RN]

We have to fight the stigma before meaningful change occurs.

Prohibition has not worked, at some point there will be a change in the way we see the use of marijuana. Times are changing, same-sex couples are having more and more rights equal to heterosexual couples, in the eyes of the law. Change will come, the younger generations are more willing to accept marijuana.

Its the older generations that are still in power that make the laws. They are the ones who grew up with the image of "refer-fever" ingrained in their heads. You cannot stop the progress of time.

In 10 years i expect marijuana in both medical/recreational setting to be the norm. At which point we will see a change in our profession as well.

[LadysSolo]

When I was working in oncology I had patients who smoked it to relieve nausea and vomiting from chemotherapy (marinol wouldn't work for the obvious reason of vomiting it back up - smoking it bypassed that problem.) I just told them I was glad they were honest with me, but I couldn't get them out of jail even though I agreed with what they were doing, so don't get caught......