“Medical Marijuana: A High Ethical Priority�

[Randy RN ASN]

Medical marijuana is rapidly spreading throughout the nation. With 23 states already onboard, it is only a matter of time before its prevalence will be as common as any other drug in our pharmacies. For some of us, this is a confusing situation since most of our lives, we have been told about the dangers of weed. Perhaps it will be easy to tolerate this change, but are we willing to put aside our internalized beliefs and actually advocate for it?

Our Ethical Obligation

In their latest position statement on medical marijuana, The American Nurses Association (ANA) states that we as nurses have an "ethical obligation to be advocates for access to healthcare for all, including patients in need of marijuana/cannabis for therapeutic use.” In that same position statement, the ANA reemphasizes that they actively support patients' rights to legally and safely utilize marijuana for symptom management, and health care practitioners' efforts to promote quality of life for patients needing such therapy (ANA, 2008).”

I stand next too the ANA on this position, and feel ethically obligated to advocate for this cause. My goal today, is to do just that, and present information that helps us become more educated on this controversial issue, ultimately for the benefit of our patients.

The Endocannabinoid System

Before giving a med in the hospital, it's important to understand what that med is and how it works on the body. That is why I believe it's best to start with introducing some fundamental concepts about marijuana, specifically in regards to the endocannabinoid system.

Marijuana has dozens of cannabinoids, with THC (the chemical that promotes euphoria) and CBD (the one with the medical benefits) being the most abundant. Within our bodies we have what is called the endocannabinoid system, which consists of receptors for these cannabinoids to bind too, as well as the endocannabinoids that our body makes naturally, e.g. anandamide. These receptors are found throughout the CNS, being most populated in areas of the brain such as the hypothalamus, hippocampus, cerebellum and spinal chord, which control appetite, memory, balance, and pain perception respectively (Volkow, 2013).

Side Effects: Short-term and Long-term

If there are so many receptors on the brain, what does that mean about the potential side effects? That's an important question to consider, because according to the British Journal of Psychiatry, they have found that Cannabis use may lead to an acute functional psychosis, similar to an acute schizophreniform state.” If used in large amounts, Cannabis use may lead to a chronic psychosis, which persists after abstinence (Johns, 2001).”

Furthermore, the National Cancer Institute (NCI) has found that other side effects may include: Increased heart rate, decreased blood pressure, muscle relaxation, red/dry eyes, slowed digestion, decreased peristalsis, feeling dizzy, altered memory, hallucinations, and paranoia. Also, symptoms of withdrawal are noted to be mild compared to opiates, but can include irritability, insomnia, restlessness, and hot flashes (Cannabis and Cannabinoids, 2014).

Marijuana, like any other drug, has its potential for side effects, and long-term psychosis is a very serious and certainly important side effect to keep in mind when weighing the benefits and risks.

Benefits and Various Uses

Some of these benefits, as mentioned by both the ANA and National Cancer Institute include, the ability to reduce inflammation, provide pain relief, slow and even kill certain cancer cells, stimulate appetite, decrease nausea and vomiting, decrease tremors in patients with MS, decrease intraocular pressure associated with glaucoma, as well as improve sleep and sense of well being (ANA, 2008 & Cannabis and Cannabinoids, 2014).

These are just a few of the possible treatments that we know of right now. I imagine that many other uses will arise once it is properly regulated and studied.

Weighing Side Effects with Benefits

Now, in comparing the risks and benefits: while certain mental health disorders may occur from excessive marijuana use, I believe these risks are minimal if monitored and dosed properly by a physician just like with any other medication. I also believe these risks are far outweighed by the known benefits of this drug alone.

Is Cannabis Safe?

Finally, when evaluating the safety of a drug, it's important to know not just the side effects, but also how many people have actually died from it.

According to the DEA no death from overdose of marijuana has [ever] been reported (DEA, n.d.).” That is startling since according to the CDC, in 2012 there were approximately 41,500 deaths from drug overdoses, with over 16,000 of those deaths being from opioid analgesics alone (Warner, Hedegaard & Chen, 2014)

If no one has ever died from marijuana, and it proves to have numerous medical benefits by researchers and medical professionals, then why is it in a schedule 1 category with heroin and LSD? That question in and of itself would take a whole other paper to answer. However, the important thing to focus on is the fact that this unreasonable regulation only restricts the ability for research to be done, and hinders our knowledge of its various uses.

So What?

So lets do something about this! Let's be part of the generation of nurses who are remembered as influential proponents of ethical issues in medicine. We can be apart of this movement by supporting various groups like the ANA, the ACNA (American Cannabis Nurses Association), and New Approach Idaho in their efforts to reclassify marijuana… into a less restrictive category (ANA, 2008).” In doing so, research could be done to confirm the benefits and risks of medical marijuana; which would allow us to provide safer and more effective care for our patients.

References

ANA (American Nurses Association), Board of Directors (2008, December 12). Position Statement: In Support of Patients' Safe Access to Therapeutic Marijuana. Retrieved May 16, 2015, from American Nurses Association

Cannabis and Cannabinoids. (2014, November 6). Retrieved May 5, 2015, from Bad Request

DEA. (n.d.). Marijuana: Drug Fact Sheet. Retrieved May 7, 2015, from http://www.dea.gov/druginfo/drug_data_sheets/Marijuana.pdf

Johns, A. (2001, February 1). Psychiatric effects of cannabis | The British Journal of Psychiatry. Retrieved May 5, 2015, from Psychiatric effects of cannabis | The British Journal of Psychiatry

Volkow, N. (2013). How does marijuana produce its effects? Retrieved May 5, 2015, from How does marijuana produce its effects? | National Institute on Drug Abuse (NIDA)

Warner Ph.D., M., Hedegaard, M.D., M.S.P.H, H., & Chen Ph.D., L. (2014, December). Trends in Drug-poisoning Deaths Involving Opioid Analgesics. Retrieved May 16, 2015.