Medical Marijuana, New Legislation in Oklahoma

[DaveICURN]

So we recently passed the Medical Marijuana Bill in our state(Oklahoma). This Bill is hailed as one of the most open, as it does not require any specific medical diagnosis for the Prescription card. So I would like to have an ongoing discussion to follow some trends.

1. What are facilities doing to be compliant with this new law? Are they amending their drug policy?

2. What changes do you see in general Pt care? Are the facilities changing admissions guidelines to request the Pt Medical Card on admission? Will your facility be providing medical substitutes for Pt with perscribed THC products?

I called and talk to our BON, they stated that all nurses will still be held to the Safe Nursing Guidelines set forth in Nurse Practice Act 567.8 b(4-5);

4. Is intemperate in the use of alcohol or drugs, which use the Board determines endangers or could endanger patients;

5. Exhibits through a pattern of practice or other behavior actual or potential inability to practice nursing with sufficient knowledge or reasonable skills and safety due to impairment caused by illness, use of alcohol, drugs, chemicals or any other substance, or as a result of any mental or physical condition, including deterioration through the aging process or loss of motor skills, mental illness, or disability that results in inability to practice with reasonable judgment, skill or safety; provided, however, the provisions of this paragraph shall not be utilized in a manner that conflicts with the provisions of the Americans with Disabilities Act.

Please be aware, I am opening this line of discussion for all parties. I was not a supporter of this bill, I felt the wording was to open and did not have enough regulation, but I accept it now as the law of the state. I will endeavor to give all my Pt the same care i always have, regardless of Pt medication regiment.

[blondy2061h, MSN, RN]

I'm curious if you thought the wording was too open on this, how do you feel about the increasing number of states with recreational marijuana?

As for imparied nurses, I think that needs to be determined by behavior. There are nurses that use chronic opioids or benzos or other mood altering drugs. They're not impaired at work. They use them as prescribed and they function normally. You probably don't even know they use. Used correctly, medical marijuana largely consists of tinctures of various concentrations of CBD/THC and is minimally to not-at-all mind altering. It's not the same as people getting high for recreational purposes. It's a medication that may or may not have side effects and if those side effects prevent people from working safely, they shouldn't be there until that can get sorted.

Tides are turning and many providers and patients alike are viewing marijuana as safer than more conventional pharmaceuticals for chronic pain, anxiety, and depression.

[DaveICURN]

The behavior comment hits the nail on the head. Since the language of the law disallows employers from disciplining based solely on a THC+ drug test, it will then be left to any adverse occurrence. Like workplace accident, repeated med variances, missed hours etc.

Furthermore, could I have some source of the claim the that the correct way to utilize medical marijuana is in a tincture? All the menus I have seen from viewing the various dispensaries online boast a wide variety of plant buds and edibles. Would not the choice default to the holder of the card to choose their own regimen? I'm just want clarification for something I have not heard before.

[blondy2061h, MSN, RN]

I guess that's more my personal experience. The state I'm in medical marijuana is only available in tincture, vape, or capsules. Things like buds and edibles are banned.

[Not_A_Hat_Person, RN]

Medical marijuana has been legal in my state for about a decade. It didn't prevent a heroin crisis.

[DaveICURN]

Medical marijuana has been legal in my state for about a decade. It didn't prevent a heroin crisis.

This is also something that I want to keep an eye on as well. If the pain management places pickup on the medical marijuana, do they see a lessening of the refills of their prescription opioids?

[Horseshoe, BSN, RN]

So we recently passed the Medical Marijuana Bill in our state(Oklahoma). This Bill is hailed as one of the most open, as it does not require any specific medical diagnosis for the Prescription card. So I would like to have an ongoing discussion to follow some trends.

1. What are facilities doing to be compliant with this new law? Are they amending their drug policy?

2. What changes do you see in general Pt care? Are the facilities changing admissions guidelines to request the Pt Medical Card on admission? Will your facility be providing medical substitutes for Pt with perscribed THC products?

I called and talk to our BON, they stated that all nurses will still be held to the Safe Nursing Guidelines set forth in Nurse Practice Act 567.8 b(4-5);

4. Is intemperate in the use of alcohol or drugs, which use the Board determines endangers or could endanger patients;

5. Exhibits through a pattern of practice or other behavior actual or potential inability to practice nursing with sufficient knowledge or reasonable skills and safety due to impairment caused by illness, use of alcohol, drugs, chemicals or any other substance, or as a result of any mental or physical condition, including deterioration through the aging process or loss of motor skills, mental illness, or disability that results in inability to practice with reasonable judgment, skill or safety; provided, however, the provisions of this paragraph shall not be utilized in a manner that conflicts with the provisions of the Americans with Disabilities Act.

Please be aware, I am opening this line of discussion for all parties. I was not a supporter of this bill, I felt the wording was to open and did not have enough regulation, but I accept it now as the law of the state. I will endeavor to give all my Pt the same care i always have, regardless of Pt medication regiment.

A nurse would also want to know the philosophy of the hiring facility. Some facilities reject nurses who lawfully smoke nicotine cigarettes, cigars, or pipes. Your facility may reject nurses who are using marijuana. Best to know these things sooner rather than later.

[Not_A_Hat_Person, RN]

This is also something that I want to keep an eye on as well. If the pain management places pickup on the medical marijuana, do they see a lessening of the refills of their prescription opioids?

More doctors are refusing to write opioid prescriptions, even for people who have taken them for years without incident.

[Not_A_Hat_Person, RN]

A recent Australian study published in Lancet Public Health found that marijuana use had no significant affect on pain in chronic pain patients prescribed opioids.

Previous systematic reviews suggested there is moderate evidence that cannabinoids are effective for certain types of pain. Previous evidence has been scarce because of studies with short duration and exclusion of participants with complex clinical profiles. In our 4-year prospective cohort of people prescribed opioids for chronic non-cancer pain, we did not find evidence supporting claims that cannabis and cannabinoids improved outcomes in chronic non-cancer pain, nor that they reduced prescription opioid use. To date, evidence that cannabinoids are effective for chronic non-cancer pain and aid in reducing opioid use is lacking. Large, well designed clinical trials are required to evaluate in which patients cannabinoids might be effective in reducing pain severity, interference, and opioid doses.