Jump to content
February 2019 Caption Contest: Win $100! Read more... ×

Medical marijuana, role of the nurse, professional organization

Medications   (37,971 Views 58 Comments)
9,699 Visitors; 280 Posts
If you find this topic helpful leave a comment.
advertisement

You are reading page 5 of Medical marijuana, role of the nurse, professional organization. If you want to start from the beginning Go to First Page.

I don't have an opinion either way on MM. I don't think the average person cares much one way or the other if a person with Cancer , Glaucoma, Fibro or other pain syndromes smokes it. Last year I read an article about steeping the leaves in a tea and drinking it as a treatment for fibromyalgia. If I wasn't a nurse I just might try it. To me that seems much less harmful than opiates. Still as I am subject to testing at any time, and I have been before the board and in diversion for Alcoholism I just won't go there. Like other "Natural" substances W/O FDA approval there is no telling the purity and strength of what you are getting. I have had two patients in the Geri Setting on Marinol (Marajuana Pills) that did help with appetite and nausea but it never seemed to make them high in anyway.

Add to that is the fact that there is no such thing in the (US anyway) of a prescription for MM. Physicians write a recommendation (Not A prescription). In California there are Physicians making a fortune by selling these recommendations for anywhere from $50.00 to $200.00.

The recommendation cannot be written on a prescription pad and must include one of the 11 conditions approved for MM in California. It must be signed and dated by the physician and state something to the effect " Patients suffers from nausea and vomiting R/T Cancer treatments and may benefit from MM"

I don't see the roll of a nurse in a MM dispensary unless you as a nurse are planning to open one yourself. There is a school in Sonoma County in California that teaches people how to grow, prepare and join a collective to market their product, but I am not sure about the particulars.

I was watching an episode of "COPS" one night and the officer pulled over a trunk he suspected had illegal alien's in the back but what he found was a truck full off marijuana plants. This was one of the states where marijuana is legal. so he cited the driver for a broken taillight and sent him on his way.

Hppy

Share this post


Link to post
Share on other sites

I wrote that article many years ago and have learned quite a bit. Maybe we don't officially take an oath to do no harm but we do have an ethical obligation to our patients. It's unfortuante that a poor comparison stopped someone from educating themselves. I still don't understand why nurses are so hard on each other. We are all on the same team.

More and more patients are coming to cannabis as a medicine. I'm personally not comfortable with patients receiving medical information from non medical professionals.

There is absolutely a role for nurses in dispensaries. With the seniors becoming the largest demographic of cannabis users, nurses could play a huge role in monitoring drug interactions,

Reducing polypharmacy, education and data collection. I really see cannabis nursing as up and coming field.

Share this post


Link to post
Share on other sites

There are many delivery methods available today. Patients can use tincture, capsules, patches, oils, transdermal agents as well smoking and vaporizing. Nurses absolutely need to be educated on the topic so they can help their patients.

One you learn about he emdocannabinoid system, I feel any nurse would be excited to have another tool in their tool box to treat pain, anxiety, sleep, nausea, epilepsy, auto immune diseases, fibromyalgia, maigraines, ADHD and on and on the list goes

Share this post


Link to post
Share on other sites

I work in the field...not in a dispensary but in a certifying office. I do know that the dispensaries have hired nurse practitioners to advise patients.

Share this post


Link to post
Share on other sites

Hi! I applaud you asking these questions.

I have countless seniors who had severe diabetic neuropathy and finally have a solution. Many find the drops under the tongue very helpful. They help with sleep and consequently are able to better manage pain. Our Canadian Nurses Association is working hard to de-stigmatize Cannabis for the purpose of supporting patients with cancer, fibromyalgia, diabetes, autoimmune inflammation, etc who find relief from this complex plant with over 140 compounds and counting. I will add links to this post from their webinar.

I will also add a link from the Academy of Medicine and Science with a free comprehensive PDF book on all the data and studies done so far on Cannabis. There are RNs working in dispensaries whose focus is medicinal use. Other dispensaries are tailored for recreational use, much like liquor stores.

RN roles thus far, are not prescribing but looking at patients profiles. For example. patient A comes in with list of medications and conditions, any interacting medications or conditions such as psychiatric (bipolar etc) are automatically flagged and the patient must get a letter from their specialist or doctor before obtaining Cannabis. This is much less interaction with a patient than happens at safe injection sites here in Canada. The nurse does not recommend, counsel, or give any advice on cannabis.

Canadian NPs may be able to start prescribing it when legislation is passed.

I would also recommend looking at the TED talk from Portugal and what they have done to reduce addiction and use dramatically in their country. They have one of the highest success rates in the world when it comes to addiction.

What I find is that there is a lot of moral judgement and nurses are supposed to be critical thinkers that put one's one morals/beliefs aside and think as evidenced based practitioners. So far I have seen emotional responses to this topic rather than informed and critical thinking based. (Cannabis: the evidence)

If patients sense judgement they will not reveal anything to nurses and this does nothing to reduce harm. I used to be in the "judgment group" and I have completely with education and research turned my views 180 degrees. I will include a number of links that may be of help. Some reference Safe Injection site documents which may help understand harm reduction. Although, of note, obviously Cannabis is not an opiate but I think it is worth considering since it is still under schedule 1.

Canadian Nurses Association on Cannabis:

National Academy of Science and Medicine, see pdf link for free: Front Matter | The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research | The National Academies Press

National Academy of Science and Medicine home page: http://nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx

Health Care Professionals | MedicalCannabis.com

A collection of nurses who work with patients and cannabis. Green Health Consultants | Medical Cannabis Treatment Plans

Harm reduction: https://www.canadian-nurse.com/articles/issues/2009/april-2009/gaining-insite-harm-reduction-in-nursing-practice?page=2

Harm reduction: https://www.arnbc.ca/pdfs/policies-and-advocacy/issues-briefs/pop-health-wellness/ARNBC-IB-Supervised-Injection-Sites.pdf

Harm reduction: https://drugpolicy.ca/wp-content/uploads/2012/06/Lightfoot-etal_09_Gaining-Insite.pdf

Canadian Federal Laws: Access to Cannabis for Medical Purposes Regulations

Google Scholar: nurses/gps and cannabis: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-7-31

Books: https://books.google.ca/books?hl=en&lr=&id=rYwQk3e77vYC&oi=fnd&pg=PR7&dq=nurses++cannabis&ots=oPLoScyavP&sig=3m4nZzT8eRbTmuMxDZD7O0_m0gE#v=onepage&q=nurses%20%20cannabis&f=false

Nursing Attitudes and patients: http://journals.lww.com/ajnonline/Citation/2001/04000/Therapeutic_Cannabis__A_patient_advocacy_issue_.26.aspx

Okay, I hope this helps others. I have read some of the negative comments that were not constructive and showed moral and emotional based judgement rather than examining it with an eye for evidence based decisions. We are a profession that must look at things from a scientific, ethical, holistic based mind. We must look at what other countries have found successful. So far, North America has failed in their war on drugs.

Another author who has written extensively on addictions is Dr. Gabor Mate. He has many videos online as well has his books. He has worked for years in the Vancouver downtown core with those who struggle with substance use. At the core of the problem is trauma and psychiatric illnesses.

See Ted talks:

A counter argument to Johann Harris talk but...with a response from the author at the bottom who clarifies: https://www.thefix.com/content/4-things-hari-gets-wrong-about-addiction

Thank you for asking these questions. :) :wavey:

Share this post


Link to post
Share on other sites

Thank you! Nurses have to consider their role in stigmatization:

"Nursing is as much, if not more, responsible for perpetuating the stigmas and misperceptions that illogically limit the use of marijuana in treating patients and keeping marijuana relegated to the "CAM" category, even though there is a wealth of evidence that says it's earned it's way out of being considered a CAM treatment."

Share this post


Link to post
Share on other sites
advertisement

I am proud to say after being an RN and working in critical care for 46 years that I have retired.

I will now start my second career working as a wellness advisor in a cannabis dispensary

First job I have EVER looked forward to going to !

Share this post


Link to post
Share on other sites

Muser69, Did the dispensary actually have the position available for an RN? That's what I'm looking for but not finding.

Share this post


Link to post
Share on other sites

This entire dialogue is ripe for rational discussion, but reading the posts I see many posts that reflect uninformed or emotionally loaded responses.

I think a few major points need to be addressed so I'll give it a shot.

- I read several here conflating the use of cannabis by nurses or healthy people with Medical Use by patients with intractable or end stage symptomology.

- Cannabis use by patients is rarely even discussed in hospital settings. In the outpatient settings such as home care, outpatient palliative, and hospice, it is a different story. It is a necessary and relevant conversation to have here.

- In states with legal cannabis, many patients are using cannabis whether or not its officially on their medication list. It's better to be open and honest with clinicians and take that into account rather than "looking the other way".

- Hospice RNs in states where medical cannabis is widely used see ALOT of patients using cannabis for symptom mgmt. Cannabis is not physically addictive, does not create side effects like constipation, and relieves a variety of symptoms like pain

- Smoking is not the sole or even preferred method used by most patients in a palliative/hospice setting. Tinctures, topical oils/balms.

- There are at least 5 therapeutic cannabinoids OTHER THAN THC (the only significantly psychoactive one) such as THCA, CBDA, CBD, CBN, CBG, CBC as well as numerous terpenes and other constituents. Many people use the raw plant which consumed raw does not actually yield converted THC and thus does not have any noticeable psychoactive effect.

- the endocannabinoid system within the human body modulates pain reception indirectly, can improve intractable nausea & improve appetite, and to some extend delay the need for or reduce the overall use of opioids, meaning less constipation and sedation in many cases.

- Nurses who advocate for the use of medical cannabis should not be considered potheads any more than nurses who advocate assertive pain management with opioids aren't treated like drug addicts/users/junkies. I see this in some posts and just shake my head. Among the strongest advocates for cannabis are nurses who have cared for dying patients at end of life with intractable symptoms, or watched their own loved ones suffer at end of life and learned from the experience.

- Cannabis can be an alternative to the use of opioids which can address the opioid epidemic in this country.

- Cannabis is often helpful where no other drugs have been effective.

Edited by Argus333
more

Share this post


Link to post
Share on other sites

With regard to the OP's original question, I will attempt to answer. There is no official role for RNs in dispensaries (which are not pharmacies and are not doctor's offices). Like another post said above, it might be a neat job after retiring as a nurse but one wouldn't be working in the capacity of an RN. None of the dispensaries or rec outfits process so many patients per day that they would need an RN to filter the assessment work before seeing a doctor. It's more of a trickle even in the busiest areas like LA.

Prescribers like NPs and MDs are operating in a grey area by making the recommendations, so most of those giving recommendations to patients were taking some risks with their licensing bodies and the federal government/DEA. Therefore they were/are usually semi-retired and using their license to earn a little in a job over webcam, some living overseas in retirement etc.

In home care the staff acknowledge cannabis is being used and may even add it to the med list for the sake of veracity, because they are taking it. But the Home Care clinicians are not ordering it or procuring the supply. It's treated alot like when a patient is taking some Chinese Herb or tea and it's noted in case anything comes up later. It is taken into consideration holistically when reviewing or changing or adding meds like psychotropics, sleep aids, anxiolytics, and pain meds. Cannabis has no known interactions or contraindications, but it's taken into consideration like a supplement is.

Edited by Argus333
.

Share this post


Link to post
Share on other sites
×