Medical marijuana

djmatte, ADN, MSN, RN, NP · Mar 10, 2019

19 hours ago, momofm1998 said:
Do you or any midlevel you know prescribe medical marijuana from an online base? Do you know any reason why may be detrimental to ones career?

Given that it is not approved by the FDA for anything, you can't and shouldn't legally prescribe it. I treat it like any other supplement. I warn people of the unknown dangers of a product that has only anecdotal evidence with no real research and I implore them to not smoke anything if they are choosing to partake.

Dodongo, APRN, NP · Mar 10, 2019

I attended a lecture about this last year. In Pennsylvania there is a list of diagnosis that one must have in order to qualify for MM (17, IIRC). That patient must see a provider qualified to recommend MM. Since it is illegal from a federal standpoint to prescribe marijuana, you aren't actually prescribing it, just recommending it. The patient will then take that recommendation and the state will prescribe it.

adventure_rn, MSN, NP · Mar 11, 2019

Both excellent points. Given that it's illegal at the federal level, there isn't any state where it's truly legal. I'd also be concerned about issues related to state-by-state jurisdiction; if you're providing a service online, I'd imagine it might be complicated to act in accordance with the laws regulating the states that you serve.

I know that many BONs have explicit clauses prohibiting nurses from using marijuana, but I'd be curious to know if any have statements about nurses recommending/prescribing it.

In light of the opioid epidemic, there's been a huge crackdown on pill mills giving out narcotics for fake or embellished pain diagnoses; providers in some of these cases have lost their licenses. What happened with narcotics could just as easily happen in the MM industry. Given the questionable legality of marijuana (and potential for recreational users to seek fake medical prescriptions/diagnoses/recommendations online), I'd be proceed with caution. With our current political climate, I wouldn't be surprised if the DEA started shutting down online systems like the one you've described. However, that's just my speculation.

djmatte, ADN, MSN, RN, NP · Mar 11, 2019

Imo, if your practice is based off evidence and sound research (which it should be), even recommending it is something we are not qualified to do.

Trauma Columnist · Mar 11, 2019

In IL, there are only a few MDs that can prescribe it. Then the pt pays for a card ($500) and goes to the dispensary where non-medical lay people
"dispense" it. Like other states there are certain qualifying diagnoses that can be used. I do provide the written literature on how to obtain a card but that is all. I don't recommend or dissuade my pts - thats their choice. However, I am not involved in it except to serve as educator.

Advanced Practice Columnist / Guide · Mar 13, 2019

I'm in California where medicinal use cannabis has been legal for many years so there are many established practices both online and in person that advertise as a "consultation" service specific for medicinal cannabis use. Now that the state also legalized recreational marijuana use, I am hearing that there is a decrease in demand for these "consultations". The public is still advised that the amount of marijuana you could purchase for recreational use is less than what you would be able to acquire or even grow if one were to carry a medical marijuana card.

I would be weary of joining an online evaluation service in California. The websites do not appear professional and there are no listings of the credentials of the providers. Besides, there are many long-standing providers in the state with their own primary care practice who have lots of years of experience with patients who use cannabis for medicinal purpose and many actually work with NP's. I would be more inclined to join such a practice if this is your interest.

However, I'm a hospital based NP who rarely if at all discharge patients to the community and don't address primary care in my practice so I have no interest in this aspect of care at all.

Oldmahubbard · Mar 13, 2019

I am in NY in LTC. When people tell me they plan to use it on discharge, that genetic hearing impairment from which I suffer occasionally seems to kick up.

offlabel · Mar 16, 2019

On 3/13/2019 at 3:51 PM, Oldmahubbard said:
I am in NY in LTC. When people tell me they plan to use it on discharge, that genetic hearing impairment from which I suffer occasionally seems to kick up.

Odds are they already use it and it ought to be part of their medical record.

xenogenetic · Apr 7, 2019

I certify patients for medical marijuana in CT. I certify that it "might" help the patient and recommend non-combustible forms and start at no/ low THC high CBD products. I advise that it medical marijuana is always only a viable option as a 3rd line treatment after psychotherapy and conventional psychotropic medications. There is a harm reduction component aspect as well, similar to that of suboxone and opioids, where patients are going to use it anyway so might as well be clean product.