NJ nurses - CBD oil

[linda1959]

I am coming at this both from the perspective of a parent AND a school nurse.

I use CBD oil for my son with autism. He will be going on an overnight trip with his school. The school nurse will not give the CBD because it is not FDA regulated. I offered to get an order from his MD - answer is no. I offered to mix it in a bottle of juice and send: they just need to make sure he drinks the juice - answer is no.

I understand it. If it were one of my students, I would work something out with the parent. That said, I completely respect and understand nurses who are by the book. But it got me thinking. Twelve years ago, my son needed a dietary supplement for weight gain. It was recommended by a nutritionist, purchased from a medical supply store, and came in a unit does container. The nurse refused to mix it into his milk or allow the staff to do it, and refused to give him the milk if I mixed it in first.

So here we are 12 years later, and none of the standards for nurses to help and accommodate families who are taking a non-prescription approach have improved. My question is: how do we change this? Who do I start with to discuss the need to allow nurses to accommodate families in a safe way when they want to use a product that is not FDA regulated?

And what is the general thought among nurses; if there is a policy in place and the paperwork is correct, would you be willing to administer CBD to a student who's family has found it helpful for whatever the reason?

[LikeTheDeadSea, MSN, RN]

Our medication policy of no non-FDA products stems from the state level, not district level, so until that changes at the state level, I won't. Districts in my state that allow for anything different than the state-level policy will have a tough time if they went to Due Process for anything related to it.

I've talked with many nurses in my area though, and in the next year or so we hope to draft something to submit to the state requesting alteration of the self-carry/administration policy for schools. Currently it is only inhalers/epi/diabetic, but students who have chronic issues that require things like enzymes with meals often want to be self administering by high school, as this is their chronic life-long condition, and what better way to promote independence and self management!? Perhaps nutritional supplements pre-mixed at home could encompassed in this self-carry? Current policy promotes hiding things from staff/nurse to get around the issues.

[k1p1ssk, BSN, RN]

I can understand both sides; From a nursing perspective, since it is not FDA regulated, where is her protection if next spring, it comes out that CBD causes XYZ problem? There's no dosing guidelines beyond what you and your son's doc say, and so I completely understand the fear and uncertainty on the nurse's part.

On the other hand, it is one time to accommodate his normal nighttime routine...

The dietary supplement would also be tricky. I have encountered students on things like Ensure or tube feeds, but it was almost always prescribed by an MD as medically necessary, and never something that needed to be mixed into another liquid.

I think what the fundamental issue at hand may be is whether or not these things HAVE to be done during the school day and are they medically necessary.

Take the school out of the equation, but replace it with an overnight hospital stay. Do you think the docs would have the nursing staff administering CBD oil as part of their orders? From my experience, especially with pediatric patients, absolutely not. They *might* consider the dietary supplement with the proper documentation (i.e. it was a nutritionist in their system who made the recommendation) but this would also be a long shot.

Unfortunately, you're looking at a legal battle that may not be worth fighting. It would mean changing the definition of supplementation vs. medication among other longstanding medical systems, not just in educational settings, but beyond...

[NutmeggeRN, BSN]

She is bound by state law.

[Flare, ASN, BSN]

It's as simple as being bound by state law for FDA approved treatments. The FDA gives a set of standards. Currently, there is only one CBD product approved by the FDA to treat one specific condition. If I was handed an order for that specific medication to treat the condition it treats then there would be no question. But then again, I do believe there probably is a difference between Epidiolex and the CBD that I could buy from the customer service desk at ShopRite at this stage of the game. Maybe in 5 years things will be different and CBD will be as ubiquitous as ibuprofen and buying an expensive trade name would not make sense when the same regulated product is available for a fraction of the cost by buying generic, but I just would not stake my license on that right now.

[Flare, ASN, BSN]

1 hour ago, LikeTheDeadSea said:

Current policy promotes hiding things from staff/nurse to get around the issues.

We've had our share of students with water to drink "with lunch only". it doesn't take a genius to figure out that the parents probably mixed in supplements, medication, etc. If they don't tell us, but we suspect it, can we be held liable?

[LikeTheDeadSea, MSN, RN]

23 minutes ago, Flare said:

We've had our share of students with water to drink "with lunch only". it doesn't take a genius to figure out that the parents probably mixed in supplements, medication, etc. If they don't tell us, but we suspect it, can we be held liable?

Probably a little more cut/dry liable if it's something like a kid with CF who suddenly isn't taking enzymes at lunch anymore via nurse. Probably a "document document document" scenario of requests for orders and communication with parents.

Your scenario is interesting though. Perhaps worth having it tossed up to district lawyers for input?

[BrisketRN, BSN, RN]

This is definitely a state law issue. When I worked private duty/home health 4 or 5 years ago we had a pediatric patient using I believe CBD oil or some derivative of marijuana for seizures--prescribed by a doctor, orders and all. Our agency told us to NOT administer the medication. Only parents could administer due to state laws. We could document the administration and any side effects or responses, but we had to clearly state it was administered by the parent and name which parent administered.

[NutmeggeRN, BSN]

On 10/3/2019 at 1:07 PM, linda1959 said:

And what is the general thought among nurses; if there is a policy in place and the paperwork is correct, would you be willing to administer CBD to a student who's family has found it helpful for whatever the reason?

Would you? Taking yourself out of the equation as a parent here for the moment...

Homeopathic remedy for something that is NOT regulated or approved by FDA? Would you put your nursing license on the line? What are the legal consequences if there is an untoward outcome? Unanticipated reaction?

I would not.

[rzyzzy]

On 10/4/2019 at 11:50 AM, NutmeggeRN said:

Would you? Taking yourself out of the equation as a parent here for the moment...

Homeopathic remedy for something that is NOT regulated or approved by FDA? Would you put your nursing license on the line? What are the legal consequences if there is an untoward outcome? Unanticipated reaction?

I would not.

Indeed - I can see the attorneys frothing at the mouth to bury the nurse who “accommodates” a parent by administering anything that is only allowed to be sold by virtue of the fact that it doesn’t “diagnose, treat or cure” anything. The language used to sidestep FDA regulation is the same language that hangs the nurse.

Supplements aren’t “allowed” by the FDA - the FDA isn’t allowed to regulate them - if they do have any medical effects at all, they’re legally “mislabeled” medications in the eyes of the FDA.

There’s a legal fiction attached to every supplement on the market- the manufacturer is effectively “certifying” to the government that they’re selling an inert product, and they’re using weasel-words and hyperbole to market that product as being something useful.

[DeeAngel]

If it’s not unit dose or in an original, labeled pharmacy container I’m not giving it. It’s my life, my license and I will not put those at risk to accommodate anyone for any reason.

[litbitblack, ASN, RN]

I work in long term care and have not had that come up yet although i may ask our medical director about for future reference. We do administer drinks of alcohol with a doctors order or administer supplements with a doctors order. If the cbd is legal in your state and you can get a doctors order then why not administer it....Unless of course it is against policy.