NTI: Medical Marijuana

**allnurses**

AllNurses staff recently attended NTI in Houston, Texas. Andrea J Efre, DNP, ARNP, ANP-BC presented on the topic of medical marijuana.

Medical marijuana is used to treat many conditions so it is reasonable to assume that many of us will come into contact with patients who use this. It is important to take this into consideration when caring for patients.

Currently, 29 states have medical marijuana laws. According to the Pew Research Center, in 2015, 53% of Americans favor legalization while 77% approve of its use for medical reasons. Each state has their own procedure for issuing "pot cards." It is important that if you work with a population that uses medicinal marijuana that you are familiar with the procedure or can provide info to the patient who asks questions.

The Center for Cannabis Research at the University of California, San Diego has an interesting site that provides a lot of evidence-based information regarding the efficacy of medical marijuana. They are in the process of several research studies regarding the use of medical marijuana in neuropathic low back pain, and HIV neuropathic pain.

There has also been research into what disease processes can be helped with medical marijuana and these are just some diagnoses that have been approved by some states for the use of medical marijuana:

AIDS/HIV
Arthritis
Epilepsy
Alzheimers
Nausea related to chemotherapy
Chronic pain
Glaucoma
Multiple sclerosis

As you can see, this covers a wide range of patients. And as with any substance, you ingest while there positives, nurses have to consider drug interactions too. According to Mayo Clinic:

Quote
"Marijuana may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin or heparin, antiplatelet drugs such as clopidogrel, and nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen."

An interesting drug interaction can occur between medical marijuana and birth control pills that contain estrogen. According to the Susan G. Komen Foundation:

Quote
"Marijuana may have effects that counteract estrogen. Taking marijuana along with birth control pills might decrease the effectiveness of birth control pills. If you take birth control pills along with marijuana, use an additional form of birth control such as a condom."

And then there are the ethical and legal concerns for nurses who might prescribe or administer medical marijuana. From Medscape:

Quote
"APRNs must continue to seek unbiased, scientific facts in order to provide the information, counseling, and referrals needed to guide patients toward a decision regarding their therapeutic options that is both fully informed and appropriate for them."

As with any drug, there can be side effects which may include:

Nausea, vomiting
Dizzyness
Syncope
Fatigue
Feelings of intoxication
Behavioral or mood changes
Anxiety
Cognitive impairment
Psychosis
Paranoia and hallucinations may be exhibited by new users

These side effects can increase also due to the original disease process which is being treated by the marijuana. For instance, in multiple sclerosis patients, who already have an increased risk of depression and anxiety, these feelings can be magnified. For patients with a cardiac history, marijuana possibly can cause tachycardia which may lead to an acute coronary syndrome (ACS). Studies that have looked at cardiac events for marijuana users are not definitive though as many also ingested tobacco products thus putting them at higher cardiac risk.

There is a difference between the recreational use of marijuana and medical use. It is important to be aware of the uses, drug interactions and side effects of ALL the medication that your patient takes.

References:

29 Legal Medical Marijuana States

Center For Medicinal Cannabis Research

Marijuana: Interactions with Drugs

Medical Marijuana: A Primer on Ethics, Evidence and Politics

Susan G Komen Foundation

Ten Diseases Where Medical Marijuana Could Have Impact

Why Americans Support Medical Marijuana

BookishBelle · Jun 1, 2017

During her cancer treatment, my sister was approved to use medical marijuana. It helped her quite a bit with chemo induced nausea, and with sleep issues. Once the prescribed steroids were done each cycle she would be exhausted from sleepless nights and still nauseated, so she would take oil drops as needed, and it would bring back some appetite and help relax her enough to stay asleep. Living in a small town she was worried about getting judged or thought of as drug seeking, which is a little ridiculous to me given that she didn't worry about that for any of the other meds she was on! Looking forward to seeing more scientific studies of its efficacy, so it can help more people.

smartassmommy · Jun 4, 2017

Thank you for this well written article. As more states legalize marijuana it is helpful to have this information.

NurseMari2018 · Jun 5, 2017

I've been meaning to do my research on how it helps people w/epilepsy. I have a student in my school that has epilepsy and within the school day he can have up to 6 or 7 episodes of seizures. They are not convulsive, but I feel so bad for this little guy. He's such a sweet child. I definitely got allot from this article, thanks for sharing.

Flatline, BSN, RN · Jun 5, 2017

It has never been well defined for me but what is the difference from Marinol? I have been giving Marinol for years with my Onc patients but never understood why the desperation for smoking or consuming raw marijuana or it's extracts.

MunoRN, RN · Jun 6, 2017

It has never been well defined for me but what is the difference from Marinol? I have been giving Marinol for years with my Onc patients but never understood why the desperation for smoking or consuming raw marijuana or it's extracts.

Marinol or dronabinol does not contain any of the components of marijuana that has been established to offer therapeutic benefit, which is why it hasn't replaced natural marijuana for medical purposes.

Marijuana contains a number of active substances, called cannabinoids. The two most common are THC and CBD. THC is the psychoactive component, while CBD counteracts the unpleasant effects of THC and is the component that has been shown to be effective against some cancers, exerts anti-psychotic effects, reduces anxiety, reduces pain, reduces nausea, increases appetite, etc. Think of it like adding some hot sauce (THC) to food (CBD), when added to food, hot sauce makes the food more interesting, but eating it all by itself is unpleasant.

For reasons that still aren't well understood, the makers of marinol decided to synthesize THC rather than CBD for medical use, even though THC isn't of much use medically. In large enough doses, THC does share some of the same benefits as CBD, but since it's unpleasant to take by itself marinol contains relatively small doses of THC, not enough to be of much medical use.

This is why there are strains and concentrates available that are primarily CBD with little to no THC.

**NRSKarenRN, BSN, RN** · Jun 15, 2017

PA approved medical marijuana sales last year, at contract stage now. With 75+ kidney stones, my son is hoping this might be of benefit instead of narcotics for renal colic + chronic neuropathic pain he has.

NTI: Medical Marijuana

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