Nurses smoking weed?

allnurses Guide · Apr 28, 2016

This is a recent study.
By Emily Underwood Jan. 18, 2016 , 3:00 PM
Roughly half of Americans use marijuana at some point in their lives, and many start as teenagers. Although some studies suggest the drug could harm the maturing adolescent brain, the true risk is controversial. Now, in the first study of its kind, scientists have analyzed long-term marijuana use in teens, comparing IQ changes in twin siblings who either used or abstained from marijuana for 10 years. After taking environmental factors into account, the scientists found no measurable link between marijuana use and lower IQ.
Twins study finds no evidence that marijuana lowers IQ in teens | Science | AAAS

There is a big difference between long-term use and IQ and short-term use and impairment at work, and further, the study found "marijuana users had lower test scores relative to nonusers and showed a significant decline in crystallized intelligence between preadolescence and late adolescence". Twin studies are great but the data on twin users/abstinent is a very small sample size and does nothing but prove there isn't a genetic predisposition to marijuana-related IQ decline.

Either way, it is of limited application to short-term impairment, which is what employers are concerned with, besides the law.

allnurses Guide · Apr 28, 2016

That may have come out differently than you intended, since what accumulates in your body are non-psycho active metabolites, not active components of the drug. Both alcohol and marijuana have acute impairment and longer term impairment phases, both are dose dependent and the evidence for each is similar. The way our laws work is that federal laws only apply to what state's have not addressed, which is why in states where the two conflict it's residents are held to the state law.

I am not exactly sure what you mean by this. The psychoactive component of marijuana is delta-9-tetrahydrocannabinol which itself is lipophilic and thus stored in the body readily and is extremely potent, measured in nanograms. If it is extracted or leeched from fat cells, both it and its psychoactive metabolite 11-OH-THC, result in long-term potential impairment. Alcohol is almost immediately psychoactive but quickly clears the body. It's metabolite, acetaldehyde, is also found in marijuana smoke...

Blood testing for active THC levels was not all that common a decade ago, in Colorado it's now widely available and is as common as blood testing for alcohol blood levels, which is why there has been a predictable increase in the number of people who test positive. There's no doubt it's unsafe to drive under the influence of either marijuana or alcohol, but there's no evidence there has been sudden increase in the number of marijuana-caused accidents.

There is also no doubt that nurses (or any HCP) should care for patients under the influence of alcohol, so the same should be true for marijuana, and acute impairment has been demonstrated at significantly longer intervals than alcohol.

I don't think chronic alcohol abuse is any more benign than marijuana use, but it is legal, for better or worse.

MunoRN, RN · Apr 29, 2016

I am not exactly sure what you mean by this. The psychoactive component of marijuana is delta-9-tetrahydrocannabinol which itself is lipophilic and thus stored in the body readily and is extremely potent, measured in nanograms. If it is extracted or leeched from fat cells, both it and its psychoactive metabolite 11-OH-THC, result in long-term potential impairment. Alcohol is almost immediately psychoactive but quickly clears the body. It's metabolite, acetaldehyde, is also found in marijuana smoke...

11-OH-THC is an intermediate metabolite and is typically further metabolized prior to lipid absorption. I wonder if you're confusing 11-OH-THC for THC-COOH which is the metabolite commonly found long term in fat stores and is what urine drug screens look for, THC-COOH has no psychoactive or other impairing properties. 11-OH-THC is absorbed in fat tissue as well, but the levels it's absorbed at and then reintroduced into circulation are far less than the plasma concentrations we know cause measurable impairment.

There's certainly some alteration of cognition and functioning beyond just the acute phase or "high", although it's not clear it's significantly different than other causes of less-than-perfect functioning. Alcohol's metabolite that is impairing and has been shown to remain in circulation for as long as two weeks, yet it would be a bit silly to say that nurses shouldn't be allowed to have a beer on their day off. I have three kids, which is a pretty clear risk for impairment since it causes me to work more fatigued and distracted than if I had no kids, should nurses be forbidden from having kids?

There is also no doubt that nurses (or any HCP) should care for patients under the influence of alcohol, so the same should be true for marijuana, and acute impairment has been demonstrated at significantly longer intervals than alcohol.
I don't think chronic alcohol abuse is any more benign than marijuana use, but it is legal, for better or worse.

Acute impairment (being "high" or "drunk") are actually about the same for both marijuana and alcohol, typically 2-3 hours for smoked marijuana and typically 4-6 hours for digested marijuana.

Unless the federal government decides to establish justification for federal jurisdiction of marijuana laws, which they don't appear interested in, the legality of marijuana falls to the states, and a number of states has made it legal.

canigraduate · Apr 29, 2016

That's at least a little misleading. Marijuana "overdose" currently only exists in theory. A lethal overdose has never been known to occur. The general consensus on the amount required to cause acute harm is roughly equivalent to smoking/ingesting an amount equivalent to what a hay barn could hold in a single sitting. Even if you cherry pick and use a loose definition of harm, the low-end amount that could cause harm is thought to be around 90mg/kg worth of peak serum levels, which would require smoking about 250,000 joints in one sitting, or about 2,000 joints per minute.
There's no arguing that marijuana is impairing and carries risks, just like alcohol and many prescribed drugs do, and nobody should drive while impaired by any of them, but to imply that the relative safety of marijuana compared to other drugs/substances used for recreational and therapeutic purposes is similar is pretty ridiculous. Drug safety is usually described in terms of therapeutic index and LD50. There no established LD50 for marijuana since the amount required to kill someone is physically impossible to ingest, and even the therapeutic index is largely theoretical. The amount of alcohol typically used for recreational purposes, or opiates or benzos used for therapeutic purposes is fairly close to the amount that causes harm, and that ratio clearly is far different than that of marijuana.

The whole point that I was trying to make is that comparing MJ to anything else is stupid.

People who promote MJ are always comparing it to alcohol, which I think is dumb, because it is completely different. Might as well compare it to water or cocaine. Apples vs. oranges, y'know?

Also, MJ users and promoters don't believe there are any toxicity issues. That's just not true.

allnurses Guide · Apr 29, 2016

11-OH-THC is an intermediate metabolite and is typically further metabolized prior to lipid absorption. I wonder if you're confusing 11-OH-THC for THC-COOH which is the metabolite commonly found long term in fat stores and is what urine drug screens look for, THC-COOH has no psychoactive or other impairing properties.

THC itself is very lipofilic, it has a Vd of 3.5/kg and is also highly protein bound. THC has a half-life of more than 30 hours. 11-hydroxy-THC also is lipofilic and has a similar half-life. Drugs screen look for THC-carboxylase because it is even further downstream and persists the greatest amount of time and while not psychoactive it is diagnostic for use, just like methadone metabolites. Drug screening is not done for psychoactive reasons, it's done to diagnose substance use/abuse.

James W. · Apr 29, 2016

I am not exactly sure what you mean by this...
There is also no doubt that nurses (or any HCP) should care for patients under the influence of alcohol, so the same should be true for marijuana, and acute impairment has been demonstrated at significantly longer intervals than alcohol.
I don't think chronic alcohol abuse is any more benign than marijuana use, but it is legal, for better or worse.

Ah, yeah.. " I am not exactly sure what you mean by this..."

Did you mean that there is "no doubt" that nurses should provide care for

people presenting as patients who are "...under the influence..."

- or that the nurse "should care for patients...",

even if the nurse is "...under the influence..."?

I think that it is right that nurses are held to be functionally unimpaired

by drugs while on duty..

As for the "its legal" so its ok, or "its illegal" therefore it is not..

Well, as nurses I feel we are responsible for our proper ethical approach,

regardless of such arbitrary values..

I note that the nurse-researcher who was studying the nurses who were

"legally" following the directions of Nazi SS Dr J. Mengele drew flak -

for even daring to approach the subject..

Are there any nurses here - who are currently working for state security agencies

doing 'legally sanctioned' but perhaps - ethically dubious - duties facilitating

potentially risky 'interrogation techniques' & would care to comment?

Maevish, ASN, RN · Apr 29, 2016

I've never tried anything edible with it in it. How about the cookies?

From what I remember, the good edibles usually taste close to the real thing (brownie, cookie, cake, etc) and there are even cookbooks out there with recipes on how to use the oils/butters to cook with to make casseroles, salad dressings, etc. Very helpful for people who are usually too nauseated to keep good nutrition down.

xo

On a side note, I don't think it should be a bad thing (but again, not willing to risk it because it would be just my luck I'd have a random test, even though I've never had one in my life lol). If you are off on the weekend and don't work until Tuesday or Wednesday, you should be able to partake on a Friday, Saturday, or early Sunday and be fine. If you're not going to go to work drunk, why would go go high? Makes no sense to me why one is legal and one isn't (and I'm in NO way anti-ETOH! :cheeky: ).

Maevish, ASN, RN · Apr 29, 2016

I think the problem they have (myself included) is it's no worse than alcohol. It has more positive aspects than alcohol will ever have, yet alcohol is legal while the other isn't. It doesn't make sense. I'd rather never have a drink again (and I love my glass or two of vino after the day is done) if I could just have the minute amount of cannabis I'd need when a migraine comes on!

xo

Maevish, ASN, RN · Apr 29, 2016

that's just a silly statement. Caffeine is the most used legal drug in the world, and one that most healthcare providers use. Well-adjusted is definitely up to interpretation, and if Coffee is a crutch then I am using a walker.
See previous posts about the positive health benefits of the Cannibidiols in THC, to include (but not limited to) reducing seizure activity, pain relief, stimulation of appetite for those on Chemo (for instance).... could go on and on. The science is there. Whether or not one should use it at work goes the way of using alcohol at work - or Oxycodone, or anything else that is worse than Marijuana. Common sense, people.

If you're coming to work high and not using the form of it they use in children for seizures, etc, then you have no business being at work. I think most people are talking about the use of it outside of work:yawn:

James W. · Apr 29, 2016

...when a migraine comes on! xo

Do you get the pre-migraine aura 1st?

I keep a trio of regular aspirin tabs in my wallet, for that annoying event..

& it stops the eye-dance/light-show routine in ~1/2 hour..

Ironically, a stiff shot of hard ETOH also does the trick,

..but I can't/won't do that at work, either..

.. for 'medicinal' purposes - or other-wise..

Maybe a decent sniff of ether would work, that's quicker acting,

& also faster - in leaving the system..

Slhengy · Apr 29, 2016

There is a big difference between long-term use and IQ and short-term use and impairment at work, and further, the study found "marijuana users had lower test scores relative to nonusers and showed a significant decline in crystallized intelligence between preadolescence and late adolescence". Twin studies are great but the data on twin users/abstinent is a very small sample size and does nothing but prove there isn't a genetic predisposition to marijuana-related IQ decline.
Either way, it is of limited application to short-term impairment, which is what employers are concerned with, besides the law.

There are plenty of other studies that support the hypothesis. You can't disregard them just because you disagree with the data.

allnurses Guide · Apr 29, 2016

There are plenty of other studies that support the hypothesis. You can't disregard them just because you disagree with the data.

I have no personal investment in this issue and I am not disregarding anything, as I stated, it is not really related to the discussion on hand (cognitive-behavioral impairment and intelligence). You also can't disregard parts of the study that don't fit your preconceived decision, that is the danger of pseudoscience. Please share these other studies so we can all read them and discuss.

There is a wealth of extant data demonstrating the cognitive impairments associated with alcohol use and marijuana use, both acutely and chronically. Even more-so is when the agents are used in tandem which they often are. I have no real opinion on whether one is better than the other, but it really doesn't matter, as one is legal and one is not.