Medical marijuana, role of the nurse, professional organization

[hotflashion]

It would be nice if we could have an intelligent and professional discussion about this topic without a whole lot of judgement going on. I tried to find an appropriate topic before stating a new one but many (most? all?) of them have been closed.

Right up front I'd like to say that federal law and state law clash on the use of marijuana in a medical contex, so there's no need for anyone to state that again. Also, the action of any state's Board of Nursing is unknown, and should be researched by those who have questions. (So, call them and ask! And let us know what you've been told.) If you know of documented cases of license suspension or revocation, provide links to verifiable information, but please, no scary stories without facts.

I started by Googling the question "What is the role of the nurse in a marijuana dispensary?" My state is one of the ones that recently approved medical marijuana use and will soon be accepting applications for dispensaries. It's an occupational setting I would consider, so I am interested in hearing from nurses who work in dispensaries or clinics.

[Eloise Theisen]

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.

[Eloise Theisen]

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

[Dale DNP, ADN, BSN, MSN, DNP]

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.

[tragicallyhip]

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:

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

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:

Thank you for asking these questions. ?

[tragicallyhip]

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."

[Muser69]

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 !

[JulsGirlBoss, RN]

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

[Argus333]

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.

[Argus333]

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.