Providing Patients with their legal medication

elkpark · Aug 7, 2014

I would guess it would be up to the prescribing physician/NP/PA to prescribe stuff. I've always worked in acute care hospitals, not LTC, but in acute care hospitals people may be on all kinds of medications at home -- but if the MD/NP/PA doesn't order it in the hospital, they ain't getting it.

HouTx, BSN, MSN, EdD · Aug 8, 2014

I'm curious about the legalities involved. As I understand it, the mj card applies only to that individual, indemnifying them against any charges related to possession of mj for their personal use. However, how does this apply when a 3rd person is interjected into the mix? Would the nurse be considered a supplier & therefore subject to legal penalties? I'm just wondering if this is covered in the laws that govern medical mj.

Can anyone shed some light on this?

toomuchbaloney · Aug 8, 2014

I'm curious about the legalities involved. As I understand it, the mj card applies only to that individual, indemnifying them against any charges related to possession of mj for their personal use. However, how does this apply when a 3rd person is interjected into the mix? Would the nurse be considered a supplier & therefore subject to legal penalties? I'm just wondering if this is covered in the laws that govern medical mj.
Can anyone shed some light on this?

I know that I have a friend who lived in Michigan and was treated for a very serious cancer at the University of Michigan. He had a medical mj rx and used the oral lozenges for nausea, anxiety (secondary to steroids), and loss of appetite. His oncologists included the med on the POC, they were aware that he pre-medicated prior to his chemo and that he sometimes popped a lozenge during the infusions. They did not prescribe nor did they dispense. The lozenges were not covered by his insurance.

kbrn2002, ADN, RN · Aug 8, 2014

Boy, interesting question! Does your state BON have any position on the legality of administering medical marijuana? Even if the BON is ok with it, I have no idea how the owner or Medical Director of a LTC facility would feel about it.

Medical marijuana use is in it's infancy and I really wonder if these issues have been addressed in the states that have legalized it.

applesxoranges, BSN, RN · Aug 8, 2014

Wouldn't it kind of fall under the same rules as patients drinking and cigarettes?

Here.I.Stand, BSN, RN · Aug 8, 2014

Card or no, without a provider order for it and without pharmacy to dispense it, I would think that if the RN prescribed and dispensed the med, that would be illegal. Just like an RN can't make the independent decision that a pt should be able to take morphine, order it, and administer it to the pt; we need a provider and a pharmacist involved. The difference between marijuana and alcohol/tobacco products, marijuana is still a controlled substance; as long as he/she is of age, there are no legalities preventing an adult from procuring and consuming a beer.

Whether I agree with the use of marijuana as a medication or not, I personally value my freedom and my nursing license too much to risk it. I don't like to see people suffer, but we still operate within the bounds of the law.

toomuchbaloney · Aug 8, 2014

Card or no, without a provider order for it and without pharmacy to dispense it, I would think that if the RN prescribed and dispensed the med, that would be illegal. Just like an RN can't make the independent decision that a pt should be able to take morphine, order it, and administer it to the pt; we need a provider and a pharmacist involved. The difference between marijuana and alcohol/tobacco products, marijuana is still a controlled substance; as long as he/she is of age, there are no legalities preventing an adult from procuring and consuming a beer.
Whether I agree with the use of marijuana as a medication or not, I personally value my freedom and my nursing license too much to risk it. I don't like to see people suffer, but we still operate within the bounds of the law.

I understand you point.

To clarify, nurses don't prescribe OR dispense medical marijuana.

Most people needing or using medicinal cannabis do so under their own energies and do not require the assist of a nurse.

Most facilities will not allow smoking of medicinal cannabis on property but have no written policy on other edible formulations.

ktwlpn, LPN · Aug 8, 2014

Card or no, without a provider order for it and without pharmacy to dispense it, I would think that if the RN prescribed and dispensed the med, that would be illegal. Just like an RN can't make the independent decision that a pt should be able to take morphine, order it, and administer it to the pt; we need a provider and a pharmacist involved. The difference between marijuana and alcohol/tobacco products, marijuana is still a controlled substance; as long as he/she is of age, there are no legalities preventing an adult from procuring and consuming a beer.
Whether I agree with the use of marijuana as a medication or not, I personally value my freedom and my nursing license too much to risk it. I don't like to see people suffer, but we still operate within the bounds of the law.

In LTC the physician writes the order to allow the resident to use tobacco or alcohol products,and even salt and I imagine will do the same for marijuana as well. We then dispense . We have to assist the resident to consume it as well. The LTC is the resident's home and they have freedom of choice. I can imagine the next generation of LTC'ers all requesting muff trims or Brazilians. The staff will have to comply.

We won't be "risking" anything as long as there is an order to cover it.

I have an idea for a nebulizer/vaporizer hybrid.I'm thinking on it.If I can come up with a suitable prototype you may see me on Sharktank.

wheeliesurfer · Aug 8, 2014

I know in CA, doctors can not "prescribe" MMJ, they are only allowed to "recommend" its use. The patient then takes this providers recommendation to the dispensary and is able to purchase their MMJ supply.

I think that since doctors can't prescribe MMJ (although it is "legal" for medicinal use in CA it is still illegal federally and a CI narc), it would be near impossible to get ordered in LTC. First, the doctor would have to order (prescribe) it, it would have to be procured (probably brought in as a "home" med, but it must be purchased by someone with a recommendation), and then "dispensed" to the resident with no clear way to monitor strength of the drug (even if they bought the same edible from the same dispensary every time, the amount of THC, CBD, etc can vary from batch to batch and plant to plant).

Here.I.Stand, BSN, RN · Aug 8, 2014

I understand you point.
To clarify, nurses don't prescribe OR dispense medical marijuana.
Most people needing or using medicinal cannabis do so under their own energies and do not require the assist of a nurse.
Most facilities will not allow smoking of medicinal cannabis on property but have no written policy on other edible formulations.

Very true! I guess I took the OP as intending the RN to have an active role in the pt obtaining it. Now if someone were ingesting the Schedule 1 herbals that their family brought in and I didn't see smoke...I'm not about confiscating people's property.

Meriwhen, ASN, BSN, MSN, RN · Aug 9, 2014

I know in CA, doctors can not "prescribe" MMJ, they are only allowed to "recommend" its use. The patient then takes this providers recommendation to the dispensary and is able to purchase their MMJ supply.

No one--doctor, NP, PA, etc.--in ANY state in the US can legally prescribe marijuana while it remains a Schedule I medication. They can only recommend.

All the medical marijuana card does is help prevent someone being hit with possession charges.