How Nurses Evaluate Cannabis Products for Safety & Efficacy

by | Jan 9, 2019 | Nursing Practices

How to Know if a Cannabis Product is Right for Your Patient

After years of working with patients using a variety of cannabis products, I began noticing a trend; different extraction and production methods often generate different effects or results.1 This realization prompted intensive research into many different formulations, resulting in the creation of this guide for evaluating optimal medical cannabis products.  

Disclaimer: The author not benefit from the sales of any products, their perspective is objective and without profit-bias.

When discussing cannabinoid therapeutics, it’s useful to understand a few basics regarding the Endocannabinoid System (ECS).

As a result of 80+ years of cannabis prohibition, most clients (including medical professionals) have never heard about this vast receptor signaling system responsible for modulating and balancing our bodies. Cannabinoids found in the cannabis plant, bind with ECS receptors found throughout the body, which promotes internal homeostasis or balance.2

We’ve come to understand that the underlying cause of most disease is stress and imbalance. Balancing benefits of the “entourage effect,” and the body’s synergy with cannabis, can be profoundly therapeutic for improving root causes of many symptoms.3

Cannabis is a very complex plant, containing over 140 cannabinoids,4 200 terpenes (essential oils), bioflavonoids,5 chlorophyll, essential fatty acids, and antioxidants.6

Many of the widely used cannabis extraction methods in today’s market isolate or fractionate cannabis components, removing many of the constituents contributing to the entourage effect of whole plant medicine.7 Whole plant formulations, containing a full spectrum of cannabis plant components, appear to be most optimal for balancing the body systematically.8 Research comparing the efficacy of whole plant cannabis formulations versus isolated forms of cannabis reflect that isolates may not be as effective for desired medical outcomes.9 Homeostasis is the goal when striving to improve medical outcomes reaching beyond superficial symptom management. 10

The following criteria are important for safe and effective medical cannabis use.

Guidelines are provided to help ensure patients are empowered to choose optimal cannabis products.

Organically Grown

This may seem like an obvious requirement, for those who understand the harm that toxins may cause.  Unfortunately, USDA Organic certification is not yet available for cannabis farming/processing, so we rely on stated “organically grown” marketing and lab reports to rule out toxic residue.  It’s important, especially when working with ill or fragile patients, to reduce any toxic exposure that may be detrimental to health or potentially negate benefits received from clean cannabis.

In addition, a recent theory has been made, linking Cannabis Hyperemesis Syndrome11 with Neem pesticide toxicity12, which appears to produce similar symptoms, further supports the importance of using organic cannabis and appropriate lab testing to rule out any unwanted chemical residuals.13

Laboratory Tested

Lab testing requirements vary from state to state. Mandatory lab testing on medical cannabis products are not required in Arizona. Whereas in Oregon, every cannabis product on a dispensary shelf is required to be lab tested by a state-certified facility.   

Lab testing is important for identifying cannabinoid content, terpene profiles, and product potency. Lab testing also helps provide information about possible contamination from pesticide and fertilizer residuals, or the presence of mold and mildew. 14

Lab testing assists with accurate dosage titration, which is important for tracking response and cannabinoid intake. Cannabis testing laboratories are currently the only “conclusive” method for knowing exactly what is contained within a specific formulation. Strain names and marketing claims may not be accurate. Scientific analytical testing is required to report, with certainty, which components are present in a cannabis product. Terpene lab results are beneficial for additional therapeutic targeting.15

Whole Plant Cannabis Products

Products that concentrate the cannabis plant as a whole, as nature created, is best for medicinal cannabis use.   Formulations made using food-grade ethanol extraction or infusion methods, are preferred to meet the criteria.16

Whole plant means, the original flower-derived cannabinoids, terpenes, bioflavonoid, essential fatty acids and so forth, remain fully intact in the final product.17

 All of these components contribute synergistically to the Entourage Effect, which exerts the systemic balancing effects of cannabis.18

Hemp Products Examined

Industrial hemp-derived products are typically produced from an isolated form of cannabidiol (CBD), void of other beneficial cannabis plant constituents.19

The most potent spectrum of cannabinoids and synergistic components are found in whole-plant formulations derived from cannabis flower. Industrial hemp flowers are relatively sparse and seed laden. As a result, producers may source oil from less optimal parts of the industrial hemp plant.20

While industrial hemp has many applicable uses, including seed production, food, fuel, textiles, bioaccumulation (cleans soil), and building materials like Hempcrete; when it comes to medicinal potency, industrial hemp derived products may not be the optimal choice for medical use.21

To clarify, some CBD producers have a USDA hemp license allowing them to legally produce and distribute hemp throughout the United States. Hemp products must meet the federal hemp regulations, containing less than 0.3% THC. A new term, medical hemp, has emerged with the intention of  differentiating products derived from high CBD cannabis flower, qualifying as hemp with less than 0.3% THC.22

The intended purpose of these guidelines help alleviate confusion and build confidence when choosing cannabis products for medical use. If you are new to cannabis, suffering a complex medical condition, or taking concurrent pharmaceutical medications, please seek medical oversight to reduce risk factors and optimize cannabis therapy outcomes.23


  1. What makes a cannabis nurse?
  2. Basics of the Endocannabinoid System
  3. Russo, E. (2001).  Cannabis and cannabis extracts: greater than the sum of their parts British Journal of Pharmacology.
  4. Echo (2017) Major and minor cannabinoids in cannabis.
  5. Fundacion Canna (2017) Cannabis bioflavonoids.
  6. Echo (2017). Other compounds in cannabis.
  7. Echo (2017).  CBD Alcohol or CO2 Extraction.
  8. Patients Out of Time Position Statement in Support of De-Scheduling Cannabis
  9. Blasco-Benito (2017).  Appraising the entourage effect.
  10. Russo, E. (2001).  Cannabis and cannabis extracts: greater than the sum of their parts British Journal of Pharmacology.
  11. Cannabinoid Hyperemesis
  12. Neem Oil
  13. Mishra, A., & Dave, N. (2013). Neem oil poisoning: Case report of an adult with toxic encephalopathy. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 17(5), 321–322.
  14. Cannabis Safety Institute (2014).  Standards for cannabis testing laboratories.
  15. Integrating Cannabis into Aromatherapy
  16. Echo (2017).  CBD Alcohol or CO2 Extraction.
  17. Echo (2017). Other compounds in cannabis.
  18. Blasco-Benito (2017).  Appraising the entourage effect.
  19. Pamplona (2018).  Potential clinical benefits of CBD-rich Cannabis extracts over purified CBD in treatment-resistant epilepsy: observational data meta-analysis.
  20. Gallily (2015).  Overcoming the Bell-Shaped Dose-Response of Cannabidiol by Using Cannabis Extract Enriched in Cannabidiol.
  21. Price, M (2015).  The difference between hemp and cannabis.
  22. Price, M (2015).  The difference between hemp and cannabis.
  23. Integrated Holistic Care

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