As Nurses, we have to advocate for patients and to educate as needed when understanding or knowledge is lacking. Knowledge and understand-ing regarding the science and practical use of cannabinoid therapeutics within the context of healthcare is an area that is deficient in our public health and medical communities. Worldwide research related to cannabis and cannabinoid therapeutics is plentiful and proliferating, despite the current Schedule I status that impedes our ability for high-level clinical research trials to be conducted on humans in the United States.

Meanwhile, state medical cannabis programs have swept our country, providing safe, legal access to cannabis and cannabis-derived products. Medical cannabis programs vary from state to state, including who may qualify as a medical cannabis patient based on a list of each states’ record of recognized medical conditions.

The information contained within patent US 6630507, Cannabinoids as antioxidants and neuroprotectants; states that “Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, and HIV dementia.”1

Based on this information, in addition to a multitude of research studies it may be assumed that state medical cannabis programs would include all “oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases” and specifically allow patients who have experienced “ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease and HIV dementia.” This assumption would be incorrect. However, States are slowing beginning to add new conditions due to the tremendous efforts made by those within the community who understand the importance of recognizing specific diseases within the cannabinoid therapeutics context.
In Arizona for instance, Nurses are leading the way.

The Arizona Cannabis Nurses Association (AZCNA) has been championing the cause for cannabis patients’ rights, and has taken repeated administrative & legal action since 2013 to encourage expansion of the Arizona Medical Marijuana Act (AMMA) to include additional medical conditions such as Post-Traumatic Stress Disorder(PTSD), Parkinson’s Disease (PD), Huntington’s Disease (HD), Traumatic Brain Injury (TBI), Neuropathy, Arthritis, Tourette’s Syndrome, Autism, and Diabetes. After a fierce legal battle, in July 2014 AZCNA celebrated a precedent-setting court case win which resulted in the successful recognition of PTSD as a qualifying condition under the Arizona Medical Marijuana Act.

All other medical conditions submitted by AZCNA have been summarily denied by the Arizona Department of Health Services, resulting in multiple court cases which are currently in a process due to the dedication of AZCNA and their legal counsel, Ken Sobel, Esq who continues to fight for the rights of patients in Arizona.

The work done by AZCNA in Arizona has created a ripple effect which resulted in 10 additional States adding PTSD as a qualifying condition for medical cannabis access. Adding new medical conditions to the cannabis program in Arizona has proven to be a tough challenge. Due to a harsh anti-cannabis political climate and resistance from the Arizona Department of Health to expand the program, safe, legal access for seriously ill patients continues to be blocked by “not enough research.” Although cannabis is proven to be nontoxic to humans, with no reported overdose deaths in 5000 years of cannabis history, we as medical practitioners are driven to provide an evidence-based practice for our patients.

The American Nurses Association (ANA) recognizes the vast benefits related to medicinal usage of cannabis, as well as addressing the issues related to why cannabis research has been difficult to conduct in recent years by stating,“Marijuana was widely prescribed in the United States until 1937 when the Marihuana Tax Act of 1937 prohibited its use (Musto, 1972). By 1970, the Controlled Substances Act completely prohibited all therapeutic use of marijuana by making it a Schedule I drug (Public Law 91-513). Schedule I drugs are defined as “drugs with no currently accepted medical use and a high potential for abuse” (Drug Enforcement Agency, 2016).

Because of this designation, a limited number of DEA licenses to perform clinical research using marijuana exist (Nutt, 2015). Also, the DEA has one single source of marijuana approved for medical research (DEA, 2016). The Food and Drug Administra- tion (FDA) supports scientific research into the use of marijuana and related cannabinoids for medical purposes but has not approved marijuana as a safe and effective drug for any indication (FDA, 2016).

While numerous scholars and organizations have called for an expansion in research, regulatory restrictions have impeded this effort.”2

Why should nurses take on the challenge of advocating for medical condition expansions with in State medical cannabis programs?

AZCNA Advocacy Timeline

2013

• January-AZCNA Founded
• July- PTSD Petition Submitted October- PTSD Public Hearing

2014

• January- PTSD Denied by AZDHS May- PTSD Appealed
• June- PTSD Appeal WIN, Administrative Judge orders PTSD to be added to AMMA
• July- PTSD Approved by AZDHS with Restrictions
• July- Parkinson’s disease (PD) Petition Submitted
• August- PTSD Restrictions Appealed
• December- PD Denied by AZDHS

2015

• January- PD Appeal
• May- PD Appeal Denied
• July- PTSD Restrictions Appeal Denied
• July- PD, Huntington’s disease, Autism, Arthritis, TBI, Diabetes, Tourette’s syndrome, Neuropathy Petitions Submitted
• August- PTSD RestrictionsAppeal in AZ Superior Court December- PD, Huntington’s disease (HD), Autism, Arthritis, TBI,
• Diabetes, Tourette’s syndrome, Neuropathy Denied by AZDHS

2016

• January- PD & HD Appealed January- Autism, Arthritis, TBI, Diabetes, Tourette’s syndrome, Neuropathy Petitions Submitted
• May- Autism, Arthritis, TBI, Diabetes, Tourette’s syndrome, Neuropathy Denied by AZDHS May- PD & HD Appeal WIN
• July- PD & HD Judges’ Decisions Denied by AZDHS August- PD & HD Appeal AZ Superior Court

2017

• January- PD & HD Legal Brief Submitted, Trial Date Pending. January- PTSD restriction Court of Appeals Hearing. Judgement Pending.

The Therapeutic Use of Marijuana and Related Cannabinoids Revised Position Statement of 2016 was written by ANA Center for Ethics and Human Rights, and Adopted by ANA Board of Directors which “addresses the roles and responsibilities of nurses related to the use of cannabinoids for health care.”

According to annual Gallup Poll surveys, nursing is consistently rated the most trusted profession in the US. “Americans have been asked to rate the honesty and ethics of various professions annually since 1990, and periodically since 1976. Nurses had topped the list each year since they were first included in 1999, except 2001 when firefighters were included in response to their work during and after the 9/11 attacks. Since 2005, at least 80% of Americans have said nurses have high ethics and honesty.”3

Advocating for the rights of patients is the most honest, ethical, and compassionate care we as nurses can provide. According to the American Nurses Association, “The nursing profession holds that health is a universal right, which includes access to health care and education concerning the prevention of health issues (ANA, 2015).

ANA has supported providing safe access to therapeutic marijuana and related cannabinoids for over 20 years. In 1996, ANA’s Congress on Nursing Practice supported research and education for evidence-based therapeutic uses of marijuana and related cannabinoids. Also, the ANA House of Delegates has gone on record as supporting nurses’ advocacy for patients using marijuana and other related cannabinoids for therapeutic use (ANA, 2003).”

References:

1. Patent US 6630507 https://goo.gl/72Q8wX
2. ANA Position Statement, The Therapeutic Use of Marijuana and Related Cannabinoids, Revised 2016 https://goo.gl/cIVNVt
3. Gallup Poll on Ethics https://goo.gl/q6nE7F