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Nursing in a medical or recreational marijuana state can be challenging with the conflict in state and federal laws. People, young and old, will present to the emergency room, hospital, doctors office, home care, hospice, and so many other places, for medical care while using some form of cannabis. The use can be general wellness, recreation, and symptom control, cancer-fighting, life-saving from some catastrophic disease or disorder. The bottom line is, they still need medical care and deserve medical care. What does the typical cannabis user get? It varies in their appearance, needs, and who is working at that moment of need. It should not be this way.

As a professional nurse, you should be offering the same compassionate care, regardless of the choice of medication. After all, isn’t choice in one’s care a patient right? If the patient doesn’t have the right to choose their medications, medical care, or choices of recreation, then what does the patient bill of rights cover (NIH: US National Library of Medicine, 2017)? Exactly, the choice to take a medication with few side effects and a safer medical profile than almost every prescription and over the counter drug is a right. As a Nurse, you need to support all the rights of the patient, including the choice of a controversial medication.
The irony in a medical state is that cannabis is considered medicine, yet has no official medicinal value. History can prove cannabis is a medicine with many medicinal uses (ProCon.org, 2017). The Federal Government has once done the following:

1. Classified cannabis as a medicine with medical purposes.

2. Allowed compassionate-use through a federal IND-FDA run program (now closed) which supplied cannabis cigarettes directly to patients.

3. Holds at least one US patent on cannabis use as a medicine (Patent No.6630507)

4. Has approved a Schedule 3 drug synthetic forms of cannabis as a medicine, and is currently allowing investigational drugs and ongoing studies using cannabis-plant-based research in the United States (Lee, 2013).

Moral of the story: Cannabis is a medicine

Patients should be informed about cannabis as a medical option. Understandably, there are limitations on prescriptive authorities, ability to prescribe a dose and to monitor cannabis. As a Nurse, we have to present all options and treatments to our patients and their families. They are the ones who decided if the treatment using cannabis is useful or not. They are the ones who will need to decide if they would like to explore this medical option, just like any other drug, surgical procedure, or medical test. The patient needs to be informed. Nurses should be able to administer the cannabis-based medication if this is the patient’s choice. Doctors should be able to prescribe and direct a nurse to administer cannabis-based medicine because it is safer and more effective than many medical treatments (ProCon.org, 2017).

Many patients will just say no without considering cannabis as a treatment. That is ok since this is their right and their choice. What the nurse did when including cannabis as a treatment option is to educate and share knowledge and open a conversation. The conversation will lead to more conversations, and maybe someday, that will be an option they may be willing and ready to consider.

The Nurse must be informed and educated about cannabis and the science behind the plant. Since there is currently no nursing school officially offering cannabis education, it is up to the professional nurse to seek out the knowledge and educate themselves about cannabis use and nursing. This does not mean a nurse needs to run to a corner and purchase a bud and smoke it. Although, it might help feed the Endocannabinoid System (eCS), improve memory, and help lower stress and anxiety (Lee, 2013).

 

The Professional Nurse needs to understand and know:

1. All mammals have an eCS in which deficiency can lead to disease and disorder (ACNA, n.d.).
2. Endocannabinoid Deficiency- Lack of cannabinoids can make the other systems in the body to not function properly and for the person to become ill and seek medical care (Lee, 2013; Russo, 2008). This is the cause of many diseases. Simply feeding and treating the eCS with cannabis from the plant, called phytocannabinoids, can improve symptoms.
3. Treatment does not mean the person will be high or unfunctional. It simply means that they will be treated, like any other treatment option prescribed by a physician, but it is not allowed by federal laws.
4. The presence and purpose of the endocannabinoids. An endocannabinoid is an endogenous cannabinoid made by the body and used, like the phytocannabinoids, at the same receptors (Lee, 2013; Russo, 2008). The most common endocannabinoids are anandamide and 2-AG and bind to the same receptors as the phytocannabinoids (Grotenhermen & Russo, 2008). The endocannabinoids have a role and function within the body and promote a sense of wellness or happiness.
5. The use of phytocannabinoids. These are the components contained in the cannabis plant that are medicine and treat so many different ailments, conditions, diseases, and symptoms. The cannabinoids attach to the CB1 and/or CB2 receptors within the body, comprised of the endocannabinoid system (Grotenhermen & Russo, 2008).

Combining these main points of knowledge will help the nurse with understanding cannabis as a medicine. The presence of the eCS and the use of both endocannabinoids and phytocannabinoids will be huge. The next step would be to understand the use and application of the medication to treat disease and disorder. How to use cannabis and methods of treatment other than just smoking a joint. Sadly, with research and knowledge being suppressed for over 80 years because of prohibition, this is not well known or documented like a traditional FDA approved drug readily available to make a patient sicker with side effects and other ailments (Lee, 2013).

“What needs to happen is that the nurse needs to be bold enough to recommend cannabis for any and all symptoms that could benefit from cannabis as a medication, regardless of the state, because the recommendation is in the best interest of the patient and their care”. – Nurse Jennie Stormes, RN, BSN

Doctors, in states where cannabis is legal for use, should be able to continue with the existing care and nurses should be able to administer the cannabis-based medications when in-patient, long-term care, hospice care, and anywhere someone needs medical care.

How does a Nurse include Cannabis?

The Nursing Process

Simply by using the Nursing Process and including cannabis in the plan of care steps, commonly known as ADPIE: Assessment, Diagnosis, Plan, Implement, and Evaluate (ANA, 2017).

Assessment this steps includes a collection of objective and subjective data about the patient (ANA, 2017). A nurse should
always ask and inquire if there is any medical cannabis use?

If the answer is yes, then inquire as to why? What symptoms? Is it working to relieve the symptoms? Is there any other benefit they notice from the cannabis use, like better sleep? Increased hunger and weight gain? Less nausea? Any unwanted side effects? How is the patient taking the cannabis: smoking, vape, tincture, oral, rectal, sublingual, topical, or another method?

Diagnosis includes the analysis of the data collected and creating nursing diagnosis to improve health outcomes for the patient (ANA, 2017). Where can the use of cannabis be included in the diagnosis to assist in the positive outcome? Neuroprotection? Anti-inflammatory? Analgesic? And so many other known properties possible.

Planning incorporates the data from the assessment and the diagnoses to create a plan of care with priorities in care needed to achieve the goals, plan of care to improve medical outcomes, and interventions to increase the odds of a positive outcome (ANA, 2017).

The nurse should consider each intervention, and when cannabis would be the safest option with the fewest side effects, cannabis should be included and implemented. For ineffective airway exchange, the use of cannabis can effect vasodilation
of the bronchioles and open the airways. With acute or chronic pain, cannabis is an analgesic. Imbalanced nutrition can be alleviated with cannabis to stimulate appetite and halt nausea and vomiting. The nursing plan should include safe cannabis options to compliment the endocannabinoid system to heal disease and address symptoms present.

Implementation of the nursing plan would involve following through with the plan and doing what is needed for the patient (ANA, 2017). Even if the plan of care includes the use of cannabis-based medication in the treatment of the patient. Obviously, in a hospital, smoking would not be an option, but there are other choices to deliver the medication and to achieve the intended effect. Topical application (salve or patch) to an area of pain could relieve pain or treat skin lesions of psoriasis. Tinctures can be administered sublingual, orally, via gastronomy (GT) or jejunum (JT) tube, and even rectal dosing to treat seizures, muscle spasms, dystonia, and so many other symptoms managed by a nurse.

Evaluation of all interventions implemented is important to determine if they are effective and did the health outcome improve or decline (ANA, 2017). The evaluation is a reassessment of the health situation by the nurse. When considering cannabis, determine if the cannabis-based medication was effective. If yes, then repeat if necessary until no longer needed. If no, then consider a different delivery route, different dosing, different strain, different cannabinoids, different ratios, cannabis break, and many other options for cannabis-based medications.

The Nursing Process should be repeated until the patient care is no longer necessary. Until that point, the nurse will repeat the assessment, diagnosis, planning, implementation, and evaluation to improve the health outcomes (ANA, 2017). Making adjustments along the way is important.

Taking into consideration the need for adjustments in cannabinoids, dosing, or ratios is an important aspect of cannabis use as a medication, especially with chronic, long-term diseases. Sometimes a cannabis break or ‘holiday’ can be beneficial to let the cannabis become more effective with maximum benefits at the receptor sites. Use of micro-dosing can help many. The use of various strategies for patients can help manage disease and discomfort. There is so much to know about the science of cannabis.

It is important for the nurse to include the Endocannabinoid System (eCS) in all steps of the nursing process. The patient deserves complete care, which addresses all body systems and all sources of disease, along with all possible treatments, even the forbidden one: cannabis. Even in an illegal cannabis state, it is not illegal for a nurse to share knowledge and teach a patient about cannabis who could benefit from the many medicinal cannabis abilities.

 

References:

ACNA. (n.d.). Our mission. Retrieved from American Cannabis Nurses
Association: https://cannabisnurses.org/
ANA. (2017). Nursing process. Retrieved from American Nurse Association: http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/Thenursingprocess.html
Grotenhermen, F., & Russo, E. (2008). Cannabis and cannabinoids: Pharmacology, toxicology, and therapeutic potential. New York, NY: Routledge.
Lee, M. E. (2013). Smoke Signals: A social history of marijuana – medical,
recreational and scientific. Scribner.
NIH: US National Library of Medicine. (2017). Patient rights. Retrieved from
Medline Plus: https://medlineplus.gov/patientrights.html
ProCon.org. (2017). 60 Peer-reviewed studies on medical marijuana. Retrieved from
The Leading Source For Pros & Cons of Controversial Issues: http://
medicalmarijuana.procon.org/
view.resource.php?resourceID=000884
ProCon.org. (2017). Historical timeline. Retrieved from ProCon.org the Leading Source for Pros & Cons of Controversial Issues: http://medicalmarijuana.procon.org/
view.timeline.php?timelineID=000026
Russo, E. B. (2008). Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in a migraine, fibromyalgia, irritable bowel syndrome and other treatment resistant conditions? Neuroendocrinology Letters, 192-200.

 

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