Nurse Practitioner's Guide to Medical Marijuana

As legislatures across the U.S. begin to legalize the use of marijuana, Nurse Practitioners will face questions about if and when patients can use the drug as part of their treatment. Marijuana legalization recently garnered national attentional during the 2016 U.S. General Election, when a total of nine states voted on recreational or medical marijuana laws. California, Maine, Massachusetts and Nevada became the newest states to legalize recreational marijuana use; Florida, North Dakota, Montana and Arkansas, similarly, all voted to pass medical marijuana initiatives. Of the nine, only Arizona voted against a proposed initiative to legalize recreational use. Nursing@Simmons has updated our guide to state-by-state marijuana legislation in the map below to account for these new laws.

To help Nurse Practitioners understand the current landscape, this article outlines the legal status of marijuana in each state and the pros and cons of its medical use. The Drug Enforcement Administration lists marijuana as a Schedule I controlled substance, a category reserved for drugs with high potential for abuse and "no currently accepted medical use." This means the possession of marijuana is illegal at the federal level. The government, however, allows states to choose their own laws regarding marijuana legalization for both medical and recreational purposes.

The use of marijuana as a medicine is relatively understudied, and its effectiveness in patient treatment is inconclusive. Marijuana's Schedule I classification also makes it difficult to research, and without research, it is not easy to change its classification. In addition, medicinal marijuana cannot be sold in pharmacies as it is not approved by the Food and Drug Administration. Until more research is allowed, Nurse Practitioners and other medical professionals should educate themselves on their state laws before recommending medical marijuana to their patients.

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Understanding State Laws on Marijuana

Illegal

For states where marijuana is currently illegal, it means that possession, sale, transportation, cultivation, or consumption of marijuana is illegal. Punishments vary across states and range from fines to felony charges.

Legal for Recreational Use

Where marijuana is legal for recreational use for adults 21 years and older, individual states specify an amount of marijuana that is classified as being for personal use. Typically, if recreational marijuana is legal it can be bought or grown at home; however, there are regulations on how much can be purchased or grown. If an individual is in possession of more than the specified amount, that person can be considered a distributor, which is punishable by law.

Legal for Medical Use

States that allow the use of marijuana for medical purposes restrict access to marijuana unless an individual has a qualifying medical condition. States where medical marijuana is legal require patients to first obtain approval from a primary care provider, usually in the form of a note or an ID card. As marijuana is a controlled substance, physicians and Nurse Practitioners cannot prescribe it; they can only recommend its use to patients. Once authorized, patients can then obtain marijuana through either a dispensary or a caregiver. A dispensary is a private business that has permission to sell marijuana under various restrictions. A caregiver is an individual who is licensed to grow marijuana and provide it to authorized people. Many states restrict the number of people a caregiver can supply with marijuana.

Why Recommend Medical Marijuana?

States that have legalized medical marijuana typically approve its use to treat debilitating symptoms of serious conditions. Approved medical conditions vary by state, but usually include conditions like cancer, glaucoma, HIV and AIDS, multiple sclerosis, and extreme nausea.

In popular culture we often see people inhaling marijuana as a smoke or a vapor, but its components can also be ingested in pill form, baked products, teas, or sprays. Medically speaking, two cannabinoids from the marijuana plant are of particular interest: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Some medications already incorporate these components in order to decrease pain and inflammation, increase appetite, and reduce nausea.

According to the National Cancer Institute, marijuana consumption during clinical trials has had a positive impact on many medical conditions, including:

  • Appetite stimulation and weight gain (for HIV & AIDS patients)
  • Relief of nausea and vomiting
  • Pain relief
  • Relief of anxiety and aid with sleep
  • Reduction of bladder cancer risk
  • Reduction of epileptic seizures

Further support for the use of medicinal marijuana is reinforced by a study from the Johns Hopkins Bloomberg School of Public Health. The study found that deaths from prescription drug overdoses are 25 percent lower in states where marijuana is legal for managing chronic pain, compared to states where it remains illegal. Part of the explanation is that stronger opioids such as Vicodin and Oxycontin are much more addictive and it is easier to overdose on them.

The Risks of Recommending Medical Marijuana

While legal in various forms at the state level, medical marijuana remains a Schedule I controlled substance, which means Nurse Practitioners must consider the ethical implications of recommending a federally illegal substance to patients. Though there appear to be medicinal benefits, there can also be harmful side effects. These include lowered blood pressure, short-term memory loss and depression.

Marijuana also has the potential to be an addictive substance for those who consume it regularly. As with any addictive substance, users can experience symptoms of withdrawal if they stop using it. The NCI includes irritability, sleeplessness or restlessness, hot flashes, nausea, and cramping (this is rare) as potential withdrawal symptoms. However, it should be noted that these are considered mild compared to withdrawal from opiates and typically only last for a few days.

The map above addresses some of the various degrees of legality that marijuana has achieved on the state level. Given the speed at which legislation is changing across the country, keeping up with these changes will require diligence and consistent attention from Nurse Practitioners. As health care professionals who take a holistic approach to care, Nurse Practitioners should be aware of the latest research pertaining to marijuana and how it is used to treat patients. They should be able to speak with their patients on the pros and cons of its use and be knowledgeable of the state laws surrounding it.