We’re going to be talking about cannabis legalisation, pros and cons, and it’s a hot topic right now. Many patients are using cannabis and I believe that clinicians feel unprepared to address the questions and legalisation is happening at state levels but not at the federal level so it’s very complex for most clinicians.
Currently we have 33 states plus the District of Columbia, Guam and Puerto Rico who allow for medical cannabis. We have 10 states plus the District of Columbia that allow for adult use and then we have 16 states that allow for high CBD low THC and only three states that have absolutely no cannabis medical laws.
Why is this such a controversial topic?
Cannabis has been illegal for the last eighty years and prior to prohibition it was widely available in most pharmacies. It was the main ingredient in a lot of different preparations – we used it for things like seizures, asthma, dysmenorrhea, pain and other neurological conditions like Parkinson’s disease. Prohibition didn’t happen because medical professionals or the scientific community thought cannabis was bad, prohibition happened for political reasons. So it’s really hard to undo all of that stigma and misinformation of eighty years and really identify and accept cannabis as a medicine.
What are some of the points made for and against the legalisation of cannabis?
Usually when we hear people who are against legalisation their biggest concerns are the kids are going to get it. They also worry about substance abuse, they worry about traffic fatalities, they worry about psychosis, increasing in psychosis, they worry about increased crimes in neighbourhoods, they have concerns that it may lead to harsher drugs. There are some people that still believe cannabis is a gateway drug. Those that are for cannabis are really trying to help decrease the stigma and improve access for patients who really will benefit from it. It’s definitely people are very much separated on their sides of the fence.
What information will you be presenting on this topic?
I will be presenting the pros of cannabis legalisation and really what my session is focussing on is that our patients are using it and we need to become educated about it so, again, that we can provide them with those resources. I do believe that federal legalisation will allow for us to do more research, it will allow clinicians to feel more comfortable talking about it, it will allow for insurances to start covering it and decrease costs for patients. It will improve outcomes for patients and their quality of life and we now have the National Council of State Boards of Registered Nursing has issued guidelines for nurses who care for patients using medical cannabis. Their position is that patients are using it and nurses are going to care for these patients and they need to become educated in six essential areas. It’s so important that we have this tool in our toolbox for oncology patients; they are seeing results that improve quality of life over and over again. So whether we as individuals believe in it or have our own bias or judgements around it we need to be able to help our patients.
What are the challenges and risks of not being able to provide medicinal cannabis to patients?
Right now the fact that it’s illegal at the federal level, there are some institutions and hospital organisations who do not want their hospital staff or clinicians to even discuss it with patients. So, of course, naturally patients are going to look for information, they may go to the internet and recent studies show that 76% of claims on the internet were inaccurate and only one was written by a medical professional. So patients’ first interactions are with a lot of misinformation on the internet and then, of course, if they don’t get good information from the dispensary they may ask their cousin, their brother, their grandkid. They may be getting it from a neighbour and we don’t know if it’s quality medicine that’s been tested and then they’re at risk for toxins like heavy metals, moulds, pesticides, fungus. So it’s really challenging if we’re not opening up that conversation and having curiosity with our patients, we’re leaving them very vulnerable.
What counter arguments do you usually receive?
People assume if you’re pro-cannabis that you throw all judgement out with it. So often I hear people saying, ‘Well, we don’t want the kids to get it,’ – I don’t either. I’m not here trying to pass it out to children, I’m not trying to encourage pregnant women to start smoking marijuana. I still use my clinical judgement, I still do a full assessment and risk versus benefit and there are some people who are not going to qualify or be appropriate to use cannabis as a medicine. But that doesn’t mean that just because we’re scared of the kids getting it we shouldn’t be developing policies around that. We should be developing policies based on the science and unfortunately we’ve never done that with cannabis.
What are some of the misunderstandings about medicinal use of cannabis?
It’s inherently hard for clinicians and nurses to become advocates of cannabis medicinally or for adult use because they don’t really understand it. There is no standardised dosing, there are no standard protocols and we’re very much accustomed to having standardised dosing and protocols. So nurses can really struggle with knowing what to tell their patients – where to get it, how much to use, how often to use it, what are the adverse effects, are there potential drug interactions? So we’re really undereducated in this area and the more educated nurses become the more they can provide that information for their patients and help them use it as a medicine. Because right now most of our patients, their first interaction is with what’s called a bud tender, somebody who works in a dispensary behind the bar, the bud bar, and they’re really the first interaction a patient has and they’re trying to answer complicated questions, medical questions, that they’re unprepared or untrained to really provide that education. So to treat it like a medicine we should really become educated so we can help our patients better navigate that and reduce some of these adverse effects that we’re seeing – some overconsumption, increases in ER visits because overconsume and have adverse effects. I do think nurses can really come in and reduce those incidences and improve outcomes.
I certainly get some inappropriate questions. Again, when people find out what you do and that you’re a cannabis clinician or that you recommend cannabis frequently, they ask you questions whether or not you’re a pot-head or a drug dealer of if I have been using it right now and just really having some inappropriate thoughts around what it means to be a cannabis practitioner. Just because I’m an advocate of it doesn’t mean, again, that I throw all common sense out of the window. Cannabis has been so stigmatised that a lot of us are uncomfortable with it. I understand that sometimes it’s their insecurities coming out when they are asking me these questions. They also ask me if I have edibles. Every time I do a presentation people want to know do I have any free samples and I’ve decided to start answering that with, ‘Yes, I have suppositories. Those are my free samples that you can have.’
I hope the questions that people start to ask are more about how to help their patients and what’s appropriate and what’s not appropriate. If they have concerns about misinformation let’s talk about it and let’s not continue to perpetuate those stigmas. I saw a talk of nurse practitioners and they dressed up in costume and one was a hippy and one was the DEA and they were having a debate and then they passed out fake edibles and they really, to me, offended me and I did have to let them know at the end of the session that I found it very offensive the way that they portrayed cannabis. We really do need to break away from that because it is a medicine that our patients are using.
How would federal legalisation affect oncology nurses?
If it was federally de-scheduled or even rescheduled, I’d prefer de-scheduled, but if it was rescheduled it would allow nurses to feel more comfortable, their institutions couldn’t prohibit them from discussing it. It would really allow us to engage with patients on a more comfortable level. Again, I think this is the perfect population that would benefit from cannabis as a medicine. It has so much to offer them in terms of reducing their symptoms and improving their quality of life and also reducing caregiver burden and stress because their loved ones are feeling better. It just has a wide range of ability to help many different areas.
What do you expect to happen in the future, and over what timescale?
I can see a timeline on it; there’s the American Cannabis Nurses Association is a national nursing organisation that just develops scope and standards for nurses who want to care for patients using cannabis. We have applied for subspecialty, so for cannabis certification recognition. It’s about a two year timeline, so it takes a while for that subspecialty to be approved and I think once that is approved you’re really going to see this boom in nurses adopting and accepting cannabis as a specialty.
What is your take home message for oncology nurses?
I hope oncology nurses walk away from this session as understanding that it’s a tool that we have in our toolbox and that our patients are seeing benefit from it. We absolutely need to become educated so that we can provide them safer access. That’s my biggest concern is that if we’re not there as clinicians to provide them with quality information, again they’re going to get it from random people. I’m concerned that some of them may get information that puts them more at risk than provides them benefit.