Quandaries Surrounding the Use of Medicinal Cannabis

March 2019 Vol 10, No 3
Eileen Konieczny, RN, BCPA
Nurses are uniquely positioned in healthcare. Not only do we advocate for our patients, we are active participants in each patient’s experience of health and illness. As nurses, we share relevant information with patients—about their condition, treatment, and ways of coping with both.

It’s been a decade, but I will never forget the day I learned that cannabis can be medicine. I was catching up with a friend of mine when he asked about the health of my sister, who at that time had been living with stage IV breast cancer for the past 5 years. We spoke about her current chemotherapy regimen, the tingling in her hands, imbalance, fatigue, and the fog they call chemo brain.

He asked me if she ever used cannabis, and I was surprised by the question. Having family members ensnarled with issues associated with drugs and alcohol, cannabis did not factor positively in my life. My friend began to tell me about the history of the plant and how safe it was, how it was used as medicine “back in the day.” He called it a “truly amazing plant” and that he knew people who used it to help tolerate their chemotherapy. It was that conversation that changed the path of my life, and I have never looked back.

So, it is with the education and experience of a nurse and the heart of a sister that I began my journey to understand cannabis as medicine. I never imagined I would be considered an expert, but that’s exactly what the last 10 years of my nursing career have led me to be. In the beginning, I educated myself with everything I could get my hands on about cannabis and the science behind the plant. I stepped out of my comfort zone to advocate for its use as medicine because I believe it is a valuable tool for patients to have access to. This put me into the public spotlight, and patients began reaching out to me for help. It was more difficult to help guide patients in the early days; there weren’t many resources, and the state programs were few, but nurses are a resourceful bunch, aren’t we? I’ve played an integral part in the development of educational programs and outreach materials, helped shape legislation, and witnessed amazing life-changing results in thousands of patients.

Once you understand the science, it’s impossible to forget.

Many people are surprised to learn that it’s only been during the past 80 years or so that cannabis has not been widely and legally available as a medicine in the United States. In fact, humans have used cannabis to ease pain and suffering for millennia. By the mid-19th century, cannabis was found as a tonic in virtually every pharmacy and was considered to be something of a “cure-all” drug. Unfortunately, the potency of medicinal cannabis preparations was variable, and individual responses seemed unpredictable, even erratic at times. By the early 20th century, cannabis tinctures were replaced by the newest drug to hit pharmacy shelves: the predictable and consistent aspirin. Political sentiments around cannabis also began to shift around that time, and with the introduction of the Marihuana Tax Act of 1937, cannabis had effectively become banned at the federal level.

Science provided a major breakthrough in 1964 when Israeli scientist Raphael Mechoulam and colleagues isolated and synthesized delta-9-tetrahydrocannabinol (THC), perhaps the best-known active compound in cannabis. During the subsequent 2 decades, scientists learned much about the clinical effects of cannabis, but no one understood how it worked on a molecular level to alter perception and achieve palliative results such as relieving pain and nausea, increasing appetite, and suppressing seizures. It took until the early 1990s before researchers began to uncover the innate bodily system that synthesizes its own cannabis-like compounds and makes use of those that come from the plant as well—the endocannabinoid system (ECS).

The ECS is a biological system present in all mammals and many other living creatures. It bridges many physiological locations and other systems in the body and impacts bodily functions as basic as eating, sleeping, relaxing, immunity, and memory formation.

The ECS interacts robustly with other noncannabinoid systems like the serotonin system, the endorphin system, the immune system, and the vanilloid system. In modulating these other systems, the ECS regulates inflammation, pain, bone health, formation of new nerve cells, fat and sugar processing, mood, energy, brain health, and hormone balance. It is through the ECS’ extensive web of influence and effect that cannabis and hemp provide such a wide umbrella of therapeutic benefit. Since it plays an important regulator function in the body, the ECS also plays a role in managing a variety of symptoms or underlying disease states. Clearly, a well-functioning ECS is essential to our health and well-being.

Since the discovery of the ECS, scientific study has begun to uncover the many medical possibilities for cannabis. At the present time, we know the most about the cannabinoids THC and cannabidiol (CBD), which are sometimes called “the power couple” of cannabis. Among cannabis’ many cannabinoids—there are more than 100—THC produces the well-known intoxicating effects of cannabis and is equally responsible for the majority of other pharmacological impacts as an anxiolytic, antiemetic, appetite stimulating, analgesic, anti-inflammatory, and neuroprotectant agent. CBD is noneuphoric and shows great promise in treating many conditions, most notably seizure control in pediatric epilepsy patients. In addition, CBD also offers anti-inflammatory, analgesic, anxiolytic, antipsychotic, and anticarcinogenic effects, among several others. Effective use of medical cannabis often requires finding a balance between the desired therapeutic effects and mitigating unwanted psychoactive effects.

With access to medical cannabis spreading across the country, patients and consumers alike are becoming increasingly aware of the potential benefits that cannabinoids offer when treating various ailments. Educated healthcare practitioners who understand cannabinoid medicines are at a premium.

No matter what the laws are in the state where you work, you need to understand the science behind the plant Cannabis sativa, and I’m not the only one thinking this way. The American Cannabis Nurses Association developed the first Scope and Standards of Practice for Cannabis Nurses, while the National Council of the State Boards of Nursing (NCSBN) has published The NCSBN National Nursing Guidelines for Medical Marijuana. As a nurse, one of our responsibilities is to make sure that our patients know where their blind spots are, understanding options that they might not be aware are available to them—the information they didn’t know they didn’t know. Your patients need you.

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Last modified: March 21, 2019

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