During the an episode of the Wolters Kluwer Expert Insights Webinar Series, speaker Carey S. Clark, PhD, RN, AHN-BC, FAAN, Professor, Pacific College of Health and Science and Past President, American Cannabis Nurses Association, discussed the current state of prohibition of cannabis, the reasons holistic approaches to medical cannabis care are key to patients' success in using cannabis safely and effectively, and the role of a cannabis care nurse including support, education and coaching. Dr. Clark has over 30 publications in healthcare journals, including Advances in Nursing Science and Holistic Nursing Practice, and is the editor of the textbook Cannabis: A Handbook for Nurses (Wolters Kluwer, 2021).
1. The current state of prohibition of cannabis
On October 6, 2022, President Joe Biden pardoned those convicted on prior federal charges of simple cannabis possession and called for state governors to follow suit and pardon those convicted on similar state charges. Biden also instructed for review of how cannabis is classified under federal drug laws since it is currently classified as a Schedule 1 substance, putting it in the same classification of heroin and LSD.
This is important in healthcare because it helps to lower the stigma around cannabis use, which will help patients feel more at ease in disclosing their use. In turn, nurses will be able to effectively support and educate their patients on how to use cannabis safely and effectively as a treatment.
Prohibition campaigns dating back to the 1930s, during the “Reefer Madness” era, brought forth the stigma of the effects of cannabis along with racial stigma that cannabis was a drug used disproportionately by people of color. This had lasting government and social affects to the population, causing a gap in education in the medical field.
2. Understanding of the human endocannabinoid system
In 2018, the National Council of State Boards of Nursing (NCSBN) stated that nursing professionals and students should be educated on six principles of essential knowledge about cannabis:
- current state of legalization and of medical and recreational cannabis use,
- federal laws and current legislation around patient use of medical cannabis,
- the endocannabinoid system (ECS),
- cannabis pharmacology and the research associated with the medical use,
- safety considerations, and
- ways to approach patients without judgment regarding the patient’s choice of treatment.
The ECS is a unique system in the brain and body that affects many important functions, including how a person feels, moves, and reacts. The natural chemicals produced by the body that interact within the ECS are referred to as endocannabinoids, and like cannabis and cannabidiol (CBD), they interact with receptors to regulate important body functions and create similar effects to cannabis in the body.
Bodies naturally have enzymes and proteins that degrade and inactivate the endocannabinoids, so our bodies need to continue to reproduce new ones. The ECS helps people maintain homeostasis and controls the central and peripheral nervous systems, energy uptake, immune responses, and inflammatory and anti-inflammatory signaling.
3. Holistic approaches to medical cannabis care
The ECS responds very well to holistic modalities which can upregulate the overall state of a person’s ECS. Approaches that have been shown to do this are exercise, diet, massage therapy, acupuncture, osteopathy, meditation, as well as cold showers. For example, runners are known to experience a relaxed, post-run feeling known as a “runner high.” This is often attributed to a release of endorphins, but in fact it is due to endocannabinoids moving through the cellular barrier within our bodies, promoting the short-term effects of reduced anxiety and feelings of calmness.
A balanced diet consisting of omega 3 and omega 6 fatty acids and a reduction in toxins in foods such as large amounts of sugar and pesticides are other methods of increasing the response of the ECS. One can also experience great benefits from practicing meditation and yoga or receiving massages and acupuncture. The more a person can enter a relaxation response, the easier it is for our ECS to maintain homeostasis.
4. Nurse’s cannabis care role
Public health considerations of cannabis use, the social and legal climate surrounding it, and patient care issues are all directly relevant to clinical nursing practice. The American Cannabis Nurses Association (ACNA), recognized by the American Nurses Association (ANA), is currently working on getting cannabis care to be recognized as a subspecialty within the nursing practice. In 2017, the Scope and Standards of Practice for Cannabis Nurses was first drafted by the ACNA, updated in 2019 to include advanced practice roles, and is currently under review.
The nurse plays an important role in assessing the patient’s palliative and healing needs – pain, nausea, anxiety, sleep issues, anorexia, etc. Factors critical to patient assessment and diagnosis are:
- past patient history,
- knowledge of cannabis use including strains and ingestion methods,
- current cannabis use,
- palliative medications for knowledge of possible side effects,
- safety concerns that patients may have with cannabis use, and
- finances to know what treatments are accessible to the patient are critical to the patient assessment and diagnosis.
Nurses have a significant role in planning, dosing, implementation, and evaluation of patient’s cannabis use. Considerations are patient goals, knowledge of cannabis use and state regulations, access to dispensaries, methods of ingestion, and dosing information. Nurses also need to evaluate the patient’s use of cannabis. One method is asking the patient to keep a cannabis diary to note doses, side effects, and effectiveness of treatment so the nurse can assess how well the treatment is, or is not, working and can work with the patient to adjust as needed.
Nurses frequently treat patients who use or are considering using cannabis as a treatment option. Practical information and current research are needed for nurses to care for patients who use or are looking to use, cannabis to treat various illnesses. As cannabis legalization continues to gain momentum, nurses must also learn more about the ECS, cannabinoids, and clinical implications to better serve their patients.