Plenty of medical associations have released position statements addressing medical marijuana, but many cite the lack of research into cannabis as a healthcare product as a barrier to writing comprehensive, evidence-based guidelines.

The American Medical Association published an updated resolution on cannabis use, calling for it to be further studied. The resolution also called cannabis a dangerous drug that is a public health concern, although it should be handled with public health-based interventions rather than incarceration.1

The American College of Surgeons’ committee on trauma developed a Statement on Cannabis Regulation and Risk of Injury. The 2018 statement authors noted that cannabis impairs the ability to perform tasks associated with driving. Further, the paper authors suggested more public education on safe driving and cannabis use.2

Marijuana legality and workplace policies are rapidly changing. This is partly why the American College of Occupational and Environmental Medicine published guidance on marijuana in the workplace as early as 2015.3

“We tried to get out our statement as quickly as possible,” recalls Natalie P. Hartenbaum, MD, MPH, FACOEM, president and chief medical officer, OccuMedix in Dresher, PA. “We wanted to say, ‘Don’t forget about safety.’ From an employer’s standpoint, that has to be a concern.”

The problem is that there are certain risks associated with marijuana use that are not as well-known as risks associated with FDA-approved medications. “We have no idea of its strength, half-life, how often it can be used appropriately, and how much is too much,” Hartenbaum says. “With prescription medicine, you know the dosing interval, and the drugs have been studied.”

The American Society of Regional Anesthesia and Pain Medicine published a brief statement on cannabis in 2016, calling on the federal government to reschedule marijuana to a Schedule II substance, allowing it to be studied in clinical trials.4

Recommendations from the Federation of State Medical Boards, issued in 2016, guide physicians on how to evaluate, inform, and share decision-making with patients over medical marijuana use. The guidelines suggest healthcare professionals document a written treatment plan that includes a review of other measures attempted to ease suffering. The treatment plan also should include a determination whether the patient with a terminal or debilitating medical condition may benefit from a recommendation of marijuana. Providers also should give advice on risks, quality and concentration of cannabis, exacerbation of psychotic disorders, adverse events, use of marijuana during pregnancy, and the need to safeguard cannabis products from children and pets.5

The National Council of State Boards of Nursing (NCSBN) appointed members to the Medical Marijuana Nursing Guidelines Committee to develop recommendations for nursing care of patients taking medical marijuana. The NCSBN published its recommendations in July 2018.6 The council’s basic conclusion is there is too little scientifically rigorous evidence to make specific safety and use guidelines, but nurses can learn more about cannabis administration, safety, and ethical considerations to improve nursing care of these patients. The recommendations noted the problem of substance-induced psychosis in which a person who ingests large amounts of THC can hallucinate and experience feelings of paranoia, delusion, confusion, and disorientation. Other risks of marijuana use noted in the NCSBN paper are the potential negative effect of inhaled cannabis on patients with asthma, bronchitis, emphysema, or other pulmonary diseases, and the potential of cannabis worsening conditions of the liver or kidney disease. Cannabis also can exacerbate bipolar disorder manic symptoms. The NCSBN paper also noted that even as cannabis legislation evolves, social acceptance may not progress at the same pace, which creates ethical challenges in patient care.

REFERENCES

  1. American Medical Association. Clinical implications and policy considerations of cannabis use, Sept. 12, 2016. Available at: http://bit.ly/3916sPS.
  2. American College of Surgeons. Statement on cannabis regulation and risk of injury, Feb. 1, 2018. Available at: http://bit.ly/2rXijhx.
  3. Phillips JA, Holland MG, Baldwin DD, et al. Marijuana in the workplace: Guidance for occupational health professionals and employers: Joint guidance statement of the American Association of Occupational Health Nurses and the American College of Occupational and Environmental Medicine. Workplace Health Saf 2015;4:139-164.
  4. American Society of Regional Anesthesia and Pain Medicine. ASRA statement on cannabis, Sept. 30, 2016. Available at: http://bit.ly/36VFTtA.
  5. Federation of State Medical Boards. Model guidelines for the recommendation of marijuana in patient care, April 2016. Available at: http://bit.ly/38YHTTT.
  6. National Council of State Boards of Nursing. The NCSBN National Nursing Guidelines for Medical Marijuana. July 2018. Available at: http://bit.ly/2PFTDTu.