The majority of states have legalized medical cannabis and more states are planning to; yet, little is known about nurses’ preparation for or response to this evolving environment. We have taken a first step to understand the implications of medical cannabis’ legalization on nursing practice and established a baseline from which change can be measured. Respondents’ commitment to serving patients—supporting their needs and preferences and using the full complement of nursing tools to do so—offset longstanding stigma or stereotypes associated with cannabis that they might have had. For these nurse leaders, viewing cannabis as a medication—rather than an illicit, street drug—was essential to their acceptance of it. To facilitate acceptance and firmly establish cannabis’ therapeutic benefits, additional investments in cannabis research should be secured and barriers to its conduct should be eliminated. While nurse leaders were consistent in their support for medical cannabis, most respondents reported that they had not thought much about it nor had they heard much about it from their colleagues. Many acknowledged—especially focus group participants—that participating in the study gave them new insights into the challenges and complexities of legalized medical cannabis.
Simply hearing colleagues’ experiences and comparing them with their own was viewed as beneficial. Especially among leaders in inpatient settings—where patients’ use of medical cannabis was described as being particularly challenging—there was an eagerness to proactively discuss the issue, and learn from colleagues. At a minimum, nurse leaders should be aware of their state cannabis policies, prioritize their own education regarding medical cannabis,vertical grow system and ensure that nurses supervised by them obtain basic instruction on the topic. Appropriate curricular and continuing education materials for nurses and learning communities around cannabis policy and practice may be helpful next steps. Use of existing practice guidelines—like those developed by NCSBN, which provide the principles for safe and knowledgeable nursing practice including the essential knowledge and clinical encounter and administration considerations when caring for patients using medical cannabis—should be encouraged Nurse leaders referred to barriers that prevented patients from using medical cannabis. These were largely consistent with previous studies—e.g., clinicians’ knowledge gaps, absence of scientific evidence, the difficulty conducting clinical trials, high cost to patients, and lack of institutional support for clinicians who wanted to certify patients’ use of medical cannabis and a sense of stigmatization among those who did .
Respondents were particularly vocal about the problems that arose from the misalignment between federal and state cannabis policies which has also been raised in prior studies , but with considerably less emphasis. Even in states that had legalized cannabis, federal law created problems for patients who used cannabis to treat conditions but were prohibited from using it during hospitalizations. In these instances, nurse leaders were distressed that some patients were transitioned off medical cannabis and onto opioids, which they viewed as more harmful.Additionally, nurse leaders should work to influence hospital policies so that patients, who are using medical cannabis legally, can continue its use during inpatient stays. Finally, given respondents’ overwhelmingly support for patients’ use of medical cannabis, their concerns about the tension between federal and state cannabis laws, and their receptivity towards nursing organizations assuming a proactive role, nurse leaders and professional nursing should take a more active role in advocating for policy action on medical cannabis. Examples of policy actions include, rescheduling marijuana, establishing dispensing standards, ensuring consistent policies across states, and/or advancing federal decriminalization or legalization.
Blood samples for THC and its metabolites were collected after arrival to the ED and prior to consent, for timeliness, cannabis grow equipment using a vial obtained solely for research purposes. The sample was discarded if no consent was obtained. Plasma samples for cannabinoid testing were frozen at 80℃ until analysis by High Performance Liquid Chromatography/Tandem Mass Spectrometry. Drug testing was performed by the clinical research laboratory at Oregon Health& Science University. Breathalzyer readings were also obtained;given the uniformity of our ability to collect breathalyzer data across sites and the cost effectiveness of breathalyzers, we opted to use breath testing as the study standard. However, if blood testing was obtained for clinical purposes, we also recorded this in the data collection instrument.We interviewed participants about the mechanism of the MVC,drug and alcohol use prior to the MVC, context of use, and past year drug and alcohol use.