The Nursing Dilemma of Medical Marijuana

Medical marijuana is legal in Oregon, where I practice. In one sense, this seems to be an enlightened act of legislation for patients who cannot tolerate conventional medications or simply prefer an herbal approach to managing pain and/or nausea. Its use is particularly prevalent in among oncology patients, and those with chronic pain.

Still, it’s a nursing conundrum. The issue is that marijuana remains illegal at the federal level. Because of this, many hospitals are reluctant to allow prescription marijuana on their campuses. Although a 2009 Justice Department memo recommends that drug enforcement agents focus their investigations away from “clear and unambiguous” use of prescription marijuana, it also says users claiming legal use but not adhering to regulations may be prosecuted.

In light of this, hospitals take the conservative approach: Attending licensed medical practitioners are prevented from prescribing medical marijuana for hospitalized patients, and create policies prohibiting the use of medical marijuana on their campuses.

For pharmacists and nurses the problem is this:

  • Pharmacists can only dispense medications prescribed by licensed medical practitioners. The federal government classifies marijuana as a Schedule I drug, which means licensed medical practitioners cannot prescribe it.
  • Nurses administer medications only with an order obtained from licensed medical practitioners.

Nurses may have run-ins with patients and caregivers unfamiliar with this policy, and a patient’s home medication routine may be disrupted.

Though it does not happen often, I had the experience of treating a chemotherapy patient expecting to smoke marijuana between infusions to control nausea and vomiting. Initially caught off guard, I struggled to find a way to manage the situation.

The campus did not permit smoking, tobacco or otherwise. When I reviewed the hospital policy, it confirmed that the medical marijuana was not an exception. I explained this to the patient, who was understanding, but skeptical.

Reviewing the premedication orders, the oncologist had done a good job of covering nausea and vomiting with conventional medications. I asked the patient to give it a try. Always having a plan B, I promised that if the medications didn’t work, I’d call the oncologist and, if necessary, the department manager.

Fortunately, the conventional medications worked. The patient enjoyed a hearty lunch and held it down. For the future, I recommended the patient smoke marijuana at home before appointments, and afterwards if indicated.

Several states have enacted medical marijuana laws. Do you work in one of them? How does this affect your nursing practice?

 

Oh, Did You Want Anti-Nausea Medications with Your Chemotherapy? You’ll Have to Pay Out of Pocket for That

   Note: If you are uninsured and diagnosed with cancer, you will probably find an oncologist and a hospital that will treat you. However, although your chemotherapy cost of tens of thousands of dollars is absorbed, no one will pay for the antiemetics (anti-nausea drugs) that your doctor will prescribe for you to take at home to manage the side effects of chemotherapy. (If you know something different, please post it in the comments.) So, if you don’t have any money, your oncologist will prescribe compazine (prochlorperazine), which is cheap, and used over 20 years ago, when people banged their heads against the toilet vomiting from chemo.  There are newer, more effective drugs, like Zofran (ondansetron) and Kytril (granisetron), that control nausea and vomiting. They are expensive. Uninsured patients usually can’t afford either. They don’t complain though, because they are getting their chemotherapy for free and they know they should be grateful. So they suffer. It’s the politics of health care.