2017 NCSBN Annual Institute of Regulatory Excellence (IRE) Conference - A
Historical, Legal and Evidence-Based Review of Medical Cannabis:
Implications for Boards of Nursing Video Transcript
©2017 National Council of State Boards of Nursing, Inc.
Event
2017 NCSBN Annual Institute of Regulatory Excellence (IRE) Conference
More info: https://www.ncsbn.org/9913.htm
Presenter
Mary Lynn Mathre, MSN, RN, CARN, Co-founder and President, Patients Out of Time, Founding
Member and Past President, American Cannabis Nurses Association
- [Mary] I'm going to probably start talking pretty fast because there's so much I need to tell you but
what I want to kind of give this overview is we've all been educated about marijuana as a drug of abuse.
The gateway drug. I had it through school back in the 70's, I was in the military got it through there so I
know we've all grown up with that. And this talk today I really am going to try to help you recognize
that we've kind of been fooled. We've brought up about marijuana this terrible drug, and we've lost the
knowledge of cannabis, a wonderful medicine, an ancient medicine to the extent that it literally you had
to grow it. In the states that I come from, Virginia, it was illegal for a farmer not to grow hemp because
it was so important for the rope and the fiber. But cannabis, you'll see in a minute, so I'm going to talk
fast, I know I'm going to sound sometimes unbelievable. I've tried to reference everything. Your last I
think 12 slides are references. Don't take my word for it, please. Look to the references. The information
is there. So today, a historical, legal, and evidence based review of medical cannabis. We all know
nurses. I'm a nurse, and I am so proud of it. I just looked the other day, I think there's about 640,000
physicians in the U. S. So we number 3.6 million. We are the most trusted. I always feel good about that.
And at my heart, I'm a patient advocate. And that's truly what this is all about. This is coming from the
patients. And we as health care professionals might not know about cannabis, but when you find a
patient, they know about cannabis, and they know about the drugs they've been given to treat some of
their problems. So the objectives. I want to go through the history of cannabis to let you know that it is
an ancient medicine. To describe the basic components and functions of the endocannabinoid system.
How many could tell me about what the endocannabinoid system is? Okay. We all have one. All
vertebrate animals have an endocannabinoid system. Hugely, hugely important. Biggest discovery of the
last century. Seriously. And so we'll talk a little bit about that. And then recognize the ethical and legal
conflicts facing nurses today as they relate to medical cannabis. So the background. Patients out of time
was started in 1995. My husband and I formed it basically to educate health care professionals and the
public about the endocannabinoid system and the therapeutic use of cannabis. We formed in 1995 it took
us five years until we could actually put on an accredited conference because no one would let us talk
about marijuana as a medicine. Our first conference was in Iowa. Iowa City, Iowa. At the University of
Iowa. And we got it there because the dean of the school of nursing, Melanie Dreyer, was at the time the
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dean. Melanie's research, she did groundbreaking research of pregnant women smoking ganja or
cannabis in Jamaica, and was able to show that it did not harm the babies. They've used it throughout
history down there. Back to Patients Out of Time, we've put on conferences so in 2000 we started a
biennial series and the research is coming so fast now, since 215 we do an annual conference and
outside there are some cards on our upcoming conference next May. It'll be the 11th national clinical
conference on cannabis therapeutics. And we bring people from around the world speaking about the
research since it's very hard to do the research with patients here in the United States. Out of our
conferences in about 2010, several nurses and myself formed the American Cannabis Nurses
Association. Today we're growing now that it's starting to take hold. We got probably about 500
members but it's growing. Once nurses learn about this they get terribly excited. Disclosure statement. I
don't have any industry relationship to disclose, and I will be discussing off-label use. I certainly haven't
made money on this. This is not a career-builder, believe me, to talk about cannabis. So if you don't
know, it's an annual plant, you have to grow it every year . It's a dioecious plant, meaning there is males
and females. And when you're talking about medical cannabis we're talking about the female plant
called sensimilla. And it's in the same family as hops plants. This, what you're seeing is, Dr. Jeffrey Guy
in England in one of his several secret places where they grow the cannabis that they use to make
Satavex. Those of you from Canada might well be aware of Satavex it's a whole plant extract of
cannabis. Can somebody bring me some water? Sorry about that. It's a whole plant extract. It's legal in
Canada and in about 23 countries in Europe and around the world. Not yet legal in the United States.
That's what they're after. If people haven't seen the plant, this is the bud, the cola of a cannabis plant.
That's the tricombs at the end is where most of the medicine is, the cannabinoids on the plant. That's just
a male flower. That's what they don't want in their crop. Cannabis as a plant. Hemp is in the cannabis
family, it's just low in THC. I'm going to talk enough about the basic of the plant. Cannabis has 60 to
100 different cannabinoids in the plant. THC is the one that gets you high. Has the euphoric effects. So
the hemp plant is low in THC, and it's grown mostly together because they want the stock. They use it
for rope, fuel, paper. We have hempcrete houses that are mold resistant and fire resistant. Very good for
any sick patient. And then we go back to marijuana. This is a new term. Mexicans called cannabis
marijuana. So back in the 1930's, American alcohol prohibition ended. We had Harry Anslinger with his
bureau of narcotics and dangerous drugs. He had all these cops. Hey what am I going to do, I need a
job? Well, the Mexicans are using this and the blacks down in the south are smoking reefer. So we had a
reefer madness campaign. Stories were made up about marijuana. And the marijuana tax act was passed
in 1937 which led to where we are today. So as I said, it's been used since recorded time. You can look
up on Google Siberian Ice Maiden, and you're going to read about this 25 year old mummy that was
discovered in 1993. Looks like she had breast cancer, as best, however they can figure these things out.
But through her DNA. But a pouch of cannabis was nearby in her. And it's been found in many other
tombs with shamen over the years. So here's a faint slide but this is Eli Lilly, a tincture of cannabis
product. In the middle it says the dose 10 to 30 minims. Continue taking. Increase until its effects are
experienced. So they knew there wasn't really an overdose problem with it. The next one, another Eli
Lilly, you see this one it says Cannabis Americana. And it's Cannabis sativa, American grown. They
were becoming into it. Now if you look at the very bottom of it, it says guaranteed by Eli Lilly and
company under the Pure Food and Drugs Act of June 30, 1906. So if you really think about it it really
was approved by the FDA in many things. This is a cannabis compound these were pills of cannabis.
This is a New York pharmaceutical company. Dysmenine very good for menstrual cramps. Queen
Victoria was prescribed cannabis for her menstrual cramps. This is a company out of Kansas City.
Again, this is pre-marijuana tax act. A painless corn remedy, they used a topical of cannabis back then.
And they had a corn plaster, I love this one because you can see that they had branches in London,
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Hamburg, Sydney, and Montreal. Again, a very popular medicine in its day. Cannadonna. Belladonna
and cannabis. Asthma cigarettes. They smoked it because they recognized it helped asthma patients.
Then along came reefer madness. Like I said, Harry Anslinger started this talking about cannabis and
they passed the marijuana tax act. So from 1850 to 1941 it in our U. S. pharmacopeia. You can go back
in your libraries and look it up. In fact, the University of Virginia where I practiced for many years as
the addictions consult nurse. We've got a historical room there, and so I went and grabbed all those old
pharmacology books of nurses, and there it is, cannabis. Listed it and in my Bloomgarten's book in 19...
I can't remember what year it was, before 1937, but it had three pages on cannabis and in bold it says it
relieves pain and induces sleep. And today, those are actually probably the two main reasons people use
it. Anyway, they pass this. No, Dr. Woodward was representing the American Medical Association and
among his testimony to say don't do it, he says "the prevention of the use of the drug for medicinal
purposes can accomplish no good and whatsoever. How far it may serve to deprive the public of the
benefits of a drug that on further research may prove to be of substantial value. It is impossible to
foresee." I'm going to be telling you about the endocannabinoid system. It was impossible back then to
foresee. Now that we understand this, it's immensely important to all of us. So we all know it's a
schedule one drug. What does that mean? It's forbidden. Schedule one along with heroine, LSD, peyote,
MDMA or ecstasy, marijuana. If you look down to schedule three, it's hard to read, that's dronabinol,
that's marinol, synthetic THC, and sesame oil. So stuff from the plant, the only chemical in the plant,
that produces the intoxication, we've taken out and made a pill and you can have that. You can't have the
plant that will never get you that high, that will never be pure THC, is illegal and forbidden, but you can
get the pure stuff and it's in schedule three. It was in schedule two, but since there was no diversion,
they've lowered it, about five years later they lowered it to schedule three. So I'm going to talk about the
fact that it is in schedule three, it doesn't belong there. And again I just want to say I'm really glad to be
talking to the state boards of nursing. I know in the regulations, the whole point is safety for the public
and protecting our patients from that, and yet we've got this prohibition that is really causing a problem
for nurses because it is a forbidden drug. Okay, so to be in schedule one we have to meet three criteria.
Not safe, highly addictive, and no medical value. And specifically no therapeutic value it says no
currently, this is quotes "no currently accepted medical use in treatment in the United States." Well, we
know today there are 28 states with medical cannabis laws, so it doesn't fit that. So I'm going to first talk
about the therapeutic value, then the safety then the addictive so we can kind of get a sense. The Institute
of Medicine in 1999 , its second study they did, they did one back in 1972 marijuana and science and
basically said it shouldn't be prohibited. This one was specifically looking at the science of medical
cannabis and they basically said it does have medical value. The federal government has a patent on
cannabinoids as antioxidants and neuroprotectants, and there's an article in there that really goes more in
detail about it and I encourage you to read it. Because it's talking about using it for a lot of things such as
Alzheimer's, and other neurodegenerative disorders. Strokes could be very important. So this is a long
list, and you kind of say "how could a medicine do all of that?" And I ask the same thing. I mean, I
would talk to people, I would get all excited to try to tell someone "Hey, cannabis it's really a good
medicine, it's good for glaucoma, and it's good for nausea and vomiting, and it's good for patients with
multiple sclerosis." And their eyes start kind of, you know, going "yeah, yeah" you know, where are you
in nana land or something? Because nothing does it like that. And you're going to know why. But
clearly, this as cannabis, and as we talk about the endocannabinoid system, has these properties. That's
amazing. Analgesic. Anti-ametic. Appetite stimulant. Antioxidant. Neuroprotectant. Relaxant. Decreases
intraocular pressure for glaucoma patients, very important. Anti-inflammatory. Anxiolytic.
Antipsychotic. Antibiotic. Anti-neoplastic. Kills cancer cells. Bone stimulant. Anti-depressant. It's
amazing to say. And again you'll hear more about it. I threw this quote in by the Veteran's Affairs Robert
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Petzel who in 2010 he was the undersecretary for the Department of the VHA and what he basically was
recognizing was this was very important for veterans. We're losing, the VA says 22 suicides a day.
Veterans specifically will say it's more like 50. Because many of them are no longer in the VA system.
But it's either suicide or overdose and most of it is not just their post-traumatic stress or traumatic brain
injury, it's the combination of the poly-pharmacy they've been prescribed. The meds have made them
feel like they're going crazy. Anyway, he recognized this so he passed a directive that if a veteran's in a
state with a medical cannabis law and they get a recommendation from a civilian physician, then they
can use it and the VA won't punish it. That's great news but it's also not fair. Veterans fight for the
United States, so a veteran in California could use the cannabis but a veteran in Virginia can not. So
we've got a dilemma there. Dosage and administration. Just again going on its use that it has a
remarkably wide margin of safety. They're stronger today than years ago? Yes. The prohibition has
made it so. It's not its normal plant. Normally this is a balance of cannabinoids. Because of the
prohibition growers have learned to grow it very high in THC. Not that it's that dangerous but for the
most part when we talk about medicine, I call it stoner pot, and you certainly don't want to give your
patient stoner pot. You want to give them medical pot, a more balanced plant. And you see the THC and
CBD. CBD is one of the most well-studied non-psychoactive cannabinoids. I shouldn't say nonpsychoactive. It has effects in the brain but not-intoxicating would be more appropriate. Now the
synthetic cannabinoids, I worry about them. These are very strong because when they're doing research
they want to target something so they can see how it works in the human body or in the animal bodies,
and these are getting out in the, kids are using it. Not a good thing. So we clearly, synthetic cannabinoids
have nothing to do with the main plant. I'm going to say raw juice from the plant. You'll learn that this
plant in its natural state, I consider it a green leafy vegetable, and I was brought up to eat my green leafy
vegetables. It is not psychoactive when it's fresh and raw. It doesn't taste so good. So people do
recommend juicing it if you want the nutrition from it and we'll go into that a little bit later. This is just
to let you know, smoking cannabis, everybody says you can't smoke our medicine. And maybe it's not
the best way. Research says it's not that dangerous. But if you want a quick response to cannabis, you
can vaporize it. No burning, no smoke, but vaporizing it. And we vaporize other medicine's we're used
to it. But there are other forms of delivery. In fact in Colorado, Mary's medicinals place makes
transdermal patches they put on your wrist or someplace and they'll last 12 hours. Excellent medicine.
These are some of the medications that are out there. Satavex is the extract of the whole cannabis plant
that is made in England. And as I said, legal in many states. Canasol, Asmasol, Canavert, are products
made in Jamaica . They use it for eye drops for glaucoma patients and the Canavert for arthritis. But
then other people are making their butters, tinctures, savs, etc. So not safe for medical use. This is a huge
issue for nurses. As a nurse, my heart could start beating like crazy when I left a patient and thought I
made a mistake. Gave the wrong drug to a patient or gave the wrong dose or something. And it
happened. I did. And I'd be panicked. What did I just do? This is a huge issue. I mean what you can feel
comfortable with cannabis is there is no way you're going to hurt somebody. No recorded deaths from
cannabis. The LD50. The lethal dose of 50 percent of the animals that we do with all the drugs is about
20 thousand to 40 thousand times like one marijuana cigarette. Or 1500 pounds consumed in 15 minutes.
You can not kill somebody with cannabis. And I'll explain that in a little bit. Here's, it's hard to read, but
this is just talking about deaths from drugs and you can see heroine down there. One in six. And they've
got the one in 20 thousand from cannabis. It just doesn't happen. These quotes here are by Francis
Young. He was the administrative law judge for the DEA. There was a petition against them started in
1971. It didn't get its hearings until the federal government kept blocking it, but finally in 1988, Judge
Young ruled, and he said it doesn't belong in schedule one. And he said "marijuana in its natural form is
one of the safest therapeutic substances known to man. It would be unreasonable, arbitrary, and
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capricious for the DEA to continue to stand between those sufferers and the benefits of this substance in
light of the evidence in this record." That long ago. But what happened? The administrators in the DEA
said "We don't care what he says". It's staying in schedule one." The Institute of Medicine in its 1999
study says "Except for the harms associated with smoking, the adverse effects of marijuana use are
within the range of effects tolerated for other medicines." If you look at side effects. Again, I'm just
talking fast and these are in your notes, you can look at it. But if you look at that, there's nothing
permanent. No permanent damage from anybody who tries it. If it doesn't help somebody, fine, don't try
it. But at least you're not leaving them with any kind of liver damage, kidney damage, whatever else
could happen. But we do have huge problems with the prohibition. Most patients don't know about the
other forms, and they aren't readily available, and they aren't available in a regulated market where the
patient has quality control on the products. So most of them smoke it. Again, it's not the harm we
thought, it clearly isn't the harm, it's less harmful. And I would quote you, if you look in the back you're
going to find a reference for Tashkin. I think I made a typo there, it's Tashin. Put the K in there it's
Tashkin. A leading pulmonologist at UCLA did long term research to show that there's not damage. But
still we don't want patients to smoke. But without the quality control patients don't know if they're
getting something that's been contaminated by pesticides or heavy metals. They could have the wrong
strain or variety of the plant. There are some that are more like, they say more heady and some are more
relaxing, body relaxing. And there's no consistency. They find something that works, well, if you're in
the illegal market how do you know you're going to get something that works the next time. And the
legal consequences. People are getting arrested all the time . The people who are in jail and in prisons
for drug related crimes clearly most of them are for cannabis related issues. People have lost their
children because of it, they've lost their homes because of testing positive for cannabis, for getting
caught with cannabis. And of course the worst thing is we don't know anything about it, as health care
professionals we're not taught about it, so they don't get any medical supervision from us. They're on
their own. And this, it might be a joke, but its very serious. People have been killed. SWAT teams going
into homes because someone's growing marijuana, or we think they're dealing marijuana. And they've
killed people. They've killed a heck of a lot of dogs. First thing they do is they do is shoot the family dog
and then put people down on the floor or whatever. The stories have been horrific. It has been this. And
sometimes it's the wrong house. So highly addictive. As I said earlier, I'm a certified addictions
registered nurse I did addictions consulting at the University of Virginia for many years. And I will
counter that, I'll show some research that does show that. This is just a, it's an old reference here, but
everybody still uses it to show, we clearly think tobacco's probably more addictive than 32 percent of
the population, but nine percent for cannabis. Lower in that regard. This slide was by leading research
substance abuse experts asked to rate these six drugs, and if you look at cannabis, the dependence that
they use there, their definition of that was more on a substance use disorder. Cannabis use disorder, or
addiction. Not physical dependence. So they found it the least addictive. The least serious withdrawal
symptoms. The least problem with tolerance. Yes it's more reinforcing than caffeine, and yes, it's more
intoxicating than caffeine or cigarettes. Okay, but fairly safe. The withdrawal symptoms, this is in your
DSM five which gives all the criteria about cannabis use disorder. Again, it's a questionable thing, and
as we talk a little further you might kind of wonder because many patients have used cannabis for sleep.
They've used it for depression. Now if you take away their medicine, they don't have their medicine
anymore. But anyway. You'll never hospitalize a patient for for cannabis withdrawal as you will for
benzodiazapene withdrawal or alcohol withdrawal which can be very serious. So the Institute of
Medicine, its book, "Marijuana and Medicine: Assessing the Science Base," basically they did an
executive summary. I think you can still find it online. But basically it does have medical value. It is as
safe as other medicines. It is not highly addictive. And it is not the gateway drug. They ruled that out.
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Basically the problem there is the illegal status is the gateway because a person has to go to a drug
dealer and he'll say "hey, I don't have any, but I've got some cocaine for you. Or I've got some
methamphetamines or I've got whatever, heroine." So and that's been proven over and over. But here we
are now. The blue states are those that have medical cannabis laws and legal for adult use. The green
states are those states that now have medical cannabis laws. The sad part is probably every state law is
different. What you can recommend it for in California is different than what you can recommend it for
in Minnesota. In some states you can't have any edibles or tinctures. In other states you can't smoke it or
vaporize it. It is crazy. In some states a nurse practitioner can recommend it. In most states a nurse
practitioner can not. New Mexico is one of those with a nurse practitioner because it was a nurse
practitioner who actually wrote the law to get it passed in New Mexico, Brian Crumm, and he made sure
nurse practitioners could do it and it's the only state law that calls it cannabis so hooray for nurses.
We've also got an additional 17 states I think it counts that have CBD only. How many saw Sanjay
Gupta's program, Weed? Anybody? You can look on the internet Sanjay Gupta the CNN reporter
finally, he's always been saying it's terrible. Well finally he went and did some research. And so he did
Weed and then he did Weed two and Weed three. And basically what he's saying is "Hey, I realize I've
been duped by the federal government and I apologize to all the patients who I dismissed you when you
told me cannabis was helpful." And in the story he highlighted a young girl. A six year old twin,
Charlotte Figi, who had Dravet Syndrome. That terrible seizure disorder. I think she had like it was
hundreds of seizures a day. She literally died a couple times. So she's six years old, kind of a little kid in
a fetal position, can't talk, can't walk. And her six-year old twin perfectly fine, cute little girl. And they
happen to be in Colorado. And were desperate because they tried all the medicines you could try, and
finally there was a group of brothers, and they this high CBD cannabis strain, low in THC. And when
you have CBD with THC it actually will dampen down the intoxicating effects of THC, so THC has a
lot of good value but when you have the CBD with it it will dampen down the high. The euphoric
feeling, so it's more of a balance. So they found a strain, they developed s strain really high in CBD very
low in THC and they tried it on her. Mom gave her a little in a tincture and they watched, no seizures.
They watched for a couple days, no seizures. I think in the first week she had one seizure. And so the
legislators around the country, not being health care professionals, being lawyers, they thought they
knew what they were doing and they were going to help those patients so a lot of states within just a
couple of years passed CBD only laws. Virginia is one of them. If you can see those with an, and most
all of these laws are for kids with seizure disorders, the ones with the asterisk after them such as Florida,
Georgia, and Louisiana are okaying it for cancer patients as well. People could use CBD for cancer.
Again, I'm not knocking CBD, it is just not at all as powerful if it's by itself. So here's the big discovery,
we now know we have an endogenous cannabinoid system. We make cannabinoids. This is huge. It's
probably th ebiggest discovery of the human body, that and genomics. What we're learning with
genomics. And the two go together. Believe me, the research is exploding in this arena. But it's a
molecular signaling system in the human body and its whole purpose is to keep us in balance to help us
maintain homeostasis from whatever stressor. From pollution from a poor diet, from bacteria, from
fungal infections. You name it, it's there to protect us from physical stress, from anything like that. And
it's in all vertebrate animals. Insects don't have one. In 1988 they first found out we have receptors in our
brain. That made the news a little bit. People who were into smoking pot for the fun of it were like
"Yeah, we're wired for pot." And the researchers said "No, no, no. There's more to it." So four years
later they found the first cannabinoid. They called it Anandamide which means bliss in Sanskrit. But
they found that we make a cannabinoid. By 1993 they found other receptors. So these first receptors,
CB1, cannabinoid receptors first found are found in the brain. Primarily in the brain. All over the brain,
except the brain stem. Which kind of explains why you can not overdose on it. We don't have many
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receptors in our brain. It's not going to stop your breathing , it's not going to stop your heart rate. Then in
'93 when they found the CB2 receptors those primarily in the immune system. Now today we know it's
literally throughout our body. By 1995 we found another cannabinoid. It's got a long name as you can
see. We simply refer to it as 2AG. By 2000, they found that we have receptors in the spinal cord. The
endocannabinoids trigger feeding in newborn mice. In the animal world, if you block Anandamide in the
mouse, all of the babies die. They don't know to eat. They don't know to go suckle. And the cannabinoid
receptors found in the lungs which helped explain the asthma in the airway issue. The thing about
endocannabinoids is we don't have a level. You can't do a blood level and say "What's your cannabinoid
level today?" They're made on demand. Something happens to the body and it stimulates the making of
this. And again, it's talking about how you degrade it, that's important. This is just to help you
understand it's that lock and key. You know, it's just like any other neurotransmitter they fit into a
receptor and then the action happens. So the cannabinoid fits into the cannabiboid receptor and it starts a
series of actions depending on what its purpose is at that time. The issue is that it regulates other
transmitters, so I think we're all most familiar with GABA which is an inhibitory neurotransmitter and
glutamate, an excitatory one. The endocannabinoid system, it gets released when it needs to slow
something down or speed something up, So it can interfere with these. That's one of its main purposes.
As it says it can put on the brakes when toxic level of excitation is approached. And this is unique. It's
retrograde. So something's made and it crosses the synapse of a cell and acts on the post side of a nerve
cell. They actually the cannabinoids are made on the post synaptic side travel back to the pre-synaptic
side and that's where they have their effect. They will stop something or speed something up depending
on what you need to maintain homeostasis. This is happening every day, every minute, every second, all
throughout our body depending on what we need. And to date no pharmaceutical drug can mimic this
synthesis upon demand. The body knows when it needs it. So if you look at the whole system now that
we're understanding, and understanding more and more of it every day. We've got our receptors, we
make our cannabinoids, and then there are these synthesizing and degrading enzymes that are all part of
this system. And research you'll see some of the articles there there's a huge one by Pacher in your
reference list that really goes into detail about the potential in medicine for this. And a lot of it is do we
block some of these synthesizing enzymes or if we want some level to stay there longer, should we
block the degrading enzymes so that it doesn't get broken down, it still remains active. So there's a lot of
ways they're looking at how this can fit with medicine. Vincenzo Di Marzo is an Italian researcher who's
probably, well he is, more published than anyone on the endocannabinoid system and he summed it up
that the endocannabinoid system helps us eat, sleep, relax, protect, and forget. Hugely important. You
can guess the eating, nausea and vomiting taking care of that stimulating the appetite. Sleep. Best sleep
medicine around. Relaxing. Whether it's relaxing the excitation of transmitters going for seizures,
relaxing muscles, relaxing an anxious patient. Many ways to look at the relaxing. Protecting.
Neuroprotectant. It is your body's defense against cancer. When there's a cancer cell in your body, the
endocannabinoid system kind of wakes up and starts the chemical process of apoptosis. Cell suicide. It
makes that cell die. Those of us who don't have a healthy endocannabinoid system, and genetic factors,
and other factors, the cancer may take hold. But it protects in that way. It actually can regenerate nerve
cells. Very important for traumatic brain injuries, for strokes, for any kind of issue to the head with
trauma. And forgetting probably the biggest area, women can relate to it, it's responsible in many ways
for forgetting child birth pain. Because if you remember how much it hurt, you might not have another
baby. But it's also it's more of a survival thing. So think of post traumatic stress. A lot of people with
severe post traumatic stress can not move forward in their life because they are just bombarded with the
horror of whatever they went through. This helps them forget that. Put it in the back of their brain. It's a
survival piece. Now to me, one of the most amazing new things these days is Ethan Russo who is one of
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the leading researchers on cannabis. He's a pediatric neurologist now living in Washington, but he came
up in 2004 he wrote an article about the clinical endocannabinoid deficiency. And the science was really
clear at that time to say it's an endocannabinoid deficiency is the cause of fibromyalgia, is the cause of
irritable bowel syndrome, is the cause of migraines. Give them cannabis, and maybe you can right this
system. He just wrote a newer article again its referenced in your list, that he expanded on that. Now the
research we're looking at for motion sickness, for multiple sclerosis, diabetic neuropathy, Huntington's
disease, Parkinson's disease, post traumatic stress symptoms, major depression, anorexia nervosa,
autistic spectrum disorders. This is huge. And think about it. We have this system. What are we doing
today? Our diet is terrible. A lot of processed food. And we are what we eat. If we aren't eating well our
own endocannabinoid system can't function well because it's depleted as well. I bring that up because as
nurses, we can, all of you today, you know, if you don't need to supplement it now, you want to think of
raw cannabis. You're going to get nothing psycho active if people take the juice of that plant. And
actually for our next conference I'm asking somebody to talk on cannabis sprouts because the cannabis
leaf would taste terrible. But the cannabis sprouts might be tasty to put in your salad. But you can take
this raw. There's nothing psychoactive but you get these cannabinoids, Fito, plant cannabinoids in it,
clearly nutritious. The hemp seed oil, which is legal, you can by that anywhere in a health food store. I
encourage many of you to talk to your patients about using it. Use it yourself. It is probably... Andy
Weil, Dr. Andrew Weil if people know him with integrative medicine, he says it is the most perfect oil
for human consumption because of its ratio of essential fatty acids. And that's just a slide to kind of
show these other places where you look flax seed oil or others to get your essential fatty acids. Hemp
seed oil wins. The other point. Cannabis, Marinol, not the same thing. Marinol is synthetic THC. The
one thing that's curious too, when you take it by mouth and you swallow it, it actually in the liver will
get converted to what's called 11-hydroxy, THC, more psychoactive than cannabis. So that's why a lot of
patients prefer to smoke it, inhale it, or even take it sublingually. Satavex is a sublingual spray. You
spray that whole extract in your mouth so it gets absorbed into the bloodstream and works before it gets
degraded and is more psychoactive. But that's why a lot of patients don't like the Marinol. They really
feel dysphoric. Not everybody. But a lot of patients feel very dysphoric from it. So then you've got the
plant. Yes, it's got a lot of chemicals but so does a tomato. So does garlic. Plants have a lot of chemicals.
That's nothing to fear. And this is just to show you some of other cannabinoids there have different
effects. These chemicals all work together. Again, just to make sure I can get through this whole thing.
The idea here too is besides the other cannabinoids there are other components in the plant. And one of
the biggies is terpenes. We're finding out terpenes are really important. Those in California and some of
the states where they've had years of work with cannabis, they're really becoming very... they're doing a
very scientific approach. Really keeping track of measuring what's in the cannabis they give to patients.
Keeping track of the results and learning what's going on. And depending on which terpene you have, it
might help with the effect. I think mercine is really good when you want sleep or for somebody to help
relax somebody. So they'll want to get a cannabis plant that is heavy with terpenes. But anyway, these
plants work together just like other herbal medicines so that they counter any negative effects and help
boost the positive effects. It's called the entourage effect. We'll talk about that in a minute. Raphael
Mechoulam who is probably the leading researcher. He's the one that first isolated THC back in 1964. It
was his lab that discovered Anandamide back in 1992. Clearly, almost every researcher spins out of
Mechoulam's lab. But he's talking about why the whole plant. And "this type of synergism may play a
role in widely held but not experimentally based view that in some cases plants are better drugs than the
natural products isolated from them." So don't just take something out of that plant. Use the whole plant.
And in this case it's a very good plant to use. And John McPartland who is a DO up in Vermont says
"the whole is greater than the sum of its parts," speaking of cannabis. So today we are in this what we
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
8
know as single drugs. We primarily, you know, that's what they study are specific chemicals together.
The problem is they might really work someplace but usually have side effects someplace else and they
cause damage or an imbalance in the body someplace else. And, as you probably know with these
various tough illnesses, chronic illnesses that we have to deal with, you start getting to poly pharmacy.
Whether you're medicating for the different symptoms, post traumatic stress is a great example because
they're medicating usually if it's a veteran you're medicating them for their pain, you're medicating them
for their depression, their anxiety, their lack of sleep, and all of these medications together create a real
problem. Whereas a natural plant, you get one medicine but many constituents in it that have a synergy.
This slide just to kind of help you know the terms. Cannabinoids similar groups of plants. So we've got
our endogenous ones. The phyto plant, the phyto cannabinoids from the plant and then synthetic
cannabinoids such as dronabinol and HU-210 is another one that's used in research. As antioxidants, this
is from the patent, the information on the government's patent. "Cannabinoids have been found to have
antioxidant properties and are found to have particular application as neuroprotectants, for example in
limiting neurological damage following ischemic results, such as stroke and trauma, or in the treatment
of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and HIV dementia."
Wouldn't you want to be able to use that? As an anti-bacterial, how about this one? "Cannabidiol
showed potent activity against a variety of meth resistant Staph strains." Against MERSA. Now
wouldn't that be nice? We have some serious problems here with our standard drugs that are out there.
This is a very busy slide, I don't expect you to loo at it, but look at Izzo. The article by Izzo in the back
that's referenced. You'll see this. He wrote an article specifically about the non psychoactive
cannabinoids in the cannabis plant, and on top it's just showing there's more research done on CBD so
it's trying to just give you the list of attributes that CBD has. Anti-bacterial, anti-spasmodic, anti-seizure,
etc. So how to find the right dose? Again as I talked before about safety, and that's what we care about,
for nurses who are getting in and starting to work with patients who use cannabis, we just use a simple
thing at this point in time. Start low and go slow. My next picture, this is Cathy Jordan. And I'm really
happy to say this is Cathy Jordan up front in the wheelchair. And I'm going to get wrong on the years
but I'll say over 30 years, Cathy has been diagnosed with ALS, Lou Gehrig's disease. She's supposed to
be dead. In fact, the insurance company was going to cut insurance on her I think because you're
supposed to be dead. But Cathy is a very strong woman. She was not liking the idea of what her life was
going to be and she actually was going to plan suicide and save bills. She happened to be down in
Florida. Wasn't living there but she came down visiting friends who said "Let's smoke a joint." And she
knew from just smoking that she could feel something change in her body. I encourage anyone to talk
with Cathy later. It's an amazing story. She is the poster patient for the state of Florida. The legislators
that have been trying to get that law passed as the Cathy Jordan Cannabis Law. But over the years she's
learned. They tried different strains and so she's figured out which one really works for her. They're
allowed to grow it. Her husband is a Vietnam vet, Bob. They're allowed to grow the cannabis for her,
she's had angels over the years who have grown it for her, risked everything by going across state lines
to bring her the medicine, but she's survived from this. And frankly I can say, and Cathy will probably
admit, she's gotten better with it. When I first met Cathy I had a really hard time understanding her
speech because of her nerve loss. And I can understand Cathy on the phone now. It's amazing. And I just
want to say that because that's what it took. One inhalation of smoking, she could feel something change
in her body. It's an amazing medicine. Didn't have the right strain then, but she learned. And the other
thing that's funny about her is she'll continue to use a cigarette for the most part because it does make
her cough. And that's essential for her to make sure she doesn't choke on her secretions. So anyway, let's
go back with more science. The animal studies, just to let you know, well, you all know we have an
opioid epidemic. It's a huge problem. This is just going to tell you a little bit about how cannabis and
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
9
opioids can work together they literally do work synergistically. There's so much stuff I've got to cover
here. The fact that this was a study that was done. Morphine being 15 times more active in rats with
small doses of THC added. And the tolerance to the opioids is slower when you add cannabis. So instead
of your patient needing higher and higher doses all the time, you bring in cannabis, they will lower their
doses and there are more studies to say that. Finally JAMA came out with their article say the "use of
marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by
high-quality evidence." They finally admitted that. We're talking here again, whole plant more effective
than THC. This is looking at you have many studies that are looking at THC, and they've been fairly
positive, but again when you compare it to the whole cannabis, the results are just different. This study
here was done in 2016, 176 pain patients using cannabis for 6 months, they not only had better pain
management and were more functional, their opiates decreased by 44%. Donald Abramson, California,
his study of 21 patients on sustained released oxycodone or morphine, they added vaporized cannabis.
What happens if you add that to them? It lowered the plasma level for the opioides but yielded a
statistically significant reduction in pain. Bachhuber. This study has gotten around. This guy looked at
the states. He compared medical cannabis states with non-medical cannabis states and there was 24.8%,
almost a 25% decreased mortality from opiates. And in the states that had a cannabis law longer, it was
higher. It would be up to 33%. So the longer a state was using cannabis, more patients were aware of it...
no, it didn't prove that, but I'm making an educated guess that gee, they were using cannabis instead of
opiates or using fewer opiates. JAMA again suggests that "medical marijuana should be a part of policy
aimed to prevent opiate overdose." Again another study to show that in Michigan, which is a medical
cannabis state, they looked at 244 chronic pain patients at a dispensary. They found a 64% lower opioid
use and an increased quality of life. And they use fewer medications, side effects because of fewer
medications used. This one, Bradford and his daughter who's a graduate student, he's a PhD in
economics, did a study on looking at the states, the primary diagnoses that they use cannabis for, and he
looked at those diagnoses and the cost in Medicare Part D and literally found that the decreased
prescription drugs for which cannabis could serve as a clinical alternative in states with medical
marijuana. A significant decrease. He's also done one it's not been published yet, I know they submitted
it, but he found the same thing for Medicaid patients. The savings is enormous because patients quit
using a lot of the pharmaceuticals and get better results with cannabis. So addiction treatment. Now I
used to run a methadone clinic years back so I'm very well aware and if people don't, methadone
maintenance is an outpatient thing. So the opiate patient comes to you, you assess them, you're going to
start them on methadone. You have to start them on a low dose by law, because you know, we could kill
them easily. So we start at a low dose. They go home. They come back the next day. We assess them.
We up the dose until we finally get to whatever dose they need. This is a very dangerous time. These are
addicts. They go home, they're feeling crappy. That little methadone took the edge off but it didn't help,
so they go out to the street and they get something. So during the induction period of patients in a
methadone treatment program, that's the highest death rate because patients are out there and they
happen to take some other medication they're used to. Whether they're going to take heroine or they're
going to find some Vicodin, whatever they're going to find, and it happens to peak at the same time the
methadone peaks. And they don't wake up. So anyway, they did a study here and looked at those who
use cannabis during that time frame and associated it with decreased symptoms of opiate withdrawal.
And basically their conclusion was "Hey, this would be a good drug to use when we're starting patients
on methodone to make sure they don't go out and use something dangerous." And a 2009 study in New
York State Psychiatric Institute was using naltrexone. Naltrexone used to fight addiction by negating the
effects of a drug such as heroine. They found a higher retention if they added cannabis in the treatment
protocol. So cannabis with opiates. It's opioid sparing, people use less. Takes care of nausea and
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
10
vomiting that a lot of people have with opiates. You don't have the constipation problem, with lower
opiates it helps the bowels move regularly. Acts as an anti-depressant. Acts as an anti-inflammatory
agent. No significant withdrawal symptoms, and it helps with sleep. So from a nurse's perspective, this
is just wonderful. From a harm reduction, from an addictions nurse, I see it as opiate sparing that's good.
We can see it as detoxification medication. I have an old Eli Lilly model of tincture of cannabis and on
the label it says that they use it for alcohol withdrawal, DTs. And they also use it for those habits of
chlorohydrate and morphine. So back in 1913, 1915 they were using as a treatment for drug addiction.
We aren't doing that today. And just for the fun of it, note that one other indication they had at the time,
"for those periods of temporary insanity peculiar to women." Cannabis we call it in the States, and
actually it was a Canadian that coined this term calling it an exit drug as opposed to a gateway drug.
They found, they've done mostly patient surveys but in Canada and several in California. You can look
for Ryman and Phillip Lucas in your references. But they're finding patients with alcohol problems,
tobacco smoking, methamphetamine, heroine, other opiates, cocaine, cannabis helps them get off of that.
It helps put their body back in balance which has been taken totally out of balance by the drugs of abuse.
It gets them back in balance and a lot of them use it to get off and stay away and their fine. Some do
maintain with it and literally call it then a substitute drug. This quote here again from Petzel with the
Veterans Administration was basically only reminding the VA docs "If a veteran obtains and uses
medical marijuana in a manner consistent with state law, testing positive for marijuana would not
preclude the veteran from receiving opioids for pain management" so that could still get opiates. Well
that's good. But what happens now when patients get an opiate, 9 times out of 10, 99 out of a hundred I
bet they've got to do the contract, and part of that contract is random drug screening. There is a purpose
for that. There's a good purpose for that. If they're prescribed some drug, you want to see that drug in
their system and not other things. But the problem is we've always tested for cannabis too and a lot of
health care practitioners have punished patients. They've kicked them out of the clinic, you know, "I'm
not going to treat you anymore if you use that," or you go to a drug treatment program and then maybe
we'll see about this. So now the CDC with this opioid epidemic, and I've got that reference in your list,
the CDC came out with guidelines for docs for prescribing opiates because we've got this huge problem.
It's number 10 of the recommendations. "Clinicians should not test for substances for which results
would not affect patient management or for which implications for patient management are unclear. For
example, experts noted that there might be uncertainty about clinical implications of a positive urine test
for tetrahydrocannabinol. Basically, they're saying it as best they can but you might not want to test for
THC. If you're going to test and then punish the patient for using it because it is a smart thing for the
patient to use. Effective delivery this is just more information for you in terms of knowing there are
other ways to give cannabis. But it gets down to the meat of what is a good nurse supposed to do? What
do you do if you've got patients, and I get phone calls, I get emails, every day serious problems. I just
got a nurse in Virginia this morning. I opened my email, a nurse I know in Virginia has a cancer patient
who wants to use cannabis who was used to using marijuana before, and so they thought we'll let you
have Marinol and it's just not helping, so now as he said, now they're looking at black-box warning
drugs for the patient. He's just troubled by that. It's like we're going to go to more stronger drugs to try to
help this patient deal through the chemotherapy of their care because cannabis is not an option. Cannabis
which can not kill anyone. So we've got treatment by geography, I talked about that. How about the
nurses with multiple licenses? Working in Virginia, hey, it's illegal. CBD only for seizure patients. You
go up to Maryland, oh maybe these patients can use cannabis I can talk about it with them. Go over to
this other state you can't. Or you have to know the different laws in each of these states. That's a very
very difficult problem. From a nursing standpoint again with the poly pharmacy what we're seeing and
at our conference we're going to do a big focus on the fact that geriatric patients are getting off tons of
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
11
medications and walking around in the nursing homes, talking to the patients, hospice patients are
having last words with their family using cannabis and getting of the other medications. The other thing
nurses, we are necessary for patients to give them good advice. In some of the state laws, the doc can
right a recommendation, and then they cant do anything else. They can't tell them where to go find it,
which is a good dispensary. What should I use? They don't know, they're clueless. They're not supposed
to advise that. They can just say I think the patient would benefit from cannabis. So they're left out in the
lurch. Nurses have been doing it. I do know a nurse in California who literally did call the state board,
what do I do? She was running an assisted living, and two family members came about their mom who
had lot of pain, was on a lot of meds, and mom was not making sense. Mom was miserable. Life sucked
for Mom. And they said, "We want to try cannabis." "Okay," she says She goes to the physician and
says, "They want to have cannabis for their mom." Okay. He writes out a recommendation. He'd known
about it. Writes up the recommendation, gives it to her and she's like, "Okay well, now what do I do?"
She calls state board and says I'm doing this, is that okay? And they kind of say "Well, treat it like a
narcotic and use your best judgement." So she calls a dispensary thinking "Oh what am I going to get."
And she finds somebody "Oh, we do deliveries. We'll deliver it to you." So they deliver her a cannabis
oil that they've used for elderly patients and he advises her how much she should give. And she's scared
to death to do it. And the patient's saying, "Give me the stuff and let me use it". She's like "I want to try
it." So she gave her a smaller dose than what they thought. And went about her business and about a half
hour later she thought how are they doing, so she calls up the woman and says "I'm fine. I'm a little
hungry now, but I feel fine." Months later, she was off all of her medications. And all the other
medications. The sad part is, years went by, she got sick, had to go in a nursing home. Nursing homes as
hospitals are scared to death of allowing a schedule one drug in there, so they took it away. And she was
without her medicine anymore. But okay, I have a few minutes left. Obviously, nurses need to monitor
the effects of the drug. If we don't know the patient's using it, how can we monitor the effects? You'll be
surprised. If you open, any nurse who starts talking to a patient about it, they will admit to it, but other
than that, they're scared to death because they're scared of what's going to happen if somebody knows
they're using it. But the biggest thing again as a nurse we are an advocate for patients, so we've got to.
Now the good news is the ANA does have a position statement. The new one that came out in 2016 part
of it supports protection from criminal or civil penalties for patients using therapeutic marijuana and
related cannabinoids as permitted under state law and exemption from criminal prosecuting, civil
liability, or professional sanctioning such as loss of licensure or credentialing for health care
practitioners who discuss treatment alternatives concerning marijuana or who prescribe, dispense, or
administer marijuana in accordance with professional standards and state laws. So the ANA is trying to
be supportive. Laura Basick, who is the Director of Ethics and Human Rights for years was invited to
our 2004 and 2006 conferences and then she spoke at our 2008 conference basically stating that the
ANA certainly does support patient access to it and does support nurses talking about it. And this last
little thing is just there are ways, again nurses need to talk to patients that they need to know where it's
grown, that it needs to be organically grown, that it is that safe, that you just start low and slowly
increase the dose. Nothing bad's going to happen. The vaporizing, the smoking, if they smoke it's the
Cheech and Chong smoking that will get people in trouble. Inhaling, holding their breath forever and
ever, keeping the smoke in their lungs, not good. Inhale, exhale would work better. Edibles not
dangerous, but you don't feel the effects right away, it might take two hours until the peak effects, so the
patient eats the brownie, I don't feel anything, five minutes later eats another one. An hour later, they're
flat on the floor and they can't get up. It'll pass but it's miserable for a while. Bottom line comes down to
we really need to get this plant free again. It is a plant. And we need to have all the products regulated as
they should be. I think you all got handouts. As I said as founding member and past president of
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
12
American Cannabis Nurses Association literally just passed this resolution about educating nurses on the
ECS. So whatever the state boards of nursing can do since you have to deal with the NCLEX, but those
who teach nurses to get it into the curriculum that we really need to understand the endocannabinoid
system. We need to know how it works, why it works, and that endocannabinoid system, the fact that it
governs the whole body, to me, that was the answer. It's like, "Oh, no wonder. No wonder it helps with
glaucoma and puts the pressure back in line." The nausea and vomiting, the spasticity, the seizures, the
whatever it is, it's affecting this system that affects our whole body and keeps us out of harms way. So as
I said, those are the references, and the other thing I want to just point out real quickly. Joy's, that book
there, the first of the books listed, that's the Institute of Medicine's. And so I've got breaking news for
you. And please take this down. Just released. The Health Effects of Cannabis and Cannabinoids. It's
literally like the third IOM study. But it's the Health Effects of Cannabis and Cannabinoids: The Current
State of Evidence and Recommendations for Research. Came out January 12th. Anyway, it's by the
National Academy of Sciences, Engineering and Medicine. And the National Academy of Medicine was
formally the IOM. So it's literally like the next biggest institute of medicine study on this so I really
encourage people to look at that. And they're cautious. They're being very cautious. Yet at the same time
can not deny the safety of the cannabis plant or others. Websites here strongly advise you to look at
them. Obviously the first one there is our Patients Out of Time one, the medical cannabis institute,
there's information out there. There is a course by the American Cannabis Nurses Association, we've got
a full online course by the Medical Cannabis Institute that any nurse can take from home, from wherever
they want to. There's also another course that they offer for physicians. These other associations
websites have some good information and the last one is for those CDC guidelines if you wanted to
look. And then of these documentaries I really encourage you to look up on the web, The Scientist. You
can find it, you can watch it for free, it's about an hour long It literally is a story about Raphael
Mechoulam. It's literally going to tell you how the study of the endocannabinoid system came about.
And if you pay attention at the end what he's saying is what we know from the mice, you learn a lot
from our rats and our mice, what we've learned from them, cannabis affects probably every disease that
happens. It's hugely important, it is so important. So here you are, regulating it, and I'm thinking if
anything to think forward, it is going to get out of schedule one. I mean, 28 states now, I don't know
when the federal government is going to call uncle, but they're going to have to admit that there is safety
in its use, it does have medical value, and it is not highly addictive. It will get out of schedule one. And
so it is going to happen. In the meantime we have a lot of nurses out there who, their hearts go out.
Hospice nurses, other nurses, their hearts go out to the patients and they see it. They see it with their
own eyes patients getting better. They have to support that. They can not be punished for it. And then
lastly, we get sick. So what happens if we get sick and we need cannabis? We need to be able to keep
our license and use cannabis. So I'm really grateful for the opportunity to speak to you. Sorry, this issue
does get to me. The many, many patients that are out there, the information is out there, it's just been
hidden from us. And I encourage you to always call this plant properly, it's a beautiful plant, it's a
wonderful plant. It's the cannabis plant. Marijuana is bullshit we've been fed for decades. For over 75
years, we have been fed about this dangerous drug. And then in the end when you see this you're going
to see the LaGuardia study. That was right after the marijuana tax act. And what that study was it went
and looked at all the newspaper articles that were published. And reefer madness was alive and well
back then. The studies in the newspapers, Hearst ran the newspaper thing. The studies in the newspapers
were "Mexican Slays White Family," "Black Guy Rapes a White Woman" all on marijuana, on that
dangerous drug, I mean, it just went on and on and on. Every one of those studies, every one of those
newspaper articles was a lie. But we passed that marijuana tax act back then based on the lies, based on
greed, and there are a whole bunch of other issues if you go in the history books, it's fascinating to find
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
13
out why we don't have it. Little tidbit that's off subject but Fords car was built to run on hemp fuel which
is biodegradable fuel, great for the environment. But they figured out how to make gasoline, and the oil
tycoons no, no, no and they convinced him to make it a gasoline engine, and we're with that today. So
we have as Sanjay Gupta says, we've been duped for a long long time. Anyway, the fact that nurses are
the most in numbers of health care practitioners and we are the most trusted, I really think we need to
lead on this, so whatever the state boards can do to try to make sure you understand this is so important
for patients it's so important for patient safety that we have to care for the nurses. And the other piece I
want to say about the cannabis nurses, a lot of them were very afraid to join. Will our list be secret?
They're afraid if their employer finds out that they're going to get drug tested or they're going to get
penalized. And in California, I've had nurses come to me, I offer a six-hour continuing ed course on
cannabis, and I've had oncology nurses come and say we've been told we can't talk to our patients about
cannabis. Nurses in Connecticut have had to sign a piece of paper saying they will not talk about
cannabis to their patients. I called the ANA on that one because it was like how can they do that? And
the ANA is saying well we can't tell hospitals what they can do. But that's atrocious. It's just wrong. So
we've got nurses who are good nurses. And I know nurses are leaving hospital systems because they
can't keep handing out some of these pharmaceuticals when they say I think this would be better. It's a
really tough dilemma. Thank you, I think I'm over. - I guess a comment more than a question. The other
presentations I've heard about marijuana have emphasized how much we don't know about it and the
potential dangers and that sort of thing. I'm a family nurse practitioner in Vermont so I can sign off for
patients, and I have done that for patients. So I really appreciate your reference list, I appreciate you
giving more things to look up and read so I can be more informed about the whole thing. The comment I
have, we've talked a lot in the last two days about opiate use and abuse and how big a problem it is. Just
anecdotally, I have three patients who came to me with chronic pain on pretty high dose opiates. And in
these three cases they asked me if I would sign off for them to get medical marijuana. Two of them have
completely stopped taking opiates, and the third has cut the dose by about half. They're doing very well,
they're happy. One who had been struggling to keep weight on is at a healthier weight nutritionally, and
overall they're better. One even went back to work 10 hours a week. So I just want to share that, it's only
anecdotal, but it's something that I see as potentially really beneficial, and I'm very grateful for the
resources you gave us. - Thank you. You made another comment that reminded me. We are very key on
double-blind placebo controlled studies. That's evidence-based research, you have to have that. Old
days, they didn't have that. Aspirin never went through double-blind placebo controlled studies. There's
also another term. Practice-based evidence. So when you see over and over something's working, and
cannabis, as I said it's an old drug, so we know... It's a not a new drug, it's an old plant. So we know
people who have used it their whole lifetime. FDA is very important for getting new chemicals approved
because it's a new chemical. What is it going to, is it going to help? Is it going to hurt? What happens
when you take it regularly? What happens when you take it for years? I have a friend who have had
surgery on her vocal cords from her asthma medicine. Her inhalant destroyed her vocal cords. We don't
know that. With cannabis, we're looking for more and more, but we really kind of do know that it
doesn't have this long term damage. - I personally have seen that. I had a couple of friends that've had
cancer diagnosis and had tried the oils and the edibles because of the loss of appetite, nausea, vomiting,
and both of them had great success, were able to enjoy food again, actually put on weight after trying
every drug available to try to curb that so I have seen good results. But my issue is that we had a case,
I'm from Michigan, we had a case come up in the disciplinary sub committee, where a nurse had, and I
can't remember exactly what had happened if he was in a car accident or was arrested or something, but
he had a drug test that tested positive for THC, and I'm thinking that must have been some type of arrest
because he didn't report it and because within the 30 days or whatever, and because it was a positive
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
14
THC he was brought to the board. Well he had a medical marijuana card. So we've really struggled with,
"Well, what do we do with that portion of it?" Because he had a card, but he was a nurse. I mean we had
a very long debate on it. We ended up not sanctioning him for the THC because it wasn't a practice
issue, it was something that was off. Recognizing that if he has a card he has a legitimate reason for
using it. The only thing we sanctioned him for was a reprimand for not reporting the incident. I had a
feeling this is going to come up sometime, I had a feeling and I'm just waiting for the next case, what
happens if it is something that where a nurse is in the hospital and it is a practice issue and they are drug
tested and it comes up positive, then what do we do? - And that's such a true and scary issue. It makes
me think of the other issues with nurses too. What if a nurse just wants to recreationally try something in
a state where it's legal to do so? But was visiting relatives in California and then goes back to Idaho?
And somebody tests her. We had a nurse here in Florida who was from Jamaica. Never used cannabis.
But she went to some big family affair back home in Jamaica. Flies back to the States. While she was
there she did have a tea, a ganja tea which it's in their culture. She came back, and she suffered dearly
because she tested positive. And it's like gee I don't even use it but it's my culture and we did it. So a lot
of issues are going to come up in practice. And I shared this story with someone else. Colorado has, to
me, a very nasty practice for physicians. If a physician is a cannabis patient, they have to give up their
license as long as they're using cannabis. And that came about, we had a physician who had bipolar
disorder. Very very sick, suicidal, terrible life. Was working with the board, his medical board, was
working with a psychiatrist and they got him on the medications, the standard medications, and he was
okay to practice. But he knew he wasn't okay. He felt totally out of it and thought I'm not safe for
patients. A couple of years later as it was legal in Colorado he tried cannabis, got rid of all his other
medications, felt great, he could work. And the board said, "No you can't practice because you're using
cannabis and you can't practice if you use cannabis." It is an issue that's going to come up, and that's
what I fear is we do get sick, and from my perspective, and that's what the patients say. That's what
Charlotte Figi's mom said, "Why didn't you tell us about this right away? Why did I have to give my kid
all of these drugs?" And you know for seizure disorders for kids, most of those drugs they give to kids
have never been approved for kids, but the doc's desperate. So they give them these pharmaceuticals that
have never been approved for children but they're hoping it will work, and the toxic effects are terrible.
So it's an issue for us to wrestle with. - How long does it stay in the blood system? How long is in there
where you could test positive for it? - And that's another issue, too, when you drink alcohol... - Right,
exactly - ...the body gets rid of it. That liver starts working it's like "ick, toxin, get it out of here." And
other drugs we get rid of them, we break it down and get rid of them. We don't with cannabis. It can stay
in the system for a long time, up to a month. - Right, so they could have done it weeks ago but on
vacation come back to work and test positive and not even be under the influence. - You're in Alaska
and somebody gave you some cannabis and you come back to work and now you're in trouble. And
hopefully you won't be. - [Jennifer] Hi, my name is Jennifer Best. I'm from Nova Scotia, Canada. And I
want to thank you. We recently in the last year, 18 months have developed a practice guideline for
registered nurses who are caring for clients who have been prescribed medical marijuana. We've called it
medical marijuana because that's what the legislation states in Canada. But we were getting a lot of
phone calls from nurses who were in the situation that patients had been prescribed, and they weren't
sure what their role was, what they should do, what they shouldn't do. They were very confused, and so
we felt there was enough of a need out there that we needed to develop something so if anyone else is
interested it's available on our website, the College of Registered Nurses of Nova Scotia, and we use
some of the resources of the American Cannabis Nurses Association website that was a great help to us
when we created the guidelines so thank you for that and I feel like we're able to support clients in Nova
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
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Scotia better because the nurses have that support. - Great, great. Anybody else? - Thank you very
much. - Thank you.
©2017 National Council of State Boards of Nursing, Inc. All rights reserved.
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