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Planting the Information Seed: Nursing Practice and Cannabis Use

April 2018

Do you know how the legalization of cannabis will impact your practice? What is your role as a nurse to ensure that you are providing safe, competent and ethical care in the interest of the public?

Presenter: Karey Shuhendler, RN, CCHN(C), MN

Program Lead, Public Policy Programs & Policy Canadian Nurses Association

Closing Remarks

In light of the pending legalization of cannabis, NANB wanted to start a dialogue with members about nursing practice and cannabis use. In May, NANB hosted a three-week Virtual Forum titled Planting the Information Seed: Nursing Practice and Cannabis use. During that time, there were a number of thought producing posts on how RNs think cannabis legalization will impact their practice and their role as nurses caring for clients

Canadian Nurses Association’s Program lead, Public Policy Karey Shuhendler RN closed the forum. Karey captures some of our questions such as: What does this mean for my patients? Will this lead to problematic substance use? If we know cannabis is harmful for the developing brain, how can I help youth in my community to reduce the risk? How can my workplace ensure nurses are not impaired by cannabis at work?  This brings us back to thinking about the available evidence and arming ourselves with accurate information about the risks and harms of cannabis use that will allow us to provide safe, competent and ethical care.

The full summary can be found in the Fall 2018 Edition of Info Nursing

Thank you for participating!

Karey Shuhendler- Bio

On April 20, 2016, the federal government announced plans to legalize cannabis for non-medical purposes, effective summer of 2018. Since that initial announcement, work has been under way by a wide range of stakeholders to prepare for this historic shift. In their 2017 discussion paper Harm Reduction for Non-Medical Cannabis Usethe Canadian Nurses Association (CNA) notes that “legalization is often seen as the best option for addressing the harms of cannabis. It allows for the regulation of quality, dose and potency. Legalization can also minimize social harms and eliminate the costs of prohibition.”

As the largest group of health care providers, and often a person’s first point of contact with the health care system, nurses are uniquely positioned to engage with patients and clients to reduce harms of non-medical cannabis use, and to support those who use cannabis for medical purposes.

The goal of this virtual forum is to provide a platform for discussion about how legalization of cannabis may impact your nursing practice.

The following questions may provide a starting place for dialogue:

  1. How do you anticipate legalization of cannabis may impact your practice?
  2. What is your role as a nurse to ensure that you are providing safe, competent and ethical care in the interest of the public?
  3. Once non-medical cannabis is legal, what is your role as a nurse to support those who use/require cannabis for medical purposes?
  4. What do you need to support you patients in their quest for accurate health information?

Archived Comments

RNRR (4 years ago)

Legalizing Marijuana was never intended to be what was best for the public. Marijuana has never been considered a public health safety concern. The legalization of marijuana was devised as a revenue generator for the government; both federally and provincially. Our health institutions have received zero funds related to education for staff/ administration regarding distribution, policies , patient /family teaching,research proving effectiveness ect.
As far as creating “safe recreational use” really????
What about oxycodone ?? Dilaudid? Fentayl? Percocet?
These are narcotics prescribed by physicians, supplied by drug companies. Therefore should be as “safe as MM “
I have heard stories from 60-80 year old patients that were waiting 18months – 1 year for orthopedic surgery and became addicted to oxycodone. Without it their pain was worse then they could imagine , vomiting, diarrhea, anger outbursts, disphoria , ect. The stories (hopefully) continue on with a grandson suggesting marijuana. Reluctantly Grammy Or Grampy tires it and feels 100 percent better. Either no pain or substainly less pain; but no withdrawal. I’ve had orthopedic surgeons not prescribe narcotic post op and instruct the patient to responsibly distribute their MM to themselves prn. But of course this only happened one or two times related to lack of policy.
As far as recreational use: who cares? If I want to go pick carrot tops out of my Vegetable garden and roll them up in a piece of paper and smoke them that is my business . So long as it doesn’t create a public safety concern. Who cares? The gateway drug? Sugar is a gateway drug . (Ever see a 4 year old on a sugar high? A demanding 10 year old begging for a Gatorade at the rink?
Caffeine? Try going 15 minutes out of bed without a coffee? Headache ? Brain fog? Then there is Tobacco. Ever here if a Nic Fit?
Armed robberies are up 10 fold in this city over the past 2 years. They are all drug related. I would bet my retirement that they are not looking to buy marijuana.
Nurses “working under the influence “. How many nurses are already taking mind altering medication for mental illness ?
What is the difference once MM is legal and is proven effective in the treatment of pain, depression, ect ??
The whole debate of marijuana legalization is spoke out of both sides of the mouth; or debated with limited education on the topic. I definitely do not have the answers. My knowledge is based on my own experience. I have not seen the studies or proposed bills. I have yet to see the effects to legalization on the public. I would like to hope that if legalization becomes the tax revenue our officials plan on , the citizens of New Brunswick will see these benefits through the health care , education , and any other public service industries.

Ouelette (4 years ago)

1. ll sera plus difficile de gérer mes patients psychotiqes qui consomme. Auparavant on ls encourageait a ne pas consommer mais maintenant que c’est légale…nous n’aurons plus grand controle donc il y aura une augmentation des troubles mentaux;psychose.

2. Cela n’ifluencera pas ma pratique puisque je ne consomme pas donc continuerai d’offir des soins sécuritaire et conforme à l’éthique. Parcontre je crois que les ens doivent recevoir de l’enseinement sur les effets néfastes de cette consommaion à long terme.

3. Aucune idée pour le moment… je suis dépassée pas le fait que ce soit endu légal. Je vais surement continuer à faire de l’enseignement sur les effets nocifs à lon terme sur leur santé.

4. incertaine encore…

infermière (4 years ago)

-Besoin de connaître les grandes lignes de la légalisation du cannabis (âge, besoin d’un permis, taux de THC …..)
-Besoin de dépliant sur le sujet pour donner à nos patients.
-Patient en possession de cannabis légal ou médical à l’hôpital, je fais quoi avec? comment savoir si c’est du cannabis légal ou illégal ou médical? Besoin de politique et procédure pour nous guider…….
-Information/session éducative sur le cannabis médical et les autres formes…….
-Pendant des années j’ai répété à mes patients que le cannabis était néfaste pour la santé, à présent je leur présente çà de quelle manière…..?
La légalisation s’en vient à grand pas et j’espère que nous aurons le support nécessaire. RN en psychiatrie.

Retired (4 years ago)

First of all- the term “historic shift” should read “notorious shift”.
The use of cannabis is a gateway to use of other drugs and used as an excuse for so many things… “It increases my appetite, it decreases my appetite, it relaxes me, it pumps me up , it helps me sleep. it helps me stay awake – it makes my troubles go away….. now we add “its legal”? Why couldn’t we have taught our children to look at changing behaviors to correct problems, rather that search for ways to avoid them? Thousands of young and VERY young people are now using energy drinks, compromising their health and THINKING- imagine combining cannabis use with this- and the outcomes for our society.. Deteriorating work ethics and attitudes of privilege are being fostered .
As a semi-retired RN, it is frightening to see the shift in work ethic in new health care staff. Politicians, the public and health care workers should consider the impact of widespread cannabis use on the care WE will receive in any health care setting. God bless the people who can use common sense instead of cannabis. Nurses need to be able to recognise cannabis use in co-workers and know they should report it.

Nurse Joan (4 years ago)

For years we have been warned about the affects of marijuana on the young developing mind. The suggested age to avoid mental heath issues was 25.
I cannot believe the decision to allow recreational use is set at 19.
It has been mentioned that legalizing will make it safer. What nonsence.
The 19 and 20 year olds will have easy access to it then cut it with whatever to sell at a profit.
I worked in Corrections and inmates confided that marijuana was definitley a gateway drug.
The police and medical professionals are saying no…why is this being pushed thru?? Stoner votes perhaps.

Stricter guidelines (4 years ago)

For years the police have come into the elementary schools to discuss the effects of drugs (The Dare Program). Marijuana is considered a gate way drug, leading to use of stronger more dangerous drugs.
I work in mental health and have seen the devastating effects of drug use on children as young as 12. I was appauled to hear that the legal age to buy marijuana is 19. The human brain is not completely formed until around 23 years for males . We have seen lives ruined by drugs, altering brain chemistry to the point that these young people will have a life time of mental illness .
I wonder why the government is willing to play Russian roulet with these young people’s lives. I warrant the profit made by legalizing marijuana will balance out with the increase health cost of admissions in and out of the mental health hospitals, increase in unemployment, disability and welfare supplements .Please think carefully . Think of Canada’s future for its young people. Set strict guidelines is that marijuana is sold only to adults, whose brains are fully developed and who are fully able to make that decision to risk their health.

Nurse E. (4 years ago)

I’m hopeful that this will lead to safer cannabis for users both non-medical users, (heaven knows what they are really buying) and better regulation of what those with a prescription actually are getting. My neighbour’s son uses the oil to control his seizures. One drop on the tongue. I asked how do they know how much to give. They said the doctor told them to start with one drop and titrate as needed. What does that even mean? How do you control the dosage when the dropper isn’t marked, how do you know the dosage when someone gives you a bag of it? How can I provide education when I don’t know how to answer the dosage question? Pharmacists can’t help me. Hopeful, that with the removal of the stigma that is attached to its use individuals will seek help for their addiction. Are we in the process of developing a community education school plan to stop children from thinking that it’s ok to use. Are policies being developed to control how it’s to be distributed in a hospital setting. I see this a positive change but to assist our clients we need to be better educated.

Stricter guidelines (4 years ago)

I don’t feel legalizing marijuana is a good idea , unless strict guidelines are followed. For years the police have been coming into elementary schools talking about the dangers of drug use and how marijuana is a gate way drug.
I work in mental health and I see the devastating effects of drugs use by children as young as 12 years old. Futures ruined because of altered brain functions and drug induced psychosis leading to permanent mental health issues. I was appauled to learn that the legal age will be 19 years old to buy marijuana . The human brain is not fully delveloped until 23 for males. It’s scary that the government plays Russian roulet with our young people’s health. I think the profits they make will certainly balance out with the extra costs of lengthy and life time admissions in and out of the mental health hospitals . Not to mention the increase in heigh school drop outs and cost of disibilty and welfare supplements paid by the government . I really think that there should be stricter guidelines and increase in age by which people can purchase marijuana.

Not overly concerned (4 years ago)

In my world, people use marijuana daily ++, often this is from dealers unknown, laced with who knows what. With MM use it will be better regulated, people will know what they are getting and taking it for legitimate reasons. It is our job to assess, diagnose and suggest this as a treatment option, no different than other medical choices. Yes there are various types and I find those who are already using MM do not want to use it to get “stoned or high”, they do not want to smoke it (smoking is not good, we know that) and they already know it works, now it is monitored and will be better prepared, I feel. As nurses, competent care is paramount, so get aware, and educated, it is coming, we need to be on top of this and kudos for CNA for the discussion paper and keeping this in the forefront.

Nursely (4 years ago)

My Concern for the increased use of medicinal cannabis is the lack of policies in hospital. We have had several instances where we were to administer capsules (THC and CBD) to patients as they requested (pt. own supply) or provide them with a locked box that belonged to the patient and chart that you’ve given it. My problem is, first, I have no real idea what is in those capsules they did not come in a medication bottle with a label, I have no idea what is in the locked box and as a nurse I sign my name that i have provided it but i have really no knowledge of what i’m providing or why. Second, Our pharmacy refuses to print these as PRN’s on the MAR or get involved in any way and as a clinician I have no pharmaceutical expert to turn to for support. Third, there is no universal document to indicate or “prove” for lack of a better term that the cannabis in dry form, capsule, oil or what have you is in fact medicinal or illicit. We have had clients bring in marijuana in plastic baggies stating that it is medicinal and that they have a “licence” I’m not even sure what this licence looks like or how clients who hold a licence for medicinal cannabis are supposed to carry their product. We’ve run in to situations where we turned the product over to security and and clients becoming angry and reported staff for disposing of their personal property, however there is no real way to determine if this product is in fact illegal, medicinal with a licence. The actions that I have taken in my practice so far have been because i was directed to by management and not of the result of actual hospital policy direction and have been generally uniformed because there have been no attempts at educating hospital staff on how to handle cannabis use for in patients.

Nurse B (4 years ago)

I am concerned about cannabis use being contraindicated with current treatment plans.

I am also concerned about public cannabis use. Where I work we have a smoke free policy, which some people do not follow. My concern is now people will be inhaling cannabis in public.

With the legalization of cannabis will their be any restrictions from our regulatory body.

Will Staff be going out for a smoke break off property and using cannabis? Obviously this could already be going on, however, what restrictions are in place for this? Would it be treated the same as the use of alcohol for example?

Guest (4 years ago)

In my current work we are seeing more patients using medical cannabis, and I personally know a number of close friends that use it medicinally for pain relief and PTSD symptom management with very positive effects, especially in comparison to prescription medications they have been on in the past for the same conditions. From a HCP perspective I hope that the legalization will lead to more data collection on its use both medicinally and recreationally, including long term effects and positive and negative outcomes and more education for healthcare providers on it as well.

I think it’s important that nurses and other healthcare providers are given education (and educate themselves) on cannabis use medicinally and recreationally and do their best to avoid bias against patients who choose to use it for various reasons, (as we all endeavour to do with any medication or substances our patients may use). I know many people who use cannabis ‘recreationally’ (I feel like that term isn’t always accurate – there are many physicians who may not be willing to prescribe it for a valid medical condition) rather than prescription medications to manage issues with sleep, anxiety, etc. or that prefer it to alcohol for social purposes. I know medicinal cannabis has been a literal lifesaver to a number of close friends with major anxiety and sleep disorders related to PTSD after unsuccessful treatment with a plethora of prescription medications and therapies, with much less in the way of adverse side effects, but often verbalize feeling stigmatized by healthcare providers and the general public.

I hope that other nurses will remain open-minded and educate themselves on cannabis use for any reason a person may use it, as I feel a lot of nurses and the public don’t know much about it (and don’t want to know). I think guidance from NANB and other nursing authorities on legal issues around this in our practice as well as coaching or direction on how to educate ourselves, how to talk with people about cannabis use in an unbiased way, and so on, would be very helpful.

CGRN ↪ Guest (4 years ago)

I completely agree. I am really hoping there will be some form of CE available to nurses regarding MM. I have been searching for a program but there isn’t much available at present. I believe there will be a role for the RN and NP in monitoring and prescribing MM to clients and nurse run clinics are hopefully on the horizon. Currently, what I am seeing in practice is a lot of clients who are going to the local “dispensaries” to get a “prescription” and purchase their product. Unfortunately these dispensaries are operating in a grey area and the staff do not have any medical based training and are counselling people with complex health diagnoses on cannabis use. I think trained healthcare professionals like RN and NP’s should be on the forefront of this movement to make MM safer and change the stigma surrounding its use for medical purposes. More training around cannabis as a medical treatment is necessary but currently unavailable unless you want to take a “budtender” course which I don’t feel fits the bill.

Marie (4 years ago)

Je crois sincèrement que la légalisation du cannabis aura un impact sur la pratique des infirmières. Présentement, la qualité de vie des infirmières est menacée par le manque de ressources dans le système de soins de santé au Nouveau-Brunswick. L’infirmière se sent souvent impuissante et boulversée face à cette problématique. Elle pourrait être tenter de consommer du cannabis pour fuir les problèmes reliés au travail. Le plus grand risque face à ceci est la sécurité des patients parce que le cannabis n’est pas “contrôlé”, en ce sens que la quantité de THC et de CBC peuvent varier d’un fournisseur à un autre. De ce fait, les infirmières peuvent demeurer sous l’influence de cette drogue pendant longtemps sans même s’en rendre compte et ainsi menaçer la sécurité des patients lorsqu’elles sont en fonction.

Certes, ce forum de discussion pourra certainement aider les infirmières à prendre position face à la légalisation du cannabis et influencer l’élaboration de politiques organisationnelles et gouvernementales de réduction des méfaits associés à la consommation de cette substance. Merci à l’AIINB pour cette initiative!

Nurse (4 years ago)

I am presuming that employers and regulators may treat use of cannabis by employees similarly to how they treat ‘substance use’ in the current workplace (with regards to policies, etc). However, many do not know the signs and symptoms to warrant concern with impairment caused by Cannabis- use. Therefore, what education can employers share with their staff, that is easily understood, accurate and not overwhelming. I don’t want to scare folks, but I also want them educated.

I’d rather post as guest (4 years ago)

I’m worried that what happened in Colorado will happen here- increased MVAs and overdoes arriving in the already overcrowded EDs. What is Canada/NB doing to avoid this?

Nurse ↪ I’d rather post as guest (4 years ago)

Can someone overdose on marijuana?