Nurses are always looking for ways to expand their knowledge and skills. Today, more patients have access to cannabis than ever before, and they have questions about using it properly. With federal decriminalization likely to happen within the next few years, nurses must be prepared to meet the needs of their patients.
Whether you’re looking to incorporate cannabis knowledge into your current practice or start your own consulting, you must start with foundational knowledge in the cannabinoid sciences. In our recent event, we asked Eloise Theisen, AGPCNP-BC—and President of the American Cannabis Nurses Association—for her advice on where to begin, and how cannabis nursing can support the needs of your patients.
Watch the full event below!
According to the American Cannabis Nurses Association’s (ACNA) scope and standards, the cannabis nurse aims to not only support and educate patients but also to work toward supporting wellness and healing through a caring presence, which supports the patient’s needs.
Cannabis nursing requires that the nurse be educated in multiple areas above and beyond all registered nurse competencies, including knowledge of:
Moreover, the cannabis nurse’s role expands as he or she acts as an advocate, coach, and navigator to guide patients through a sea of cannabis information and misinformation. The cannabis nurse is a leader in guiding patients toward a maximal state of homeostasis through the upregulation of the endocannabinoid system.
The cannabis nurse practices self-care to maintain a professional and caring presence with patients.
The National Council of State Boards of Nursing (NCSBN) asserts that nurses need practical information to care for the increasing number of patients who utilize cannabis, and who self-administer cannabis as a treatment for various symptomatology or for recreational purposes.
Individuals are using cannabis and nurses will care for these patients.
The NCSBN Guidelines entail the following Six Principles of Essential Knowledge:
The endocannabinoid system (ECS) is found in all vertebrate animals and some invertebrate animals, and it is responsible for maintaining homeostasis by regulating mood, appetite, pain-sensation, memory, and sleep.
Medicinal cannabinoid use affects two main areas physiologically.
The homeostatic effects produced by Cannabinoid Receptor CB1 stimulation include an increased drive to sleep and eat, a reduction of perceived pain, fear and anxiety, maintenance of well-being, and the promotion of recovery during stress.
There are very few CB1 receptors in the brainstem or in the cardiorespiratory centers, which accounts for the absence of a lethal dose when using cannabis.
CB2 receptors, on the other hand, are primarily found in the immune system. The homeostatic effects produced by CB2 stimulation include a reduction of the release of inflammatory mediators and a reduction of immune cell migration into the brain.
Dronabinol (Marinol)
Nabilone (Cesamet)
Cannabidiol (Epidiolex)
More than 113 cannabinoids can be found in plants. The two most common are THC and CBD.
So far, cannabis legalization in the US is as follows:
Drugs can be categorized into distinct categories or schedules depending on the drug's accepted medical use as well as its abuse or dependence potential.
Federally, marijuana is a schedule 1 drug, while hemp was descheduled in 2018, and CBD is a schedule 1 drug (per DEA and FDA regulations).
High THC (marijuana): States with medical and adult use programs sell high THC products through licensed dispensaries. Products are tested and regulated.
High CBD (hemp): CBD can be found online, in some health food stores and is legal in 47 states (ID, NE, KS). Not regulated, may be tested. THC content must be 0.3% or less.
Note that CBD from hemp and CBD from marijuana are the same molecule.
Hemp plants can flower, but hemp is mostly grown for its industrial uses; stalks and stems are used for rope, textiles, concrete, paper, and a variety of other uses. Flowers are best for producing medicine.
Farmers are growing cannabis that is defined as legal hemp (with <0.3% THC) but using techniques to emphasize the promotion of CBD from flowers. Look for companies who advertise their hemp-derived products as “flower-derived CBD.”
Currently, there are more than 3,000 CBD products available on the market.
When choosing products, look for those that:
And avoid products that:
There is moderate evidence in the medical literature that cannabis and cannabinoids are effective at improving short-term sleep outcomes with sleep disturbances associated with obstructive sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis.
There is also conclusive evidence that cannabis or cannabinoids are effective for treatment of chronic pain in adults. CBD has been shown to be effective at reducing inflammation, modulating pain, boosting opioid analgesic effects, and shifting the dysphoria associated with pain.
Many patients self-medicate with high-THC cannabis for depression. A 2016 survey found that 50% of cannabis users were seeking relief from depressive symptoms.
Additionally, a 2018 study demonstrated that the ECS plays a significant role in regulating mood and a dysfunctional ECS can contribute to depression.
Below, the following sections outline what you should do before, during, and after a cannabis consulting appointment with a patient.
Before meeting with the patient, ensure that you review the patient’s:
During the appointment, make sure you discuss the patient’s:
Make sure you prepare the patient to begin a cannabis regime. Here are some steps you can follow:
The following are legitimate educational resources you can use to pursue further education in cannabis nursing:
Additional resources for getting involved:
Challenges you may face when preparing to become a cannabis nurse:
Opportunities, or what you can do:
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