Whether you work in a state where cannabis is fully legal for adult use or one where medical cannabis can be recommended, as a nurse, you will frequently encounter patients who use cannabis. One of the issues healthcare professionals have now is that patients often view cannabis use as either harmless and not worth mentioning or
as a substance that is stigmatized, and so they become fearful around mentioning their cannabis use. As the U.S. heads toward the likelihood of cannabis being made federally legal, nurses need to be comfortable and confident with their ability to assess patients’ cannabis ingestion and support, educate, and coach them around safe and effective cannabis use.
Here are 3 common questions I hear frequently from nurses and nursing students who are interested in cannabis care nursing and supporting patients’ safe and effective use of cannabis:
1. How does cannabis work for so many different disease issues?
Our bodies have a master regulator system called the endocannabinoid system (ECS). We make and then degrade our own endocannabinoids (cannabis-like substances) that interact with this system to ensure our bodies remain in homeostasis, and endocannabinoids help the immune system to function properly so that we stay well. When the ECS does not have what it needs to function properly due to stress, illness, dietary, or lifestyle issues, we may not make adequate endocannabinoids to meet the system’s needs. People with a variety of illnesses may find that they have a clinical endocannabinoid deficiency, and they will need to supplement cannabinoids to feel healthy and well (Russo, 2016). We now know that when patients are guided toward proper self-titration of cannabis, they can safely and effectively use the medicine to support their healing process and palliative needs without getting high or becoming addicted to the medicine (Clark, 2021).
2. If cannabis is federally illegal, how can I talk about it in the healthcare workplace?
The federal legality issue has never been an issue in any healthcare setting; no facility has ever lost funding for patients using cannabinoids or healthcare practitioners talking about cannabis. We can always remain in our scope of practice by educating and coaching patients. In fact, in an issue of the Journal of Nursing Regulation
, the National Council of State Boards of Nursing (NCSBN) (2018) identified the 6 essential areas that all nurses must be educated around when providing care for cannabis patients You can view and download The NCBSN National Nursing Guidelines for Medical Marijuana
free and share it with others in your workplace.
3. How do I convince my workplace that we should be assessing patients for cannabis use and educating them around using it effectively?
The first step is educating yourself and gaining confidence around how cannabis works in the body; why and how prohibition of cannabis has created a stigma for patients and vulnerable populations; proper dosing of cannabis; access to safe cannabinoid therapeutics; and our ethical obligation to address these issues in the workplace. Use your professional communication tools and published literature when speaking with colleagues and administrators. In addition to sharing the NCSBN (2018) guidelines, the American Cannabis Nurses Association (2019) created The Scope and Standards of Practice for Cannabis Nurses
(Clark et al., 2019). The first textbook for nurses that provides you with a depth of information about cannabis care nursing
is also now available.
Cannabis has long been used to stigmatize vulnerable populations and people of color during the prohibition era. As nurses, we can help to end the stigma around this plant entheogen and begin to usher in a post-prohibition era where patients can safely use cannabis to help manage their palliative and healing needs, including symptoms of pain, appetite issues, sleep, anxiety, spiritual healing, and quality of life concerns.
Clark, C.S. (2021). Cannabis: A handbook for nurses. Wolters Kluwer.
Clark, C.S., Bernhard, C.E., Quigley, N., Smith, K., Theisen, E., & Smith, L.D. (2019). Scope and standards of practice for cannabis nurses. American Cannabis Nurses Association. https://www.cannabisnurses.org/scope-and-standards-of-practice-for-cannabis-nurses
National Council of State Boards of Nursing. (2018). The NCSBN national nursing guidelines for medical marijuana. Journal of Nursing Regulation, 9(2), supplement. https://www.ncsbn.org/The_NCSBN_National_Nursing_Guidelines_for_Medical_Marijuana_JNR_July_2018.pdf
Russo, E. (2016). Clinical endocannabinoid deficiency: Current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis and Cannabinoid Research, 1(1). https://www.doi.org/10.1089/can.2016.0009
About the Author
Carey S. Clark, PhD, RN, AHN-BC, FAAN serves as Professor of Medical Cannabis at Pacific College of Health Sciences. She is the Past President of the American Cannabis Nurses Association, and has been a nurse since 1994, with a wide practice background including experience within the acute care setting, pediatrics, hospice care, and parish nursing. Dr. Clark has over 40 publications in journals such as Advances in Nursing Science, International Journal for Human Caring, Holistic Nursing Practice, Clinical Journal of Oncology Nursing, and Creative Nursing.
Dr. Clark has presented at many national and local conferences, particularly with oncology and holistic nurses, where she focuses on bringing basic knowledge about the endocannabinoid system, medicinal use of cannabis, and the nurse’s role. She is the editor of the textbook Cannabis: A Handbook for Nurses (2021, Wolters-Kluwer).
*Author Carrie Clark will host a webinar early this fall. In it she will,
- Consider the current state of prohibition of cannabis.
- Provide a basic understanding of the human endocannabinoid system.
- Explain the nurse’s cannabis care role, including education and coaching.
- Define why holistic approaches to medical cannabis care are key to patients' success in using cannabis safely and effectively.