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Running head: MARIJUANA
The New Alternative Medication: Marijuana
Sara Anderson & Sherry Brabon
Ferris State University
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Abstract
Marijuana has been used in one way or another for centuries. A brief history of the many uses of
this plant is presented in this paper. Next, current Michigan law will be provided. In 2008, the
Michigan Medical Marihuana Act was passed despite the fact that marijuana is still classified as
a Schedule I drug and illegal under Federal law. Next, this document will provide the reader
with some of the debates surrounding this drug’s use. The term gateway drug has been used to
describe marijuana, the authors point out that other drugs may be considered a gateway drug
instead also; the lack of scientific research is debated. Current ethical applications and nursing
considerations are important for nurses to contemplate. A nurse must first understand their
feelings toward a drug once, and still considered in some states, as illegal. Finally, ways in
which nurses can adapt their nursing practice to accommodate for patient use of medical
marijuana will be offered.
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The New Alternative Medication: Marijuana
The use of medical marijuana is increasing. Marijuana gained popularity as a
recreational drug decades ago and now, this alternative treatment is being prescribed to treat
pain, nausea and anorexia. Many states have legalized this drug and as a result nurses need to be
aware of its side effects, uses and interactions with other prescribed medications. Many
providers are unaware of this drug’s uses and treatments for other addictions. The history,
current laws, argument surrounding use and nursing roles and ethics surrounding medical
marijuana use will be discussed.
History of Marijuana Use
Marijuana has a negative following as this drug has historically been viewed as an illegal
recreational drug. However, this drug has had many beneficial contributions to mankind. The
first documented use of marijuana was between 2000 and 1400 BC (Bostwick, 2012). This herb
was used for a variety of daily activities. Paper, nutrition, rope and medicinal were some of the
early uses (Bostwick, 2012). According to Bostwick (2012) and Lucas (2012) the first
documentation of marijuana use in Western medicine in the 1830’s. Medicinal uses at that time
treated pain, vomiting, convulsions and spasticity symptoms. By 1854, this herb was listed in
the United States Dispensatory (Bostwick, 2012). More uses for this alternative treatment was
then found. Tinctures and extracts of marijuana were used for insomnia, headaches, anorexia
and sexual dysfunction. The drug was removed from the dispensatory in 1942 due to its
perceived role in deviant behaviors (Bostwick, 2012). In 1999 a study found marijuana was
beneficial in treating symptoms of AIDS and cancer (Bostwick, 2012; Lucas, 2012). Marijuana
has documented evidence of effective symptom management dating back to ancient times.
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Marijuana has been used for recreational purposes. In the 1950’s recreational use of
marijuana became more popular than medicinal use (Bostwick, 2012). In 1970 marijuana was
considered as having a high potential for abuse and addiction and the United States Congress
determined it illegal. It was then considered a Schedule I drug meaning it was now a street drug
with high potential for abuse (Bostwick, 2012). Despite marijuana’s continued recreation use, it
has come full circle and is once again used for medicinal purposes as will be described later in
relation to the Michigan Law surrounding marijuana use.
Current Use and Law
In 2008 Michigan enacted the Medical Marijuana Act, which enabled certain individuals
with qualifying chronic debilitating medical conditions under the care and with the approval of a
licensed physician to legally possess and use marijuana for symptom control and management in
the state of Michigan (Michigan.Gov, 2013). Each qualified patient must also have an assigned
primary caregiver. A caregiver is defined as an individual that is allowed to grow marijuana
plants and supply the patient with medicinal marijuana (Michigan.Gov, 2013). Michigan law
protects a primary caregiver as well and states that multiple conditions must be met in order to
become a certified caregiver. The caregiver must be over the age of twenty-one without any
felony offenses (Michigan.Gov, 2013). Each caregiver may possess up to two and a half ounces
of marijuana and up to twelve plants per patient. Each caregiver may have up to five patients
(Michgan.Gov, 2013). Medical Marijuana Act patients and caregivers receive a license issued
by the state of Michigan, which must be renewed annually, by not only the prescribing physician
but the State as well (Michigan.Gov, 2013). The rules and regulations surrounding the Medical
Marijuana Act are complex and ever changing with several amendments added to the Act over
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the past seven years in an effort to fine tune the Act and make it as effective as possible
(Michgan.Gov, 2013).
According to Federal Law, Marijuana is classified as a Schedule I controlled substance
and is not legal under any circumstances (Office of the National Drug Control Policy, 2013).
The term “medical marijuana” does not exist under Federal law as Schedule I drugs have no
current accepted medical use or treatment and high potential for abuse (Office of the National
Drug Control Policy, 2013).
The Great Debate
The argument for and against marijuana is endless. Some of the more common and
thought provoking issues will be addressed here. First, this herbal supplement should be treated
as any other herbal supplement. Marijuana has proven effective in assisting withdrawals from
alcohol, prescription drugs and illicit drugs (Bostwick, 2012; Lucas, 2012). However, argument
remains that the use of marijuana may lead to other health problems such as lung, heart and brain
problems. Marijuana has been considered the “gateway” drug, meaning the use of this drug
potentiates the use of illicit drugs. Some claim this is not true as those that use marijuana may
already be exhibiting other deviant behaviors; furthermore, the availability of other drugs once
marijuana is introduced becomes greater (Bostwick, 2012). In addition, Lucas (2012) states that
to be a gateway drug, the first substance must lead to the use of more higher order substance.
When this definition is used, the gateway drug would be alcohol and nicotine, not marijuana.
Yet others argue that users of marijuana can become addicted to the drug in the same manner as
those that smoke cigarettes (ProCon.org, 2013). Lucas (2012) claims that marijuana is an exit
drug for other substance abuse. This is yet to be determined and further studies are warranted to
substantiate either claim.
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Another area of concern with use of medical marijuana is the lack of scientific evidence
of its effectiveness. A government website that provides insight, studies and information
regarding the use of complementary and alternative medicines does not contain any information
on medical marijuana (United States Department of Health and Human Services, 2013). Doctors
remain indecisive of whether marijuana is the safest drug of choice to treat symptoms such as
nausea, vomiting and pain. The American College of Physicians endorses physician prescriptive
authorities regarding marijuana use (ProCon.org, 2013).
It is easy to see the concerns surrounding the use of marijuana. There are valid concerns
and arguments both for and against the use of this debated drug. Limited studies fail to
substantiate either side. Until further scientific evidence can provide more information, this
debate will continue.
Nursing Ethics
As with any type of treatment nurses must remember the ethical principle of autonomy.
Patients are allowed to make their own decisions regarding treatment options. Nurses should
always be available to offer education and information. If a nurse is strongly opposed to a
patient’s choice, that nurse should ask to be reassigned or sign a contract with the patient
claiming the nurse explained the benefit and risks related to the patient’s behavior. The principal
of veracity also applies here. The nurse must research the topic to fully understand all aspects of
treatment. Currently, there is conflicting information available surrounding marijuana use, the
nurse must ensure that he or she is not swayed by popular vote but, by scientific evidence.
The principles of beneficence and nonmaleficence also apply. At the same time the nurse
is preventing harm, he or she should not cause harm. Once a nurse is educated about the
potential risks and benefits of marijuana, then he or she can make an individual assessment of
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whether that treatment is the best for the patient. The role of nurses is described below. Finally,
confidentiality should always be maintained no matter who or what is involved.
Nursing Role
As with any medication or herbal supplement, nurses must be aware of use, side effects
and interactions with other meds. Furthermore, nurses are responsible for understanding allergic
reaction potentials, interaction with other over the counter meds and prescription meds as well as
perioperative complications associated with any alternative medicines (Mandel, 2009). Science
Daily (2012), states, “nurses and other healthcare professionals need to be well informed about
the medicinal effects of cannabis and how this can interact with other medication the patient is
being prescribed”.
The most common route of marijuana is inhalation. Side effects noted by Bostwick
(2012) are mild euphoria, relaxation, time distortion, decreased mental clarity, fatigue, increased
heart rate, vasodilation and intensified ordinary experiences. He further reports some individuals
have reported despair, anxiety, cognitive impairment and paranoia. Oral forms of marijuana use
provide unpredictable results and side effects. Because of the erratic absorption, concentration
levels fluctuate with oral ingestion. Inhaled ingestion provides a more rapid response and dosing
is easier.
Bostwick (2012) identified a correlation between psychiatric symptoms and marijuana
use. He claims “Cannabis [Marijuana] use has been implicated as a potential cause, aggravator
or masker of major psychiatric symptoms, including psychotic, depressive and anxiety disorders
particularly in young people”. It is theorized that the effects of marijuana on the dopamine and
other neurotransmitters are the cause of this correlation. Furthermore, these effects are seen most
with adolescent use of marijuana (Bostwick, 2012).
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Few drugs have been marketed to mimic the role of marijuana. Marinol has been FDA
approved since 1985 and is a Schedule III controlled substance. This drug is a CB1 receptor
agonist. It is used for nausea, vomiting and anorexia. Onset is 30 to 60 minutes and lasts up to
six hours (Bostwick, 2012). Another FDA approved drug is Cesamet, the indications for use are
similar to Marinol the onset is 60 to 90 minutes with effects lasting up to 12 hours (Bostwick,
2012). These meds are typically used when standard therapies fail to control unwanted
symptoms.
Nurses need to understand the use of this drug as with any other drug. Using reputable
sources such as governmental websites or published peer reviewed articles are both a good place
to start. Encouraging and supporting scientific studies should also be a nursing role to promote
drug knowledge (Roberts, D., 2010). Finally, nurses need to initiate the conversation
surrounding alternative medical treatments such as marijuana. Listening in a non-judgmental
manner and encourage discussion surrounding complementary and alternative medical
treatments is a great way to provide excellent nursing care.
Future Implications
As a nurse practicing in the state of Michigan it is vitally important to be educated with
the most recent and evidence-based practice information pertaining to therapeutic uses of
marijuana (American Nurses Association, 2013). It is the nurse’s responsibility to learn the rules
and regulations of the Michigan Medical Marihuana Act, as the nurse will most likely encounter
a patient with medical marijuana privileges in the near future. It is also the nurse’s responsibility
to know the specific hospital or institution’s policies related to medical marijuana use and follow
those rules accordingly.
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As nurses in Michigan see more and more patients using alternative therapies such as
marijuana, the nurses themselves will have to become familiar with marijuana and its side effects
(American Nurses Association, 2013) in order to know what to expect and anticipate as normal
versus abnormal. It is essential that nurses are educated and aware of the appropriate scope of
practice ensuring the proper care and education to medical marijuana patients. Nurses must
know the benefits, risks, effects, appropriate uses, and possible drug interactions, if any, of
marijuana therapy (Science Daily, 2012).
Nurses may consider continuing education in alternative or holistic therapies in order to
build their knowledge or skill set as these types of therapies increase in popularity and use. As
of February 2013, Michigan has 131,861 active registered medical marijuana patients with
applications received and approved on a daily basis (Michigan.Gov, 2013). It is only a matter of
time before a nurse practicing in the state of Michigan encounters a medical marijuana patient in
the same state.
Conclusion
Marijuana has had many beneficial contributions reported throughout history. The debate
remains whether marijuana should be used for medicinal purposes or recreation. Since this drug
is now legal for prescribed medicinal purposes in Michigan, further studies will demonstrate the
benefits this drug may have on certain diagnoses such as cancer pain, nausea and anorexia. In
the meantime, nurses need to provide ethical care while maintaining a non-judgmental attitude.
Furthermore, nurses need to be aware of this alternative treatment and effects that may be
encountered. Nurses may become familiar with marijuana and its uses, side effects, and
interactions by completing continuing education units on this subject matter.
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Reference
American Nurses Association. (2013). In support of patients’ safe access to therapeutic
marijuana. Retrieved from http://www.nursingworld.org/MainMenuCategories/PolicyAdvocacy/Positions-and-Resolutions/ANAPositionStatements/Position-StatementsAlphabetically/In-Support-of-Patients-Safe-Access-to-Therapeutic-Marijuana.pdf
Bostwick, J. M. (2012). Blurred boundries: The therapeutics and politics of medical marijuana.
Mayo Clinic Proceedings, 87(2), 172-186.
Lucas, P. (2012). Cannabis as an adjunct to or substitute for opiate in the treatment of chronic
pain. Journal of Psychoactive Drugs, 44(2), 125-133.
Mandel, E. D. (2009). Dietary supplements: Do you know what your patient is taking?
Clinician Reviews, 19(9), 22-28.
Michigan.Gov. (2013). Michigan medical marijuana program. Retrieved from
http://www.michigan.gov/lara/0,04601,7-154-35299_63294_63303_61869---.00.html
Office of National Drug Control Policy. (2013). Marijuana resource center: Federal laws
pertaining to marijuana. Retrieved from http://www.whitehouse.gov/ondcp/federal-lawspertaining-to-marijuana
ProCon.org. (2013). Top 10 pros and cons: Should marijuana be a medical option? Retrieved
from http://medicalmarijuana.procon.org/view.resource.php?resourceID=000141
Roberts, D. (2010). Complementary therapies: The nurse’s role. Medsurg nursing, 19(3), 147.
Science Daily. (2012). Medicinal cannabis review highlights dilemmas facing healthcare
professionals. Retrieved from
http://www.sciencedaily.com/releases/2010/09/100902073633.htm
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United States Department of Health and Human Services, National Center for Complementary
and Alternative Medicine. (2013). Health topics A-Z. Retrieved from
http://nccam.nih.gov/health/atoz.htm
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