2014 PPE
Disclosure Statement
It is the policy of the Oregon Hospice Association to insure balance, independence, objectivity, and scientific rigor in all its educational
programs. All faculty participating in any Oregon Hospice Association program is expected to disclose to the program audience any
real or apparent affiliation(s) that may have a direct bearing on the subject matter of the continuing education program. This pertains
to relationships with pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services
are related to the subject matter of the presentation topic. The intent of this policy is not to prevent a speaker from making a
presentation. It is merely intended that any relationships should be identified openly so that the listeners may form their own
judgments about the presentation with the full disclosure of the facts.
This presenter has no significant relationships with companies relevant to this presentation to
disclose.
1
Cannabis Challenges in
Community Settings
Terrie Cress-Sargent BSN RN
Tim Malone LCSW
Victoria Johnson BA
Cynthia McDaniel MSN RN
What is Cannibus – the plant?
Cannabis (/ˈkænəbɪs/) is a genus of flowering plants that includes three
different species, Cannabis sativa,[2] Cannabis indica and Cannabis ruderalis.
These species are indigenous to Central and South Asia. Cannabis has long
been used for hemp fibre, for seed and seed oils, for medicinal purposes, and
as a recreational drug. Industrial hemp products are made
from Cannabis plants selected to produce an abundance of fiber.
To satisfy the UN Narcotics Convention, some Cannabis strains have been
bred to produce minimal levels of THC, the principal psychoactive
constituent responsible for the high associated with it and which is obtained
through the dried flowers of Cannabisplants selectively bred to produce high
levels of THC and other psychoactive cannabinoids. Various extracts
including hashish and hash oilare also produced from the plant.
-Wikipedia
What is Cannibus – the drug?
▪ Cannabis, commonly known as marijuana and by numerous other
names, is a preparation of the cannabis plant intended for use as a
psychoactive drug and medicine. The principal psychoactive
constituent of cannabis is istetrahydrocannabinol (TCH). The plan has
at least 483 known compounds including at least 84 other
cannabinoids such as ascannabidiol (CBD) and cannabinol (CBN).
▪ Cannabis is often consumed for it’s psychoactive and physiologic
effects, including heightened mood or euphoria, relations, increased
appetite, and decreased nausea.
-Wikepedia
What is Cannibus?
Cannabidiol (CBD) is a compound in cannabis that has medical effects
but does not make people feel “stoned” and can actually counter the
psychoactive effects of THC. After decades in which only high-THC
Cannabis was available, CBD-rich strains are now being grown by and
for medical users. CBD appears to relieve convulsions, some types of
inflammation, anxiety, and nausea.
THC is the main psychoactive component in marijuana buds. THC
appears to help relieve pain and is neuroprotective(helps keep brain
from degenerating over time). THC mimics the action of anandamide,
which is a naturally occurring cannabinoid in the brain. THC is thought
to be the cause of the following effects of cannabis: relaxation,
euphoria, altered space-time perception and appetite stimulation.
Oregon’s Program Oversight & Regulations
The Oregon Medical Marijuana Program is a State registry program
within the Public Health Division, Oregon Health Authority.
Their role is to administer the Oregon Medical Marijuana Act as
approved by the voters of the State in November 1998.
The program actively pursues administrative streamlining processes in
an effort to better serve patients while maintaining the highest level of
confidentiality.
Oregon Medical Marijuana Program (OMMP)
http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/M
edicalMarijuanaProgram/Pages/index.aspx
Oregon Revised Statute
http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/M
edicalMarijuanaProgram/Documents/ORS.pdf
Oregon Administrative Rules
http://arcweb.sos.state.or.us/pages/rules/oars_300/oar_333/333_008.ht
ml
Rule Definitions
▪ “Patient” - means a person who has been diagnosed by an attending
physician with a debilitating condition and for who the use of medical
marijuana may mitigate the symptoms or effects of the person’s
debilitating medical condition.
▪ “Primary Caregiver” – means a person 18 years of age or older who
has “significant responsibility” for managing the well-being of a
person who has been diagnosed with a debilitating medical condition
and who is designated as such on the person’s application for a
registry identification card or in other written notification to the
Department of Health.
Rule Definitions
▪ “Person Responsible for Marijuana Grow Site” – means the person
who has been selected by the patient to grow their medical
marijuana, and who has been registered with the Health Department
for this purpose. The patient can assign their grow site card to
themselves, to their designated caregiver, or to another person who
will be responsible for their grow site.
▪ “Medical Use of Marijuana” – means the production, possession,
delivery, or administration of marijuana, or paraphernalia used to
administer marijuana, as necessary for the exclusive benefit of the
patient to mitigate the symptoms or effects of his or her debilitating
condition.
Rule Definitions
▪ “Seedling or Start” – means a plant that has no flowers, is less than
12 inches wide and is less than 12 inches tall. All three criteria must be
met to be a seedling or start.
▪ “Mature Plant” – means any plant that does not fall within the
definition of a seedling or start. A mature plant can be in either the
vegetative, or the flowering stage of growth.
What Conditions Allow Use
▪ (a) Cancer, glaucoma, agitation incident to Alzheimer's disease, positive status for human immunodeficiency
virus or acquired immune deficiency syndrome, or a side effect related to the treatment of these medical
conditions;
▪ (b) A medical condition or treatment for a medical condition that produces, for a specific patient, one or more
of the following:
▪ (A) Cachexia;
▪ (B) Severe pain;
▪ (C) Severe nausea;
▪ (D) Seizures, including but not limited to seizures caused by epilepsy; or
▪ (E) Persistent muscle spasms, including but not limited to spasms caused by multiple sclerosis;
▪ (c) Post-traumatic stress disorder; or
▪ (d) Any other medical condition or side effect related to the treatment of a medical condition adopted by the
Authority by rule or approved by the Authority pursuant to a petition submitted under OAR 333-008-0090.
How is a Card Obtained
▪ Application from person
▪ Signed document by physician - MD or DO
▪ Copy of driver’s license or state issued identification card
▪ Application fee
Fee $200 – reduced fees for some populations
Annual renewal 90 days before card expires
Testing and Packaging of Product by Grower
Testing
▪ Pesticides, mold, mildew
▪ TCH
▪ CBD
Packaging
▪ Tamper proof, child proof containers
▪ Opaque
▪ Closable if more than single dose
▪ Labeled
Product Types
Other Routes of Delivery
Challenges
▪
▪
▪
▪
▪
▪
▪
▪
Finding a physician to order
Application
Allowable setting
Access – identifying a caregiver and locating a dispensary
Deciding on route of delivery
Determining amount
Writing instructions for person administering
Inventory control
Stories, Processes, and Outcomes - Panel
Questions and Discussion