When conducting an initial intake on all patients, always ask about their use of cannabis. They may not be willing to volunteer the information, but most patients will admit to use if asked directly (Mathre, 1985). If they admit to use, continue to assess their use patterns and reasons for use. This will help you understand if they are using it recreationally or medicinally. Either way, patients still need to understand the potential risks and benefits and be taught how to use cannabis safely.
Until cannabis is removed from Schedule I, begin by reminding the patient or family members that cannabis is illegal under federal law and that they are subject to legal consequences if arrested for possessing or growing the plant. For example, you could say “You understand that cannabis is illegal, so I cannot help you obtain it and you could get arrested if your use is known by law enforcement.” This is simply stating the fact and also letting the patient know that you are not going to report their use.
It is important to ask the patient if they want their use noted in their record. Some patients will not, due to fear of their use being known by others, yet the record can be useful if they are arrested for cannabis possession and need to prove medical necessity. In the legal medical-cannabis states, patients need to understand that they are still in danger of federal prosecution.
The healthcare professional needs to know the conditions under which cannabis can be recommended for medicinal use because they vary among states. Another area of concern is reciprocity between states; patients need to understand that even though they have a legal recommendation for cannabis in one state, it does not mean they can take their medication into another state and use it.
Here are some other points to help patients use cannabis safely and responsibly:
- Vocabulary. Teach patients to call it “cannabis.” This allows the patient to understand that there is a long history that supports cannabis as medication.
- Legality. Know the laws of the state regarding how much a patient can grow or possess and under what conditions/diagnoses medicinal cannabis may be recommended.
- Storage. Dark glass or metal tins are preferred over plastic. Use an opaque container or store in a cool, dark area. Freeze for long-term storage.
- Inhaling cannabis:
- Use a pipe rather than a cigarette to be more efficient.
- Clean the pipe daily because the tar will build up after each use. Glass pipes are easy to clean. Purple Power is a biodegradable cleaner that is effective and can be found in automotive supply stores.
- Do not hold your breath for more than 3 seconds after inhaling. Holding it for longer periods of time will only allow more smoke to be absorbed into the pulmonary tissue.
- Never use cannabis with mold on it. If you are in doubt, it can be baked at 350°F for 15 minutes. This will kill any aspergillus, which can be dangerous, especially to patients with a compromised immune system.
- Encourage the use of a vaporizer to eliminate any potential harm from smoking.
- Always begin with one inhalation when using a new supply and wait several minutes to determine if you need more.
- Taking Cannabis sublingually. Start with a few drops, wait 10 minutes, and take more only if needed. Store in dark glass container.
- Using medibles. Keep them clearly marked and out of reach of children or others who could ingest the food without realizing it is medication. Take a small dose and wait at least 30 minutes to determine its effects.
- If obtaining medication from a dispensary. Ask about quality control testing. Ask for strains that are rich in CBD (this will encourage growers to develop and grow these strains). Expect the dispensary to clearly label the contents of their products, including the cannabinoid and terpenoid content.