THC is included in most urine drug screens that are used in the workplace for pre-employment, random, and for-cause testing. In the hospital setting, urine drug screens have been used as a diagnostic tool in the emergency department, on newborn babies if drug use is suspected, and in pain clinics when opioids are prescribed. Healthcare professionals should understand that drug screens are not diagnostic of drug abuse—they only help confirm recent drug use.
Cannabis is different from the other drugs included in the screening in that it can be detected in the urine for as long as a month after the last use (Gieringer, Rosenthal, and Carter, 2008). This is important to understand, because a positive urine drug screen for THC does not confirm impairment by cannabis.
Some clinicians believe they must confirm that the patient is not using cannabis before they can prescribe an opioid because it is illegal to provide an opioid to a narcotic addict. Cannabis is not a narcotic, but because it is an “illicit” drug many clinicians blindly include it in the testing. If the patient tests positive for THC, some clinics counsel the patient to quit and others either deny further treatment or simply stop prescribing any opioids.
With an understanding of the safety and efficacy of cannabis for management of chronic pain, one could question the value of including THC in the drug panel that is used to screen patients. One could further question the therapeutic value with pain patients of a urine drug screen for THC. If patients experience better pain management and require lower doses of opioids when using cannabis for pain management, how does it make sense for the healthcare provider to demand that the patient stop using the cannabis? If the only answer is that cannabis is illegal, one can wonder if the healthcare provider is practicing law rather than medicine. Due to the epidemic of opioid overdoses, the Centers for Disease Control (CDC) just recently issued guidelines on prescribing opioids for chronic pain. In them, the authors question the need to include THC in the random drug screens since it poses no clinical risk to a patient on opioids (Dowell et al., 2016).
As stated previously, NIDA allows the University of Mississippi to grow cannabis for research purposes, but until recently, NIDA was only interested in studies on the abuse potential or negative effects of cannabis and did not allow the cannabis to be used in studies regarding its medicinal value. Although clinicians and legislators demand more research to validate the medical value of cannabis, but it is very difficult to conduct clinical research on cannabis in the United States because of all of the legal restrictions.
There has been a legal challenge to allow for another research facility to grow medicinal-grade cannabis for research studies. Lyle Craker, of the University of Massachusetts, applied for such a license and won his case before a DEA administrative judge. However, the ruling has been ignored, and to date cannabis can only be legally grown at the University of Mississippi farm (Craker, 2010). A U.S. Court of Appeals for the 1st Circuit ruled against him in 2013.
The DEA announced in August 2016 that it would grant additional cultivation licenses. As of July 2017, 25 applications had been submitted to the DEA and none had been approved, with no timeline given by the DEA for the approval of any licenses (Edwards Staggs, 2017).
Over the years, numerous combat veterans have found cannabis helpful in managing symptoms of post traumatic stress as well as chronic pain related to wounds or injuries. In July 2010, the Undersecretary of Health for the Department of Veterans Affairs issued a directive to the healthcare providers of the Veterans Administration that provided some access to some veterans (VHA Directive 2010-035). Because cannabis remains illegal under federal law, the VA physicians still cannot recommend it to their patients, but this directive states that if a veteran lives in a medical marijuana state and has a recommendation for cannabis from a civilian physician, then the VA will treat that as medication and will continue to treat the veteran. However, this creates another problem—in effect, this directive allows veterans access to cannabis based on their geographic location and thus creates unequal treatment for veterans.
As a healthcare professional, it is important that you use the proper name of the plant, cannabis, rather than the derogatory term, marijuana. Using the term cannabis lets others know that you are aware of its long history as a medication and allows you to educate others on its medicinal value. Using the correct term can also help change the negative image associated with marijuana.
Learn more. Since 2000, Patients Out of Time has co-sponsored an accredited biennial series of national clinical conferences on cannabis therapeutics that feature international cannabis researchers, clinicians, and cannabis patients. All of the proceedings have been filmed and are available as DVD sets. In addition, much information is available on the website: www.medicalcannabis.com or www.patientsoutoftime.org. Based on the discovery of the endocannabinoid system and the value of cannabis as medication, a new specialty nursing organization has been created: the American Cannabis Nurses Association (www.cannabisnurse.org). Although in its infancy, this organization can be a resource to healthcare professionals who need or are interested in learning more about cannabis and the ECS.
Based on science, history, and compassion, there is no justification for the placement of cannabis in Schedule I. Because cannabis is still a Schedule I drug, patients are denied safe and legal access to a medication that can relieve suffering and improve quality of life. Nursing leaders agree that healthcare professionals should be more involved in public policies, especially when they are health-related. We now have a variety of state laws that are meant to help patients gain access to this medication, but as long as it remains in Schedule I on the federal level, patients remain under threat of legal consequences for growing or possessing cannabis and healthcare providers are hesitant to recommend its use when there is no assurance of quality control. Healthcare professionals need to help correct this situation by being more proactive:
Educate your legislator.
- Get your state association or professional specialty organization to pass a formal resolution supporting patient access to cannabis.
- Break the silence and discuss the medicinal use of cannabis with your co-workers.
- Encourage patients who use cannabis to use a vaporizer or other delivery forms rather than smoking it.
- In states that allow medicinal cannabis, work to create policies in healthcare facilities (hospitals, assisted-living facilities, clinics) to allow patient use of their medication.
- Request the medicinal use of cannabis as a topic at your professional conferences.
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