Cannabis and Cannabidiol Policy Proposal

Healthcare policy is the public program that identifies specific community goals,  plans, decides, and implements programs and actions to achieve those goals. Healthcare policy determines and selects reference points and targets to measure short term and long term goals. These goals are the foresight of the direction of healthcare which  systematically plans for the future. It summarizes the plan, establishes roles of groups, systematically plans solidarity, and educates communities (World Health Organization, 2019).

Scientific research influences healthcare perceptions and with increased discussions comes increased influences, through lobbying, to sway policy (Annesley, 2019). Special interest groups, when united have the most leverage and the nursing profession, united, can have the most impact on policy reform. According to the United Nations 2030 sustainable agenda (Rosa et al., 2019), nurses are key stakeholders in obtaining and identifying goals. The agenda identified several health areas where attention should be focused. The health needs of the poor, causes and effects of malnutrition, safe water and sanitation, improving diets, education to improve health and equality, clean air and research and development are some of the goals identified. Nurses are in a unique position to lead change as their profession is one of caretaker and firsthand knowledge of inequalities and lack of resources for their patients. Nurses can identify how improved healthy lifestyles and interventions can improve patient outcomes. They protect the patient’s rights and support patients independent and preferred decisions and treatments (Davoodvand, Abbaszadeh, & Ahmadi, 2016).

Nurses as advocates have knowledge that can help shape these goals through empowered policy making and action. The advanced practiced nurse through education and nursing practice has a responsibility to the future of the nursing as a profession, to ensure that their voices are heard and that the health of their communities is prioritized. This can only be accomplished through involvement with agencies and coalitions responsible that influence the implementation of policies (Goodman, 2014). This paper will identify and examine concerns with the administration of medical cannabis and CBD in facilities, the solution policy that can be proposed and implemented, the presentation of the policy proposal to an elected official and conclusion of all aspects of the proposal.

Identification of Selected Healthcare Concern

The Drug Enforcement Agency (DEA) has classified marijuana as a schedule 1 drug, therefore nurses cannot administer marijuana products to patients as it is federally illegal (Cambron, Guttmannova, & Fleming, 2017). This poses a problem with patients who are in hospitals, nursing and residential long-term care facilities. Many of these patients meet criteria for medical marijuana but are not allowed to bring these drugs onto the premises (Pettinato, 2018). This situation forces many patients to violate facility policy and bring these drugs into facilities and medicate their symptoms without the knowledge of the health care practitioner. In long-term care facilities, family members must bring their family member off premises, administer the drug and bring them back to their facility. The healthcare professional may not have an accurate medical history of patients health, partly due to the legality and partly due to fear patients may be experiencing with their provider. 

Individual states do not have impact on the classification of drugs, as the classification of a drug can only be changed by the Attorney General, typically after Health and Human Services files a petition for review. Several states have legalized medical marijuana, but have not provided the guidance for health care professionals in these facilities the protection to administer (Lee & Mallinson, 2018). In fact the adoption of medical cannabis has shown to be more about capital revenue than the medical benefits associated with these drugs (Lee & Mallinson, 2018). The state therefore must act in accordance with their constituents to provide legislation to assist with obtaining medical cannabis .

Patients and residents who reside in hospitals and long-term care facilities with a medical need may not have the necessary access to medical marijuana and CBD products. Cannabis and CBD have been shown to improve pain associated with cancer and chronic conditions (Ware, Wang, Shapiro, & Collet, 2015).  Research has shown improvement with symptoms of pain, anxiety, insomnia, seizures and nausea without the addictive features of current prescribed medications (Bigand, Anderson, Roberts, Shaw, & Wilson, 2019). With the only possibility of relieving symptoms for patients in these facilities is to prescribe narcotics, prescribers, nurses and patients no longer have holistic options to treat. These narcotics have numerous adverse side effects and are highly addictive perpetuating the opioid national epidemic (Lucas, 2017). 

Policy Solution to Selected Healthcare Concern

The proposal for this health care concern is for the state of New York, which has a medical marijuana program, to institute a policy that addresses the ability for nurses and facilities to possess, distribute, and administer medical cannabis and Cannabidiol (CBD) oils and edibles to patients who have a medical marijuana certification, without the threat of prosecution to nurses and healthcare professionals. With the ability for patients and residents in facilities to have access, there is an improvement in health outcomes. This will allow for patients to continue necessary treatments while allowing for practitioners in these facilities to have an open dialogue and provide continuity of care and treatment for their patients. 

Evidence has shown that medical and recreational use of cannabis has had a positive effect on public health. This is due to the substitution of cannabis for opioids. The increased use of cannabis has shown to reduce the use of alcohol and has reduced the need for the and use of opioids, to treat pain and anxiety. In states that have established medical marijuana programs, there is a reduction in the opioid mortality rate by 24.8% (Lucas, 2017) In 2016, it was noted by Medicare, that there was a reduction in the number of prescription for narcotics, anti-anxiety, neuroleptics, anti-nausea and sleep-aids (Lucas, 2017). The reduction in the these prescriptions is paramount in addressing the national addiction epidemic, as many patients receive the necessary pain relief without the addictive side-effects, noted using narcotics (Lucas, 2017). Despite some reported adverse side effects with the use of cannabis, no reported incidents of overdose have been reported, making Cannabis a better choice than prescription narcotics (Bigand et al., 2019).

Numerous healthcare conditions can be benefited by holistic approaches versus pharmaceutical interventions. Cannabis and CBD can meet the need of pain relief, anxiety, insomnia, and various chronic conditions. Legalizing marijuana has been identified as a complex political issue and many states have legalized medical and recreational marijuana (Cambron et al., 2017). This has been a benefit and much needed service to patients who qualify for the use of medical marijuana. This is only advantageous to the patient in a home setting and does not follow the patients should there be an inpatient stay or admission into long-term care. This barrier prevents continuity of care and provides for only one treatment option. 

To facilitate this process, if policy is accepted, would be the incorporation of patient specific certificate of need forms for each patient, admitted as an inpatient, in a facility. This ensures that patients and residents have a documented diagnosis for the need of cannabis or CBD. The storage of this drug and the destruction must continue to meet DEA guidelines for current narcotics to safeguard these drugs while protecting public safety. Facilities should have nurses obtain specialized nursing training in the area of cannabis and CBD to assist with the education of these drug therapies to patients and their families and be champions of these program in their facilities (Elsevier, 2018). 

The success of these programs can be monitored by the rate of reduction in opioid overdoses and the reduction in prescription rates for traditional narcotics. Patient reporting and observable alleviation of signs and symptoms of pain, anxiety, seizures, and movement disorders can be reported by facilities for the use of research and development. Increased research can offer further study of cannabis and CBD products with nursing interventions captured.

Challenges of implementing this policy can be many. The storage of these drugs in residential facilities, where clinical nurses may not be directly on-sight can be a barrier of safeguarding these drugs. In the facilities that provide services to the intellectual and physical disabilities, the guidance of the office of Persons with Developmental Disabilities (OPWDD) has been that these types of drugs must be kept in fixed and unmovable boxes with keyless double locking abilities (OPWDD.ny.gov, n.d.). These medications must be counted every time medication is administered, combinations  must be changed every time staffing changes and each RN must provide competencies to each staff member that will be handling these drugs.

The stigma by communities and healthcare professionals alike can be a barrier to the implementation of this policy. Many healthcare providers, including nurses do not agree with the administration of cannabis and CBD drugs to treat diseases and disorders. This would require that nurses and healthcare practitioners be educated regarding the benefits of these drugs while maintaining a non-judgmental attitude when treating patients. This can be combated with educational classes that specialize in cannabis and CBD to alleviate the concern of risk versus benefit. As nurse leaders we must always treat our patients in non-judgmental, like how we ourselves, or our loved ones would want ourselves and our loved ones treated. Therefore, continuing to treat each individual with integrity is the backbone of the nursing (Elsevier, 2018)  

Identification of Elected Official

Monica Martinez is the senator for district 3. Monica, as a committee member of   Veterans, Homeland Security and Military Affairs this policy is essential to those living in these facilities (The New York State Senate, n.d.). Veterans suffer from anxiety and depression at a higher rate than other community members. Access to medical cannabis while residing in veteran facilities can treat symptoms of depression and alleviate anxiety, therefore reducing depression from PTSD. This policy can reference similar policies that were passed in Virginia allowing for nurses to possess and distribute medical cannabis to students without being prosecuted for violating federal law (S. Res. HB 1720, 2019). 

Conclusion

In conclusion, with the implementation of this new healthcare policy positive change can be seen throughout various communities. The overall long term effect with the proposal and approval of this policy will have a drastic impact on patients who reside in healthcare facilities with the additional protection to the licensed professional.

Questions often arise from patients and their families  admitted to short-term and long-term care facilities regarding the use of medical cannabis to augment current treatment. Community members have difficulty in conceptualizing that treatments aimed at relieving pain, treating movement disorders and seizures are not allowed in facilities despite the patients having medical marijuana certifications. There is often confusion regarding the use of these drugs in facilities versus home settings. The advanced practice is at a disadvantage to providing patients with individualized treatment options for disorders and pain. Patients treated with medical cannabis prior to admission can have difficulty in obtaining similar treatment results from traditional prescribed medications. 

Having medication and drug options are within patients’ rights when choosing treatment, as well as discussing these options with doctors and nurses while in the hospital or short-term and long-term care facilities. Nurses and healthcare professionals have an obligation to their patients to respect treatment options. If the nurses or doctor cannot possess nor administer these necessary drugs, patient health will suffer. This is a very important topic that requires contemplation and approval due to the national , opioid epidemic, the overuse and over prescribed narcotics. Nurses who administer these drugs in states that have medical approved marijuana programs should be able to carry out their job function without the threat of federal prosecution and the threat of losing their nursing license.

References

• Annesley, S. H. (2019). The implications of health policy for nursing. British Journal of Nursing, 28(8), 496-502. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=135966436&site=eds-live&scope=site
• Bigand, T., Anderson, C. L., Roberts, M. L., Shaw, M. R., & Wilson, M. (2019). Benefits and adverse effects of cannabis use among adults with persistent pain. Nursing Outlook, 67(3), 223-231. http://dx.doi.org/10.1016/j.outlook.2018.12.014.
• Cambron, C., Guttmannova, K., & Fleming, C. B. (2017). State and national contexts in evaluating cannabis laws: A case study of Washington state. J Drug Issues, 47(1), 74-90. http://dx.doi.org/10.1177/0022042616678607
• Cannabidiol oil and THC-A oil: possession or distribution at public school, S. Res. HB 1720, 116th Cong., (2019) (enacted).
• Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: A qualitative study. Journal of Medical Ethics and History of Medicine, 9(5), 1-8. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=120285800&site=eds-live&scope=site
• Elsevier. (2018). Medical marijuana education in APRN nursing programs. In M. Alexander (Ed.), Journal of Nursing Regulation (9). Retrieved from https://www.ncsbn.org
• Goodman, T. (2014). The future of nursing: An opportunity for advocacy. AORN Journal, 99(6), 668–671. http://dx.doi.org/10.1016/j.aorn.2014.03.004.
• Lee, H. A., & Mallinson, D. J. (2018). Defiant innovation: The adoption of medical marijuana laws in the American states. Policy Studies Journal, 46(2), 402-423. http://dx.doi.org/10.1111/psj.12211
• Lucas, P. (2017). Rationale for cannabis-based interventions in the opioid overdose crisis. Harm Reduction Journal, 14(1), 1-6. http://dx.doi.org/10.1186/s12954-017-0183-9
• OPWDD.ny.gov. (n.d.). https://opwdd.ny.gov/sites/default/files/documents/health_medmanpharmfaqcontrolled.pdf
• Pettinato, M. (2018). Marijuana regulatory frameworks in four US states: An analysis against a public health standard. American Journal of Public Health, 108(7), 914. http://dx.doi.org/10.2105/AJPH.2018.304401
• Rosa, W. E., Kurth, A. E., Sullivan-Marx, E., Shamian, J., Shaw, H. K., Wilson, L. L., & Crisp, N. (2019). Nursing advocacy to lead the United Nations sustainable development agenda. Nursing Outlook. http://dx.doi.org/10.1016/j.outlook.2019.06.013
• The New York State Senate. (n.d.). https://www.nysenate.gov/senators/monica-r-martinez/about
• Ware, M. A., Wang, T., Shapiro, S., & Collet, J. (2015). Cannabis for the management of pain: Assessment of safety study (COMPASS). The Journal of Pain, 16(12), 1233-1242. http://dx.doi.org/ https://doi.org/10.1016/j.jpain.2015.07.014
• World Health Organization. (2019). https://www.who.int/topics/health_policy/en