Pubdate: Sat, 01 Apr 2006
Source: American Journal of Nursing
Section: Vol. 106(4), pp 77-79
Author: Susan Trossman, RN
Bookmark: (Cannabis - Medicinal)
Bookmark: (Chronic Pain)
Bookmark: (Decrim/Legalization)
Bookmark: (Treatment)
Note: Susan Trossman is the senior reporter for the American Nurse, 
published by the ANA


Promoting Research On And Acceptance Of This Treatment Option For Patients

As an RN, Rhonda O'Donnell has always seen herself as a patient 
advocate. But she never imagined that she would become the face of 
the medical marijuana movement in her home state of Rhode Island. 
But-through a series of events-she has. And she's fine with it if it 
means diminishing people's pain, as well as other symptoms associated 
with certain chronic and terminal conditions.

I'm not promoting the use of illegal drugs and I'm not discounting 
the value of pharmaceuticals, says O'Donnell, who takes several 
federally-approved medications for multiple sclerosis (MS). But if 
using marijuana can ease people's suffering, why not let people use 
it without being afraid of getting arrested?

Activity around the issue of medical marijuana has increased lately, 
including efforts by RNs and nursing organizations, such as the Rhode 
Island State Nurses Association (RISNA), the Wisconsin Nurses 
Association (WNA) and the ANA, to win measures legalizing its use and 
to promote and publicize advances in clinical research.

This month, the partially nurse-created organization, Patients Out of 
Time ( ), is featuring the latest 
science-based research at its Fourth National Clinical Conference on 
Cannabis Therapeutics. Some 350 clinicians, patients, lawmakers, and 
others are expected to attend.

In The States

The efforts of O'Donnell and RISNA contributed to the passage of a 
new state law this year allowing Rhode Islanders diagnosed with 
specified illnesses to legally use marijuana solely for medicinal 
purposes. The Rhode Island legislature overrode the governor's veto 
to make the law possible-making it the 11th state allowing the 
limited use of marijuana.

The reason for the law is compassion, and I'm so grateful to the 
legislators in Rhode Island who saw it the same way, says O'Donnell, 
who hopes marijuana will help alleviate the leg spasms and pain she's 
experienced since she was diagnosed with MS nearly 12 years ago.

I chose not to use medical marijuana to deal with my symptoms until I 
could do it legally, O'Donnell says. Like others, O'Donnell must 
obtain an identification card-probably at an annual cost of $100-to 
be immune from potential local or state prosecution.

Both she and Donna Policastro, RNP, president and interim director of 
the RISNA, participated in a community hearing earlier this year by 
the Rhode Island Public Health Department, which is charged with 
developing regulations around the measure.

We collaborated with many other organizations, such as the Rhode 
Island Medical Society, to promote the legislation which we view as a 
patient safety and advocacy issue, Policastro says. We're very happy 
the measure passed, but we do have some concerns about safety that we 
tried to address at the hearing.

As it stands now, Policastro says that patients in the program must 
still go to street vendors to obtain marijuana-unlike in California 
where patients can obtain marijuana safely through state-sanctioned 
clubs. RISNA nurses also have concerns about patient confidentiality 
and have urged state officials to keep only minimal information on 
qualified medical marijuana users in its database-such as identifying 
patients by an assigned number instead of by name.

Additionally, Policastro says RISNA wants to ensure that nurses' 
practices aren't compromised if they help-or elect not to 
help-administer medical marijuana to patients, such as those in a 
long-term care facility. And as an NP, she still expresses some 
concern about federal surveillance of health care professionals who 
provide the documentation needed for patients to enter the medical 
marijuana program-despite the existence of certain protections issued 
by the courts.

Meanwhile advocates of medical marijuana use in New York and 
Wisconsin suffered setbacks.

We passed a reference at our annual meeting in 1999 to make marijuana 
a legally prescribed medication in cases where it's shown to be safe 
and effective, says Gina Dennik-Champion, MSN, MSHA, RN, executive 
administrator of the WNA.

Over the years, WNA nurses have testified before state lawmakers, 
participated in media interviews, and signed on to a resolution 
introduced by the New York State Nurses Association (NYSNA)-and 
ultimately passed-at the ANA's House of Delegates in 2003.

Our members have been very outspoken in their belief that if medical 
marijuana works as part of a palliative care regimen, it should be 
allowed, Dennik-Champion says.

In her assembly testimony, she noted its therapeutic benefits, such 
as reducing nausea and vomiting associated with chemotherapy, 
stimulating appetite for AIDS patients experiencing wasting syndrome, 
and reducing intraocular pressure associated with glaucoma.

However, as 2005 ended, the state assembly passed on considering the 
medical marijuana bill (AB 740) further. But WNA nurses won't give up 
their campaign.

And neither will NYSNA nurses even though the New York legislature 
has not taken a floor vote on its medical marijuana measure. As part 
of a consumer-driven coalition, the NYSNA has lobbied for several 
years to finally give patients who use or want to use medical 
marijuana legal protection.

This issue is about treatment options and patients' rights, says 
Shaun Flynn, assistant director in the NYSNA's Nursing Advocacy and 
Information program. And it's one our members believe in strongly. 
But it has lost a lot of traction among our state legislators 
following the recent Supreme Court ruling.

In June 2005, the Supreme Court ruled that the federal law-the 
Controlled Substances Act of 1970-makes no exception for medical 
marijuana use. But officials in several states contend that their 
medical marijuana laws are still in effect.

And in what seem to be contradictory approaches, the Drug Enforcement 
Administration still views cannabis as an illegal substance worthy of 
raiding and prosecution even though there's a longstanding federal 
program, known as compassionate use, that provides medicinal cannabis 
to a handful of U.S. citizens who registered for it decades ago.

Additionally, in California-the first state to pass a medical 
cannabis law, in 1996-San Diego County supervisors filed a suit in 
late January asking the federal court to overturn the state law.


Some nurses blame the banning of medical marijuana on politics. 
Others suggest it's about pharmaceutical companies not wanting to 
support research and promotion of a natural product that will not 
make money for them. And still others say marijuana myths-most 
commonly that it's a gateway drug that will lead to hard-core drug 
use-persist because people, including many nurses, aren't informed 
about its history or the most recent research.

At the request of nurse leaders attending the ANA's 2003 House of 
Delegates, the ANA Congress of Nursing Practice and Economics Work 
Group developed a position statement-approved by the ANA board in 
2004-that outlines the profession's views on the issue.

According to the statement, the ANA supports the right of patients to 
have safe access to therapeutic marijuana under appropriate 
professional supervision; research on marijuana's efficacy, including 
alternative methods of administration; laws that prevent patients who 
use and professionals who prescribe therapeutic marijuana from 
criminal penalties; and the education of RNs on current, 
evidenced-based therapeutic use.

Marva Wade, RN, an NYSNA member and work group chairperson, says many 
nurses believe marijuana should be in the arsenal of treatment 
options they can offer certain patients.

But some nurses oppose the profession taking a stand on something 
they consider outside the law and against the code of ethics, Wade says.

We don't support the illegal use of any drug. We support changing 
laws so patients have safe, legal access to medical marijuana, days 
Laurie Badzek, MS, RN, JD, LLM, director of the ANA's Center for 
Ethics and Human Rights and a professor at West Virginia University 
School of Nursing. Also, the code says that nurses must advocate for 
their patients, and that's what we're doing when we lobby for change.

One longtime advocate of medical marijuana use is Mary Lynn Mathre, 
MSN, RN, CARN, director of Patients Out of Time and a Virginia Nurses 
Association member.

She reports that for years there has been phenomenal research from 
many countries outside the United States involving marijuana and 
products derived from cannabis. A United Kingdom company, GW 
Pharmaceuticals, won regulatory approval from Canada for its 
oral-mucosal spray derived from cannabis to relieve pain in MS 
patients. Recently, the U.S. Food and Drug Administration approved 
the start of clinical trials in the United States to test the drug's 
ability to alleviate pain in cancer patients.

There is a national petition gaining steam that would change the 
classification of marijuana from a Schedule 1 to a Schedule 3 drug, 
allowing it to be treated like a prescription drug such as codeine, 
according to Mathre. Petition information is available at .

As for O'Donnell, she says, I won't be sorry if it doesn't help me. 
Ever since I started speaking about medical marijuana, I've met so 
many people who say it's helped them.
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MAP posted-by: Beth Wehrman