Medicinal Cannabis use

Who are the stakeholders both in support of and in opposition to medicinal cannabis use?

The use of cannabis as medicine results a controversial and frequent debate in all levels of society. Mostly in comparison with others legal drugs as alcohol and tobacco which have not proven health benefits. Different arguments have been posters by the pro-marijuana use: is a plant not a drug, healthy than tobacco, not everyone to takes drugs becomes an addict, is harder to overcome from alcohol abuse that marijuana use, is another crop to develop farmer industry, helps with pain, allows to “die with dignity”, also has anti inflammatory properties, antiemetic, and has been use as medicine for hundreds of years. It can be used in many ways, and not need to get high to enjoy its benefits.

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But for some legislatives, is another addictive substance, a gateway drug. Also, researches have demonstrated that affect short-term memory, impair cognitive abilities, cause lung damage, increase the risk of lung cancer. Impairs driving skills causing collisions. Is consider illegal under federal law being placed as Schedule I drug in the Controlled Substance Act same as heroin (The Debate Over the Legalization of Marijuana for Medical Use, 2021).

Multiple and diverse interests are mixed, the drug companies saw a unique opportunity to make money, legislatives and politicians use it as campaign logo, to gain votes, and beyond planning a way to tax the sale. Others advocate the right of freedom to have a recreational not harmful activity. Economically is another way for farmers to diversify production as herb or hemp. By the other hand the use among young people can lead to other drug dependency, alter family stability, and affect scholarity. On the peak of the iceberg stands medical benefits, health professionals need to adhere to laws and best practices (Gardiner et al., 2019).

What does current medical/nursing research say regarding the increasing use of medicinal cannabis?

           The use of marijuana as a medicine date back centuries, it was even listed in the US. pharmacopeia. Unfortunately, it was very popular among the marginalized, minorities, poor class and Afro-American musicians as a recreational drug and there began the legal and social problems that favored The Marijuana Tax Act of 1937 (Mason et al., 2016). Despite the prohibition and all social issues, researches identified that health professionals support the use of medicinal cannabis, exist a lack of knowledge regarding legislative and clinical domain, and the risk of psychiatric events (Gardiner et al., 2019). The highest risk on implementing medicinal cannabis is the potential for recreational misuse. Also, exist a gap among pharmacist related to dosage, administration, side effects, and interactions that must be filed by evidence and research. Education about this topic must be provided to professionals because is a trending medicine nowadays (Abazia & Bridgeman, 2018).

The effects of phytocannaboids can be reached by a variety of routes of administration giving a broad spectrum for medicinal use. Inhalation is the most common way having the quickest onset of action appropriate for those which requires a rapid release of symptoms with a shorter duration. Oral administration has a longer duration but slower onset of action, very effective on chronic pain. Oro mucosal is also another alternative to treat spasticity on multiple sclerosis and neuropathic pain. Rectal use is uncommon but available to treat chemotherapy nausea and emesis. Topical administration has been proven effectivity on glaucoma (Mouhamed et al., 2018).

All of above prove the beneficial effect of medicinal marijuana, bust still exists a lack of studies analyzing benefit-harm of this alternative method of treatment. More evidence-based report is needed to plenty support this option. However, many countries including some states of the union have approved the use of medical marijuana. Worldwide 45-80% of patients are using this modality of treatment (Tawfik et al., 2019).

What is the policy, legal and future practice implications based on the current prescribed rate of cannabis?

Since 1996 when California passed the Proposition 215 that allows patients to use herbal cannabis the changes on laws and policies began. During the 20th century many states approve the use of medicinal marijuana by provider prescriptions or by individual use. Regulations vary in terms according internal legislations on each state. In that aspect the dispensaries acts more or less aggressive, providers are required to be aware of policies, the form of distribution vary from states to states as well as chain of supply (National Academies of Sciences, Engineering, and Medicine et al., 2017).

The H.R. 5657: Medical Marijuana Research Act facilitates medical marijuana research and directs the Drug Enforcement Administration to register practitioners, manufactures and distributors for that purpose (Summary of H.R. 5657: Medical Marijuana Research Act, 2021). A new classification is needed in order to reschedule this drug and move it to Schedule II or create a new one cannabis only schedule IV to accommodate all cannabis product and facilitate well designed clinical trials (Ryan et al., 2021). The use of appropriate terminology is important, a heath provider can recommend the use but this substance is still a Schedule I, so they only can prescribe the products authorized by law and according their license terms.

References

Abazia, D. T., & Bridgeman, M. B. (2018). Reefer madness or real medicine? A plea for incorporating medicinal cannabis in pharmacy curricula. Currents in Pharmacy Teaching and Learning, 10(9), 1165–1167. https://doi.org/10.1016/j.cptl.2018.06.003

Gardiner, K. M., Singleton, J. A., Sheridan, J., Kyle, G. J., & Nissen, L. M. (2019). Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis – A systematic review. PLOS ONE, 14(5), e0216556. https://doi.org/10.1371/journal.pone.0216556

Mason, D., Gardner, D., Hopkins, F., & O’Grady, E. (2016). Policy & Politics: in Nursing and Health Care (7th ed.). Elsevier.

Mouhamed, Y., Vishnyakov, A., Qorri, B., Sambi, M., Frank, S. S., Nowierski, C., Lamba, A., Bhatti, U., & Szewczuk, M. (2018). Therapeutic potential of medicinal marijuana: an educational primer for health care professionals. Drug, Healthcare and Patient Safety, Volume 10, 45–66. https://doi.org/10.2147/dhps.s158592

National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, & Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. (2017).

Ryan, J. E., McCabe, S. E., & Boyd, C. J. (2021). Medicinal Cannabis: Policy, Patients, and Providers. Policy, Politics, & Nursing Practice, 22(2), 126–133. https://doi.org/10.1177/1527154421989609

Summary of H.R. 5657: Medical Marijuana Research Act. (2021). GovTrack.Us. https://www.govtrack.us/congress/bills/117/hr5657/summary

The Debate Over the Legalization of Marijuana for Medical Use. (2021, January 23). Verywell Health. https://www.verywellhealth.com/what-are-the-pros-and-cons-of-medical-marijuana-1132484

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (1st ed.). National Academies PressTawfik, G. M., Hashan, M. R., Abdelaal, A., Tieu, T. M., & Huy, N. T. (2019). A commentary on the medicinal use of marijuana. Tropical Medicine and Health, 47(1). https://doi.org/10.1186/s41182-019-0161-x .

The history of medical cannabis goes back to ancient times. Ancient physicians in many parts of the world mixed cannabis into medicines to treat pain and other ailments. In the 19th century, cannabis was introduced for therapeutic use in Western Medicine. An Irish physician, William Brooke O’Shaughnessy, is credited with introducing the therapeutic use of cannabis to Western medicine. Since then, there have been several advancements in how the drug is administered. First testing his preparations on animals, then administering them to patients to help treat muscle spasms, stomach cramps or general pain (Alison & Janet, 2000). Later in the century, researchers investigating methods of detecting cannabis intoxication discovered that smoking the drug reduced intraocular pressure (Lop, n.d.).

Later, in the 1970s, a synthetic version of THC was produced and approved for use in the United States as the drug Marinol. Voters in eight U.S. states showed their support for cannabis prescriptions or recommendations given by physicians between 1996 and 1999.

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis.

The public health impact of marijuana legalization remains a controversial issue. Advocates of legalization contend that this policy change will provide for more stringent regulation and safer use of marijuana, more efficient use of law enforcement resources, and possibly even a decline in the prevalence of marijuana use among adolescents and of the use of “harder” drugs (e.g., cocaine and heroin) (Project, n.d.). Those opposing legalization cite the adverse effects of marijuana and worry that legalization will lead to an increase in use, and thus an increase in health problems attributed to marijuana. The latter view is reflected in the official position statements of prominent professional medical associations such as the American Psychiatric Association, the American Society of Addiction Medicine, and the American Medical Association, which have expressed concern regarding the negative consequences of marijuana use.

Numerous studies carried out to date confirm the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances. The psychological effects of cannabinoids, such as anxiety reduction, sedation, and euphoria can influence their potential therapeutic value.

The CSA placed cannabis in Schedule I, the most restrictive category reserved for substances that have no currently accepted medical use, alongside heroin and lysergic acid diethylamide (LSD). Each state maintains its own set of laws that regulate the supply and use of the drug. In most cases, acts involving cannabis are subject to criminal prohibition, but sanctions vary considerably by state, each of which is constitutionally entitled to establish its own criminal codes and penalties. The law generally provides an

affirmative defense for individuals using cannabis for medical purposes. Reforms at the state level continued in the waning years of the 20th century, with a handful of states passing laws to allow doctors to prescribe medical cannabis or allow for a legal defense for use of medical cannabis.

Medical cannabis laws and policies vary greatly in terms of the regulations governing supply and use. Some are more restrictive than others, limiting the access of the drug to a certain class of individuals who suffer from certain illnesses or conditions, or establishing stricter limits on the production and distribution of the substance to at-home cultivation by patients and caregivers. Some states legally protect and regulate the operation of storefronts known as dispensaries (Hanson & Garcia, n.d.).

Most researchers recognize that a growing general public acceptance of the drug for medical and recreational purposes has been encouraging the changes at the state level. It remains to be seen if cannabis will be legalized at the national level or if such public opinion will continue. In 2015, according to a Gallup tracker poll, 58 percent of Americans favored legalizing cannabis, marking the third straight year that cannabis legalization found majority support (Gallup, 2015).

References

Alison Mack; Janet Joy (7 December 2000). Marijuana As Medicine?: The Science Beyond the Controversy. National Academies Press. pp. 15–. ISBN 978-0-309-06531-3.

Gallup,Inc.(2015,October21).InU.S.,58%BackLegalMarijuanaUse.Retrievedfrom http://www.gallup.com/poll/186260/back-legal-marijuana.aspx

HansonK.,&Garcia,A.(n.d.).Retrievedfromhttp://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

Lop. (n.d.). Retrieved from http://www.zauberpilz.com/golden/g31-40.htm

Project,M.P.(n.d.).MarijuanaProhibitionFacts.Retrievedfromhttps://www.mpp.org/issues/legalization/marijuana-prohibition-facts/)

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