MEDICINAL CANNABIS RISING TO THE TOP
By Lori Straba Frohe, APRN, CPN, PMHNP-BC
Patients will call and ask me if I can prescribe them medical cannabis, to which I explain that I cannot prescribe, but I can help them through the New Mexico Medical Cannabis Program (NMMCP) application process. I explain that I only evaluate patients for the diagnosis of Post-Traumatic Stress Disorder (PTSD) and if they meet criteria for PTSD, I will recommend that they should be considered into the program.
Today 24 states have a medical cannabis program, which allows providers to “recommend” medical cannabis to patients with specific diagnosis’ allowing these patients to benefit from medicinal cannabis’ therapeutic effects (Shtern, Kase, Fisher-Corn, & Corn, 2016).
I feel that lack of knowledge is a huge barrier for many providers. I did not study medical cannabis in the University where I received my Nurse Practitioner license, but I have educated myself through continuing education medical courses, as well as the limited research that I can find. As Shtern and colleagues explain, currently, a provider cannot learn about cannabis’ side effects and contraindications from many legitimate medical or psychiatric resources, such as the Physicians’ Desk Reference, which is often used by most practitioners (2016).
Different from new pharmaceuticals available today, cannabis remains illegal, controlled by federal law and therefore declared unsafe by the Food and Drug Administration (FDA). The federal government, Drug Enforcement Administration (DEA) categorizes cannabis as a Schedule I controlled substance, which means it is looked at just like heroin and LSD. Therefore, cannabis has been put into the designated category of “no acceptable medical use, high potential for abuse, and lack of a safe use”. Surprisingly, this schedule by the DEA labels methamphetamine as a Schedule II (DEA, 2016); meaning by federal standards, it has more medicinal use and does not have as high of a potential for abuse as cannabis does. This flawed scheduling system has impeded research and education, leaving providers unaware of medicinal cannabis and legal implications of incorporating it into their practice (Shtern, Kase, Fisher-Corn, Corn, 2016). The lack of availability to resources, leave providers reluctant to participate in any state endorsed program for fear of criminal prosecution.
In New York, providers wanting to certify patients for medical cannabis and pharmacists who work in cannabis dispensaries are required to complete a course on the medical use of cannabis (Shtern, Kase, Fisher-Corn, Corn, 2016). Many other states are now considering to adopt similar requirements in order to help address the risks caused by the lack of education and resources regarding cannabis in the medical community.
The United States DEA approved a clinical trial to study the cannabis plant for treatment of PTSD. The FDA, along with the National Institute on Drug Abuse (NIDA) and the Public Health Service (PHS) have all agreed on the beneficial importance of this study (Jun, 2016). It is the first ever U.S. randomized controlled trial to examine the efficacy of cannabis on 76 war veterans with the diagnosis of chronic, treatment-resistant PTSD. The study is awaiting medical cannabis from the NIDA and is expected to start later this year. The research is sponsored by a non profit alternative medicine organization known as the Multidisciplinary Association for Psychedelic Studies (MAPS; Jun, 2016).
Many could argue that currently, healthcare providers, as along with the Veteran’s Affairs Health System seem quick to prescribe anti-anxiety drugs, antidepressants, sedatives, and other medications for PTSD. Unfortunately, that has not been able to attribute much to slow the ever-increasing trend of veteran suicides. Cannabis, despite promising results for many veterans who are dealing with PTSD, is off the table (Coughlin-Bogue, 2016). Possession of cannabis is still a federal crime, and the VA is a federal agency. However, veterans across the country are speaking up in favor of cannabis, saying that it’s succeeded where pharmaceutical medications have failed (Coughlin-Bogue, 2016).
The Senate Appropriations Committee passed that VA providers can now recommend therapeutic cannabis to veterans. This amendment is part of the 2017 Military Construction, Veterans Affairs and Related Agencies bill (Cruz, 2016) which allows VA doctors to openly discuss medicinal cannabis to their patients. Veterans are referred to outside providers (for a fee) to help them through the process of obtaining a medical cannabis card, unfortunately most veterans cannot afford an outside providers fee, thus leaving the veteran no other choice but to seek cannabis illegally.
As the demand for medical cannabis continues to grow, I am hopeful that there will be an increase in medical and legal research increasing everyone’s education on the beneficial effects of medicinal cannabis.
Coughlin-Bogue, T. (2016). Three Military Veterans Explain What Weed Does for Their PTSD. These Vets Who Use Cannabis Talk About How It’s Saved Lives-Specifically, Theirs. The Stranger. Available at: “http://www.stranger.com/weed/2016/04/13/23950860/three-military-veterans-explain-what-weed-does-for-their-ptsd (Accessed August 2016).
Cruz, P., K. D. (2016). Veterans Can Now Get Medical Marijuana; VA Doctors Can Now Recommend Therapeutic Cannabis to Patients. Lawyer Herald. Available at: “http://www.lawyerherald.com/articles/43212/20160419/veterans-medical-marijuana-va-doctors-therapeutic-cannabis.htm (Accessed August 2016).
Jun, C. (2016). DEA Approves First Trial of Medical Marijuana for PTSD. Available at: ‘http://www.popsci.com/dea-approves-first-ever-trial-medical-marijuana-for-ptsd(Accessed August 2016).
Shtern, Y., Kase E., Fisher-Corn, M., & Corn S.B. (2016). When Your Patient Asks for Medical Marijuana. Physicians Practice Blog. Diagnostic Imaging. Available at: http://www.diagnosticimaging.com/ (Accessed August 2016).
United States Drug Enforcement Administration: Drug Schedules (2016). U.S. Department of Justice; DEA. Available at: https://www.dea.gov/druginfo/ds.shtml (Accessed August 2016).