Medical Marijuana Ethical Dilemmas

In the medical profession, doctors and nurses run into ethical dilemmas every day whether it be a mother who wants to abort her baby or a patient who has decided they want to stop cancer treatment. It is important for the nurse to know where they stand with their own moral code, but to make sure they are not being biased when educating the patient. Nurses are patient advocates, it is in the job description, so although the nurse may not agree with the patient on their decisions, the nurse to needs to advocate for the patient regardless.
Medical marijuana is becoming increasingly popular with patient with chronic pain, cancer, HIV patients, and patients with epilepsy. Patients who use medical marijuana are able to use many different forms of

the plant, such as oils, lotions, and edibles, that contain the psychoactive drug of THC. Because THC doesn’t become active until the patient burns it or heats it to cook it, it stays inactive, so patients use the lotions or oils, are not going to have the psychoactive effects of someone who was smoking a joint or eating a cannabis cookie. (TWB, 2014)
In the article, “Sanford Hospital Patient Denied Medical Marijuana”, it explains the dilemma that happens to patients who regularly use medical marijuana for chronic issues, and are denied it while in the hospital. Marijuana is regulated by the federal government, but is governed by the individual states themselves. Hospitals are also governed by the federal government and because of this, they have to follow federal laws, regardless of the individual state law. The patient in the article is Eric Chapman, who was in a car accident 40 years ago, and now has chronic pain from that accident. In the state of Maine, patients are able to have medical marijuana and use it, but not within the hospital setting. Not only is it prohibited because of federal law, but since marijuana is not approved by the FDA, providers are not able to prescribe or administer it to patients, who it could benefit. A bill was proposed to ensure that patients who regularly use medical marijuana be able to have it in the hospital as well, but it was vetoed. Patients such as children with epilepsy, where they depend on the medical marijuana to reduce the epileptic seizures from occurring, need constant access to it, but if they become hospitalized, they lose that. Chapman stated that since his accident he has consistently smoked the plant as well as used it in lotion forms to help with his pain and stiffness from his accident, and that it helps enough to where he does not need to use narcotics for pain. He was hospitalized for a blood infection at Sanford Hospital in Maine, where he was told he had to remove his medical marijuana lotion off the premises or they would confiscate it from him. “Dr. Dustin Sulak stated topical cannibis is especially effective for pain relief and as an anti-inflammatory.” (Graham, 2015)
Nurses need to advocate for their patient who is a medical marijuana user, because it can be a very effective pain reliever or anti-inflammatory.

More and more nurses and doctors are turning their heads when patients are in the hospital and have marijuana tinctures or lotions, because they know that patient needs to have that relief. It is estimated that 2,604,079 people in the United States use a type of medical marijuana. (Number of Legal Medical Marijuana Patients, 2016) If those 2,604,079 people were to be hospitalized, then every single one of them would be losing their ability to use that medical marijuana for an plethora of conditions. Medical marijuana helps HIV patients to help increase their appetite, patients with epilepsy to decrease the neuron signals in the brain, patients with chronic inflammatory issues, cancer patients to help increase their appetite, patients with chronic pain, and even in patients who have

ADHD.
There is a stigma with marijuana, people use marijuana, are “stoners” and are “lazy”.

Although this is typically seen with recreational marijuana. Although some effects of patient’s using marijuana, can be that they lose motivation to participate in activities, and they may become tired, because the effects can cause your body to slow down. Marijuana mainly affects the neurons in the brain and the pathways, and when a patient uses marijuana they are inhibiting the normal brain development and the normal function. Effects of medical marijuana will be decreased because it is less potent than recreational marijuana, but may still affect the person. Some short term effects can be impaired memory, inability to problem-solve, and altered sense of time. Long term effects can be learning dysfunction from abnormal brain development, especially in teenagers. Studies have shown that although tobacco is usually the drug that leads to lung complications and problems, patients who smoke medical marijuana can also have lung issues because the drug is irritating to the alveoli. (Morrow,

2017)
Although many patients in the United States use some type of medical marijuana for a clinical/medical reason as listed before, there is still not enough research to confirm whether it works to effectively manage pain or inflammation. (Morrow, 2017)
In the nursing profession, we have a legislative group of nurses in every state, to help advocate for patients when it comes to laws. In this situation, given that it is a federal law problem ,advocacy for patients like Chapman who depend on the medical marijuana to get them through pain, or inflammation flare-ups is important. Narcotics have been abused drugs and still are, and are increasing in certain communities. In small communities, narcotics such as Heroin and cocaine are highly abused drugs and are considered the same schedule of drug as marijuana. Schedule I drug class is defined as
“ illegal because they have high abuse potential, no medical use, and severe safety concerns; for example, narcotics such as Heroin, LSD, and cocaine. Marijuana is also included as a Class 1 drug despite it being legal in some states and it being used as a medicinal drug in some states.” (Schedule or Classes of Drugs)
In the definition of a schedule I drug, it states the drug has no medicinal use, but marijuana does have medicinal properties for an approx. 2,604.079 people in the United States. The government needs to understand that although some people who smoke recreational marijuana, do have a higher stigma than patients who use medical marijuana. Medical marijuana is less potent than the recreational marijuana and so patients are not as “high” as someone who bought a joint off the street.
Due to marijuana being a schedule I drug though also means it has an abuse potential. Medical marijuana has more of a psychological addiction, rather than physical because marijuana affects the brain. The psychological addiction symptoms the patient will show are mood swings, depression and anxiety. Depending on the person, patients may have a more intense addiction to the marijuana, and some patients may be able to use it once occasionally and have no addiction effects. (Administrator, 2014)
Typically because of the lower potency of the medical marijuana, the addiction rate to the drug is lower than with recreational marijuana. (Administrator, 2014)
Advocating for patients in a situation such as this one, where the problem is not within the hospital, but within the federal government, it can be hard to decided what to do as a nurse. Legislative nursing can be a great resource for nurses who want to advocate for a patient to the state or even federal level of the law. Educating patients, as well as community members about the good reasons for medical marijuana, and advocating for more research into the effectiveness of the medical marijuana is a good way to inform people of the benefits.
Within the community nurses can advocate to their state legislator, provide education to patients and the community, as well as advocating and allowing patients who need that medical marijuana to decrease the pain or inflammation, to have family bring cannabis lotions for the patient to help.