About Medical Cannabis

These are all common labels for cannabis. However, this may be soon to change. New research with cannabis may prove the effectiveness of cannabis and its byproducts in the treatment of several severe and chronic diseases. Soon, those negative terms will become positive ones, such as treatment, medication, comfort, and relief. Cannabis works several ways within the body, may affect certain populations differently, requires thorough consideration before use, acts on several disease processes, and continues to be researched.

The cannabinoid system is quite complex.

Cannabis itself contains over 100 phytocannabinoids (Stinson & DeAngelis, 2016). According to research by Stinson and DeAngelis (2016), the two most endogenous chemicals of cannabis are tetrahydrocannabinol (THC), which is the psychotropic component, and cannabinol (CBD), which produces the therapeutic effects. These two chemicals act on two receptors in the body: CB1 and CB2. CB1 is found predominantly in the nervous system, more specifically in the basal ganglia, cerebrum, hippocampus, hypothalamus, cerebellum, medulla, and spinal cord, while the CB2 receptors are found mainly in the immune system organs and lymphocytes (Stinson & DeAngelis, 2016).

Cannabis and cannabinoids may be used as a form of alternative medicine, such as with palliative or hospice care, and adjunct treatment of many diseases and conditions including chronic pain, epilepsy, arthritis, cancer, and inflammatory bowel disease (IBD). It may also be used in the maintenance of post-traumatic stress disorder (PTSD), anxiety, depression, and insomnia (Green & De-Vries, 2010). The patients seeking medical cannabis may be of many age groups, races, ethnicities, and disease processes. In most cases, these clients have tried several other medications, treatments, and surgeries to relieve their symptoms, yet nothing has been successful. Although cannabis is a highly illegal drug in most states, it has been extremely therapeutic for patients suffering from a variety of illnesses such as asthma, glaucoma, chronic pain, muscle spasms, multiple sclerosis (MS), amyotrophic lateral disease, and acquired immune deficiency syndrome (AIDS) (Green & De-Vries, 2010).

There are many things to consider when determining the best treatment for a client. Will the client have access to this product? Does the client have the means to retrieve this product? Will this medication help this client? What other remedies has the client tried? If cannabis is a treatment option for this client, is it legal in the state in which they reside? According to the Marijuana Policy Project, roughly 30 states have legalized medical marijuana, but with laws and regulations surrounding the circumstances (2018). Although Indiana has now legalized the use of cannabinoid (CBD) oil, the oil must be THC free. Indiana is one of the stricter states when it comes to marijuana laws, threatening jail time for possession of even the smallest amount. However, in 2017, Indiana's governor legalized marijuana for the treatment of epilepsy that has been proven resistant to any other forms of treatment ("Medical marijuana bill," 2018).

Another aspect to think about when considering medical cannabis is what form you may use. According to Stinson and DeAngelis (2016), medical cannabis has "multiple routes of administration including edibles, vaporization, and oils" (p. 538). Some medications that are cannabis-based include dronabinol, nabiximols, and nabilone. Each drug has its own medical use as well. These drugs are referred to as cannabinoids. They act upon the CB1 and CB2 receptors of the body. Dronabinol may be used to improve appetite, relieve nausea and vomiting, improve sleep, and provide analgesia and pain relief by acting on the medulla (Stinson & DeAngelis, 2016). According to Parmar, Forrest, and Freeman (2016), nabiximols may be used for neuropathic and cancer-related pain, fibromyalgia, and the muscular issues associated with MS, such as bladder control and tetany. It acts on the spinal cord, which is the center for peripheral sensitivity and pain (Stinson & DeAngelis, 2016). Nabilone has also been used to relieve nausea and vomiting related to chemotherapy, pain, and muscular spasticity (Parmar, Forrest, & Freeman, 2016).

In addition to availability and form of cannabis being used, another concern is the ethics of it. Some ethical issues associated with medical cannabis use may include where and when one may use. Is it ethical to smoke cannabis before going in for a shift at the emergency room? Is it ethical to ingest cannabis when experiencing a flare up of pain at work? Is it ethical to inhale cannabis before driving or operating heavy machinery? There are many ethical issues that may determine the time and place for cannabis use. Another issue is the regulation of it. If it is purely medical, how can one ethically determine when another takes his or her medication? If someone is using cannabis for chronic pain, it may not be ethical for someone else to determine when the patient treats his or her self, especially since pain is subjective. These questions and concerns are still not fully answered, as the states who have legalized medical marijuana use are still determining how it should be regulated effectively.

Despite regulation and ethical concerns, long-term cannabis use may contribute to other complications. Hall and Degenhardt (2009) stated that cannabis users who have regularly smoked cannabis have experienced more symptoms indicating chronic bronchitis and have had an increase in risk for respiratory infections. In addition, users have reported symptoms of withdrawal such as anxiety, depression, insomnia, and decreased appetite (Hall & Degenhardt, 2009). There are also many risk factors associated with cannabis use. These may include central nervous system (CNS) effects and psychosocial effects. According to Hall and Degenhardt (2009), studies have found a connection between slight cognitive impairments and impaired educational outcomes with cannabis use.

Parents of young children who are suffering from severe epilepsy have been seeking an effective treatment for years. Epilepsy is a seizure disorder that occurs due to an imbalance between excitatory and inhibitory effects at the synapse of neural cells, resulting in hyperexcitability (Flynn & Babi, 2017). According to Elisa Sobo (2017), "epilepsy is among the most common pediatric neurological disorders" (p. 190). For intractable epilepsy, three out of every four patients diagnosed seek complementary and alternative medicine, including medical cannabis (Sobo, 2017). Several families found that CBD oil did not result in any psychoactive effects, as it does not contain THC, but it did limit seizures (Sobo, 2017). In a separate study, Parmar, Forrest, and Freeman (2016) surveyed 19 families who use marijuana as treatment of their child's epilepsy and found that roughly 74% of these families witnessed a reduction in number of seizures..

Not only may cannabis be used to greatly reduce the number of seizures in a child suffering from epilepsy, it may also aid in relieving PTSD. The exact pathophysiology of PTSD is known, but it is suspected to occur as a result of a traumatic experience, genetics, or an imbalance in chemical and hormone release during stress ("Post-traumatic stress disorder," 2018). Bonn-Miller, Babson, and Vandrey (2014) conducted a study with over 200 adult participants to find their reason for legally using cannabis. These participants were categorized into having PTSD or not. In the patients who had PTSD, the common motive for use was for sleep and coping, while in the patients without PTSD, it was most commonly used for enjoyment (Bonn-Miller, Babson, & Vandrey, 2014).

In cases where no other treatment is found effective, palliative care might be considered. Palliative care focuses less on treatment or curation of the illness and more on relief, comfort, and reducing stress. According to Aggarwal (2016), cannabis has aided in increasing appetite and weight gain in patients suffering from AIDS, which is caused by the human immunodeficiency virus (HIV). HIV results from the progressive infection of the immune system by retroviruses (Bennett, 2018). In addition to relieving the symptoms of AIDS, cannabis can also be used to relieve nausea and vomiting associated with chemotherapy. In Stinson and DeAngelis's (2016) study of 1300 patients using cannabinoids, 70% gained full control of nausea and 66% gained full control of vomiting.

Cannabis may also be used to manage ALS. It may be used for pain relief, to relax muscles, reduce saliva and secretions, stimulate appetite, induce sleep, and provide the high feeling, which may help with depression (Green & DeVries, 2010). In addition, cannabis may also produce these same effects in multiple sclerosis. Unfortunately, there is no objective data proving the relief. Current research is relying on client testimonies and reports (Green & DeVries, 2010). Other uses for medical cannabis include arthritis, depression, and anxiety. Another study measured the improvement of these conditions with the use of cannabis. With arthritis, 70% of the patients reported an improvement of their symptoms, with depression, 71.6% of the patients reported an improvement, and with anxiety, 77.5% improved (Zaki et al., 2017).

Each disease process has its own nursing interventions. Interventions are the actions nurses do to care for a client. Most nursing interventions for any disease or condition will likely be centered around the client's comfort and safety. For a client with epilepsy, safety would be the first priority. This includes maintaining an open airway and having suction ready, to prevent aspiration. If the client is prescribed antiepileptics, administer those as ordered. When the client is having a seizure, turn the client on his or her side and refrain from putting anything in his or her mouth ("Nursing Care Plan for Seizures," 2017). For a client with PTSD, it is imperative to maintain a calm, nonthreatening, and therapeutic environment and relationship. Safety is also of the priority in order to prevent anxiety. Also, support the client experiencing a panic attack and comfort them (Vera, 2016). For a client with AIDS, the prevention of infection is priority. It is crucial to improve skin integrity, relieve pain, increase comfort, and improve nutritional status (Belleza, 2016).

Although there are several circumstances that indicate that cannabis is effective in relieving the symptoms of many diseases and disorders, there is still insufficient research to prove its benefits above all other treatments. According to Green and DeVries (2010), the lethal doses of cannabinoids in humans has yet to be discovered and research is still continuing to determine how quality of life may change with the use of cannabis for chronic, progressive illnesses. Not only is the research on cannabis growing, so is the legalization for it. In June of 2018, Canada legalized recreational marijuana use amongst the nation. Roughly 30 states have legalized medical marijuana and nine have legalized the use of marijuana recreationally as well (Webb, 2018).

For decades, marijuana has been considered a gateway drug and has been portrayed very negatively in the media and in schools. However, this will soon change. As more research is conducted, cannabis may soon become the treatment patients seek. People will become more educated on how cannabis works within the body and how it may affect certain populations differently. Potential patients will consider many items before making a final decision on using cannabis. Cannabis will soon be discovered to act on several more disease processes and will continue to be researched for more potential benefits. Soon, cannabis will not be considered a drug; it will become the future of medicine.

References

1. Aggarwal, S.K. (2016). Use of cannabinoids in cancer care: palliative care. Current Oncology, 23, S33-S36. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791145/pdf/conc-23-s33.pdf
2. Belleza, M. (2016, November 23). Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Retrieved from https://nurseslabs.com/hiv-aids/#nursing-interventions
3. Bennett, N.J. (2018, September 12). HIV infection and AIDS. Retrieved from https://emedicine.medscape.com/article/211316-overview
4. Bonn-Miller, M.O., Babson, K.A., & Vandrey, R. (2014). Using cannabis to help you sleep: Heightened frequency of medical cannabis use among those with PTSD. Drug and Alcohol Dependence, 136, 162-165. Retrieved from https://doi.org/10.1016/j.drugalcdep.2013.12.008
5. Flynn, S. & Babi, M.A. (2017). Pathophysiology of epilepsy. Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/pathophysiology-of-epilepsy
6. Green, A.J. & De-Vries, K. (2010). Cannabis use in palliative care – an examination of the evidence and the implications for nurses. Journal of Clinical Nursing, 19, 2454-2462. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20920073
7. Hall, W. & Degenhardt L. (2009). Adverse health effects of non-medical cannabis use.
8. The Lancet, 374, 1383-1391. doi: 10.1002/dta.1506 Medical marijuana bill to be introduced next session! (2018, June 28). Marijuana Policy Project. Retrieved from https://www.mpp.org/states/indiana/
9. Nursing care plan for seizures. (2017, June 30). NRSNG. Retrieved from https://www.nrsng.com/care-plan/seizures/#nursing-interventions
10. Parmar, J.R., Forrest, B.D., & Freeman, R.A. (2016). Medical marijuana patient counseling points for health care professionals. Research in Social and Administrative Pharmacy, 12, 638-654. Retrieved from https://doi.org/10.1016/j.sapharm.2015.09.002
11. Post-traumatic stress disorder. (2018, July 6). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
12. Sobo, E.J. (2017). Parent use of cannabis for intractable pediatric epilepsy: Everyday empiricism and the boundaries of scientific medicine. Social Science & Medicine, 190, 190-198. Retrieved from https://doi.org/10.1016/j.socscimed.2017.08.003
13. Stinson, J. & DeAngelis, C. (2016). Is there a role for medical cannabis in the treatment of chemotherapy-induced nausea and vomiting? Journal of Pain Management, 9, 535-540. Retrieved from https://www.researchgate.net/publication/316544702_Is_there_a_role_for_medical_cannabis_in_the_treatment_of_chemotherapy-induced_nausea_and_vomiting_A_commentary
14. Vera, M. (2016). 7 anxiety and panic disorders nursing care plans. Nurseslabs. Retrieved from https://nurseslabs.com/anxiety-panic-disorders-nursing-care-plans/
15. Webb, J. (2018, June 22). Canada just legalized marijuana: Indiana may follow suit. Retrieved from https://www.courierpress.com/story/opinion/columnists/jon-webb/2018/06/22/canada-just-legalized-marijuana-indiana-may-follow-suit/719837002/
16. Zaki, P., Ganesh, V., O'Hearn, S., Wolt, A., Chan, S., Zhang, L., ... Blake, A. (2017). The use of medical cannabis in common medical conditions excluding cancer. Journal of Pain Management, 10, 363-374. Retrieved from https://medreleaf.com/app/uploads/2018/01/JPM-2017-104-Zaki-Non-Cancer.pdf

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