The Dark Side Of Medical Marijuana


 
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By Barbara Ficarra, RN, MPA

Patients legally using medical marijuana (cannabis) at home may be stunned if they are admitted to a hospital because many hospitals may prohibit them from using it.

In the United States, medical marijuana is legal in 31 states, and research shows that medical marijuana can effectively treat pain — but patients beware. The issue of medical marijuana is a complicated one, and patients may be precluded from using it on hospital property. Even though it’s legal in some states, marijuana is in the same class as heroin — it’s a Schedule 1 substance with a high potential for abuse and with no currently accepted medical use. Additionally, the U.S. Food & Drug Administration (FDA) has not approved marijuana as an effective and safe drug for any use.

In a California hospital, the “don’t ask, don’t tell policy” has been adopted. In New York, according to California Healthline (produced by Kaiser Health News), “Some have a ‘don’t ask, don’t tell’ approach, said Devinsky, who sometimes advises his patients to use it.” Dr. Orrin Devinsky is director of NYU Langone’s Comprehensive Epilepsy Center, but David Harlow, health care attorney and consultant, who blogs at HealthBlawg.com, cautions this practice. “A hospital’s “don’t ask, don’t tell” policy runs the risk of being sanctioned by surveyors for licensure and governmental certification, or for accreditation by the Joint Commission, which requires that the hospital “safely control” all medications brought into the hospital by the patient or the patient’s family or independent licensed practitioners,” he explained in an email interview. If a facility is willing to risk these sanctions, then there are state law issues to contend with, he added.

However, some hospitals are addressing the issue of medical marijuana use. Strong Memorial Hospital – University of Rochester Medical Center in New York has designed a policy for medical marijuana use. The policy for medical marijuana includes an exemption. According to the policy, “An attending physician may request an exemption to this policy to permit use of medical marijuana for a patient during an inpatient admission.” Harlow explains that “some state laws permit facilities to design policies that allow patients to use medical marijuana.”

There are times when patients bring in their own medications from home, and they follow the standards set forth by the hospital and The Joint Commission. The problem with medical marijuana is that it is a Schedule 1 substance, by federal law, it’s not a legal substance.

The question is, can an illegal substance be permitted to be used in a hospital? Some hospitals like Strong Memorial Hospital have designed their policy, but hospitals could face sanctions.

“Virtually all hospitals in the U.S. contract with the federal government as Medicare providers and/or with states as Medicaid providers — Medicaid is a federal-state jointly-funded program,” Harlow explains. “Since any use of marijuana is illegal under federal law — this is a fundamental problem, at least in theory, and any program designed to enable inpatients to use medical marijuana (and any program that gives a facility “possession” of medical marijuana) jeopardizes Medicare participation and could invite sanctions,” he added.

Other hospitals addressing medical marijuana use include Johns Hopkins Medicine and Penn Medicine.

John Hopkins Medicine has a policy that bars medical marijuana use even though medical marijuana is legal in Maryland, while Penn Medicine has a “limited exception” policy when it comes to patients using medical marijuana. It states on its website that the use or possession of marijuana in any form is prohibited, including medical marijuana in all facilities with limited exception — “Self administration is prohibited. Only a designated caregiver may be permitted to administer medical marijuana during inpatient admission.”

The National Academies of Sciences, Engineering, and Medicine’s news release reports that “the committee found evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms.” If research supports the therapeutic effects of medical marijuana, and it can help treat pain effectively, are patients needs being met if they are unable to use it during their hospital admission?

It’s clear that some hospitals are designing their own policies and addressing the needs of the patient. It’s imperative that hospitals gain insights from physicians, nurses, pharmacists, and attorneys.

If hospitals aren’t addressing patients needs, a gap in care and treatment may develop. If a gap evolves, quality patient care can suffer. How can nurses and physicians adequately care for patients, and demonstrate excellence in patient care, if they are precluded from continuing their treatment in a hospital?

Medical marijuana is a complicated issue, and it’s clearly at the intersection of medicine, law, and politics. If the research is accurate and medical marijuana does indeed effectively treat pain, perhaps the first step ought to be to include “accepted medical use” by the United States Drug Enforcement Administration (DEA).

A bipartisan bill has been introduced by New York State Senator Kirsten Gillibrand along with Senators Cory Booker (D-NJ) and Rand Paul (R-KY), “to recognize that marijuana has accepted medical use and that it is the states’ responsibility to set medical marijuana policy.”

Due to the complexity of this issue, many hospitals that I contacted for an interview declined to comment.

This complex topic needs insights from health care professionals who are at the forefront of patient care and pain management.


 
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