Nurses in Support of Medical Cannabis

By Mary Lou Smart © 2012 www.medicalcannabisart.com

The American Nursing Association (ANA) is the only full-service profes- sional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. The ANA advances the nursing profession by fostering

high standards of nursing practice, promoting the rights of nurses in the work- place, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

About ANA, www. NursingWorld.org

For more than 15 years, the ANA has supported medical cannabis.

In 1996, the ANA’s Congress on Nursing Practice pushed for the education of registered nurses in evidence-based therapeutic uses of cannabis as well as the investigation of therapeutic efficacy of cannabis in controlled trials. In 2003 the ANA’s broad policy-setting body, its House of Delegates, passed a resolution supporting nurses’ “ethical obligation to be advocates for access to healthcare for all,” including patients in need of cannabis for therapeutic use. The ANA’s Congress on Nursing Practice and Economics position statement entitled “In Support of Patients Safe Access to Therapeutic Marijuana,” was approved by its Board of Directors in December 2008.

For an even longer period of time, nurses with first-hand experience of how cannabis improves patients’ lives have followed the ethical mandate of their profession by advo- cating for reform.

How the Federal Government Tried, and Failed, to Bury Evidence

Many credit the birth of the modern-day medical cannabis movement to Bob Randall, who suffered from glaucoma. He realized in the 1970s that the plant he’d been using for recreation actually helped his condition by reducing ocular pressure. Told in his 20s that

he’d be blind in two years, he became a strong advocate for medicinal marijuana and also retained his vision for the rest of his life. The primary motivator for him was the realization that individuals within the  National  Institute of Drug Abuse (NIDA) and the Food and Drug Administration (FDA) understood that marijuana could help individuals with glaucoma, and were deliberately ignoring the information.

Randall and Alice O’Leary, his wife, petitioned the fed- eral government through the FDA for legal access to federal supplies of marijua- na for treatment of glauco- ma, which he received in November 1976. Randall was the first patient in the g o v e r n m e n t ’ s

Compassionate Investigational New Drug (IND) Program. Wanting to help others, Randall created proto- cols for prospective patients for glaucoma, multiple scle- rosis, chronic pain and AIDS. With his help, several patients were accepted into the program. Randall contin- ued to advocate for patients until his death in 2001.

By 1992, as evidence of medical benefit mounted, and faced with a surge in people applying to get into the IND for many conditions, the first Bush Administration  shut its program down, but continued to service the few it had admitted. While the numbers vary, the federal govern- ment states that there were 15 patients in the program at that time.

Carrying on the work begun by Randall and O’Leary,

Mary Lynn Mathre,  MSN,  RN,  CARN,  and  her  husband Al Byrne founded Patients Out of Time in 1995. Their motivator was the realization that the federal government was waiting for the remaining patients in the IND pro- gram to die.

“Al and I were just looking at each other and looking at  the patients, and we were saying, “You know, the federal government is just hoping that you guys will die and nobody knows their dirty little secret, which is that they’re growing marijuana and giving  it to you  and  nobody else is getting it because they want to continue claiming it has no medical value.”

The existence of an organization such as Patients Out of Time ensured that the government’s strategy — supplying the chosen few with a monthly supply of cannabis for decades but refusing to study them — backfired in a big way. While the federal government might have wanted its program slip into obscurity after the IND  patients  died off, Patients Out of Time embraced them, studied them, and let the world know about them. Today, four IND patients remain alive and medicating with a United States government-sanctioned supply of cannabis.

Despite the federal government’s ongoing efforts to make sure mainstream media receives an endless supply of hol- low sound bites to fan the flames of myth, the truth about the benefit of medical cannabis can no longer be buried or ignored.

Mary Lynn Mathre – Pushing for Reform

During most of her career as a nurse, Mathre has promoted cannabis medicine. Her commit- ment led to Patients Out of Time’s professional conferences, which are approved by the American Medical Association (AMA)  and  the ANA for continuing education credits.

From day one, Patients Out of Time’s focus has been  to pull together doctors, nurses and clinicians in addition to patients. Its website — www.medicalcannabis.com — is cram packed with information, including video presenta- tions from the scientists, clinicians, doctors, nurses and patients who speak at its conferences.

Melanie Dreher, PhD, RN, FAAN, is the Dean of Nursing at Rush University Medical Center in Chicago, Illinois. In an interview with Susan Trossman for The American Nurse, she referred to Mathre as a role model for nurses in

political action. “She’s fighting a battle all the way on the issue of medical marijuana, but she stays upbeat and undaunted,” she said. “She’s definitely one of my heroes.”

More than one third of the state governments in the United States either have established or are incorporating medical cannabis programs, many with the assistance of nurses who have supported, even written, medical cannabis legislation. Throughout the country, nurses have pushed their own state nurses’ associations to back posi- tion statements in support of whole plant therapy. Mathre was the first. A Virginia resident, she lobbied her state’s professional organization to support medical cannabis, and it did.

With the assistance of Mathre, dozens of health care groups, including the American Public Health Association and the National Nurses Society on Addictions,  have issued similar white papers in support of medical cannabis. Mathre has had a hand in virtually all of  the state nursing association medical cannabis resolutions.  She frequently speaks at state legislative hearings for the adoption of programs. Her background in medical-surgi- cal and critical care nursing and her certification as an addictions specialist give her in-depth knowledge of the interaction of diseases and symptom relief. She under- stands why patients can be better off with a non-toxic, non-addictive therapy that often allows a quality of life that would not be possible with pharmaceutical alterna- tives.

“She really was the inspiration for  me going to my state’s nurses’ associ- ation,” said Ken Wolski, MPA, RN, and a New Jersey State Nurses Association (NJSNA) member. Indoctrinated into the cruelty of the Prohibition after becoming friends

with a glaucoma patient who was imprisoned, lost every- thing he owned, and eventually left the country, Wolski spent a decade studying the science of cannabis medicine. He wanted to help the growing number of patients in his state, but was unsure of how to proceed. “When  I  saw that Mary Lynn  went  to the  Virginia  Nurses  Association, I said, “Well, here is something that I can do that is mean- ingful, and could be very productive.””

He approached the NJSNA, which passed a resolution in support of medical marijuana in 2002. At that time, the organization also urged the state to pass a medical cannabis law. New Jersey’s medical cannabis program was signed into law in 2010.

According to Wolski, it is only natural that nurses lead the way toward reform.

“RNs have a unique position in the health care field,” he said. “We are with the patients 24 hours a day, 7 days a week. I think that we are in a unique position to really evaluate the effectiveness of marijuana therapy, and  we do, and we come out wholeheartedly in support of it. We are also traditionally advocates for patients. We go to bat for them when they need help.”

Bryan Krumm, psychiatric nurse practitioner, helped draft New Mexico’s medical cannabis legisla- tion, pushing for the addition of Post Traumatic Stress Disorder as an approved condition and

including nurse practitioners as well as physicians as pro- fessions permitted to make referrals. A speaker at Patient Out of Time’s Seventh National Clinical Conference on Cannabis Therapeutics in Tucson, Arizona in April 2012, he spoke about the many ways cannabis helps his patients. In an earlier interview, he stated why he has even gone so far as to sue the federal government to reschedule cannabis, which is currently in the no-medical-benefit cat- egory of the Controlled Substances Act.

“In terms of safety, there is nothing that we have to offer pharmaceutically that can match the safety of cannabis,” he said. “In my own practice as a clinician, I have never come across a single pharmaceutical agent that is as well tolerated, and lacking in significant side effects, as cannabis.”

The Rhode Island State Nurses Association (RISNA) lob- bied and testified in favor of a state law, arguing that  a lack of state access was endangering the sick. Rhode Island’s program was approved in 2006, not by voter ref- erendum, but by legislature following the endorsement of the medical community and testimony by patients. RISNA supports the ANA’s “Safe Access to Therapeutic Marijuana” policy.

RISNA was a co-sponsor of Patient Out of Time’s 2010 conference, and Executive Director  Donna  Policastro,  RNP, gave the opening address. In it, she explained why RISNA helped lobby and testify for Rhode Island’s legis- lation.

“It’s an access issue. It’s a safety issue. We believe very strongly in it and we want to move forward and continue to be proponents of this issue,” she said.

American Cannabis Nurses Association

At the Rhode Island conference, a nursing advocacy group, the American Cannabis Nurses Association (ACNA) was estab- lished.

The mission of the  ACNA  — www.cannabisnurse.org  — is to bridge the knowledge gap through educational, pro- fessional, patient advocacy, collegial networking and sup- portive nursing practices. The aim of the specialty nursing association is to educate nurses, health care professionals, policy-makers and the public about the therapeutic use of the cannabis plant. The rationale of those volunteering to make ACNA viable is that only in integrating cannabis patients and the nurses who care for them into nursing practice can the overall objective of the ANA in ensuring access to healthcare for all be met.

As the professional organization developing nursing stan- dards, credentialing and certification procedures for cannabis nurses, a goal of the ACNA  is  to  become  an ANA organizational affiliate.

“Just as there are critical care and psychiatric nurses asso- ciations, there needs to be a nursing association that sup- ports all of the unique issues that come up with a special- ty like endocannabinoid therapeutics,” said Ed  Glick, ACNA secretary. “There are hundreds of thousands of nurses around the country that are dealing on a daily basis with people who use cannabis for many conditions. A doctor can prescribe a medicine, but it is the nurses that really are able to guide a person through the subtleties of using it. It is critically important that we have something that any nurse can tie into to learn about cannabinoid medicine.”

In Tucson this past April, ACNA board members, includ- ing Mathre, Glick, Krumm and Wolski, met with nurses attending Patients Out of Time’s conference. Many are active in the field of cannabis and endocannabinoid ther- apeutics. The response was enthusiastic.

Heather Manus, RN, practices nursing in northwestern New Mexico. Like many, she was afraid, at first, to let anyone know that she was supporting her patients in their therapeutic use of cannabis. Like many patients, she was afraid of being stigmatized. Gradually, though, as she real- ized how many of her patients were using it, her feelings changed.

A home health care nurse, she surveyed her clients and learned that of the 43 percent that were medicating with cannabis, only 83 percent had registered with New Mexico’s medical cannabis program. She now carries a supply of applications to the state’s program.

“I felt that it was my job to help these patients get legal,” she said. “They should not be subject to arrest because of  a medication that they choose to use.” Part of Manus’s change of heart came as a result of watch- ing patients on opiates receiving a better quality of life with a non-toxic herbal remedy.

“When you have patients on opiate med- ication, a lot of times they are home bound,” she said. “They hurt. They are zonked out. If they can supplement with cannabis, they can enjoy their lives again. When you look at what pharmaceutical medications can do to the human body, it is not good. When we are able to replace some of those with an herb that has min- imal side effects, I feel that we are doing something that is really, really good for patients.”

Manus is telling every nurse she knows about ACNA. “Nurses need to go online to the cannabisnurse.org site and register to become members,” she said. “They can see stories about other nurses that are dealing with cannabis patients, and learn what they are doing and how they are doing it. This is one more step in having people under- stand that this really is medicine. As nurses, we need to be compassionate about and understanding of what our patients are doing. We need to advocate for these patients.”

These days, Manus no longer has second thoughts. She is passionate about her chosen field and about the ACNA. “Up until about six months ago, when people asked me what I did, I’d say home health,” she said. “Now I’m get- ting to the point where I say that I am a medical cannabis nurse. I am following the law.”