Imagine you are the parent of a 10-year-old child with leukemia who has vomited for 18 days and has lost 26 pounds during a 10-month battle with cancer.
You are desperate to see your child eat a morsel of food; as well as you desperately want to avoid feeding tube placement.
The doctor offers your child Marinol (dronabinol), the only cannabinoid that has undergone research and been developed into a prescription drug.1
Marinol is a safe, effective, schedule III drug that is the synthetic form of tetrahydrocannabinol (THC), the active ingredient in the cannabis plant, commonly known as marijuana.
You are aware that the use of medicinal marijuana in patients who suffer from severe nausea and vomiting secondary to chemotherapy treatments or in patients with cancer, and those with severe pain.
But what are the risks, benefits, and contradictions of marijuana in patients with chronic diseases and terminal illness you ask yourself.
Nurses who have patients who use medicinal marijuana may find themselves in the middle of a right versus right dilemma. When faced with patients who use, or want to use, cannabis for symptom management and to improve quality of life, nurses may be in a position of moral and professional conflict.2
Modern Struggle
The use of cannabis for medicinal purposes has been documented for at least 3,000 years.
The Marijuana Tax Act was introduced in 1937 to dissuade physicians from prescribing it.
In 1970, cannabis was labeled a controlled substance and was designated as having no medicinal purpose. Cannabinoids have been shown to play a role in immunity as well as pain control, eating behavior, and memory.3
Nineteen states and the District of Columbia, already have statutes which recognize the legal therapeutic use of herbal cannabis or cannabinoid-based medicinal preparations.4
THC is approved for use by the Food and Drug Administration.
Contraindications & Standardization
The main ingredient in cannabis is THC, which has been labeled as an analgesic, anti-inflammatory, sedative, anticonvulsant and antispasmodic agent.3
Contraindications for using marijuana can be related to the fact that there is no recommended standard dosage for its use.
Marijuana also contains hundreds of pharmacologically active compounds that could potentially interact with other medications.5
Most medications pose some threat of drug-related interactions, however.
Another contraindication to the conventional method for using marijuana is the fact that it is generally smoked or inhaled. This process may lead to an increase in hypoxic symptoms for patients as well as lung damage.5
Ethical Issues
The medical use of marijuana has become a reality in several states and has been approved for recreational use by voters in both Colorado and Washington.
The primary ethical concern for most nurses, however, remains whether it is possible for the benefits of medical use of marijuana to exceed its known risks, and whether it should be recommended without the usual protections afforded to patients.6
Another ethical issue surrounding the use of medicinal marijuana includes the limitations of the physician-patient relationship.6 This limitation is a direct result of physicians who are prescribing marijuana as an illicit substance in 48 states.
Lastly, it would be important to consider the adverse effects of inhaled marijuana and perhaps find a way to use marijuana without smoking or inhaling it. As healthcare providers it certainly poses an ethical dilemma that requires the ability to be nonjudgmental.
Evidence-Based Research
To facilitate the legalization of medicinal marijuana attention will need to be directed at evidenced-based research, which demonstrates the medical benefits of marijuana in specific medical conditions.6
