Nurses are becoming an increasingly important part of the movement to educate patients, other healthcare providers, and the public about cannabis use. Cannabis nursing, a specialty nursing practice focused on providing education and guidance to healthcare consumers on the therapeutic use of cannabis, furthers this effort.

But even nurses acknowledge the lack of information in clinical education and in literature.

“There’s a huge disconnect between patients, providers, and dispensaries,” when it comes to cannabis knowledge, said Sherri Mack, BSN, RN, an American Cannabis Nurses Association (ACNA) board member.

That’s changing, however, with recent strides made in the nursing profession and the healthcare environment.

In September 2023, the American Nurses Association (ANA) announced the formal recognition of cannabis nursing as a specialty. “This recognition highlights the essential role and special contribution of cannabis nurses to the healthcare system and promotes enhanced integration of cannabis therapies for healthcare consumers across diverse healthcare settings,” said ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN. ACNA became an organizational affiliate of ANA in 2022.

To guide nurses in their practice, ANA has partnered with ACNA to publish Cannabis Nursing: Scope and Standards of Practice. This May 2024 publication provides 18 national standards of practice and professional performance with accompanying competencies.

In 2018, the National Council of State Boards of Nursing (NCSBN) identified six principles of essential knowledge about cannabis for RNs, advanced practice RNs and nursing students.

Recently, and more broadly, the U.S. Drug Enforcement Agency (DEA) announced in April that it plans to reclassify marijuana from a Schedule I drug to a Schedule III drug. Schedule I classification includes substances defined as having no accepted medical use and a high potential for misuse, like heroin and methamphetamines. Schedule III drugs are controlled substances like steroids and Tylenol with codeine, which are subject to regulation but considered less prone to misuse.

These developments have set the stage for a shift towards acceptance of cannabis in healthcare, with nurses leading the way.

Filling the knowledge gap

Because nursing school curricula typically don’t cover cannabis outside the framework of substance misuse, most nurses have had to educate themselves on its attributes.

Kim King, MSN, FNP-C, who consults on cannabis care through her business, Thrive to Care and Wellness Education Consulting, hopes to see cannabis education added to nursing program curricula in the next 5 years. “We’ve got to educate all nurses, from LPNs to RNs to APRNs,” she said. “Education is the cornerstone of nursing. And I really hope to see that all healthcare providers are educated about cannabis in the next 10 years.”

Deanna Sommers, PhD, MSN, RN, PNP-BC, a Florida Nurses Association member, is an assistant professor at Galen College of Nursing in St. Petersburg and an associate professor emerita at Aurora University. Her cannabis education journey started when, as an associate dean at another college, she questioned her university’s drug screening policy after having to dismiss a student who tested positive for cannabis.

“I realized I knew nothing about cannabis,” she recalled, and felt compelled to learn all she could. She attended an ACNA conference in 2019 and began collaborating with experts like past ACNA presidents Carey S. Clark, PhD, RN, AHN-BC, FAAN, and Llewellyn Dawn Smith, MSN, RN-BC. After writing chapter 3 of Clark’s Cannabis: Handbook for Nurses, Sommers went on to become a contributing author of Cannabis Nursing: Scope and Standards of Practice.

Mack, who also contributed to Cannabis: Handbook for Nurses, began studying the plant when she found that it relieved the severe pain she suffered after contracting C. difficile on the job, which wiped out her microbiome, causing multiple complications and autoimmune conditions. An RN with decades of experience, Mack was shocked that she’d never learned about the benefits of cannabis.

“Once I went down that rabbit hole of learning about cannabis medicine, there was no going back,” said Mack, who, in 2015, started her own consulting business, The Green Nurse.
The business started as “a nonprofit educational platform to educate and empower patients to navigate the medicinal world of cannabis and make choices that meet their needs,” said Mack. Now called Holistic Caring & The Green Nurse, the company has evolved to offer education, products, and services.

Research roadblocks

In a 2021 position statement, ANA declared its support for the review and reclassification of marijuana’s status from a federal Schedule I controlled substance to facilitate urgently needed clinical research that informs patients and providers on the efficacy of mariju-ana and related cannabinoids. (bit.ly/4buvjeZ)

Conflicting federal and state cannabis regulations obstruct research by limiting access to products and prohibiting standardization and quality control of cannabis and cannabis-derived products within and across states, according to Cooper and colleagues.

Armiel Suriaga, PhD, MSN, assistant professor at Christine E. Lynn College of Nursing at Florida Atlantic University, whose research focuses on cannabinoid-related mortality and harm reduction, remains optimistic about the impact rescheduling will have.

“Right now, we have a lot of anecdotal evidence about cannabis use from patients and providers,” he said, “but the gold standard is evidence-based research.” Rescheduling will help remove some barriers to funding, which will enable increased research opportunities, according to Suriaga, who is a Florida Nurses Association member.

Mack believes that rescheduling may cause confusion for consumers. She wants to see cannabis descheduled altogether but agrees that rescheduling will benefit cannabis healthcare. “The opportunities for research are going to expand significantly, which will open up job opportunities for nurses.”

Consumer confidence

Nurses need practical information to care for the increasing number of patients who self-administer cannabis as a treatment for various symptomatology or for recreational purposes. Individuals use cannabis and nurses will care for them as patients, according to NCSBN’s “National Nursing Guidelines for Medical Marijuana,” a 2018 supplement to the Journal of Nursing Regulation.

Working as a geriatric primary care nurse practitioner, King, an ACNA board member, said that many of her patients ask about medicinal cannabis and are open to using it—often before they know much about it.

“They may have heard about cannabis from friends, or they might feel that the medication they’re on isn’t working for them and they want to try medicinal cannabis instead,” she said.

It’s important for her, as a provider, to ask the right questions. “I need to know what their health conditions are, what medications they’re currently taking, what’s not working for them, and why they want to use medicinal cannabis,” King said.

Her older patients are mainly interested in relief of pain associated with arthritis and other ailments, and often believe they can get a prescription.
“No one can prescribe cannabis; it’s illegal under federal law,” she said.

Patients must see a physician, or, in some states, a nurse practitioner, who can then decide whether to recommend them for a medical cannabis card—a process that varies from state to state.

Although 38 states plus Washington, D.C., Guam, Virgin Islands, Puerto Rico, and the Northern Mariana Islands currently allow medical cannabis under specific qualifying conditions, each state and territory has different laws regulating its use. And each state has its own list of qualifying conditions. A patient who wants to take cannabis to help relieve anxiety, for example, may live in a state where that’s not a qualifying condition.

“It’s complicated,” Sommers noted. “Illinois does it one way, Florida does it another.”

Once a patient has a medical cannabis card, they’re on their own when it comes to purchasing the substance. Dispensaries don’t typically have healthcare providers on staff to offer guidance.

King and Mack offer coaching for patients visiting dispensaries. But stigma can be an even greater barrier than lack of knowledge.

“When I first got my medical cannabis card, I went to another town to get certified and shopped at a dispensary far from my home due to the stigma,” said Mack. “My mother didn’t want anyone to see me!”

People frequently have outdated ideas about cannabis. “I’m trying to tear down that stigma through education,” King said.

As more healthcare consumers use cannabis, whether medicinally or recreationally, providers need more education. “They’ve got to be aware of contraindications, what cannabis use may mean for patients undergoing surgery, and how certain conditions present in cannabis users,” said Mack.

Providers must learn what Sommers calls the basics—the signs and symptoms of cannabis use and how it affects a patient’s vital signs.

“When I was working in the emergency department and a patient came in showing signs of cannabis use, I would ask them when they used,” Sommers said. “I need to know that if I’m going to be administering medication.”

Safety beyond the bedside

Cannabis nurses are advocating for increased acceptance of cannabis in healthcare, while recognizing that the stigma surrounding its use does societal harm.

“The social justice piece of this is extremely important,” said King, who added that nurses need to address this issue as part of their advocacy.

ACNA released a statement in 2020 acknowledging that “cannabis has long been used to discriminate against Black, Indigenous, and People of Color (BIPOC) and incarcerate people who are non-violent drug offenders. As cannabis care nurses, we must stand against racism and discrimination, and commit ourselves to ending racially based healthcare disparities and violence toward BIPOC.”

King, Mack, Sommers, and Suriaga agree that ANA’s recognition of cannabis nursing as a specialty will help further the legitimization of cannabis in healthcare and hopefully increase the safe use of cannabis for all.

“The recognition from ANA gives validity to cannabis nursing,” said Suriaga. “We’re the most trusted profession, and this will encourage patients to look to nurses for guidance.”
Rescheduling also is a step forward, said King, but it won’t necessarily increase access to cannabis for medicinal purposes. “It needs to go further,” she said. “Yes, it affirms that cannabis has medicinal value, but it doesn’t make it more affordable for Medicaid patients, for instance.” King also would like to see cannabis descheduled over time.

Cannabis nursing is about maximizing the efficacy of using this plant and minimizing harm to patients, said Mack. She and her nursing colleagues say the actions from ANA, NCSBN, and the DEA have them feeling positive about the future.

“There’s just so much more education that we need to be doing for everybody,” said Sommers, “and I can’t wait to see what happens next.”

— Elizabeth Moore is a content creator at ANA.

American Nurse Journal. 2024; 19(7). Doi: 10.51256/ANJ0724