The growing acceptance of medical and recreational cannabis in the United States is a relatively recent phenomenon. While cannabis has been used medicinally for centuries, only in the last few decades has it been given serious consideration by the health care community. The medical use of cannabis is legal in 38 states, three U.S. territories, and the District of Columbia, while some states have also legalized recreational cannabis use. However, barriers to accessing medical cannabis still exist, and clinical information is limited regarding its therapeutic benefits and interaction with other drugs and disease states.
A major barrier to accessing medical cannabis is social stigmatization of cannabis use. Many patients hesitate to seek out medical cannabis because its use is negatively viewed by society, including by some members of the medical community. In clinical settings, cannabis is not controlled, prescribed, or administered in the same way as other controlled medications such as opioids. Health care providers often ask patients about use of illicit drugs when taking their history and may have a negative opinion of patients who take cannabis to treat an illness.
The current legal status of cannabis contributes to the stigma surrounding its use and creates barriers to patient access. Despite medical cannabis being legal in many states, at the federal level, cannabis-derived products that have over 0.3% of the psychoactive cannabinoid delta-9 tetrahydrocannabinol (THC), also known as marijuana, are classified as Schedule I substances under the Controlled Substances Act. Schedule I controlled substances are defined as having a high potential for misuse and abuse and no accepted medical use. Possession and/or distribution of these substances are federal offenses. It is challenging for health care institutions subject to federal rules and regulations to create policies addressing medical cannabis use during hospitalization.
Managing a patient’s medical cannabis use raises many questions that may limit patient access and impede appropriate care during admission.
- If a patient is authorized to use cannabis, is their certification from outside the state? Transporting cannabis across state lines is a federal crime.
- What forms of the drug are allowed during an admission? Edible gummies may be allowed while marijuana smoked in a pipe or vaporized is prohibited.
- Does the drug interact with the patient’s current treatments? Other medicines have boxed warnings outlining possible safety concerns.
- Will a pharmacist or nurse be involved in product verification, administration, and documentation? Although such involvement could support safe cannabis use, institutions may be hesitant to let staff handle a Schedule I substance.
- Where can the drug be safely stored? It cannot be kept with an institution’s regular inventory.
The Marijuana Opportunity Reinvestment and Expungement Act (H R 3617) and the Cannabis Administration and Opportunity Act (S 4591) would deschedule marijuana and THC and require expunging certain federal marijuana offenses. Other proposals would continue to hold cannabis as a controlled substance but move it to a less restrictive schedule to allow for prescription medical use. Such changes could help reduce stigma and break down legal and logistical barriers to patient access, enabling health care institutions to implement appropriate policies and procedures for medical cannabis use.
Additional evidence-based research remains necessary to provide unbiased clinical care, as cannabis has not undergone the same rigorous clinical trials as other medicines. The Medical Marijuana and Cannabidiol Research Expansion Act (H R 8454) would ease requirements for research involving marijuana and cannabidiol (CBD), creating specialized procedures for Drug Enforcement Administration approval and authorizing the manufacture, distribution, dispensing, or possession of marijuana or CBD for medical research.
The needs of our patients should come first, and states are moving ahead of the federal government in eliminating barriers to access to medical cannabis. Health care professionals should encourage changes in practice and be open-minded, nonjudgmental, and aware of biases to promote patient well-being.
