Denise has been a registered nurse since 1974. Her nursing practice has focused on critical care, nursing management, the integration of electronic health record systems, length of stay issues, the transition of care issues, and nurses in crisis. These experiences have created a background rich in hands-on care, administration of patient care units and hospital staff, nursing informatics, and nurse advisory.
CannaSafe teamed up with Denise to discuss cannabis as medicine, cannabis research, changes needed in the cannabis space, and recommendations for first-time users. Here’s what she had to say:
Overcoming Obstacles for Medicine to Catch Up
I have a decades-long history of critical care nursing and researching evidence-based medicine. My passion for healthcare began when I was an adolescent, solely out of a desire to help others, and has continued to this day. A huge part of my practice has been education-we don’t realize how little most people know about their bodies and the miracle of our lives! All of this has developed into a love of intelligently interpreting science for the non-scientists in my life-patients, family, friends, and associates! After many inquiries from patients and friends regarding its use, I delved into the emerging body of knowledge on the endocannabinoid system and the use of cannabis as a therapeutic option.
Cannabis and Impediments for Research
Even though cannabis has an extensive history of healing, modern medicine has not embraced the benefits of this plant. In 1937, against the advice of the American Medical Society (now the American Medical Association) and without scientific reasoning, the United States criminalized all use of cannabis. In 1942 it was removed from the U.S. Pharmacopeia.
There is now a growing interest throughout the medical community in the use of cannabidiol (CBD) for treating numerous disorders. However, medical education for physicians and nurses has been minimal, and adequate research on humans is lacking due to many impediments.
- Investigators seeking to conduct research on cannabis or cannabinoids must navigate a series of review processes that may involve the National Institute on Drug Abuse (NIDA), the U.S. Food and Drug Administration (FDA), the U.S. Drug Enforcement Administration (DEA), institutional review boards, offices or departments in state government, state boards of medical examiners, the researcher’s home institution, and potential funders.
- There are specific regulatory barriers, including the classification of cannabis as a Schedule I substance, that impede the advancement of cannabis and cannabinoid research. It is often difficult for researchers to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions on the health effects of cannabis use.
- The gold standard in medical research is a randomized controlled trial using a well-defined drug. This is to provide the best evidence for the safe administration of a substance. To develop conclusive evidence for the effects of cannabis use on health outcomes, improvements, and standardization in research tactics (including those used in controlled trials and observational studies) are needed.
- As more research is evolving, the healthcare world will need to develop best practice standards for the use of cannabis in clinical care; and then sharing clinical evidence is imperative.
- There also exists a need to defend and expand practitioners’ rights to practice and prescribe
These are but a few of the obstacles facing healthcare practitioners. The practical challenges and the regulatory, financial, and access barriers described above affect the ability to conduct comprehensive clinical research on the health effects of cannabis use. In the absence of an appropriately funded and supported cannabis research agenda, patients may be unaware of viable treatment options, providers may be unable to prescribe effective treatments, policymakers may be hindered from developing evidence-based policies, and health care organizations and insurance providers lack a basis on which to revise their care and coverage policies. In short, such barriers represent a public health problem.
Options for Change
Legal or not, people across the country are using cannabis for medicinal purposes. And while there is significant polarization among various groups, there is broad agreement on the need for more research.
Recommendations from major agencies include:
- Address research gaps
- Identify strategies to improve the quality of research
- Strengthen federal and state-based public health surveillance efforts
- Address regulatory barriers to cannabis research
Recommendations for First Time Users
- Regular inhalation of combusted cannabis adversely affects respiratory health outcomes. It is generally preferable to avoid routes of administration that involve smoking combusted cannabis material.
- Driving while impaired from cannabis is associated with an increased risk of involvement in motor vehicle accidents. It is recommended that users categorically refrain from driving (or operating other machinery or mobility devices) for at least 6 hours after using cannabis.
- Do not use synthetic cannabis products.
- Not for use during pregnancy.
- Confirm your choice to ingest cannabis with your physician.
- Know the purity of your choice. Require a Certificate of Analysis by an accredited laboratory to validate the product quality.
- All drugs come with risks, some known and some unknown. Prior to use, both the potential risks and the likely benefits should be considered. Your goal should be to maximize the benefits and minimize the risks.
Questions about the overall effectiveness of cannabis underscore the need for the research, safety studies, and controlled clinical trials that typically support an FDA-approved medication. However, the Schedule 1 classification strictly limits the type, amount, availability, and funding of such research. Practitioner’s concerns remain about its toxicity, pharmacology, form, delivery method, dosage, and potency.
The challenge is to educate and engage while supporting safe and effective patient care.
The barriers have not stopped me from exploring the science and the interest in cannabis, and specifically, cannabidiol (CBD). Cannabidiol is one of 113 identified cannabinoids (components) of the cannabis plant. While CBD is an ingredient of the cannabis plant, by itself it is not psychoactive (does not give you a “high”). According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…To date, there is no evidence of public health-related problems associated with the use of pure CBD.”
Working closely with physicians and cannabis healthcare advisors, I am in the development of an MD grade CBD line of products. You can follow our investigations and progress at www.chesnehealthmogul.com.
I COMMIT TO TAKING RESPONSIBILITY FOR PROVIDING HEALTH FACTS ACCURATELY, PUTTING THEM INTO PERSPECTIVE, AND HELPING YOU TO UNDERSTAND HOW THE RESEARCH FINDINGS MAY AFFECT YOUR HEALTH CHOICES!