Running Head: MEDICAL MARIJUANA PROBLEM-BASED RESEARCH 1

Medical Marijuana Problem-Based Research

Kei-Sha Dollard

Delaware Technical Community College

NUR 340-6W1 Nursing Research

May 7, 2020
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PROBLEM-BASED RESEARCH

Medical Marijuana Problem-Based Research

Marijuana is becoming legal in an increasing number of states for both medical and

recreational use. Healthcare professionals are unable to properly care for the growing population

of medical marijuana users due to lack of formal education and scientific evidence-based

research to form evidence-based practices. The evidence for the legitimate medical use of

marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia,

nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis.

Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still

lacking (Wilkinson, Yarnell, Radhakrishnan, Ball, & D’Souza, 2016). Nurses have the challenge

of providing care and advocating for individuals wanting to pursue medical marijuana as an

alternative treatment plan for their health conditions to improve their quality of life. However,

the majority of nurses are unaware of their states laws, scientific evidence, and nursing

implications to care for medical marijuana patients.

Statement of the Problem

Since 1996, 33 U.S. states, the District of Columbia, Guam, Puerto Rico, the U.S. Virgin

Islands, and all Canadian provinces have passed legislation legalizing the use of marijuana for

medical purposes (Russell, 2019). However, the Controlled Substance Act of 1970 classified

marijuana as a Schedule I substance, the highest level of drug restriction. The Act defines

Schedule I substances as those that (1) have high potential for abuse; (2) have no currently

accepted medical use in treatment in the United States; and (3) have a lack of accepted safety for

their use under medical supervision (National Academies of Sciences, Engineering, and

Medicine; Health and Medicine Division; Board on Population Health and Public Health
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Practices; & Committee on the Health Effects of Marijuana, 2017). According to Russell 2019,

while marijuana remains a Schedule I Controlled Substance, there is an impact on the legality of

a healthcare provider’s prescription of marijuana outside of a medical marijuana program

(MMP), but also the accessibility of marijuana available for research. The classification of

cannabis as a Schedule I Controlled Substance therefore directly limits the amount of moderate-

to-high-quality human evidence regarding the effectiveness of marijuana for certain conditions,

dosage, adverse effects, or safety. Individuals are using medical marijuana more frequently,

regardless of the limited evidence, and nurses are left without evidence-based, clinical resources

to care for them.

Literature Review

As stated above, the majority of states have implemented laws surrounding the use of

medical and recreational cannabis, however, there is limited scientific evidence-based research to

guide healthcare practices, which has caused controversy regarding the public health impact due

to the legalization of medial and recreational cannabis use. The literature reviewed for the

purpose of this research paper focused on the impact of marijuana legalization and public health,

patient perspectives for choosing medical marijuana as an alternative treatment plan, and to

provide guidance for nurses to enhance clinical practice related to medical marijuana.

Marijuana Legalization: Impact on Physicians and Public Health discussed topics in

research that implies that marijuana poses a negative impact on public health. The article

focused on the effects of acute marijuana intoxication on driving abilities, unintentional ingestion

of marijuana products by children, the relationship between marijuana and opioid use, and

whether there will be an increase in health problems related to marijuana use, such as

dependence/addiction, psychosis, and pulmonary disorders.

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Effect of medical cannabis on thermal quantitative measurements of pain in

patients with Parkinson’s disease used the quantitative research method to prove that there is a

reduction in pain with medical marijuana use in patients with Parkinson’s disease. The study

concluded that cannabis use improved motor scores and pain symptoms in thresholds and that

peripheral and central pathways are probably modulated by cannabis. This research supports the

use of medical marijuana as therapy for chronic pain management.

Chronic Pain Patients’ Perspectives of Medial Cannabis used a qualitative research

method to explore the perspectives of medical marijuana patients perceived beliefs and

experiences of using medical marijuana. The results of the study implied that medical marijuana

has a positive impact on patients suffering from chronic pain, Post-Traumatic Stress Disorder

(PTSD) and sleep disorders to improve their quality of life. The findings also indicated that

there is lack of support of healthcare professionals to help individuals navigate through the

medical marijuana treatment process, which can result into increased public health issues.

The Experiences of Medical Marijuana Patients: A Scoping Review of the Qualitative

Literature goes into detail about most research regarding medical marijuana is done using the

qualitative research method due to lack of funding and restrictions on scientific quantitative

research. Furthermore, it concluded that medical marijuana patients seek and use marijuana for

the treatment of their symptoms, often without the guidance of healthcare providers. Healthcare

providers remain unsure and often are uneducated about the beneficial effects of marijuana.

Several participants in research studies stated that they were warned of the addictive potential of

marijuana and were counseled on addiction management instead of being advised on how to use

the medical marijuana safely. This has left medical marijuana patients to navigate through this

new treatment alone without professional medial guidance.

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The NCSBN National Nursing Guidelines for Medical Marijuana is an evidence-based

resource to guide the nursing practice of medical marijuana. This was created by the National

Council of State Boards of Nursing (NCSBN). The NCSBN stated that medial and recreational

use of cannabis raises concerns for public health, nursing practice, science, legal, education, and

social issues. Of significance, there is a contradiction between the federal law classifying

cannabis as a Schedule I Controlled Substance and various states legalizing its use medically,

recreationally, or both. This has resulted in restrictions on marijuana research, leading to

increasing challenges for nurses to care for medial marijuana patients. To address the lack of

guidelines for nurses when caring for individuals utilizing cannabis, the NCSBN of Directors

appointed members to the Medical Marijuana Nursing Guidelines Committee. The committee

did extensive reviews of relevant statistics, current legislation, scientific literature, and clinical

research on cannabis as a therapeutic agent to create guidelines for: nursing care of the patient

using medical marijuana, medical marijuana education in pre-licensure nursing programs,

medical marijuana education in Advance Practical Registered Nurse (APRN) nursing programs,

and APRNs certifying a medical marijuana qualifying condition.

Analysis

The above-mentioned articles implied that medical marijuana patients are having

difficulties with navigating through the medical marijuana process. They feel that there is a lack

of trusted guidance and resources available to support their decision to use medical marijuana

safely and effectively. Healthcare providers are unable to support the use of medical marijuana

due to the lack of knowledge, stigma, nondisclosures of use to healthcare professionals, the

blurred lines between recreational and medial use, and the lack of scientific evidence-based

research on the risk versus the benefit of using medical marijuana (Ryan & Sharts-Hopko, 2017).
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There is more research conducted using the qualitative research method due to restrictions on

research for cannabis. Qualitative research is multimethod in focus, involving an interpretive,

naturalistic approach to its subject matter. This means that qualitative researches study things in

their natural settings, attempting to make sense of, or interpret, phenomena in terms of the

meaning people bring to them (McLeod, 2019).

Recommendations

It is recommended that healthcare professionals advocate for changes in the

classifications of marijuana as a Scheduled I Controlled Substance. With a lower classification,

there would be more funding available for research and more quantitative research studies can be

conducted to weigh the benefits verses the risks of medical marijuana. Healthcare professionals

with formal education and evidence-based research, can effectively provide care to medical

marijuana patients. There also needs to be more programs available to educate physicians,

nurses and pharmacists about cannabis. The research should be conducted to have validated

specified indications, dosage, route, safety, adverse effects, and long-term effects of cannabis.
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References

McLeod, S. (2019) What’s the difference between qualitative and quantitative research?

Retrieved from: https://www.simplypsychology.org/qualitative-quantitative.html

National Academies of Sciences, Engineering, and Medicine; Health and Medicine

Division; Board on Population Health and Public Health Practice; Committee

On the Health Effects of Marijuana (2017). The health effects of cannabis and

Cannabinoids. Washington, DC: National Academies Press

The NCSBN Medical Marijuana Guidelines Committee (2018). The NCSBN national nursing

guidelines for medical marijuana. Journal of Nursing Regulation 9(2). s1-s60

Piper, B. J., Beals, M. L., Abess, A. T., Nichols, S. D., Martin, M., Cobb, C. M., & DeKeuster,

R., (2017) Chronic pain patients’ perspectives of medical cannabis. Pain 158(7). 1373-

1379. doi: 10.1097/j.pain.0000000000000899

Russell, K. A. (2019) Caring for patients using medial marijuana. Journal of Nursing

Regulation,

10(3), 47-61

Ryan, J. & Sharts-Hopko, N. (2017) The experiences of medical marijuana patients: a scoping

review of the qualitative literature. American Association of Neuroscience Nurses 49(3),

185-190. Doi: 10.10977/JNN.0000000000000283

Shohet, A., Khlebtovsky, A., Roizen, N., Roditi, Y., & Djaldetti, R. (2016) Effect of medical

Cannabis on thermal quantitative measurements of pain in patients with Parkinson’s

disease. European Journal of Pain 21(3) doi: 10.1002/ejp.942

Wilkinson, S. T., Yarnell, S., Radhakrishnan, R., Ball, S. A. & D’Souza, D. C. (2016) Impact on

physicians and public health. Annual Review of Medicine 67: 453-466

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doi: 10.1146/annurev-med-050214-013454