Cannabis Use in LTC: We Need To Be Prepared!

There was a time not long ago when the use of marijuana was deemed completely illegal, and judged morally reprehensible by a large proportion of the population. In fact, marijuana is even now a Schedule I controlled substance per the DEA, a category that includes heroin, LSD and mescaline!  The DEA defines Schedule I drugs as having these characteristics: The drug or other substance has a high potential for abuse, it has no currently accepted medical treatment use in the U.S., and it has a lack of accepted safety for use under medical supervision.  For comparison, methamphetamine, morphine and fentanyl are Schedule II.

Over the years, there has been recognition that cannabis may possess some medicinal qualities. The term “cannabis” is used to refer to marijuana (the plant that contains the drug THC, tetrahydrocannabinol, which has the stereotypical central nervous system effects associated with getting “high”) , as well as other cannabinoids, most of which have no psychoactive properties, and can be derived from marijuana or hemp.

Over the past several years, there has been a revolution in the attitudes surrounding cannabis; presently, 33 states have made marijuana legal for medicinal purposes, and 10 have made it legal for recreational use (including California). Though we may “restrict” the use of recreational marijuana in our facilities (the same way we restrict alcohol consumption), how do we feel about preventing someone from ingesting a “medicine” that is recommended by their physician? (It should be noted: most physicians are reluctant to “prescribe” marijuana, since it is still a Schedule I drug, and instead write “recommendations” based on examinations of the patients, who then use these “recommendations” to obtain a legal marijuana “card,” which can be used to purchase marijuana at dispensaries in states where it is legal).  This is more complex considering that dosages are not well-regulated or defined in non-prescription cannabis products available for purchase.

Marijuana is thought to have efficacy in everything from treating certain kinds of pain to ameliorating nausea from chemotherapy, to increasing appetite in people with AIDS, to soothing anxiety. There are some compelling research papers exploring this, but large-scale, placebo-controlled studies have not been undertaken. Nevertheless, many health care providers have decided the evidence is compelling enough, especially with regards to pain treatment…would you rather recommend medical marijuana, or prescribe OxyContin? Which has the higher potential for diversion/abuse, especially in our setting? Would you rather have a resident on a scheduled anxiolytic, or cannabis? These are questions we will have to address moving forward.

Even if one is completely opposed to the idea of marijuana as a medicine, cannabinoids are already being prescribed (and are FDA-approved) for certain conditions: Epidiolex, which is purified cannabidiol (one of many cannabinoids, also known as “CBD”) and is used to treat some rare seizure disorders; Marinol and Cyndros, which contain a synthetic THC known as dronabinol (used to treat the “wasting syndrome” associated with AIDS); and Cesamet, which contains nabilone (chemically similar to THC), and is used to treat the nausea associated with chemotherapy.

Finally, there is increasing use of cannabinoids in “OTC” therapy, including lotions, ointments, tinctures and balms. Many patients swear by these remedies, and are certain that they are more effective than NSAIDs or even narcotics in treating pain. Any adult over the age of 21 in many states can purchase these products without a prescription, and could conceivably bring them into our facilities (or have family members bring them). Are we going to permit this sort of therapy? If so, how are we going to secure these medications?

The challenges around cannabis will only increase as our resident population becomes increasingly made up of younger “baby boomers” and “GenXers,” who grew up with a more liberal attitude around its use. We would be wise to implement common-sense policies to ensure the safety and compassionate care of all of our residents, as well as the legal protection of our facilities!

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