NRSG 617 Policy and Politics Unit 4 PAPER_ Carver
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MEDICINAL CANNABIS
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A Public Health Policy Controversy: Medicinal Cannabis
Name
University
Course
Professor
September 24, 2023
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Abstract
As time passes, we continue to see changes throughout the medical industry. Some may say these
changes are for the better and some may say these changes are for the worse. One marked
advancement this generation has seen worldwide is technology. Technology has afforded opportunities
on a global scale. I would dare to say that one of the greatest advantages of technology is the ability to
instantly communicate from across the neighborhood, across the nation, to nations on the opposite side
of the Earth. Enhanced communication has allowed collaboration on life-changing issues, affecting lives
everywhere. It has also allowed people to be more aware of current issues, voice their support or
opposition to these issues, and influence societal changes in ways unlike previous generations. These
issues range from taxes to human rights to healthcare reform and beyond. One such issue is multifaceted
with an extended reach into social norms, economics, federal laws, local laws, health policy, and more.
This issue is the debate on the legalization, utilization, and integration of both recreational and medical
marijuana, also known as Cannabis.
The benefits and harms of Cannabis have long been debated and continue to this day through
social media, national and international governing boards, political advocate groups and more. One side
proposes proven and potential adverse effects with many that are being currently anticipated in ongoing
research, while the opposing side supports the use and legalization of Cannabis for recreational and
therapeutic purposes such as relief of pain and anxiety. The medical industry is caught in the middle of
the Cannabis controversy with stakes in social determinants of health, patient-centered care, and public
health policy on the global, national, and local scales.
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A Public Health Policy Controversy: Medicinal Cannabis
Cannabis ranks third behind alcohol and tobacco as the most used psychoactive substance in the
world with its potency continuing to increase as time passes which is increasing adverse effects such as
cognitive impairment, potential for certain cancers, increased emergency room visits, and more
(Gorelick, 2022). An article in the Nordic Studies of Alcohol and Drugs (NAD) examines both the adverse
effects, the reasons for support of Cannabis use, and the politics at play in this controversy (Søgaard &
Lerkkanen, 2021). The authors explain that while cannabis is being critiqued for the aforementioned
adverse effects, the controversy lies in contrasting positive effects reported which include relief of pain
and anxiety. Furthermore, Cannabis is being decriminalized and legalized in many areas including
multiple U.S. states, though, much of the world still disallows its use and production. This dissension
leads to cross-cultural policy issues such as abundant diversification of the end-product leading to
varying administrative methods and potencies making it difficult to safely regulate nationally and
internationally. Søgaard & Lerkkanen (2021) expands on the cross-cultural policy issues by reporting how
socio-material context such as preferred administrative methods can affect onset and intensity of
Cannabis effects which is only exacerbated by the rapid expansion of Cannabis into the medical market
where users identify as patients and may be more vulnerable to adverse, long-term effects with
co-morbidities and prescriptions by medical providers.
It is our responsibility as healthcare providers to understand local, national, and global health
policies regarding Cannabis, understand both the positive and negative impacts it has on patient care,
who the key stakeholders are, and how the evidence is being gathered and implemented for this issue
with the goal of providing optimal, evidence-based care for our patients.
The Health Policy Issue
Worldwide conflicting regulations surrounding cannabis administration, particularly for
medicinal purposes, has created immense controversy within the healthcare industry. Multiple aspects
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of medicinal cannabis use are debated including cultural morality, risk versus benefits, physical safety,
mental health safety, efficacy, economic impacts, and more.
To start, we can see conflict in our own federal and state regulations. The National Conference of
State Legislatures (NCSL) provides updated information on current regulations, including the use and
administration of medical cannabis (
State Medical Cannabis Laws
2023). On a federal level, cannabis is
classified as a Schedule 1 substance considered high risk for dependency, not allowed for medical use,
and making it a federal offense to distribute or prescribe cannabis. States, however, have developed
creative ways to distribute medicinal cannabis by having providers recommend or place referrals for
cannabis in place of a prescription. In addition, states who authorize medicinal cannabis typically create
registries with the intention of providing protection for patients to have a certain amount of cannabis in
their possession for medicinal purposes. The health policy issue largely rests in the asynchrony of
regulations and conflicting beliefs about the harms and benefits of medicinal cannabis leading to
back-channel methods of care delivery, difficulty in efficient safety monitoring of its use, and inability of
the healthcare industry to effectively collaborate which is crucial to any intervention in medicine.
The Impact on Healthcare: Practice and Outcomes, Patient Population, and Financing
Practice and Outcomes
The National Institute of Health (NIH) published an article about the effects of the current
political climate surrounding medicinal cannabis, reporting that conflicting policies between federal and
state legislature is a breeding ground for inhibiting necessary medical research which can impact all key
stakeholders including patients, families, providers, and healthcare delivery systems as well as create
ethical and socioeconomic dilemmas impacting patient care and increasing health disparity (Ryan et al.,
2021). More specifically, the categorizing of cannabis as a Schedule 1 substance prohibits researchers
from examining public health questions such as the therapeutic versus adverse effects of cannabis which
leads to a lack of high-level evidence and subsequently insufficient data on the safety and efficacy of
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cannabis use for medicinal purposes. Nurses and other healthcare providers lack adequate evidence and
information leading to a lack of education on the utilization of cannabis for patient care and are,
therefore, not able to effectively advise patients on its use, let alone, incorporate it into patient care.
Evidence-based practice is the heart and soul of medicine, without it we are left with suboptimal and
higher-risk patient care.
Patient Population
Beyond research, the NIH reports that the inadequacy of the current health policies surrounding
medicinal cannabis leads to disparities and ethical tension within the healthcare industry (Ryan et al.,
2021). Differing cultural moralities and beliefs lay the groundwork for stigmatization of cannabis use
causing patients to not be transparent with their providers for fear of prosecution and increases the risk
of patient harm due to incomplete medical histories. Furthermore, stigmatization can affect healthcare
providers by increasing bias which can impact patient care as well as the progression and development
of medicinal cannabis health policies nationwide.
Financing
Another influencing factor of medicinal cannabis use, and the current public health policies is
cost. The geographical location of the patient as well as their socioeconomic status greatly impact their
access to medicinal cannabis, one example being providers of veteran’s being unable to register the
veterans in state-run marijuana programs which forces the veterans to obtain private insurance with high
fees to see non-veteran providers who can provide them a recommendation for medicinal cannabis
(Ryan et al., 2021). Furthermore, a 2019 qualitative study compared the use of medical cannabis with
other prescription drugs as well as user understanding of policy issues that limit its use (Mercurio et al.,
2019). The researchers found that users of medicinal marijuana viewed its use as a suitable alternative to
opioids, but found providers were limited in presenting options for use, stigmatization limited its use,
and there was a presence of financial burden due to lack of insurance coverage with the additional
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observation obtaining opioids is cheaper and easier to do than medicinal cannabis. The lack of continuity
in public health policy of cannabis use yields ethical and economic disparities, disinformation, lack of
education, stigmatization, safety issues and ultimately an immense burden on all key stakeholders.
Pros, Cons, and Concurrence of Medicinal Cannabis Public Health Policy
Pros
Controversy over the use and implementation of cannabis in the healthcare industry continues
to grow with the legalization of cannabis escalating globally. The proposition of those advocating for the
integration of medicinal cannabis with support of public health policy focus on the belief in the medical
benefits cannabis can provide.
An observational study with an end-total of almost three million cannabis users discerned trends
in registration for medical cannabis as well as reasons for use in the United States over a period of four
years (Boehnke et al., 2022). The researchers found that enrollment in medical cannabis registries
increased 4.5-fold with the prominent qualifying conditions being chronic pain and post-traumatic stress
disorder (PTSD). Other qualifying conditions observed were multiple sclerosis, arthritis, and
chemotherapy-induced nausea. The authors notably report that qualifying conditions with supporting
evidence of medicinal cannabis providing therapeutic value decreased from 84.6% to 68.2% over the
course of the study. The findings cause the authors to conclude the need for public and provider
education of evidence-based therapeutic values of medicinal cannabis as well as consistent federal and
state health policies to encourage proper, safe, and effective use of cannabis in healthcare.
Cons
Opposition to enhancing medicinal cannabis use, especially through public health policy, is
founded on potential risk-factors with an emphasis on the risks of developing Cannabis Use Disorder
(CUD). Risk factors for cannabis use include genetics, frequency of use, duration of use, psychosocial
factors including depressed mood and co-use of other substances such as alcohol, education, and
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parental monitoring habits with most of these risk factors increasing the chances of developing CUD
(Gorelick, 2022).
The European Archives of Psychiatry and Clinical Neuroscience published a literature review
exploring the opposition to medicinal cannabis, the belief for its potential to cause harm with the
evidence of CUD, and the impact of public health policy (Budney et al., 2019). The authors report a 10%
to 30% prevalence of CUD in cannabis users. CUD is briefly defined as risky use, physical dependence,
and addiction as summarized per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and
the International Statistical Classification of Diseases and Related Health Problems (ICD-10 or 11). The
literature review suggests similarities in definition and consequences of CUD and other substance use
disorders (SUD). Consequences include an increased risk for additional psychosocial problems, engaging
in violent behaviors, increased emergency room visits, increased potential for other SUDs, and
self-injuring behaviors. The authors call for increased awareness, research, and education of the public
and policymakers so the proper regulations and monitoring methods can be implemented to keep
patients safe.
Concurrence
Interestingly, both the opposers and supporters of medicinal cannabis can agree on one thing:
federal and state public health policy need to be consistent to provide the safest, most effective medical
interventions for patients. This alone should speak volumes to the public as well as policymakers. There
is concurrent belief that consistency is key and collaboration among healthcare providers at the local,
national, and international levels are critical for safe and effective patient care. Agreement in this area is
encouraging that there may be genuine opportunity to make a collaborative difference for our patients.
Coverage and Reporting
An important aspect of any health policy issue to consider is the source of information, how
accurate the information is, and how effectively this information is reaching key stakeholders. The issue
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of medicinal use of cannabis is reported in the current, though limited, research as utilized in this paper.
We can also refer to prominent healthcare and legislature agencies for accurate information on the
current political climate and stances on health policy issues such as the ones referenced in this paper
including the NCSL and NIH. Peer-reviewed literature and research as well as prominent agencies provide
accurate statistics and information for professionals and the public to utilize with a proper level of
scrutiny.
Another source of information to consider, especially in our technology-driven generation, is
social media. A study completed in 2021 examined 14 different cannabis business profiles on social
media and how they exert their influence on cannabis users (Jenkins et al., 2021). The researchers found
the primary theme to be normalization of cannabis and primary methods used to do this included
referencing pop culture such as celebrity users, creating community involvement, developing a group
identity with insider language, and combating negative views. These sources of information should be
approached with skepticism, assessed for support of professional standards of evidence, and considered
by health professionals and policymakers for monitoring.
It is important to note the variety of ways our patients consume data and how accurate that data
is. It is even more important for healthcare providers and policymakers to have a professional level of
understanding to provide accurate, evidence-based education and care.
Final Word
Medicinal cannabis remains a topic of great controversy in the medical and public arenas alike.
As medical professionals and future advanced practice providers, we must understand the current
political climate and current public health policies locally and internationally so that we can properly
advocate for our patients and provide optimal, evidence-based care.
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References
Boehnke, K. F., Dean, O., Haffajee, R. L., & Hosanagar, A. (2022). U.S. trends in registration for medical
cannabis and reasons for use from 2016 to 2020.
Annals of Internal Medicine
,
175
(7), 945–951.
https://doi.org/10.7326/m22-0217
Budney, A. J., Sofis, M. J., & Borodovsky, J. T. (2019). An update on cannabis use disorder with comment
on the impact of policy related to therapeutic and recreational cannabis use.
European Archives
of Psychiatry and Clinical Neuroscience
,
269
(1), 73–86.
https://doi.org/10.1007/s00406-018-0976-1
Gorelick, D. (2022, December 21).
Cannabis use and disorder: Epidemiology, pharmacology,
comorbidities, and adverse effects
. UpToDate.
https://www.uptodate.com/contents/cannabis-use-and-disorder-epidemiology-pharmacology-c
omorbidities-and-adverse-effects
Jenkins, M. C., Kelly, L., Binger, K., & Moreno, M. A. (2021). Cyber-ethnography of Cannabis Marketing on
Social Media.
Substance Abuse Treatment, Prevention, and Policy
,
16
(1).
https://doi.org/10.1186/s13011-021-00359-w
Mercurio, A., Aston, E. R., Claborn, K. R., Waye, K., & Rosen, R. K. (2019). Marijuana as a substitute for
prescription medications: A qualitative study.
Substance Use & Misuse
,
54
(11), 1894–1902.
https://doi.org/10.1080/10826084.2019.1618336
National Conference of State Legislatures. (2023, June 22).
State Medical Cannabis Laws
. National
Conference of State Legislatures.
https://www.ncsl.org/health/state-medical-cannabis-laws#anchor8842
Ryan, J. E., McCabe, S. E., & Boyd, C. J. (2021).
Medicinal Cannabis: Policy, Patients, and Providers
,
22
(2),
126–133.
https://doi.org/10.1177/1527154421989609
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Søgaard, T. F., & Lerkkanen, T. (2021). Overview: Exploring the onto-politics of Cannabis.
Nordic Studies
on Alcohol and Drugs
,
38
(4), 321–328.
https://doi.org/10.1177/14550725211025847