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The Cannabis Conundrum

AJN, American Journal of Nursing: December 2019 - Volume 119 - Issue 12 - p 12
doi: 10.1097/01.NAJ.0000615712.78397.12
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Abstract

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One in seven Americans say they use cannabidiol (also known as CBD) products, according to a recent Gallup poll. Some people use CBD for pain, while other use it for anxiety or for sleep. Available as an oil, CBD is a nonpsychoactive chemical compound derived from the cannabis or hemp plant that is believed to have therapeutic effects. Since being legalized federally last year, cannabidiol has gained popularity as an additive to lotions, various foods and drinks, and even the fibers of workout clothes, among other products. For nurses encountering patients using CBD, it's important to understand the benefits, safety, and regulation of the cannabis plant—and its derivatives.

In 1970, cannabis was classified as a controlled substance and deemed to be a Schedule I drug. However, 33 states and Washington, DC, have since legalized its sale for medicinal purposes, and 11 states and Washington, DC, allow recreational use. The 2018 Farm Bill legalized—under strict conditions—the sale of hemp-derived CBD, which contains less than 0.3% tetrahydrocannabinol (THC), the principal psychoactive component of cannabis. (Cannabis containing over 0.3% THC is considered to be “marijuana” and is still classified as a drug.) But many CBD products are mislabeled: an analysis published in JAMA found that of 84 products purchased online, 26% contained less CBD than disclosed on the label, and about 22% contained THC, some in amounts twice the legal limit for nonpsychoactive products.

The only CBD product approved by the Food and Drug Administration is Epidiolex, which is used to treat seizures associated with the rare epilepsy syndromes, Lennox–Gastaut and Dravet. CBD has also shown promising but limited results in alleviating the withdrawal effects of cocaine and methamphetamine use, and in reducing alcohol consumption in people with alcohol use disorder, thereby potentially diminishing liver and brain damage.

A recent literature review found that CBD may help reduce episodic anxiety associated with stressful events, such as public speaking, and may be effective in the treatment of patients with schizophrenia. However, its potential as a treatment for chronic anxiety hasn't been studied, and data on its effects on pain, spasticity, and Parkinson's disease remain sparse.

Despite the limited science, some manufacturers of CBD products continue to falsely tout them as cures for a range of conditions, including depression, anxiety, cancer, and AIDS. In response, the Federal Trade Commission (FTC) in September sent letters to three unnamed companies, warning them, the FTC said in a statement, “that it is illegal to advertise that a product can prevent, treat, or cure human disease without competent and reliable scientific evidence to support such claims.” Such warnings, however, may not be sufficient to stem public enthusiasm for CBD products. By 2022, CBD-related consumer spending is expected to reach about $1.8 billion—up from roughly $500 million in 2018.

To help nurses care for patients using medical cannabis, the National Council of State Boards of Nursing has released The NCSBN National Nursing Guidelines for Medical Marijuana. Among the recommendations are that nurses stay informed on the benefits and risks of cannabis, become familiar with state laws, assess patients for adverse effects, and communicate clinical findings to other members of the health care team (see https://ncsbn.org/the_ncsbn_national_nursing_guidelines_for_medical_marijuana_jnr_july_2018.pdf). Another resource is the American Cannabis Nurses Association, which offers an online course (see www.cannabisnurses.org).—Dalia Sofer

Bonn-Miller M, et al JAMA 2017;318(17):1708–9; White CM. J Clin Pharmacol 2019;59(7):923-34.
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