Position Statement: On Medical Marijuana

INTENT

The intent of this position statement is to acknowledge the role of nurses in advocating for patient access to marijuana for medical purposes and in facilitating the legislation that legalizes medical marijuana for symptoms that are uncontrolled by conventional therapies.

POSITION

The New York State Nurses Association:

• Supports the legislation in New York State that amended Article 33 of the Public Health Law and allows for the use of marijuana for certified patients.
• Endorses the use of marijuana for serious and life-threatening medical conditions as defined by the New York State legislation.
• Endorses the expansion on currently limited diagnoses that count as “qualifying conditions” for the use of marijuana.
• Endorses research to recognize the role medical marijuana can play in reducing opioid addictions and death

BACKGROUND

The New York State Nurses Association acknowledges the commitment of the registered professional nurse (RN) to society and to change social structures that may detract or diminish health and well-being (ANA, 2015). Furthermore, the RN has an ethical and moral obligation to support social policy to meet the health needs of patients and to collaborate with other health professionals to promote efforts determined to meet the health needs of the public.

Marijuana has been used for centuries for medicinal purposes and was legal in the United States until 1937 when the Marijuana Tax Act of 1937 prohibited the use of the drug in the United States (ANA, 2004). Anecdotal accounts from patients demonstrated the antiemetic, sedative and analgesic effects as well as the stimulation of appetite and improved food intake, which prompted clinical trials in the 1970s and 1980s (The leading edge, 2001).

The benefits of medicinal marijuana have been supported by clinical research. Scientific reports released by the National Institutes of Health (NIH, 1997) and the Institute Of Medicine (Joy, Watson & Benson, 1999) have helped to further enhance the status of marijuana research in the scientific community (The leading edge, 2001). Marijuana has been found to be effective to manage the following symptoms and illnesses:

• pain and nausea, particularly nausea following chemotherapy (Tramer, Carroll, Campbell, et al, 2001; The leading edge, 2001),
• migraines,
• wasting syndrome associated with AIDS and cancer,
• muscle spasticity associated with multiple sclerosis (Dyer, 2001), and
• seizures associated with epilepsy.

In August, 2017, New York patients became eligible for medical marijuana if they have been diagnosed with one or more of the following severe debilitating or life threatening conditions:

Qualifying conditions as defined by 10 NYCRR §1004.2(a)(8)(xi):

• Amyotrophic Lateral Sclerosis (ALS)
• Cancer
• Chronic pain
• Epilepsy
• HIV/AIDS
• Huntington's Disease
• Inflammatory bowel disease
• Parkinson's Disease
• Post-Traumatic Stress Disorder
• Multiple Sclerosis
• Neuropathies
• Spinal cord damage

The severe debilitating or life threatening condition must also be accompanied by one or more of the following associated or complicating conditions: cachexia or wasting syndrome, severe or chronic pain, severe nausea, seizures, or severe or persistent muscle spasms. There are an estimated 38,642 patients receiving medical marijuana and 1,358 registered practitioners participating in the program as of December 8, 2017 (New York Medical Marijuana Law, 2017).

Effective December 27, 2017, registered organizations (ROs) are allowed to manufacture and distribute additional marijuana products including topicals such as ointments, lotions and patches; solid and semi-solid products, including chewable and effervescent tablets and lozenges; and certain non-smokable forms of ground plant material. All products are subject to rigorous testing, and the New York State Department reserves the right to exclude inappropriate products or those which pose a threat to public health.

As set forth in 10 NYCRR §1004.1(a), practitioners seeking to issue certifications for their patients to receive medical marijuana products must meet the following criteria:

• Be qualified to treat patients with one or more of the serious conditions set forth in Public Health Law §3360(7) or as added by the Commissioner.
• Be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law in New York State, or be certified, in good standing as a nurse practitioner and practicing, as defined in Article 139 of the Education Law, in New York State, or be licensed, in good standing as a physician assistant and practicing in New York State, as defined in article 131-B of the Education Law, under the supervision of a physician registered with the New York State medical marijuana program;
• Have completed a four-hour course approved by the Commissioner; and
• Have registered with the New York State Department of Health (NYSDOH).

Currently, there’s much insecurity and instability at the federal level with President Trump’s Attorney General threatening to erode protections of the 29 states and Washington, D.C. with medical marijuana programs and Congress blocking federally-funded research. – it is more important than ever for New York to step up as a leader in this pivotal moment and set an example for other states to follow.

In January, 2018, Governor Cuomo proposed funding a state government panel to study the impact of legalizing marijuana for recreational use in New York in light of surrounding states, including Massachusetts and Vermont, legalizing recreational use.

Still, as in other states, headaches for applying and actual marijuana entrepreneurs in New York arise from conflicts between federal and state laws regarding marijuana. Several state lawmakers in New York have called on the federal government to enact legislation that would legalize medical marijuana at the federal level. The architects of New York’s medical marijuana program, state Sen. Diane Savino of Staten Island and Assemblyman Richard Gottfried of Manhattan, both Democrats, immediately asked for Congress to pass legislation protecting medical programs throughout the country. U.S. Rep. Elise Stefanik, a Republican who represents northern New York, said she is considering a legislative fix to allow states to continue their medical marijuana program (Valsquez, 2018).

In New York, Assembly Speaker Carl Heastie said there are criminal justice reforms that have to be considered if New York seeks to legalize recreational, adult use of marijuana. Heastie has noted that African-Americans and Latinos account for a disproportionate number of marijuana arrests although they and white people use marijuana at similar rates (Valsquez, 2018).

A poll conducted in July by Siena College shows that New Yorkers are closely divided on adult, recreational use. Forty-nine percent of registered voters polled supported legalizing recreational use of marijuana, while 47 percent opposed it. Younger voters in New York overwhelmingly support legalization, the poll showed, with 68 percent in favor (Valsquez, 2018).

By contrast, in November, a poll conducted by Emerson College and commissioned by the Marijuana Policy Project Foundation and the Drug Policy Alliance found 62 percent of New Yorkers approved of legalizing marijuana for adult use. The survey also showed that taxing sales of legal marijuana was a far more popular way of closing the state’s $4.4 billion budget deficit than higher taxes, new tolls or reduced education spending (Valsquez, 2018).

RECOMMENDATIONS

• The New York State Nurses Association recommends that registered professional nurses:
• Actively support the legislation in New York State that provides patients the right to safe access of marijuana for their medical use.
• Educate themselves about the current therapeutic and evidence-based uses of marijuana.
• Collaborate with other health professionals engaged in research efforts designed to investigate the scientific validity of medical marijuana and the patients’ therapeutic response.
• Actively support the expansion on currently limited diagnoses that count as “qualifying conditions.”
• Support more Nurse Practitioners become enrolled to write prescriptions in 2018.
• Actively support research to show the role medical marijuana can play in reducing opioid addictions and deaths.

Approved by the Board of Directors on June 29, 1995
Reviewed by the Councils on Ethical Practice and Human Rights on April 29, 2005
Approved by the Board of Directors on June 8, 2005
Reviewed and Revised March 8, 2018

Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.