The State of Marijuana

In the past, one of the more common nursing violations has been testing positive for illegal substances such as opioids, marijuana and amphetamines. This has inevitably led to loss of employment and discipline by the Nevada State Board of Nursing. One of the most common substances for which nurses test positive is marijuana.

Why would nurses risk their careers and licenses through the use (or abuse) of such substances? I cannot provide an exhaustive list, but let me give you the top two reasons I have discovered while representing nurses before the Nevada State Board of Nursing. Let's take opioids as our first example. Sometime in the past, a nurse may have sustained a physical injury; she or he was prescribed narcotics and then became addicted through the legal use of these narcotics. However, he or she becomes addicted to the meds, and when the prescription ends, feels compelled to obtain these substances illegally.

Another common scenario was the medical use of marijuana when it was illegal. Nurses would choose to use marijuana for pain management in lieu of narcotics. If you look at the list of harmful addictive substances and the possibility of overdose, narcotics are almost at the top of the list, even though marijuana is safer, much safer than other drugs, and not nearly as addictive, in fact, cannabis is far less addictive than nicotine found in tobacco products. Nonetheless, many people develop a marijuana use disorder (estimated at 30 percent). In many of the cases I've seen, nurses who use marijuana do it to manage chronic pain.

When I first started representing nurses, any amount of marijuana found in the body was cause for discipline. Once Nevada legalized the use of marijuana for medicinal purposes, the waters became murky, and nurses still faced discipline as the Board struggled with what to do. After all, no one wants nurses taking care of patients when they are "high."

Years later, the Nevada voters legalized the use of marijuana for recreational use. With the growing acceptance and tolerance of marijuana among many states, together with the growing conflict between nursing practice standards and the legality of these substances, the National Council of State Boards of Nursing (NCSBN) needed to address the issue and offer solutions. State Boards look heavily to the NCSBN for guidance.

Although I'm not sure how long the NCSBN studied the issue, they came out with guidelines in the summer of 2018. I've read those guidelines, and if you want to read them for yourselves, click here to download the PDF. For those of you who do not want to read this well-written, 57-page masterpiece, I'm going to give you the short version as it applies to nurses in the State of Nevada. I'm also going to give you some unsolicited advice before I close out this post. Here are the basic guidelines:

1. If you receive a recommendation by a physician for marijuana use (i.e., you have a medical marijuana card), then if you test positive for marijuana, the Board will not take action against you unless there is also evidence of impairment. It's similar to how the Board deals with alcohol use--if you are intoxicated while working (i.e., "impaired"), you will face disciplinary action.

2. If you are found to have marijuana in your system and are only a recreational user, you may be disciplined by the Board, even without a showing of impairment or that it affected you at work.

These are the rules in Nevada as I understand them (based upon my experience). Now, here comes the unsolicited advice, which I hope you will heed:

A. Employers can still terminate you for any amount of marijuana in your system. They do not have to allow you to work for them and be a marijuana user, even if you have a medical card. I'm not an employment attorney and I imagine that this will eventually be dealt with by the courts, but you don't have the time and won't want to spend the money to fighting this issue.

B. Some studies are beginning to suggest that the long-term use of marijuana may adversely affect blood flow to your brain. Go here. Others proclaim many of the medicinal benefits from the use of cannabis. Visit here. The take-away is to stay informed as more research is conducted.

C. There are many types of marijuana and how the body interacts with the chemicals found in these different plants, which affect different humans differently. The same chemical (cannabinoids) can affect Jane Doe completely differently than it affects Susy Smith. There is a dearth amount of research on the effects of marijuana and no medical guidelines based on empirical research. Nearly all of the information is based on anecdotal evidence under uncontrolled conditions, but that has begun to change.

D. Do not advocate the use of marijuana while acting as a nurse. If you use your license in Nevada to promote marijuana use, the Board will discipline you. This is because of the point made in paragraph C--there are little if any clinical findings of the best way to use this substance for various ailments.

E. Marijuana has many uses to alleviate human suffering and to manage several medical conditions. Many medical personnel attest that marijuana use is a safer solution that many other kinds of legally available remedies. If you have a medical card, find someone who has a breadth of knowledge about cannabis. One person that I would recommend is Jenn Shepherd, who used to be a registered nurse in the

State of Nevada but now practices elsewhere. Click here to go to her website. She has had extensive experience dealing with hundreds of people who have used marijuana medically. I've spent hours learning from her about both the benefits and risks of marijuana. In a nutshell, most users need to learn through trial and error what type of cannabis they should use, and what form to take that works best for them (ingestion, topical, oils, etc.). I strongly believe that the medical profession must begin to study the medicinal effects of marijuana, what works and what doesn't. There's a huge gulf between its legal availability and its proper use.

F. I've never used marijuana for any reason, so I cannot personally vouch for any of its medicinal properties or benefits, but I voted "yes" for its medicinal applications because I see its long-term potential. I have a relative with chronic back pain and I know he benefits from the medicinal properties of this amazing plant.

Final point: Federal laws concerning marijuana still conflict with state laws, so why is it legal in some states? Because of a famous memorandum that was written during the Obama administration in 2013 known as the Cole Memorandum. It basically states that the federal government will not enforce federal laws in states that have legalized it. Federal laws still categorize marijuana as a Class I controlled substance, with severe penalties, which I think is ridiculous when compared to other drugs that are far more dangerous that are found in lower classifications.

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