Role of the nurse in the treatment of cannabis

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The role of nursing in the treatment of cannabis

In recent years we have been aware of the development of cannabis and the requirements for obtaining a medical license in accordance with the Ministry of Health procedure 106 are increasing. Among the many roles of nursing care are to promote excellence, education, research and development policy. It is therefore natural that the nursing profession will also integrate in the treatment of cannabis.

In the first stage it is very important that the nurses learn about the subject. Nurses are closer to the patient than any other staff member and guide patients and their families in a variety of areas. Many patients are monitored in the community and therefore the nurse is in the treatment center [1]. (Mathre and Krawitz, 2002)

Cannabis for medicinal use is a plant remedy whose growth process is not controlled as is customary for medical preparations. It can contain contaminants (bacteria, fungi and mold, as well as organic and inorganic pollutants, organic heavy metals and phosphates). The concentration of active ingredients in plants is not constant. Variation exists between the various plant parts, the different species, the towers and seasons. In the plant there are three groups of substances: cannabinoids, terpenoids and flavonoids.

Active cannabis compounds bind to cannabinoid receptors in the pain pathways in the brain and spinal cord and lead to pain relief. The active ingredients in cannabis are quickly absorbed through the mucosa of the mouth and through the lungs. Gastrointestinal absorption occurs when the active substances of varying pH levels, digestive enzymes, intestinal epithelium and primary liver secretion are used by the liver enzymes to which the drug is absorbed directly through the entropy and thus the biological availability of low oral preparations.

Side effects:

Many drugs in the field of palliative care are toxic and dangerous to the patient, and cannabis is very safe relative to conventional treatments and has not been reported to be toxic or dangerous to humans [2] (Carter and Ugalde, 2004). Yet every patient in cannabis should have a caregiver who accompanies and follows the treatment . There is no risk of addiction to cannabis, and even if the patient’s dependence on treatment develops, it is negligible in relation to the benefit he produces and in improving the symptoms of the illness he suffers from. If dependence develops, it is usually psychological rather than physiological [4] (Green and de-Vries, 2010; Peat, 2010)

An examination of patients with synthetic cannabinoids (Nabilone) has shown that cases of cannabis abuse in patients with chronic pain are rare [5] (Ware and St Arnaud-Trempe, 2010)

Of the hundreds of substances in cannabis, there is one cannabinoid with psychoactive effect, THC, and our body has receptors for this substance mainly in the nervous system and immune cells. After consumption of cannabis, cannabinoids break down and move through the blood stream to all parts of the body. The side effects of cannabis therapy may appear differently in different people. Some people may not experience them at all, some can only experience some of them and some people will experience them all. There is also a relationship between the concentration of the active ingredient in the cannabis plant consumed and the consumption side effects, and there is also a relationship between the duration and frequency of use and the side effects. The main substance that causes the side effects is the psychoactive cannabinoid, THC. On the other hand, there is a feeling of drowsiness and calmness, general good feeling, laughter for no logical reason, distortions in perception of time and space, increased sense of taste, smell and sense of touch. In addition, there may be dry mouth, increased appetite, decreased blood sugar and decreased blood pressure, and high doses above 20 mg may include hallucinations, impaired judgment, an experience of synesthesia, Subjective effect on behavior and difficulty in performing simple motor functions. There may be severe deficiencies in concentration, thinking, and memory.

The most common side effects and ease of prevention are low blood sugar and mouth dryness which increases with sweet drinks before consumption.

The use of this medicine should be avoided in patients with schizophrenia and patients with bipolar disorder, mainly due to the possible side effects of psychotropic cannabinoids (THC), such as dysporia, anxiety, panic attacks, and psychosis. In older patients with cardiovascular disease, the risk of changes in blood pressure, tachycardia, heart attack, recurrence of angina, cardiomyopathy, sudden cardiac death, arrhythmia. As well as cerebrovascular events such as stroke and ischemic events. Peripheral vascular injury, vasculitis, cannabis arthritis, intermittent lameness Reynaud syndrome necrosis of the fingers have also been reported [7]. As a result, long-term use of inhaled cannabis increases the risk of paringitis, rhinitis, asthma, bronchitis, lung infections, emphysema, and lung cancer. Therefore, cannabis smoke can damage the mucous membranes caused by the burning of the grass, reduce air conduction and damage the macrophages. It is advisable to use more oil than smoking [8], [9], [10], [11].

Legal aspects:

There is a commitment to the patient to maintain confidentiality and to maintain the basis of patient-therapist trust. The Patient’s Rights Law 1996 and the Basic Law of Human Dignity and Liberty guarantee the privacy and confidentiality of each patient, and if necessary the nurse must breach confidentiality in order to consult with patient care partners, such as to investigate drug interactions with cannabis and other drugs with the pharmacist, And for the patient’s benefit.

It is important that a clear policy includes all the considerations in accordance with the relevant laws and if treated with cannabis it is used in public transport is important to report it. If there is a suspicion that the patient has been abused or his cannabis used illegally for health purposes such as drug trafficking, the nurse must consider the patient’s best interests and may have to report to the appropriate authorities.

In conclusion:

  1. Nurses have a responsibility to be  up-to-date and to know the medications that patients receive including Cannabis in a medical license, in all its ways of consumption.
  2. Many patients with degenerative diseases and other conditions benefit from cannabis treatment and it is important to monitor them and make sure they are not at risk.
  3. The right of patients to receive information about the physiological and psychological effects of cannabis and how it affects in combination with other drugs.
  4. The nurses must document in the patient’s file the use of cannabis and the desired and undesirable effects – side effects.
  5. The nurses must make sure that the patient is aware that he is still a dangerous drug under the law and the punishment for cannabis being used against the law.

[1] Mathre ML, Krawitz M (2002) Cannabis series – the whole story. Part 4: the medicinal use of cannabis pre-prohibition. Drugs and Alcohol Today; 2: 3-7.

[2] Carter GT, Ugalde V (2004) Medical marijuana: emerging applications for the management of neurological disorders. Physical Medicine and Rehabilitation Clinics of North America; 15: 943-954.

[3] Green AJ, De-Vries K (2010) Cannabis use in palliative care – an examination of the evidence and the implications for nurses. Journal of Clinical Nursing; 19: 2454-2462.

[4] Peat S (2010) Using cannabinoids in pain and palliative care. International Journal of Palliative Nursing; 16: 10, 481-485.

[5] Ware MA, St Arnaud-Trempe E (2010) The abuse potential of the synthetic cannabinoid nabilone. Addiction; 105: 3, 494-503.

[6] Ashton CH, Moore PB, Gallagher P Young AH: Cannabinoids in bipolar affective disorder: a review and discussion of their 9-therapeutic potential. J Psychopharmacol, 19 (3): 293-300, 2005

[7] Thomas G et al: Adverse cerebrovascular, cerebrovascular and peripheral vascular effects of marijuana inhalation: What Cardiologists need to know. Am J Cardiol. 113: 187-190, 2014.

[8] Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review. CMAJ; 178: 1669-78, 2008. Hall W, Degenhardt L: Adverse health effects of non-medical cannabis use. the Lancet, 374 (9698): 1383-1391, 2009

[9] Hall W, Degenhardt L: Adverse health effects of non-medical cannabis use. the Lancet, 374 (9698): 1383-1391, 2009

[10] Pertwee RG: Cannabis and Cannabinoids. Pharmacology and ratione for clinical use. Forsch Komplementarmed; 6 (suppl 3): 12-8. 15, 1999

[11] Gur Roth, shedding light on the dark side of medical marijuana MEDICINE FROM GROUP MEDICAL, 12-11, July 3113.

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