As previously described, the Schedule I listing of cannabis according to federal law and DEA regulations has led to difficulties in access for research purposes; nonpractitioner researchers can register with the DEA more easily to study substances in Schedules II—V compared with Schedule I substances. For example, the Center for Medicinal Cannabis Research at the University of California—San Diego had access to funding, marijuana at different THC levels, and approval for a number of clinical research trials, and yet failed to recruit an adequate number of patients to conduct five major trials, which were subsequently canceled. The limited availability of clinical research to support or refute therapeutic claims and indications for use of cannabis for medicinal purposes has frequently left both state legislative authorities and clinicians to rely on anecdotal evidence, which has not been subjected to the same rigors of peer review and scrutiny as well-conducted, randomized trials, to validate the safety and efficacy of medicinal cannabis therapy.

Furthermore, although individual single-entity pharmaceutical medications, such as dronabinol, have been isolated, evaluated, and approved for use by the FDA, a plant cannot be patented and mass produced by a corporate entity. The Schedule I designation of cannabis causes hospitals and other care settings that receive federal funding, either through Medicare reimbursement or other federal grants or programs, to pause to consider the potential for loss of these funds should the federal government intercede and take action if patients are permitted to use this therapy on campus.

Similarly, licensed practitioners registered to certify patients for state medicinal cannabis programs may have comparable concerns regarding jeopardizing their federal DEA registrations and ability to prescribe other controlled substances as well as jeopardizing Medicare reimbursements. In , U. Attorney General Eric Holder recommended that enforcement of federal marijuana laws not be a priority in states that have enacted medicinal cannabis programs and are enforcing the rules and regulations of such a program; despite this, concerns persist. The argument for or against the use of medicinal cannabis in the acute care setting encompasses both legal and ethical considerations, with the argument against use perhaps seeming obvious on its surface.

States adopting medical cannabis laws may advise patients to utilize the therapy only in their own residence and not to transport the substances unless absolutely necessary. Canada has adopted national regulations to control and standardize dried cannabis for medical use. The argument can be made that an herb- or plant-based entity cannot be identified by pharmacy personnel as is commonly done for traditional medicines, although medicinal cannabis dispensed through state programs must be labeled in accordance with state laws.

Dispensing and storage concerns, including an evaluation of where and how this product should be stored e. Inpatient use of medicinal cannabis also carries implications for nursing and medical staff members. The therapy cannot be prescribed, and states may require physicians authorizing patient use to be registered with local programs. Despite the complexities in the logistics of continuing medicinal cannabis in the acute care setting, proponents of palliative care and continuity of care argue that prohibiting medicinal cannabis use disrupts treatment of chronic and debilitating medical conditions. Patients have been denied this therapy during acute care hospitalizations for reasons stated above.

Legislation in Minnesota, as one example, has been amended to permit hospitals as facilities that can dispense and control cannabis use; similar legislative actions protecting nurses from criminal, civil, or disciplinary action when administering medical cannabis to qualified patients have been enacted in Connecticut and Maine. Despite lingering controversy, use of botanical cannabis for medicinal purposes represents the revival of a plant with historical significance reemerging in present day health care. Legislation governing use of medicinal cannabis continues to evolve rapidly, necessitating that pharmacists and other clinicians keep abreast of new or changing state regulations and institutional implications.

Ultimately, as the medicinal cannabis landscape continues to evolve, hospitals, acute care facilities, clinics, hospices, and long-term care centers need to consider the implications, address logistical concerns, and explore the feasibility of permitting patient access to this treatment. Whether national policy—particularly with a new presidential administration—will offer some clarity or further complicate regulation of this treatment remains to be seen. Disclosures: The authors report no commercial or financial interests in regard to this article. Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation. PMCID: PMC Mary Barna Bridgeman , PharmD, BCPS, BCGP and Daniel T.

Abazia , PharmD, BCPS, CPE. Author information Copyright and License information Disclaimer. Bridgeman is a Clinical Associate Professor at the Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, in Piscataway, New Jersey, and an Internal Medicine Clinical Pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. Abazia is a Clinical Assistant Professor at the Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, and an Internal Medicine Clinical Pharmacist at Capital Health Regional Medical Center in Trenton, New Jersey.

Copyright © , MediMedia USA, Inc. THE MEDICINAL CANNABIS DEBATE As a Schedule I controlled substance with no accepted medicinal use, high abuse potential, concerns for dependence, and lack of accepted safety for use under medical supervision—along with a national stigma surrounding the potential harms and implication of cannabis use as a gateway drug to other substances—transitioning from a vilified substance to one with therapeutic merits has been controversial. ADVERSE EFFECTS Much of what is known about the adverse effects of medicinal cannabis comes from studies of recreational users of marijuana. MEDICINAL USES Cannabis and cannabinoid agents are widely used to alleviate symptoms or treat disease, but their efficacy for specific indications is not well established.

Open in a separate window. Access to marijuana through home cultivation, dispensaries, or some other system that is likely to be implemented;. Allows either smoking or vaporization of some kind of marijuana products, plant material, or extract. Footnotes Disclosures: The authors report no commercial or financial interests in regard to this article. Drug Enforcement Administration Office of Diversion Control. Schedules of controlled substances. b Placement on schedules; findings required. Springfield, Virginia: U. Department of Justice; Title 21 United States Code USC Controlled Substances Act. Subchapter I—Control and enforcement Part B—Authority to control; standards of controlled substances § Available at: www. World Health Organization.

Management of substance abuse: cannabis. Substance Abuse and Mental Health Services Administration. Behavioral health trends in the United States: results from the national survey on drug use and health. Office of National Drug Control Policy. Answers to frequently asked questions about marijuana. Swift A. Oct 19, Quinnipiac University. Allow marijuana for vets with PTSD, U. voters say , Quinnipiac University national poll finds; slim majority say legalize marijuana in general. Jun 6, Adler JN, Colbert JA.

Medicinal use of marijuana—polling results. N Engl J Med. Kondrad E, Reid A. J Am Board Fam Med. Moeller KE, Woods B. Am J Pharm Educ. National Conference of State Legislatures. State medical marijuana laws. Nov 9, Available at: ncsl. Food and Drug Administration. FDA and marijuana. Jul 7, Throckmorton DC. FDA work on medical products containing marijuana. Food and Drug Administration; Mar, Bennett C. In: Holland J, editor. The Pot Book: A Complete Guide to Cannabis. Rochester, Vermont: Park Street Press; Zias J, Stark H, Sellgman J, et al. Early medical use of cannabis. Malmo-Levine D. Recent history. Musto DF. The Marihuana Tax Act of Arch Gen Psychiatry.

Giancaspro GI, Kim N-C, Venema J, et al. The advisability and feasibility of developing USP standards for medical cannabis. Pharmacopeial Convention; [Accessed August 5, ]. Cameron JM, Dillinger RJ. Narcotic Control Act. In: Kleiman MAR, Hawdon JE, editors. Encyclopedia of Drug Policy. Thousand Oaks, California: SAGE Publications, Inc; State marijuana laws in map. Nov 11, Sidney S. Comparing cannabis with tobacco—again. About marijuana. Clark PA, Capuzzi K, Fick C. Medical marijuana: medical necessity versus political agenda. Med Sci Monit. National Institute on Drug Abuse. Drug facts: is marijuana medicine? Jul, Should marijuana be a medical option? Dec 28, MacDonald K, Pappas K. Why not pot? Innov Clin Neurosci. McPartland JM, Duncan M, Di Marzo V, et al. Are cannabidiol and Δ9-tetrahydrocannabivarin negative modulators of the endocannabinoid system?

A systematic review. Br J Pharmacol. Kaur R, Ambwani SR, Singh S. Endocannabinoid system: A multi-facet therapeutic target. Curr Clin Pharmacol. McPartland JM, Guy GW, Di Marzo V. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system. PLoS One. doi: Ben-Shabat S, Fride E, Sheskin T, et al. An entourage effect: inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. Eur J Pharmacol. Izzo AA, Borrelli F, Capasso R, et al. Nonpsychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb.

Trends Pharmacol Sci. Pertwee RG, Howlett AC, Abood ME, et al. International Union of Basic and Clinical Pharmacology. Cannabinoid receptors and their ligands: beyond CB 1 and CB 2. Pharmacol Rev. Fasinu PS, Phillips S, ElSohly MA, Walker LA. Current status and prospects for cannabidiol preparations as new therapeutic agents. Zhornitsky S, Potvin S. Cannabidiol in humans—the quest for therapeutic targets. Pharmaceuticals Basel ; 5 — Borodovsky JT, Crosier BS, Lee DC, et al. Smoking, vaping, eating: Is legalization impacting the way people use cannabis? Int J Drug Policy. Huestis MA. Pharmacokinetics and metabolism of the plant cannabinoids, delta9-tetrahydrocannabinol, cannabidiol, and cannabinol.

Handb Exp Pharmacol. Huestis MA, Henningfield JE, Cone EJ. Blood cannabinoids. Absorption of THC and formation of OH-THC and THCCOOH during and after smoking marijuana. J Anal Toxicol. Hartman RL, Brown TL, Milavetz G, et al. Controlled cannabis vaporizer administration: blood and plasma cannabinoids with and without alcohol. Clin Chem. Ohlsson A, Lindgren JE, Wahlen A, et al. Plasma delta-9 tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking. Clin Pharmacol Ther. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids.

Clin Pharmacokinet. Stout SM, Cimino NM. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. Drug Metab Rev. Sativex oral mucosal spray. electronic Medicines Compendium eMC May, Marinol dronabinol capsules USP prescribing information. North Chicago, Illinois: AbbVie; Volkow ND, Baler RD, Compton WM, et al. Adverse health effects of marijuana use. Gage SH, Hickman M, Zammit S. Association between cannabis and psychosis: epidemiologic evidence. Biol Psychiatry. Curran HV, Freeman TP, Mokrysz C, et al. Keep off the grass? Cannabis, cognition, and addiction. Nat Rev Neurosci. Joshi M, Joshi A, Bartter T.

Marijuana and lung diseases. Curr Opin Pulm Med. Blanco C, Hasin DS, Wall MM, et al. Cannabis use and risk of psychiatric disorders: prospective evidence from a U. national longitudinal study. JAMA Psychiatry. de Graaf R, Radovanovic M, van Laar M, et al. Patients do, however, report many benefits of CBD, from relieving insomnia, anxiety, spasticity, and pain to treating potentially life-threatening conditions such as epilepsy. The videos of this are dramatic. The most common use for medical marijuana in the United States is for pain control. In particular, marijuana appears to ease the pain of multiple sclerosis, and nerve pain in general. This is an area where few other options exist, and those that do, such as Neurontin, Lyrica, or opiates are highly sedating.

Patients claim that marijuana allows them to resume their previous activities without feeling completely out of it and disengaged. I have also heard of its use quite successfully for fibromyalgia, endometriosis, interstitial cystitis , and most other conditions where the final common pathway is chronic pain. Marijuana is also used to manage nausea and weight loss and can be used to treat glaucoma. A highly promising area of research is its use for PTSD in veterans who are returning from combat zones. Many veterans and their therapists report drastic improvement and clamor for more studies, and for a loosening of governmental restrictions on its study.

This is not intended to be an inclusive list, but rather to give a brief survey of the types of conditions for which medical marijuana can provide relief. As with all remedies, claims of effectiveness should be critically evaluated and treated with caution. Many patients find themselves in the situation of wanting to learn more about medical marijuana, but feel embarrassed to bring this up with their doctor. This is in part because the medical community has been, as a whole, overly dismissive of this issue. My advice for patients is to be entirely open and honest with your physicians and to have high expectations of them.

Tell them that you consider this to be part of your care and that you expect them to be educated about it, and to be able to at least point you in the direction of the information you need.

There are few subjects that can stir up stronger emotions among doctors, scientists, researchers, policy makers, and the public than medical marijuana. Is it safe? Should it be legal? Has its effectiveness been proven? What conditions is it useful for? Is it addictive? How do we keep it out of the hands of teenagers? Is it really the "wonder drug" that people claim it is? Is medical marijuana just a ploy to legalize marijuana in general? These are just a few of the excellent questions around this subject, questions that I am going to studiously avoid so we can focus on two specific areas: why do patients find it useful, and how can they discuss it with their doctor?

Marijuana is currently legal, on the state level, in 29 states, and in Washington, DC. The Obama administration did not make prosecuting medical marijuana even a minor priority. President Donald Trump promised not to interfere with people who use medical marijuana, though his administration is currently threatening to reverse this policy. Least controversial is the extract from the hemp plant known as CBD which stands for cannabidiol because this component of marijuana has little, if any, intoxicating properties. Marijuana itself has more than active components.

THC which stands for tetrahydrocannabinol is the chemical that causes the "high" that goes along with marijuana consumption. CBD-dominant strains have little or no THC, so patients report very little if any alteration in consciousness. Patients do, however, report many benefits of CBD, from relieving insomnia, anxiety, spasticity, and pain to treating potentially life-threatening conditions such as epilepsy. The videos of this are dramatic. The most common use for medical marijuana in the United States is for pain control. In particular, marijuana appears to ease the pain of multiple sclerosis, and nerve pain in general. This is an area where few other options exist, and those that do, such as Neurontin, Lyrica, or opiates are highly sedating.

Patients claim that marijuana allows them to resume their previous activities without feeling completely out of it and disengaged. I have also heard of its use quite successfully for fibromyalgia, endometriosis, interstitial cystitis , and most other conditions where the final common pathway is chronic pain. Marijuana is also used to manage nausea and weight loss and can be used to treat glaucoma. A highly promising area of research is its use for PTSD in veterans who are returning from combat zones. Many veterans and their therapists report drastic improvement and clamor for more studies, and for a loosening of governmental restrictions on its study. This is not intended to be an inclusive list, but rather to give a brief survey of the types of conditions for which medical marijuana can provide relief.

As with all remedies, claims of effectiveness should be critically evaluated and treated with caution. Many patients find themselves in the situation of wanting to learn more about medical marijuana, but feel embarrassed to bring this up with their doctor. This is in part because the medical community has been, as a whole, overly dismissive of this issue. My advice for patients is to be entirely open and honest with your physicians and to have high expectations of them. Tell them that you consider this to be part of your care and that you expect them to be educated about it, and to be able to at least point you in the direction of the information you need.

However, hospice practitioners in the United States are advocating for marijuana to be used for medical purposes due to its positive significant impact on human health. CB 2 is principally associated with cells governing immune function, although it may also be expressed in the central nervous system. State regulatory authorities became more prominently involved in the production and distribution of marijuana by overseeing the dispensing, manufacturing, and labeling of cannabis-derived products. Finished papers: Studies carried out among health practitioners show that more and more patients are inquiring about the use of marijuana for palliate symptoms. Substance use among adolescent students with consideration of budget constraints.

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