Medicinal cannabis review highlights dilemmas facing health care professionals

Dr Anita Green and Dr Kay De-Vries studied more than 50 published papers, together with professional and Government guidance documents, official reports and media coverage, from 1996 to 2009.

They point out that the fact that the cannabis is usually obtained illegally can have consequences for those who choose to use it for its medicinal value and create real dilemmas for the nurses and other healthcare professionals who care for them. For example, it is vital that any drug use is recorded on the patient's medical records for their own safety, but many patients may be unhappy for that to happen.

"Nurses are increasingly likely to deal with patients using medicinal cannabis and it is important that they put their personal views to one side and deal with the health consequences of that drug use" says Dr Green, a Nurse Consultant for the Sussex Partnership NHS Foundation Trust and Visiting Fellow at the University of Brighton.

"The literature on the medicinal use of cannabis repeatedly refers to changes that could improve people's quality of life, like improved sleep, a better appetite and reduced depression, and these perceived benefits have led to greater usage.

"However, it also states that far more research is needed and it is very important that patients are fully aware of the legal consequences of taking cannabis, together with the physical and psychological effects it may have on them.

"Nurses and other healthcare professionals need to be well informed about the medicinal effects of cannabis and how this can interact with other medication the patient is being prescribed. It is also vital that the patient's cannabis use is accurately documented in their records and that other professionals, such as pharmacists, doctors and substance misuse teams are brought in to provide advice, with their permission."

Cannabis, which has been widely used as a herbal remedy since ancient times, was brought to Western Europe at the beginning of the 19th century by Napoleonic soldiers who had been fighting in North Africa.

Its medicinal use was advocated in European and American medical articles as far back as 1849, but was banned in the UK in 1928 after UK delegates at an international opium conference were persuaded that cannabis caused insanity.

"Our review shows that the general view of integrating cannabis derivative medications into mainstream medical use remains extremely cautious" says Dr Green. "Most of the research we studied indicated that there was a need for more clinical trials examining the optimal administration routes and dosing regimes.

"It is repeatedly pointed out in the literature that the development of cannabis and isolated synthetic cannaboids for medicinal purposes is still in its infancy and has a long way to go.

"The aim of our study was to review the literature and to raise awareness of the questions and dilemmas facing the medical profession, specifically nurses, when it comes to caring for patients who use cannabis for medicinal reasons.

"We hope that the review - which looked at the research published into the pharmacological qualities of cannabis and its use in palliative care, for example cancer, multiple sclerosis and motor neurone disease - will stimulate further debate.

"In the meantime, it is vital that nurses and other healthcare professionals act within the law and follow the guidance laid down by their professional organisations."

The authors say that the review highlights the real dilemmas created for the medical profession by the medicinal use of cannabis.

"Nurses have a caring responsibility to maximise their patients' quality of life, but should they also be reminding them that the medicinal use of cannabis remains illegal?" asks Dr Green. "Or should they respect the patient's right to take the drug and just make sure that it does not conflict with any other treatment, such as prescribed medication?

"It is clear that further debate is essential and that nurses need ongoing support and guidance to help them tackle these thorny dilemmas and provide the best healthcare they can for their patients without compromising their professional integrity."

More information: Cannabis use in palliative care - an examination of the evidence and the implications for nurses. Green A J and De-Vries K. Journal of Clinical Nursing. 19, pp2454-2462. (September 2010). DOI: 10.1111/j.1365-2702.2010.03274.x

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