RX FOR MEDICAL MARIJUANA?

Promoting Research On And Acceptance Of This Treatment Option For Patients

As an RN, Rhonda O'Donnell has always seen herself as a patient
advocate. But she never imagined that she would become the face of
the medical marijuana movement in her home state of Rhode Island.
But-through a series of events-she has. And she's fine with it if it
means diminishing people's pain, as well as other symptoms associated
with certain chronic and terminal conditions.

I'm not promoting the use of illegal drugs and I'm not discounting
the value of pharmaceuticals, says O'Donnell, who takes several
federally-approved medications for multiple sclerosis (MS). But if
using marijuana can ease people's suffering, why not let people use
it without being afraid of getting arrested?

Activity around the issue of medical marijuana has increased lately,
including efforts by RNs and nursing organizations, such as the Rhode
Island State Nurses Association (RISNA), the Wisconsin Nurses
Association (WNA) and the ANA, to win measures legalizing its use and
to promote and publicize advances in clinical research.

This month, the partially nurse-created organization, Patients Out of
Time ( www.medicalcannabis.com ), is featuring the latest
science-based research at its Fourth National Clinical Conference on
Cannabis Therapeutics. Some 350 clinicians, patients, lawmakers, and
others are expected to attend.

In The States

The efforts of O'Donnell and RISNA contributed to the passage of a
new state law this year allowing Rhode Islanders diagnosed with
specified illnesses to legally use marijuana solely for medicinal
purposes. The Rhode Island legislature overrode the governor's veto
to make the law possible-making it the 11th state allowing the
limited use of marijuana.

The reason for the law is compassion, and I'm so grateful to the
legislators in Rhode Island who saw it the same way, says O'Donnell,
who hopes marijuana will help alleviate the leg spasms and pain she's
experienced since she was diagnosed with MS nearly 12 years ago.

I chose not to use medical marijuana to deal with my symptoms until I
could do it legally, O'Donnell says. Like others, O'Donnell must
obtain an identification card-probably at an annual cost of $100-to
be immune from potential local or state prosecution.

Both she and Donna Policastro, RNP, president and interim director of
the RISNA, participated in a community hearing earlier this year by
the Rhode Island Public Health Department, which is charged with
developing regulations around the measure.

We collaborated with many other organizations, such as the Rhode
Island Medical Society, to promote the legislation which we view as a
patient safety and advocacy issue, Policastro says. We're very happy
the measure passed, but we do have some concerns about safety that we
tried to address at the hearing.

As it stands now, Policastro says that patients in the program must
still go to street vendors to obtain marijuana-unlike in California
where patients can obtain marijuana safely through state-sanctioned
clubs. RISNA nurses also have concerns about patient confidentiality
and have urged state officials to keep only minimal information on
qualified medical marijuana users in its database-such as identifying
patients by an assigned number instead of by name.

Additionally, Policastro says RISNA wants to ensure that nurses'
practices aren't compromised if they help-or elect not to
help-administer medical marijuana to patients, such as those in a
long-term care facility. And as an NP, she still expresses some
concern about federal surveillance of health care professionals who
provide the documentation needed for patients to enter the medical
marijuana program-despite the existence of certain protections issued
by the courts.

Meanwhile advocates of medical marijuana use in New York and
Wisconsin suffered setbacks.

We passed a reference at our annual meeting in 1999 to make marijuana
a legally prescribed medication in cases where it's shown to be safe
and effective, says Gina Dennik-Champion, MSN, MSHA, RN, executive
administrator of the WNA.

Over the years, WNA nurses have testified before state lawmakers,
participated in media interviews, and signed on to a resolution
introduced by the New York State Nurses Association (NYSNA)-and
ultimately passed-at the ANA's House of Delegates in 2003.

Our members have been very outspoken in their belief that if medical
marijuana works as part of a palliative care regimen, it should be
allowed, Dennik-Champion says.

In her assembly testimony, she noted its therapeutic benefits, such
as reducing nausea and vomiting associated with chemotherapy,
stimulating appetite for AIDS patients experiencing wasting syndrome,
and reducing intraocular pressure associated with glaucoma.

However, as 2005 ended, the state assembly passed on considering the
medical marijuana bill (AB 740) further. But WNA nurses won't give up
their campaign.

And neither will NYSNA nurses even though the New York legislature
has not taken a floor vote on its medical marijuana measure. As part
of a consumer-driven coalition, the NYSNA has lobbied for several
years to finally give patients who use or want to use medical
marijuana legal protection.

This issue is about treatment options and patients' rights, says
Shaun Flynn, assistant director in the NYSNA's Nursing Advocacy and
Information program. And it's one our members believe in strongly.
But it has lost a lot of traction among our state legislators
following the recent Supreme Court ruling.

In June 2005, the Supreme Court ruled that the federal law-the
Controlled Substances Act of 1970-makes no exception for medical
marijuana use. But officials in several states contend that their
medical marijuana laws are still in effect.

And in what seem to be contradictory approaches, the Drug Enforcement
Administration still views cannabis as an illegal substance worthy of
raiding and prosecution even though there's a longstanding federal
program, known as compassionate use, that provides medicinal cannabis
to a handful of U.S. citizens who registered for it decades ago.

Additionally, in California-the first state to pass a medical
cannabis law, in 1996-San Diego County supervisors filed a suit in
late January asking the federal court to overturn the state law.

Breakthroughs

Some nurses blame the banning of medical marijuana on politics.
Others suggest it's about pharmaceutical companies not wanting to
support research and promotion of a natural product that will not
make money for them. And still others say marijuana myths-most
commonly that it's a gateway drug that will lead to hard-core drug
use-persist because people, including many nurses, aren't informed
about its history or the most recent research.

At the request of nurse leaders attending the ANA's 2003 House of
Delegates, the ANA Congress of Nursing Practice and Economics Work
Group developed a position statement-approved by the ANA board in
2004-that outlines the profession's views on the issue.

According to the statement, the ANA supports the right of patients to
have safe access to therapeutic marijuana under appropriate
professional supervision; research on marijuana's efficacy, including
alternative methods of administration; laws that prevent patients who
use and professionals who prescribe therapeutic marijuana from
criminal penalties; and the education of RNs on current,
evidenced-based therapeutic use.

Marva Wade, RN, an NYSNA member and work group chairperson, says many
nurses believe marijuana should be in the arsenal of treatment
options they can offer certain patients.

But some nurses oppose the profession taking a stand on something
they consider outside the law and against the code of ethics, Wade says.

We don't support the illegal use of any drug. We support changing
laws so patients have safe, legal access to medical marijuana, days
Laurie Badzek, MS, RN, JD, LLM, director of the ANA's Center for
Ethics and Human Rights and a professor at West Virginia University
School of Nursing. Also, the code says that nurses must advocate for
their patients, and that's what we're doing when we lobby for change.

One longtime advocate of medical marijuana use is Mary Lynn Mathre,
MSN, RN, CARN, director of Patients Out of Time and a Virginia Nurses
Association member.

She reports that for years there has been phenomenal research from
many countries outside the United States involving marijuana and
products derived from cannabis. A United Kingdom company, GW
Pharmaceuticals, won regulatory approval from Canada for its
oral-mucosal spray derived from cannabis to relieve pain in MS
patients. Recently, the U.S. Food and Drug Administration approved
the start of clinical trials in the United States to test the drug's
ability to alleviate pain in cancer patients.

There is a national petition gaining steam that would change the
classification of marijuana from a Schedule 1 to a Schedule 3 drug,
allowing it to be treated like a prescription drug such as codeine,
according to Mathre. Petition information is available at www.drugscience.org .

As for O'Donnell, she says, I won't be sorry if it doesn't help me.
Ever since I started speaking about medical marijuana, I've met so
many people who say it's helped them.