When COVID-19 burst onto the scene in March of 2020, and now with the next wave looming larger than ever, it dominates the health care industry and the thoughts of the public. However, it is important to remember that people still get sick with other illnesses. They still get injured, and chronic illnesses are predominant worldwide.
We were in the midst of a huge opioid crisis when COVID-19 took over the stage. That still looms out there and chronic pain and acute injuries, surgeries and illness demand pain and symptom control. Keeping a hold on opioids is still a huge issue, it’s just not the focus it was a year ago. With the promise of vaccines and new treatments for COVID-19, perhaps we will get “back to normal” sometime in 2021 and we’ll find the opioid crisis still exists. APRNs are encouraged to study the use and prescribing rules for pain and symptom management medications and help be a part of managing the opioid crisis. Additional CEUs for nurses are also available for continuing education in the use of medical marijuana and CBD.
Increasing Use of CBD and THC
Meanwhile, medical marijuana (also known as THC) and cannabinoid (CBD) use continues to grow as more and more states have legalized the use of THC. CBD is considered to be legal in all 50 states and has a broad use for anything from aiding in pain management to anxiety and neurological disorders such as epilepsy and seizure disorders, Parkinson’s disease and Tourette’s syndrome. It also helps aide in sleeping issues especially when mixed with melatonin.
Marijuana and cannabinoids are derived from plants which belong to the genus Cannabis and three specific species known as Cannabis indica, Cannabis sativa, and Cannabis ruderalis. Marijuana contains a psychoactive property known as THC while CBD is non-psychoactive and non-addictive.
It’s Nothing New
The medicinal use of cannabinoids is not new. The ancient Chinese Emperors used cannabinoids over 4000 years ago. In fact, it was included the US Pharmacopeia from 1851-1942 when it was considered to be dangerous and said to have no real medical use. In the 1970’s it was classified as a Schedule I drug indicating it has a high potential for abuse and little if any medicinal use.
This made research nearly impossible until the Farm Act of 2014 legalized the use of hemp which many presumed to be a legalization of CBD products which are a hemp derivative. The Federal government has not recognized CBD as legal and therefore doctors cannot prescribe it and it isn’t used in hospitals. Medicare and Medicaid being federal programs do not recognize nor approve the use either. Slowly states are passing comprehensive medical marijuana laws with specific guidelines for the use and distribution.
While more research is needed to fully understand action and potential for medical marijuana and CBD, there are neuro receptors in the brain for THC, CBD 1 and CBD 2. The anti-inflammatory and antioxidant properties in THC and CBD attach to organs throughout the body to manage the likes of immune function, gastric motility, heart rate, intraocular pressure. They can also help regulate cognition, coordination, pain, anxiety, memory and appetite.
FDA Approved Formulations
There are three THC synthetic or purified cannabinoid formulations available with FDA approval that work on these receptor’s in the brain as endogenous cannabinoids. They can be smoked, vaped, or ingested in the form of teas and edibles. These are Marinol (dronabinol), Cesamet (nabilone, and Syndros (dronabinol). Additionally, there is one cannabis-derived product, Epidiolex. These are all available by prescription from licensed healthcare practitioners.
Typical uses for these drugs include the treatment of symptoms such as nausea and vomiting associated with chemotherapy in patients who do not respond to conventions anti-emetic drugs. Cesamet is a Schedule II drug typically prescribed for this. Dronabinol drugs (Marinol and Syndros) are Schedule II drugs which are also used for ant-emetics purposes in cancer patients, but they are also used to treat anorexia and weight loss in HIV/AIDS. Epidiolex is typically prescribed in the treatment of severe forms of epilepsy in patients who are two years and older with life-threatening issues from poor control with other anti-epilepsy drugs. Other uses include neuropathic pain (primarily diabetic neuropathy), cancer pain, HIV/AIDS neuropathy and fibromyalgia.
Further Research Needed
Promising studies have shown improvement in Parkinson’s disease, MS, anxiety, depression, Schizophrenia and other psychosis, sleep disorders and substance abuse issues. According to the American Cancer Society, there is potential evidence from in vitro studies of the slowing of growth as well a cell death in some forms of cancer.
State laws regulate the prescribing of these drugs including who is licensed to prescribe as well as authorizing patients to have them prescribed. These las and regulations will vary by state and APRNs need to be versed in the legal issues of prescribing in the state where they practice.
The scientific community expects to refine the use and derivations of cannabis to improve the uses and outcomes. Hopes for the future include agonists for obesity and addiction, improved anti-inflammatory outcomes for patients with diseases such as scleroderma, better treatment options for diabetes and metabolic syndrome and antipsychotic treatments.