Urging Adoption of Cannabis Nursing Practice Guidelines
Public Forum, 9/21/2023
By Janna Champagne, DMCS, BSN, RN (Ret.)
Thank you, Director Prusak, and esteemed board members, for inviting me to testify today. My name is Janna Champagne, and I retired my RN license last year, after nearly a decade of serving medical cannabis patients in Oregon.
My journey into nursing specialization of Cannabinoid Therapeutics was not my planned career trajectory, and instead this was an organic path impelled by my own health crisis in 2012. Prior to that, I held high-level nursing positions in acute and critical care at Asante Regional Hospital in Medford. I was also in graduate school when my health necessitated that I drop out, just a few credits shy of completing my Master’s degree to become a Nurse Practitioner.
My introduction to cannabis as medicine occurred shortly thereafter, as a patient who happened to be a nurse, seeking alternatives to manage my chronic pain. I discovered OMMP certification as a safe alternative to opioids, a choice driven by the science verifying that cannabis reduces opioid reliance (1), combined with the well-documented risks associated with opioid use (2). My cannabis results surpassed all expectations, by managing my pain effectively, while also promoting systemic homeostasis, and eventually resolving my functional limitations. The research confirms what I experienced, and cannabis is evidence-based for providing deeper balancing benefits, as explained by over 35,000 reputable and statistically valid journal articles (3). My remarkable health outcomes prompted me to delve deep into cannabis research, where I finally learned the Cannabinoid Science that was absent in my BSN curricula at OHSU. Today I share some of my profound findings.
Historically, cannabis was mainstream medicine in the US until 1937, with thousands of preparations made by hundreds of producers in our pharmacopeia. This changed when cannabis became financially inaccessible to most due to targeted taxes on “Marihuana.” The American Medical Association (AMA) opposed the Marihuana Tax Act, and physicians were confused by the new terminology, not realizing that “marihuana” was, in fact, cannabis (4, 5). Sudden lack of access to cannabis ushered in our medical reliance on synthetic pharmaceuticals to ease patient’s symptoms. Prior to 1937, Cannabis was used by humans around the globe for over 5,000 years to enhance human health, without a single death or adverse effect. As such, cannabis is well-established as a safe and effective remedy for use across the lifespan, reflecting its unparalleled safety profile (5).
Scientific evidence also suggests that cannabis improves EndoCannabinoid Deficiency, which is linked with many chronic illnesses (6). Supplementing with cannabis flower can seamlessly replenish these endogenous vital nutrients, thereby promoting systemic homeostasis, by objectively improving biomarkers associated with EC Deficiency (7). Yes, you heard me correctly – our bodies produce vital nutrients called EndoCannabinoids, which share structural form and functional roles with phytocannabinoids from the cannabis flower. I’ve provided numerous citations with my written testimony for those of you interested in exploring this fascinating human system (8).
Today, I urge the OSBN to provide practice guidelines and support nurses serving cannabis patients, with whom they will inevitably interact, considering our legal accessibility spanning 25 years in Oregon. Further, in 2021, HB3369 was passed, allowing Nurse Practitioners to certify patients for OMMP, and specifying that nurses are allowed to discuss cannabis with their patients (9). However, OSBN has yet to release an Interpretative Statement for HB3369, nor adopt nursing scope of practice guidelines as required by ORS 678.150.
I’ve provided links to the NCSBN (10) and ACNA (11) guidelines for nursing care of medical cannabis patients, which serve as templates for legal states creating scope guidelines for this specialty. As these documents reveal, nurses are uniquely qualified to support cannabis patients, by providing evidence-based education, facilitating a well-informed approach, and reducing risk factors – with the primary consideration being pharmaceutical interactions. Absent competent medical cannabis education, patients are forced to rely upon less reputable resources, which jeopardizes their chance at optimal outcomes, and increases risk of Cannabis Use Disorder, Cannabis Hyperemesis Syndrome, and other preventable adverse effects (12). Unfortunately, OR nurses choosing an ethical approach, and discussing cannabis with patients per HB3369, must still operate in a licensure gray area.
As per our foundational medical ethics, nurses must provide informed consent, protect patient autonomy, and assist patients in objectively evaluating their treatment options (13). This simply isn’t the reality in Oregon, and I encourage you to explore my in depth and fully-cited articles on this subject (14, 15). Oregon’s need for improvement is also independently reflected in the 2022 Americans for Safe Access (ASA) State of the States report, which awarded Oregon a grade of only 54% on our handling of cannabis patient’s needs (16).
After regaining my health and function, I started serving cannabis patients as a grower/caregiver, nurse educator, and individual consultant. Currently, I am a university professor educating integrative and functional medicine degree students of Medical Cannabinoid Science – as such, I have a unique perspective on this topic. My personal health experience, combined with those of thousands of patients I have served, reflect that cannabis is a powerful harm reduction tool. When patients are privy to competent guidance allowing an optimal medical approach, they commonly experience reduced reliance on pharmaceuticals, with improved quality of life and function. (12).
I am here to offer my support and expertise with the goal of improving cannabis-inclusive care in Oregon that meets our ethical nursing standards. Having witnessed the discriminatory treatment of this patient cohort, my oath and ethics compel me to advocate for change. I’m happy to answer any questions.
References:
- Nguyen T, Li Y, Greene D, Stancliff S, Quackenbush N. (2023). Changes in prescribed opioid dosages among patients receiving medical cannabis for chronic pain, New York State, 2017-2019. JAMA Netw Open 6(1). Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2800813
- Wang, et al (2023). Predictors of fatal and non-fatal overdose following prescription of opioids for chronic pain: A systematic review and meta-analysis of observational studies. Lancet 3(1). Retrieved from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4374583
References (Cont.):
3. NORML (2020). Record number of scientific papers published in 2020 about cannabis. Retrieved from: https://norml.org/blog/2020/12/16/record-number-of-scientific-papers-published-in-2020-about-cannabis/
4. Wikipedia (2023). Marihuana Tax Act of 1937. Retrieved online at: https://en.wikipedia.org/wiki/Marihuana_Tax_Act_of_1937#:~:text=The%20American%20Medical%20Association%20(AMA,and%20medical%20cannabis%20cultivation%2Fmanufacturing.
5. Bridgeman MB, Abazia DT. Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting. P T. 2017 Mar;42(3). Retrieved online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/
- Russo E. B. (2016). Clinical Endocannabinoid Deficiency reconsidered: current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis and cannabinoid research, 1(1), 154–165. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576607/
- Siani-Rose M, Cox S, Goldstein B, Abrams D, Taylor M, Kurek I. Cannabis-Responsive Biomarkers: A Pharmacometabolomics-Based Application to Evaluate the Impact of Medical Cannabis Treatment on Children with Autism Spectrum Disorder. Cannabis Cannabinoid Res. 2023 Feb;8(1):126-137. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/34874191/
- Devane WA, Hanus L, Breuer A, Pertwee RG, Stevenson LA, Griffin G, Gibson D, Mandelbaum A, Etinger A, Mechoulam R. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science. 1992 Dec 18;258(5090):1946-9. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/1470919/
- HB3369 (2021). Oregon Legislative Assembly. Retrieved from: https://olis.oregonlegislature.gov/liz/2021R1/Downloads/MeasureDocument/HB3369/Enrolled
- Koch, G. (2019). The NCSBN National Nursing Guidelines for Medical Marijuana. OSBN Sentinel, August 2019. Retrieved online at: https://www.oregon.gov/osbn/Documents/Sentinel_2019_August.pdf
- Clark, C., et all (2019). ACNA Scope and standards of practice for cannabis nurses. American Cannabis Nurses Association. Retrieved online at: https://www.cannabisnurses.org/assets/docs/2019_RN_APRN%20Cannabis%20Scope%20and%20Standards%20WEBSITE.pdf
- Temple, L., Lampert, S., Ewigman, B. (2019). Barriers to achieving optimal success with medical cannabis: opportunities for quality improvement. The Journal of Alternative and Complementary Medicine. Retrieved from: https://www.liebertpub.com/doi/10.1089/acm.2018.0250
- ATrain Education – Medical Professional Code of Ethics (2021). Retrieved from: https://www.atrainceu.com/content/2-professional-codes-ethics
- Champagne, J. (2022). The demise of medical cannabis in Oregon. Retrieved from: https://integratedholisticcare.wordpress.com/2022/05/12/the-demise-of-medical-cannabis-in-oregon/
- Champagne, J. (2022). Mission: Educate and advocate. Retrieved from: https://wordpress.com/post/integratedholisticcare.wordpress.com/484
Americans for Safe Access (2021). 2021 State of the States Report, p. 96. Retrieved online at: https://american-safe-access.s3.amazonaws.com/sos2021/StateoftheStates21_Web2.22.pdf
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