By Janna Champagne, BSN, RN (Ret.)
As detailed in my article, Demise of Medical Cannabis in Oregon, our medical cannabis program in Oregon is failing to meet the needs of vulnerable OMMP patients, despite 24 years of legal Medical Cannabis access in our state. Medical professionals are lacking an understanding of cannabis science, which supports its therapeutic applications and harm reduction potential. Unfortunately, many barriers exist in improving receptivity of cannabis-naïve practitioners to learning about and utilizing cannabis in their practice, and the many contributors are detailed below.
Federal Schedule I placement is another deterring fear factor for medical professionals, who wrongly assume that cannabis (in the form of THC) meets these criteria for justifying harsh accessibility restrictions: 1. Harmful 2. Addictive/Potential for Abuse 3. No accepted medical use (1).
Then there’s the reality:
As early as 1988, we’ve had multiple federal judges rule in favor of descheduling cannabis, when presented with the above objective evidence that it doesn’t meet the criteria for Schedule I placement (7) . Yet here we are in 2022, with cannabis still under federal Schedule I restriction, effectively disallowing cannabis access for most patients in our country who might otherwise benefit. “When politics lack logic, follow the money” is the only clear rationale for this 34-year delay in patient justice.
Cannabis obviously competes with pharmaceutical profits, and from my experience educating thousands of cannabis patients, it’s common for patient success in medical cannabis therapy to concurrently reduce their reliance on prior pharmaceuticals. The leading contributor to politician recipients is pharmaceutical lobbyists, constituting more than double the next leading industry of oil and gas (8) This sure could explain why cannabis is still plagued by federal level restrictions, despite 60% of the country being pro-medical cannabis use (9).
Becoming a medical cannabis practitioner also requires overcoming the seemingly deliberate barriers to medical professionals service of cannabis patients. In Oregon, despite longstanding legal cannabis access for our patients, the medical and nurse licensing boards are notoriously discriminatory towards practitioners serving those who choose cannabis therapy (10). Ethical practitioners determined to serve cannabis patients must disregard the fear of possible licensure ramifications, and choose to follow their oath and serve patients without prejudice. Historically, many Oregon physicians and nurses have been subject to harassment, investigation, and even license discipline or retraction (11, 12). It’s for this very reason that I decided to retire my RN license this month (in good standing), to facilitate my ability to freely advocate without this inherent liability.
Oregon licensing boards are capitalizing on their own failure to adopt guidelines for their licensees working with medical cannabis patients, forcing ethical practitioners to operate in a licensure gray area. This entails risking licensure to abide by our ethical oath to provide nondiscriminatory service to patients in need. This situation exists in Oregon despite 24 years of legal patient access to medical cannabis, representing ample opportunity for our state’s licensing boards to support practitioner’s needs.
Here’s an example of the poor handling of this issue, by the Oregon State Board of Nursing (OSBN), which effectively placed a gag order on nurse education of Oregon cannabis patients in November of 2019. This decision effectively amplified the severity of the already critical educational gap experienced by our cannabis patients in Oregon. Nurses are uniquely qualified to provide patient education, and screen pharmaceuticals for possible interactions with cannabis, which represents the primary risk of cannabis therapy today.
This discriminatory OSBN cannabis nurse gag order increased the likelihood that medical cannabis patients would fail to meet reasonable therapeutic goals, or potentially suffer negative effects of combined pharmaceuticals (13). This ridiculous mandate resulted in Oregon nurses being legally allowed to administer cannabis to patients, meanwhile being strictly prohibited from educating these same patients about the substance being administered.
After 18 months of advocacy, OSBN adhered to forcible retraction by efforts of. My attorney Lee Berger, and the proven unlawful cannabis nurse gag order ceased in April 2021 (14). This was further supported by passage of HB3669 effective 1/1/22, which specifically protects nurses from license discipline for providing cannabis education to patients.
While this may appear as progress, we are effectively back to pre-2019 conditions, where Oregon nurses are forced to operate in a gray area, absent parameters to guide their patient health education practice, thereby risking their unencumbered license status. This, despite the 2018 release of National Counsel State Board of Nursing (NCSBN) guidelines, which specify the requirements of nurses education of cannabis patients, which were presented to every state board of nursing for adoption (15).
All of my attempts to educate or converse with OSBN board members on this topic since 2015 have been ignored, and deliberate ignorance and stigma are the main issue. The Oregon Medical Board is not handing this topic any better, and they have historically investigated and even rescinded cannabis physician licenses in response to their attempts to serve medical cannabis patient’s needs. It’s logical that these boards should accept some responsibility in lieu of pursuing disciplinary action, and instead examine how they are failing to support and guide the medical professionals ethical service of patients using cannabis.
Oregon boards’ refusal to examine the prolific medical cannabis education and science resources, and failure to adopt scope of practice guidelines for those serving this specialty cohort of patients, is a major contributor to the current failure to serve our vulnerable medical cannabis patient population. There is no excuse for licensing board’s discrimination against, and continued disenfranchisement of, our Oregon medical cannabis patients. We are bound by medical ethics, and patient autonomy and informed consent are both compromised as a result of our licensing boards’ cognitive dissonance.
Research supports the role of medical professionals to ensure cannabis patients achieve their health goals, and experience optimal therapeutic outcomes (16). It's time that we advocate for change, so that medical professionals may uphold our ethical duty to serve cannabis patients without prejudice or discrimination.