Medical Marijuana: Implications for nurses in Ohio

As cannabis use becomes more mainstream in both medical and recreational contexts, nurses must stay informed. In a recent webinar, Associate Professor Lori Catalano, PhD, JD, RN discussed the historical, legal and clinical implications of medical cannabis, with a special focus on Ohio law and nursing responsibilities.

Historical and Legal Context

Cannabis has been used medicinally for thousands of years. Ancient cultures in China, India, Egypt, and the Islamic world used it to treat pain, seizures, inflammation, glaucoma and nausea. It was widely used in Western medicine during the 19th century and was listed in the U.S. Pharmacopeia until 1942. However, restrictive legislation like the 1937 Marihuana Tax Act and its Schedule I classification in 1970 severely limited its medical use.

In 1996, California became the first U.S. state to legalize medical cannabis, paving the way for other states like Ohio to do the same-despite federal prohibition remaining in place.

Medical Use and Clinical Considerations

Today, evidence supports medical cannabis use for conditions such as chronic and acute pain, cancer-related nausea and appetite loss, neurological disorders and mental health issues. Cannabis strains vary in their effects-some are more energizing, while others are more relaxing-depending on the type (indica or sativa) and THC and CBD content. The FDA has no official guidance for medical professionals, so the general rule is to "start low and go slow" with dosing.

In Ohio, only licensed physicians (MDs or DOs) with a Certificate to Recommend (CTR) can authorize medical cannabis. Advanced Practice Nurses cannot prescribe or recommend cannabis, and cannabis cannot be administered in hospitals due to federal law and institutional policies however, they are still responsible for understanding the potential complications, interactions and effects of cannabis use, especially since pharmacists currently do not screen for drug interactions with cannabis, leaving a gap nurses must be aware of. Additionally, patients commonly do not disclose the use of marijuana or other recreational drugs unless asked, so it is paramount for the nurse to assess for this.

Nurses and Personal Use

Most hospitals in Ohio-and many across the U.S.-still prohibit marijuana use, including for medical purposes. Despite its legalization at the state level, cannabis remains illegal federally and is classified alongside drugs like heroin. As a result, nurses can be disciplined by the Ohio Board of Nursing for testing positive for marijuana, even with a valid medical marijuana card, if their use is determined to impair safe practice. The same rules apply to nursing students, who must remain unimpaired in clinical settings.

Federal Developments

Federal policy may be shifting. In 2024, the DEA and Department of Justice proposed reclassifying cannabis as a Schedule III drug, similar to Tylenol with codeine. This change would recognize its medical use but still require prescriptions filled through pharmacies-not dispensaries. Two major federal bills are under consideration: the STATES 2.0 Act, which would allow states and tribal authorities to set their own cannabis laws without federal interference, and the PREPARE Act, which would create a national framework to regulate cannabis like alcohol.

Guidance and Professional Resources

The American Nurses Association officially recognized cannabis nursing as a specialty in 2023, publishing Cannabis Nursing: Scope and Standards of Practice. The American Cannabis Nurses Association also provides resources for nurses working with cannabis-related care. The National Council of State Boards of Nursing (NCSBN) recommends including cannabis education in nursing programs so that nurses are aware of the effects it may have on treatment decisions.

Medical cannabis is no longer a fringe issue. Whether or not nurses personally support its use, they will inevitably care for patients who use it. Being informed about its effects, risks, and legal status is essential for ensuring safe, effective and ethical nursing care.

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