Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.
Mount Hood, Oregon, as seen from the Washington State side of the Columbia River Gorge/photo by Julianna Paradisi
Wednesday, July 9, 2014, marked the first day of legal, recreational marijuana sales in the state of Washington, not long behind similar new laws in Colorado earlier this year. As in Colorado, the marijuana supply in Washington was initially insufficient to keep up with demand; stores ran out of cannabis before all customers waiting hours in line got through the front door.
The following weekend, my husband and I (we live in Portland, Oregon) took a road trip through the Columbia Gorge on the Washington side of the river.
“Hey, we could buy a joint here, and share it,” I joked. (Neither of us actually partakes.)
My husband, a pharmacist, remarked, “It may be legal, but testing positive at work could get either of us fired or invite state board investigation.”
For my husband and me, as Oregon residents, the point is moot: no amount of THC in our urine or blood is legal. For Washington and Colorado residents, however, the newly legalized status of marijuana creates confusion for employers and employees alike. In Washington and Colorado, a drug test positive for THC is no longer illegal, but being under the influence of legal substances like alcohol, for instance, violates employer policies.
This fact was illustrated in the news on the very first day of marijuana sales in Washington. A Spokane resident was fired when his purchase became public. Since then, the man has been rehired. After considerable media coverage, the company decided that, since he had the day off when he made the purchase, he was not under the influence while at work, the possibility of which is the underlying rationale for their drug testing policy.
Does being a nurse or health care provider add another layer of complexity to this issue? I think so. Positive drug tests are not acceptable for the majority of nurses and health care professionals. Smoking a joint legally in Washington over the weekend means that THC may remain detectable in urine for about a week, and longer for regular smokers.
You can see the dilemma: It may be legal for a nurse, pharmacist, or surgeon to smoke cannabis in Washington, or Colorado, but you probably also want to know that they are not under the influence of any mind-altering substances, legal or otherwise, during patient care. And, crucially, a positive drug level indicating intoxication has not been established for cannabis, as it has for alcohol.
What I foresee as an initial solution is that hospitals and clinics may make clean drug tests a requirement of employment (many already do). This may sound invasive or behind the times, but remember, marijuana use, recreational or medical, remains illegal on the federal level. The current administration takes a relatively lenient approach to the matter, but future administrations are under no compulsion to do likewise. Then there’s the issue of workmen’s compensation insurance, which often requires drug tests to differentiate employee or employer liability for on-the-job injuries, experienced injury attorneys are the only ones that can properly navigate these waters, don’t be a hero and try it on your own.
Further, compare hospital policies requiring drug-free employees to those applied by a rapidly growing number of hospitals to tobacco, which is legal throughout the United States. (See this recent AJN post on the ethics of such no-smoking policies.) In the same manner, hospital employers may be able to independently establish work policies that exclude the use of marijuana.
Recreational marijuana use may come to be restricted by state boards of nursing in a way that parallels their approach to alcohol use: impairment on the job will not be tolerated and will result in license suspension.
Surveys suggest that most people support decriminalization of recreational marijuana; however, the enforcement of safe workplace standards where it is legal is still in development. The presence of THC in blood or urine is not an indication of intoxication, but without an agreed upon blood level by which to measure intoxication, a more conservative approach to positive tests may win out in health care until a more nuanced approach becomes possible.
(Since this post was written, many more states have legalized cannabis products. For a more recent blog post on these issues, published in December 2020, please click here.)
Insane comments by some. One comment even chooses to bring politics in along with a potty mouth. She would not make a decent nurse. I lived with a daily pot smoker for over 30 years. I married him as a kid and he came back from war hiding his pot smoking from me. He has passed away but his last several years he stopped smoking completely. Said he didn’t like his son seeing him smoke. Anyway, he was a design engineer his entire career and it didn’t seem to effect his job. But he never smoked during the day, only at night. I saw a difference in his behavior often when he smoked. The house could have burned down and he would sit there. He was very relaxed and simply cared less about anything. He was not motivated, alert, in any way. I hated it. He was never engaged simply a zombie. He was this way smoking for 30 years. I tried smoking pot more than once because he wanted me too. I hated it. I sat staring at a clock. I had two children asleep but if they needed me I was worthless. I am strongly against dope smoking. I hate drinking too and even cigarettes. I have no use for those who need crutches to live unless medically needed. But many use pot just because. My children knew once older their father smoked pot but he quit in their teens. Thank God my children want nothing to do with it. If I were treated by a nurse smelling like pot or realizing they had recently used pot, I would sue them personnaly. I refuse to put up with trashy behavior.
As a nurse for 30 years and a caregiver for a mmj pt I disagree…the, psychoactive effects are gone in a few hours..but will still in the,urine for days…Not as harmful as opiates and as a psych, substance abuse and mental health experienced as well as regular nursing I know a lot are working dependent but NOT IMPAIRED any worse than those 10 monstordrinks a day co workers…less harmful.than narcs. Most are on something to continue to work, with bad backs, diseases…can’t retire …may as well be harmless vs fatal drugs.
For all you people that think that people don’t get high………… There are more potheads out here than drunks in the USofA. I’ll take anyone smoking weed the night before before I would with anything else. RN. DR. Pilot. Teacher. Hell even the president if we had a good one. At least one that don’t lie everyday.
So I am a nurse who is diagnosed with MS… according to many of the posts I am in the “proven category” So I have to take medications & Narcotics that I despise taking and make me feel like crap versus medical marijuana. The laws need to change. I should be permitted to take the medical marijuana, not recreational, as there is a difference in being pleasantly stoned and not stoned at all. My Doctor was comfortable prescribing me the medical marij despite knowing I am a nurse, he even advised me which were the safer non hallucinogenics. The Nursing board needs to stop being prudes see the reality of the future. It’s ok for me to be hopped up on narcs & my irresponsible co workers to get plastered the night before work and this is safe, but not medical marijuana? Rediculous. I have always given very safe, very reliable care to my patients in the ER. I am considered one of the better nurses on staff. I would NEVER put a patient in jeopardy so that I could get high, but I also cant give the care I give when my pain controls my life.
Obvious solution: If nurse is suspected of on-the-job use, blood test them. Otherwise why should they be punished for use on their days off?
My husband, a pharmacist, remarked, “It may be legal, but testing positive at work could get either of us fired or invite state board investigation.”
I’m pretty sure that was not an exact quote
For all of those people who keep saying that people who smoke weed should not come to work stoned I agree. Problem is the THC can stay in your system up to a week or more. So unless you are going to only work one day every week or so until the THC is out of your system (Unlikely a medical doctor or nurse is only going to work one day a week) then you should be fine….NOT!
I do not advocate the recreational use of marijuana but have seen the benefits of the oil of canitubus helping patients. The oil is extracted from the plant so the hallucinogenic part is removed. I have a family member who had stage IV cervical cancer who was treated with the oil injected into the tumors and is now cancer free for the last year. She delivered a healthy baby girl last week. Granted she had to go to Colorado for treatment and not our local MD Anderson Cancer Center. I have also heard reports of children with seizures that were poorly controlled until treated with the oil in pill form. Now instead of 10-20 seizures a day, they might have one. Their quality of life is 100% better that what it was. They are functioning without side effects or “appearing” stoned. As they do not smoke it and the oil has had the hallucinogenic properties removed from it.
If you are a drinker, do you go to work drunk? No? So why is it ASSUMED that marijuana users will show up to work stoned? “I wouldn’t want a stoned surgeon operating on me”, well no kidding, and you ESPECIALLY don’t want a drunk surgeon operating on you, right? I live in Washington State. Us Washingtonians voted in favor for recreational use of marijuana (majority won). Now shall Washingtonians say who should and should not be able to use? Is that right? Do we do that with alcohol or ANYTHING else (okay nicotine–but that’s a another sensitive subject). Because Washington nurses do not have this right that our people voted for–they are excluded. Why? Because apparently every pothead goes to work high (pretty ridiculous assumption, yeah?). Now as for detecting intoxicating THC levels go, there is a blood test that will detect toxicating nanograms (this is how law enforcement is able to charge a stoned driver with a DUI). Medical Marijuana patients who are nurses cannot legally practice. This needs to change. Because if that nurse was Rx a more serious drug (like Valium), they could still practice. Malarkey!!
solution- remove marijuana from the drug test… not every thing that is mind altering is tested.
An employee should not come to work under the influence at all. This includes alchohol,marijuana and any other substances that may potentially impare thier judgement. Using responsibly is the key here.
I am a nurse and have been for 15 years. I am in Colorado. My mother just died in April. She used marijuana regularly for pain with no unwanted side effects,(large edible doses). I know many nurses, including myself, (I am not working at this time), who use marijuana off hours. I have also known OF medical professionals, not just nurses, who were drunks, pill heads, junkies, meth users, etc ad nauseum, who still worked until they were caught, (one lovely was sucking morphine out of kids IV lines). If I were a patient, I would much rather have care from someone who smoked a bowl the night before, than from someone who tied one on the night before and was called in to work hungover. When I decide to go back to work, I will have to not smoke for at least a month. Just the way it is right now. I don’t agree with it, but I don’t run the world, yet…..
If you have never smoked marijuana & have commented, you might as well delete your post, because your opinion on something you know NOTHING about is not useful. I am going to be a nurse and have to quit smoking because of it. It helps me study, I am much more focused, yet I can’t smoke it because it’s a “drug”; the only way it alters my mind is by making it work better. Weed grows in the ground!!! We have every right! I’d much rather smoke weed, than take a prescription, which could give me worse side effects than my original issue. By the way, whoever said weed kills, you’re a complete moron. I never drink alcohol or do actual drugs (especially pain medicine, which is highly addictive and prescribed!!), because I don’t like giving up my cognitive abilities, which from personal experience, weed enhances, not inhibits. I wouldn’t mind a stoned nurse, I’d mind an alcoholic/junkie one-which weed prevents.
I wouldn’t want to be treated by a medical professional under the influence of anything. I agree that deciding on a level of THC that indicates “intoxication” will be important as more states legalize marijuana, or have medical marijuana programs. I also agree with a previous commenter who stated that she wished she could use medical marijuana to manage her back pain at work. Medical marijuana has its uses and a true medical-needs user is not using it ‘to get high’. Thanks for your article! Sara
http://www.batiksforlife.com
We as nurses know the effects of drugs on the body. We took a vow to care for people. We should hold ourselves to a higher standard. We owe it to our patients and ourselves to be clean of alcohol and drugs.
As nurses we should be held at the highest standards! It is not ok to drink or do drugs! Alcohol is legal but it doesn’t mean that it’s good for you and it can kill you if used in excess. Marijuana is legal now but it is defientely not good for you just like smoking it can hurt youor kill you also. Prescription drugs are also not good for you but we must out weight the benefits verses the risks. They have to be written as a prescription from a MD peolpe can’t just decide they want to take a medication, that’s why they are called prescription drugs. I believe marijuana can help many people as a prescription but it should be given as a last resort to people who need it most. But as professionals we should not test positive for any drug!! We should never put ourselves in the position of being addicted to any thing that is not good for us! Be professional we are supposed to have degrees!!
I know this is years late, but I can’t just let this one slide. Cannabis does not have the potential to kill people. It is not a toxin, as most (if not all) other substances are, such as alcohol. Sure, the actual smoke isn’t great for your health, but there are numerous ways of partaking in cannabis, especially now. Also, it has been found that CBD is the part of cannabis that provides the pain-relieving properties, and it is now widely isolated and extracted for people to use, without having to experience any mind-altering effects.
The reality is that marijuana is detectable in the body for an extended period of time. Many other mind altering drugs are passed out of the body within 3-4 days. A nurse, theoretically could use heroine, crack/ cocaine, etc on Thursday/ Friday and on Monday when its time to go back to work; pass a drug test. A nurse prone to wanting to alter their LOC, will use hard drugs over marijuana so that they can pass a drug test and keep their job. This is a problem because these nurses have access to these hard drugs. I’m curious if diverting rates would decrease if nurses were allowed to use marijuana in their personal life.
A frequent/ chronic user of alcohol will have just as many cognitive deficits as a frequent marijuana user. I know many non substance users who have cognitive deficits without any assistance from a drug. Suspending and firing should be strictly based on performance ON the job. Firing someone for using marijuana on their day off is simply ludicrous. If an employer notices that an employee is struggling on the job, they should be given a blood drug test to decide if they came to work under the influence.
i dont uderstand why its ok for me to take Norco at work 2x a day every day and i still have a job they say nothing and i do have random drug testing they know i take my Norco.But on my day off i cant smoke Mary J , I just dont get it …..
Now that Obama has removed marijuana from the shedule 1 list of drugs, would you be okay with coming up positive on a urine test at work for THC?
To the OR nurse above: I think it is just common sense…you don’t drink wine before work, why would you smoke a joint before work? But you can do whatever you want on your day off or after work, as long as you ensure enough time has passed or you don’t over -do it. As a nurse myself, I would MUCH rather have a nurse who smoked pot the night before take care of me than one who went out drinking, even in moderation.
Interesting someone mentioned airline pilots. I feel they could do their job just fine if they smoked some marijuana the night before. Just like I feel they would do fine if they had a few drinks the night before, everything in moderation. Many airline pilots don’t really drink all that much or even think about getting high, none I’ve talked to anyway. One friend of mine who flew for United told me about a pilot who showed up for work still drunk and actually got in the cockpit, this person was a copilot. The captain asked if he was drunk and he admitted he was. The fines and jail time for showing up to work drunk as an airline pilot are much more severe then a DUI in a car. Doing drugs or drinking all the time as an airline pilot is unacceptable behavior to any true professional pilot and the person who does this will not be allowed to fly. Trust me a a true pro looks at the passengers who board their plane and they feel love for the passengers as they do their aircraft. You could legalize all drugs and not test for drugs. I doubt 99% of pilots would use any. The 1% who would would stand out like a sore thumb to the pros and would not be allowed to fly.
Great information. However this is a topic that will have many opinions. There are many reasons to use it and not use it, just as narcotics are needed and often become abused. It is a topic of high interest and needs further research before any “real” evidence based answers can be given. As stated above that the two uses are MS and CA patients, I agree but further would say anxiety and depression could possible benefit as well. Again, more research is needed and real peer reviewed literature and evidence based research is needed. I wish all the best on what the future could bring. Mistakes are required to learn, so may we all learn from them and grow on our practice.
Glans RN, BSN and Grad student for NP
Great article. As a California resident, I feel that legalization of this substance is right around the corner for us too. I also agree that safe workplace standards have not been set in states like Colorado or Washington and that scares me. I’m not against legalization, but this definitely blurs the lines of personal and professional exposures while under the influence.
This isn’t true. As an employed professional in Washington state, a great number of employers follow the Federal law not state. Those with locations spanning multiple states apply the more stringent policy. And especially those where safety is a concern and those with contracts with the DOD or federal government.
Ladies and gentlemen, It was brought to my attention that there is a group named the American Cannabis Nursing Association. It is a relatively new group (gee!) and supposedly is for the support of green card patients. However, since proven use of marijuana for medical use is strictly limited (MS and end of life cancer pain) how necessary is this group to advocate for those TWO uses? Also, it must be smoked for any systemic value. So, light up MS patients and CA pts and get some relief. The cookies, brownies, lollipops, drinks, etc., mean nothing. Pain MD from Mesa Az addressed my grad school class and was explicit in the above. He stated that there is NO SCIENTIFIC PROOF marijuana aids anyone but the two above groups. Also, I never want to be taken care of by anyone under the influence. However, THC is in your system for 30 days; alcohol leaves in 24 hours. Think about it. Do you want stoned people giving you drugs, taking care of you, and assisting doctors in clinical decisions? For me, a big resounding NOPE, no dope.
I hope that a happy medium can be identified. As a nurse with Chronic back pain from a combination of arthritis, slipped and herniated discs. I manage to go to work every day, but it is agony most times. I have sleep issues due to the pain. It all affects my ability to concentrate on my job. I hope that someday, healthcare workers will not be discriminated against and will be able to use the legal marijuana for pain management. I have even considered giving up my career just so I can have a chance to manage my pain. How fair is that?
This OPINION article is just that. An opinion. Please do not try and pass off ur opinion as valid on smoking marijuana if you do not partake. An individual who partakes Is not necessarily smoking a joint before their shift in the icu or anywhere else. And not to mention, It’s just as possible, if not more possible, that someone could have a drink before coming into wrk. Is there a breath test before you enter into your job at the ICU?? How can I trust that you didn’t hve a drink before you came to work?? Marijuana is less harmful and alters functioning to a lesser degree than alcohol, yet you do not even make mention of the dangers of ur nurse have a glass of wine before a shift. Drug testing is an invasion of someone’s privacy. If someone is suspected to be under the influence at work, then a drug or alcohol test would be appropriate. Otherwise corporations have no right entering the home, telling individuals what they can and cannot do. Huff post, you need to stop allowing these opinion pieces from individuals whose opinion is not valid, as their expertise and personal experience does not match up with the topic they are discussing.
Just to be clear here, no one is saying in this post that a nurse is intoxicated at work if they smoked marijuana at another time (say, the day before). That’s part of the issue being addressed and the legal gray areas that are associated. Also, the reference to the Huffington Post is unclear…this is not the Huffington Post. It is the blog of the American Journal of Nursing.
Asa patient, I would not want to be treated by any healthcare professional who was a known maijuana user (or any thing else). I am an OR nurse, and have witnessed the effects of a surgeon who was subsequetly suspended for alcoholism. Also, I have had to cover for colleagues who were too hungover to work. I believe that anyone who was caught, would be on precarious ground medico-legally. When judgement and critical decision making are part of a profession, this must be a no-no. The time for discussion is now, before there is a tragic accident. The civil liberties people may be up in arms about the right to choose, but the patients also have a right to, and are paying for,safe care.
Great article. This is the same discussion I get into with my “it’s legal and I can smoke it when I want to” friends. Their defense seems to be it’s ok as long as you’re not doing it at work. They pause when I ask if they’d mind me taking care of their loved on in ICU if I smoked a joint before I came to work. I mean I didn’t do it at work. Do they mind that the airline pilot who is transporting their child, smoked it last night? Seems like the research is lagging behind the law!