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Marijuana Legalization and Potential Workplace Pitfalls for Nurses Who Partake

July 30, 2014

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

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.

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.

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11 comments

  1. 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.

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  2. […] Off the Charts. In a drop-in life drawing studio I drew a connection between art and nursing. A road trip with my husband inspired this post. And a close call with danger inspired yet […]

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  3. 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

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  4. 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.

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  5. 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.

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  6. 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.

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  7. 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?

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  8. 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.

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  9. 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.

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  10. 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.

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  11. 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!

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