Voters in still more states opt for marijuana legalization.

THC-infused gummies

If there’s a chance something you’re doing, even if it’s legal in your state, could nevertheless endanger your nursing license or cost you your job, are you likely to risk it? This is the quandary many nurses find themselves in when it comes to the use of medical or recreational marijuana or even cannnabidiol (CBD) oil.

During the November presidential election, five more states voted on ballot initiatives to legalize either recreational marijuana (Arizona, New Jersey, and South Dakota), medical marijuana (Mississippi), or in one case (Montana) both at the same time. Every year more states legalize medical and/or recreational marijuana.

And CBD, a hemp-derived compound that in certain formulations contains trace amounts of the main psychoactive ingredient in marijuana, THC, has rapidly become available in stores, cafes, and online and in multiple forms.

Whether prescribed by a physician and obtained at a medical marijuana dispensary, purchased legally in a state that allows its sale for recreational use, or obtained through other means, marijuana is increasingly being used by Americans for a wide range of problems major and minor, including chemotherapy-induced nausea, insomnia, epilepsy, and certain types of chronic pain. CBD oil in various forms is also being widely used for multiple health conditions.

Marijuana is still classified as a Schedule I substance.

Many nurses are likely to be among those who would hope to benefit from the real or promised benefits of these drugs. But marijuana is still illegal at the federal level and continues to be classified as a Schedule 1 substance (along with heroin, cocaine, and similar illegal drugs). Legislative efforts in Congress to legalize marijuana continue to face obstacles. For these reasons, research into the effectiveness and safety of cannabis products has been impeded, leaving consumers with little reliable guidance. And any health care institution that participates in federal health programs like Medicare must abide by all federal laws, which supersede state laws.

Health care workplace testing of nurses for THC.

Putting aside the need for improved quality control and a lot more research into efficacy and safety, the rules in hospitals and other workplaces for nurses and other health care workers on use of these drugs are, in many cases, stricter than either state or federal laws.

Since THC is stored in the fatty tissue, it can show up at high concentrations long after the use of marijuana; that is, the test doesn’t measure for whether you’re currently functionally impaired. While unlike marijuana, CBD doesn’t induce a high or radically alter perception, trace amounts of THC in “full-spectrum” CBD products (and in products with poor quality control) can in some cases lead to nurses “popping” positive on workplace drug tests.

It’s no secret that the consequences from such positive drug tests for THC for health care workers can quickly multiply, from job loss to a complaint with the state board of nursing that can lead to a loss or temporary loss of license. The intent of such rigorous standards is to protect the safety of patients, and no one would argue with this. But is the current system adequately adapted to the realities of a changing climate in which marijuana products may soon be legal throughout the country and in which existing drug tests aren’t able to accurately measure for current use or impairment?

Marijuana and nurses: towards a more nuanced regulatory approach.

While there have been some indications that the National Council of State Boards of Nursing is moving toward providing individual state boards with more nuanced guidance on applying a “right-touch” approach to cases involving positive THC tests in nurses, one that takes into account a number of circumstances beyond the test results, the intent of state boards of nursing and employers will by definition remain one of erring on the side of patient safety. And while nurses who have been dismissed by hospitals for positive THC tests have begun to win cases against their employers, no nurse wants to be the one who sued their former employer.

Options for nurses?

So where does this leave nurses who would like to exercise their right to legally use medical marijuana, obtained with the consent of a physician, for a medical issue like chronic pain or chemotherapy-induced nausea? Or those who might want to occasionally take a marijuana gummy sold legally in their state instead of a drink after a long shift or on their off day from work?

Is the only answer still to just say no? Is there any leeway? AJN will be publishing a more extensive update in an upcoming issue on the topics raised in this post, and we are seeking stories stories from individual nurses about their experiences. Given the sensitive nature of the topic, anonymity will be respected as requested. Please write to nursingblog@wolterskluwer.com, with the email heading “marijuana legalization and nurses.”

(A more in-depth and up-to-date treatment of the legal and licensure concerns for nurses who use medical marijuana can be found in our February 2021 issue AJN Reports. For a broad look at some of the other issues and evidence nurses should know about now that patients have access to a broad range of cannabis products, see “The Cannabis Conundrum” in our December 2019 issue. And for a closer look at a study of worrisome ED and urgent care trends among adolescents in one state after legalization, click here.)