Rising tide of medical cannabis
Some time ago a colleague requested assistance in working on a governance structure for a non-profit medical cannabis dispensary. I was somewhat aware of medical cannabis and its impact following the referendum in Massachusetts and other states to legalize medical cannabis.
A former colleague reported that cannabis in a cookie taken before bedtime helped her to sleep and function with her pain. While anecdotal, the public relates similar situations. It's only a matter of time before healthcare providers become involved. There is a rising tide of public expectations and is leading to ethical and risk conundrums for providers.
Rising tide of expectations
Eighty-one percent of respondents in a recent Harris poll percent favored legalizing medical cannabis. Few issues rate that level of approval. In many ways, this represents a social movement with broad support.
Unlike in healthcare reform, which is driven from the top down, this movement represents more a rising tide of public expectations driven by affected stakeholders.
Much the effort has occurred as a result of the actions of states and initiative petitions. Federal law still allows federal enforcement of those who grow, consume sell or otherwise deal in cannabis. This ambiguous situation leaves many providers at risk for zealous or ambitious prosecutors who seek to perpetuate the failed war on drugs. It keeps providers in a state of limbo with state laws that cover medical cannabis dispensaries but may not cover providers. States are working their way through these issues despite the continued federal prohibition.
The stereotype of the potheads, hippies, secret gardens and drug dealers is slowing given ways to a more professional image particularly given the powerful state and local regulations for dispensaries and cultivation.
Further, medical cannabis is not the same as opioids. They represent two different situations. There is some evidence that the use of Medical Cannabis reduced opioid use.
Conundrum for providers
Due to U.S. federal policies, there are not many rigorous scientific studies to demonstrate the efficacy of medical cannabis. Israel and Canada have conducted significant research and indicate that medical cannabis works to alleviate suffering, improve the ability to function and enhance the quality of life. The use of medical cannabis in Israel is widespread as a treatment. Its impact is palliative and ameliorative, designed to help maintain function and quality of life.
Medical cannabis has fewer side effects than opioids and less social consequences. There is a good deal of anecdotal information on its effectiveness in modifying the side effect of many drugs in HIV and cancer. t has the potential of improving the experience of the person served and the quality of their lives, even if it has not received the same examination as other treatments.
Despite the significant public approval, there is reticence among providers because of their risk aversion generated not only by the federal prohibition but also by their lack of understanding. Much of the recent dialogue revolves around the risk and legal factors and concerns about licensing and liability with little focus on potential benefits.
Trend assessment of medical cannabis
Sometimes it is difficult to notice trends that will alter and affect the provision of care. Strategy and trend assessment is not the bailiwick of many long-term providers. Unfortunately, the industry spends more time reacting to regulations, regulators, upstream providers and little time to assess trends that may affect us in ways that even policy makers have not considered. Medical cannabis is one of those trends.
We have little doubt given its public approval and the professionalization of its services through regulated dispensaries that it will have an impact on hospices, home care, assisted living and skilled nursing facilities. Since it provides relief the pain of suffering for those for whom no cure is probable, it is likely to become more popular in palliative care.
Providers have not addressed how they will adapt to what their stakeholders desire and assessed its value especially among the aging, those in chronic pain and chronically impaired. Besides the legal and risk factors, there is the ethical and mission directive to relieve pain and suffering, and the rights of citizens to direct their care.
Rising expectation meets risk aversion
While there is some concern about potential abuse of medical cannabis, it is overshadowed by its potential benefits. If state agencies and providers do not address the benefits of medical cannabis, they will face a rising tide of public expectation and experiences it may undermine further their credibility and ability to influence the public on this issue.
In many ways, the rise and success of medical cannabis provide a model for reform that moves from the bottom up. If providers and professionals believe that they always know best, they face not just in this area but potentially in others a rising tide of the public expectations and actions. The issue here for providers is not if, but when and how and whether, they will be proactive or reactive. It is also whether the public successful in this area will move in other areas of healthcare where they encounter provider resistance and self-interest and make their voices heard.
James Lomastro, Ph.D., has worked in a variety of acute, community-based and long-term care in healthcare for 35 years. He has held an administrator license since 1991. Before involvement in administration, he held academic and research appointments at Boston University School of Medicine and Northeastern University.