Cannabis Nursing 101

Are you interested in holistic treatments that combine plant medicine with cutting-edge research? Cannabis nurses use evidence-based practice to help patients living with Crohn’s disease, epilepsy, glaucoma, cancer, and more. And there’s job growth expected for cannabis nursing — the medical cannabis field could have a market volume of nearly $23 billion by 2028.

While cannabis is still federally illegal, more than half of states allow it as a medical treatment. The FDA has approved several cannabinoid medications, and more are likely to emerge with research. In fact, nearly 1 in 40 U.S. residents use cannabis for medical purposes, and its use is on the rise.

Medical cannabis comes from the Cannabis sativa plant. The leaves and buds of this plant contain cannabinoids like CBD and THC. When ingested, vaporized, or smoked, these cannabinoids can alter mood or consciousness. But typical doses for medical cannabis are too low for patients to experience a “high.” They’re used to treat and mitigate symptoms for patients who are suffering from:

• Neuropathic pain
• Parkinson’s disease
• Nausea and vomiting related to cancer treatment
• Anxiety
• Sleep disorders
• Tourette syndrome
• Crohn’s disease
• HIV and AIDS
• Post-traumatic stress disorder
• Multiple sclerosis
• Spinal cord injuries

Cannabis medicine has specific considerations for dosing, patient education, and safety. In 2015, the National Council for State Boards of Nursing (NCSBN) formed a specialized committee to explore medical cannabis and its implications for nurses.

What Is Cannabis Nursing?

Cannabis nursing is an ANA-recognized specialty that focuses on the management of patients going through medical cannabis treatment. Cannabis nurses have specialized knowledge of administration, dosage, safety, and symptom management for patients using medical cannabis. The NCSBN Guidelines for Medical Marijuana include six essential knowledge areas for nurses working with medical cannabis:

1. Must have a working knowledge of the current state of legalization of medical and recreational cannabis use.
2. Must have a working knowledge of their jurisdiction’s medical marijuana program (MMP).
3. Must have an understanding of the endocannabinoid system, cannabinoid receptors, cannabinoids, and their interactions.
4. Must have an understanding of cannabis pharmacology and the research associated with medical cannabis.
5. Must be able to identify the safety considerations for patients using cannabis.
6. Must approach patients without judgment regarding the patient’s choice of treatment or preferences in managing pain and other distressing symptoms.

But what does this knowledge base look like as applied to patient care and nursing practice? Cannabis nurses might use their specialized skill set to:

• Guide patients in selecting a route of cannabis administration
• Educate patients to understand the safety implications of medical cannabis
• Look over a patient’s medication list to identify drug interactions
• Consult with cannabis manufacturers to develop helpful products
• Identify a patient with chronic pain for cannabis research

Cannabis Nursing Jobs and Salaries

Nursing professional roles are always evolving, with opportunities opening up in different settings. These are the most common areas where cannabis nurses use their skill set to help patients and the public.

Dispensary Nursing

In medical dispensaries, nurses offer education and guidance to patients who qualify for medical cannabis, so they can access the treatment they need. This might include advising patients on transdermal patches, vaporizing oils, and strains of cannabis they’d recommend. Cannabis nurses might also document a patient’s progress and follow up on their outcomes.

The average dispensary nurse salary is $48,300 per year.

Cannabis Nurse Navigator

Nurses guide patients through the treatment process, connecting them to resources and guiding them to make informed decisions for their own care. They might refer patients to specialists, help them access assistance programs, or get help for families. Nurse navigators work within the cannabis specialty, or in acute and post-acute care.

The average nurse navigator salary is $98,650 per year.

Cannabis Consulting Practices

In certain states, nurse practitioners may prescribe medical cannabis to patients. NPs can start their own cannabis consulting practice or join clinics and for-profit companies that assist patients. These nurses work on-site, remote, and in traveling positions.

The average nurse practitioner salary is $128,490 per year.

Cannabis Product Manufacturing

Nurse consultants can collaborate with manufacturers to guide product development and advocate for patient safety. Cannabis nurses provide insight into specific disease processes, helping companies tailor products and education to patients. They can also guide company decisions and policies related to medical cannabis.

The average cannabis consultant salary is $115,000 per year.

Academic and Research Cannabis Nursing

Cannabis medicine is undergoing rapid research and development, and nurses have a key role to play. In academic and research settings, cannabis nurses help recruit patients, examine their eligibility, offer education, document and measure outcomes, and contribute to publishing. These nurses might work in academic institutions, pharmaceutical companies, healthcare facilities, and nonprofit institutions.

The average research nurse salary is similar to a salary for a medical scientist, which is $112,380 per year.

How to Become a Cannabis Nurse: 4 Steps

Interested in this specialty? Here are the steps you’ll need to take to enter and thrive in this exciting field.

1. Graduate From a Nursing School

An associate or bachelor’s degree in nursing will help prepare you to enter the medical field. You’ll have your first experiences of patient care through clinicals and take classes on anatomy and physiology, pharmacotherapeutics, and pathophysiology. Cannabis nurses need a deep understanding of disease progress, medication administration, and patient safety, which nursing school will cover.

2. Pass the NCLEX

The NCLEX-RN is the national council licensure examination for registered nurses, and you’ll need to pass it before you can practice. Learn about how to prepare for the NCLEX exams so you can pass with flying colors.

3. Gain Experience

Most new graduate nurses go into an acute care specialty, such as med-surg, cardiac, or critical care. You might not need to get inpatient experience to be a cannabis nurse, but it could help you gain insight into patient care and disease processes. Consulting gigs and corporations often look for clinical experience when seeking nurses.

4. Earn a Cannabis Nursing Certification

Continuing education will help you gain a specialized skill and knowledge base in this exciting specialty. Unlike other nursing specialties, there is no national certification for cannabis nurses (yet). But there are two organizations where you can access specialty education and a community of like-minded nurses:

• The American Cannabis Nurses Association (ACNA)
• Cannabis Nurses Network

Safety Considerations for Medical Cannabis

Because medical cannabis is rapidly evolving, cannabis nurses should be aware of safety risks. These can relate to dependency, reactions and adverse responses, and contraindications with medical cannabis.

Cannabis use disorder (CUD) is a pathological dependency on the substance. This dependency is associated with other mental health diagnoses, like mood disorders, anxiety disorders, and PTSD. Chronic cannabis use is associated with altered brain development, cognitive impairments, and even driving impairments. Nurses have a responsibility to educate patients on the risks of cannabis dependency.

Cannabis use has also been linked to psychotic reactions, and nearly a quarter of new psychosis cases in adolescents are related to cannabis. For patients who smoke as a route of administration, lung cancer and COPD are risks. Patients should also be aware of the risks of periodontal disease, impaired spermatogenesis, and other adverse responses.

Despite the hype, cannabis is not a universal treatment, and it’s contraindicated in some patient groups:

• Patients with psychotic schizophrenia
• Patients with bipolar disorder
• Patients who are pregnant or breastfeeding
• Patients with unstable cardiovascular disease
• Patients with respiratory diseases
• Older adults, who many be at higher risk for interactions

Legal Considerations in Cannabis Nursing

Cannabinoids are still federally illegal, although laws can vary by state, county, and city. Cannabis nurses must adhere to both state and federal regulations concerning cannabis use and healthcare. Understanding the legal framework in your area is essential to protecting patients and your license.

Cannabis remains a Schedule I controlled substance, and medical I.D. cards can only be given by a physician, nurse practitioner, or physician’s assistant, as directed by your state. Cannabis nurses should refer to the MMP in their state for guidance on scope of practice and ongoing legislative changes.

Cannabis Nursing: State Guide

Cannabis laws can be confusing. Currently, 38 states, Washington, D.C., and three territories allow some use of cannabis products, though even among the states where use is permitted, policies differ.

(Map: ncsl.org)

Cannabis nurses need to understand policy changes, since these impact patients, treatment plans, and even your nursing license. There are four main ways that state policies outline cannabis use:

1. Adult and Medical Cannabis Program

In states with both adult and medical use programs, cannabis can be consumed by qualifying adults. If someone doesn’t have a medical use, this is sometimes called recreational use. These states typically also recognize specific conditions that a patient must have in order to qualify for a medical cannabis ID card. States and territories with these programs include:

• Alaska
• Arizona
• California
• Colorado
• Connecticut
• Delaware
• Guam
• Illinois
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Missouri
• Montana
• Nevada
• New Jersey
• New York
• Oregon
• Rhode Island
• U.S. Virgin Islands
• Vermont
• Virginia
• Washington D.C.
• Washington State

Even in these states, most insurance companies do not reimburse medical cannabis because it’s not yet FDA-approved. Keep in mind that patients with a medical ID card from one state might not be recognized by another. Additionally, traveling with medical cannabis to another state (even one with a use program) may be prohibited.

2. Medical Cannabis Program

States with medical cannabis programs restrict cannabis use to patients who qualify for treatment. Using a medical ID card, they can go to a dispensary nurse for recommendations on strains and route of administration. You can find medical cannabis programs in these jurisdictions:

• Alabama
• Arkansas
• Florida
• Hawaii
• Kentucky
• Louisiana
• Mississippi
• New Hampshire
• North Dakota
• Ohio
• Oklahoma
• Pennsylvania
• Puerto Rico
• South Dakota
• Utah
• West Virginia

Remember that even when a patient has an ID card, this isn’t a “prescription” for medical cannabis. Providers cannot prescribe it because it’s not FDA-approved. ID cards allow patients to buy and possess cannabis in varying quantities, but the formulations and strains they choose are up to medical dispensaries. Also, keep in mind that state boards of nursing and facility regulations vary if you are planning to use cannabis as a nurse.

3. CBD or Low-THC Program

These states allow low-THC or CBD cannabis products. CBD is less potent than THC, while still maintaining anti-epileptic, anti-inflammatory, and anti-anxiety benefits. The following states offer these programs:

• Georgia
• Indiana
• Iowa
• North Carolina
• South Carolina
• Tennessee
• Texas
• Wisconsin
• Wyoming

In most of these states, CBD is available without a medical ID card in the form of gummies, vaporizing pens, and lotions. However, certain states, like Georgia, require a Low THC Oil Registry card, which a physician will need to fill out in order for a patient to qualify for THC treatment.

4. No Public Cannabis Access

In states with no public cannabis access policy, cannabis is not legally accessible to medical or recreational users. These states may decriminalize cannabis, but there is no public regulatory program for its use. There is no public access to cannabis in these jurisdictions:

• American Samoa
• Idaho
• Kansas
• Nebraska

But even within these states, patients can receive FDA-approved cannabinoid medicines such as dronabinol and cannabidiol. These are typically administered in pill form on a prescription basis.

Keep in mind that loopholes may still allow certain cannabis products like Delta-8 to exist in the marketplace. These may be marketed as health products, but they haven’t been evaluated by the FDA and can have psychoactive and intoxicating effects. Nurses need to be aware of the legal landscape of medical cannabis, as well as the ways that it’s still being researched and investigated for the best patient outcomes.

Find Your Next Cutting-Edge Nursing Opportunity

Cannabis nursing is just one of the ways you can help patients access holistic care. If you’re curious about new nursing jobs in your area, IntelyCare has you covered. Let us know what you’re looking for and we’ll send you the nurse jobs that match your interests.