Health policy change can create sustainable positive or negative consequences for stakeholders. If nurse practitioners in Arizona were legally allowed to “recommend” and “certify” medical marijuana for patients with qualifying medical conditions, they still would not be able to manage the patient’s use of marijuana or dose, because this would be “prescribing.” Marijuana is still a Schedule I drug and is defined as having no medical value. Rescheduling of marijuana at the federal level should be changed in order to provide follow-up, guidance, and assistance with dosing beyond explaining the health risks and benefits of medical marijuana.
However, it is difficult to dose marijuana, also known as cannabis. According to Carter, Weydt, Kyashna-Tocha, and Abrams (2004), there are many variables such as differences in phenotypes, composition (varying amounts of THC, cannabidiol, or cannabinol), and differences in potency during harvesting times. In addition, the effects are different on everyone, such as patients who are marijuana naïve compared to someone who has built tolerance. Furthermore, the effects are different depending on the method of administration. For example, the effects of marijuana fade rapidly over 30 minutes if smoked compared to effects lasting 1-6 hours if ingested with a delayed onset. The metabolites of marijuana also compete with the cytochrome P450 system if ingested. Fortunately, the safety profile of cannabis is similar to gabapentin. The toxicity is low and dosing limits can be high. A person would have to smoke 628 kg of marijuana in 15 minutes to achieve a lethal dose (Carter, Weydt, Kyashna-Tocha, & Abrams, 2004).
According to Carter, Weydt, Kyashna-Tocha, and Abrams (2004), the current guidelines for dosing marijuana used Dronabinol (Marinol) prescribing guidelines to guide dosing recommendations. Dronabinol is pure synthetic THC and it is also a Schedule III drug. A conservative dose of Dronabinol is 2.5 to 60 mg of THC a day. The average medical marijuana patient uses 10-20 grams a week or 1.42 to 2.86 grams of cannabis a day (one joint is usually 0.5 to 1.0 grams), and one gram of cannabis is estimated to contain about 10%-15% of THC. This translates to about 34-68 mg of THC a day, which is similar to the amount of THC in a conservative dose of dronabinol. It is recommended that patients’ self-titrate as needed to determine therapeutic effects or relief of symptoms (Carter, Weydt, Kyashna-Tocha, & Abrams, 2004).
According to CostHelper (n.d.), the average cost of a gram is $5-$20, an eighth (3.5 grams) is $20-$60, and an ounce usually costs about $200-$400. Edible products are $2-$5 a dose, tinctures are usually $15-$50 per 1-oz bottle, and concentrates such as hash, oils, and waxes cost $20-$60 per gram. In addition, rolling papers cost about $2, glass pipes cost $20, a water pipe (bong) is about $50-$300, and vaporizers cost $100-$700 (CostHelper, n.d.).
Carter, G. T., Weydt, P., Kyashna-Tocha, M., & Abrams, D. (2004). Medicinal cannabis: Rational guidelines for dosing. Retrieved from http://cannabisplus.net/cannabis-research-pdf/Dosage/Abrams%20%20Medicinal%20Cannabis%20Rational%20Guidelines%20for%20Dosing%20.pdf
Cost Helper. (n.d.). Medical marijuana cost. Retrieved from http://health.costhelper.com/medical-cannabis.html