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.).
References
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
lynnkrus 
Lynn, this is a great overview. With all of the considerations of dose, form, and cost that you outlined, what is your recommendation for establishing and sustaining an effective NP role for patient care related to medical marijuana policy? -HMR
LikeLike
Lynn,
This was a good overview of the cost of Cannabis. It will be nice to develop specific guidelines for the prescription of cannabis. Varying degree of potency of products and self titrating to relive symptoms by patients could make the treatment difficult and guidelines ineffective. What are your suggestions to deal with this potential problem?
LikeLike
Hello, Lynn. Once again, I find your topic so interesting – in so many ways. Here we are discussing marijuana in terms of healthcare policy versus an illegal substance – such as alcohol once was. It is almost as if we (society) are able to foresee a piece of the negative impact of legalization – for example alcohol has lead to increased incidence of liver disease and liver failure in addition to social distress – impact of alcoholism on society) but are forced into a corner and made to make the best decision for the public as possible. This really is a no-win situation. I believe the government will once again be faced with the implications of legalization of medical marijuana and inability to appropriately dose, monitor, and control despite the foreseeable problems of abuse, disuse, and harm to society. However, on the other hand, maybe legalization of marijuana across the US will decrease criminality related to marijuana such as distribution, obtaining, and consumption. And just as alcohol was legalized and remains legalized, so will medical marijuana. However, society is, in effect, responsible for forcing the implementation and sustenance of these types of political/healthcare policy changes. Essentially, we are unable to protect ourselves from ourselves.
LikeLike
As we talk about innovating strategies, I can’t help but tie this piece to a news piece I heard this morning. In Colorado, some discussion is going on about the acceptability of medical marijuana in schools. Since it IS a medicinal option to some with deliberating diseases/conditions, and seeing how it is legal in CO, even recreationally, there were still some outstanding issues that the school board had with it, as they want to keep schools drug free aside from what the law is saying. Interesting stuff.
LikeLike