Jessica is a fifty-five-year-old woman who has terminal cancer. She is currently undergoing chemotherapy as treatment. The sessions cause her a great deal of pain as well as loss of appetite. Her medical regime includes the use of a combination of different opioids for pain management. However, the opioids are not entirely successful in providing relief from pain. Additionally, they cause Jessica side effects such as constipation and dizziness, as well as increasing nausea and vomiting that she is already experiencing. This leaves her in a weakened state where she is unable to take care of herself.
A relative suggested the use of marijuana as an alternative to the opioids. She noted an increased level of pain relief and an improvement in her appetite. The use of marijuana in the state where Jessica lives has not been legalized. As a result, she has to follow her discretion on the dosage and use. Jessica is only one out of the more than 14.5 million Americans estimated to be living with cancer. These patients go through similar challenges and side effects in the course of their treatment as well as the resultant pain management process (Compton et al., 2015).
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The American Cancer Association (2015) are of the opinion that further scientific research needs to be done to ascertain the capabilities of marijuana. This is because some studies show that marijuana aids in the alleviation of pain in terminally ill patients. It tends to treat vomiting and nausea in cancer patients undergoing chemotherapy. It further prevent weight loss by boosting the patient's appetite. Despite these benefits, many patients are unable to gain access to marijuana. Some like Jessica have to take calculated risks to access their supply of marijuana.
In 2016, the American Nursing Association has in an official statement advocated for the reclassification of marijuana. The plant and its derivatives are currently classified as a federal Schedule 1 controlled substance. This classification hinders the distribution and use of marijuana as well as its participation in clinical trials. The ANA supports the use of the substance for treatment of diseases and the management of symptoms if it is done within a medical context (Compton et al., 2017). An interpretive statement from the ANA Code of Ethics supports their stance. Provision 7 reads in part that the nurse should advance the profession through research and the generation of nursing and health policy. Provision 2 which emphasizes that the nurse’s primary commitment is to the patient also supports this position on the use of marijuana. The ANA aims to protect patients, medical personnel and any other stakeholders in ensuring that the patient can access marijuana.
The use of marijuana has raised concerns from various stakeholders and policymakers. A section of the medical practitioners cites the danger it poses due to its potential to be abused. There is also a disconnect between the measure to be used for dosing. Marijuana is presented in the form of cigarettes, baked goods or through vaporization. This gives a monitoring and dosage challenge for administering agents. A position paper presented by the American College of Physicians stated that marijuana use might be potentially harmful. Although marijuana had been shown to have neuroprotective properties, among other benefits, it still posed risks associated with its administration through smoking. This included lung cancer and pneumonia. Both tobaccos, baked and vaporized marijuana were likely to cause addiction, hallucinations, and other psychiatric conditions. It was also linked to short and long term cognitive effects and reproductive problems during and after pregnancy (De Boer et al., 2017).
Medical practitioners fear a time when patients can request a marijuana prescription despite the availability of other options. The abuse of this drug could lead to a spiraling of drug abuse due to the lowered cost and ease of accessibility. Opinion is still broadly divided between those who support the use of marijuana and those who oppose it. Those in support of its medical use rely heavily on the theory of Consequentialism which holds that the right moral stance should be directed by the resulting consequence. In other words, the end justifies the means. Those against it support the theory of Principlism. It argues that decisions made must account for religious beliefs, personal convictions, and societal expectations. The theory of Principlism is the most applicable in this situation. Various stakeholders have expressed their concerns about the medical use of marijuana. Therefore, a reasonable approach would be to accommodate the positions of all and use each person's strong point to chart a way forward (American Nurses Association, 2015).
Twenty four out of fifty states in the US have already legalized the use of marijuana for some medical purpose. This is a step towards ensuring that more patients can benefit from the substance. However, the access to marijuana is still hampered. A Supreme Court directive gave the legal mandate to Congress to criminalize growing and use of marijuana at home. The Drug Enforcement Administration (DEA) supported this move through a statement provided by the acting chief early in 2017. They used an earlier report from the Food and Drug Administration (FDA) that asserted that marijuana had no medical value to strengthen their stand.
Philipsen et al. (2017) argues that this is amid a growing number of legal issues that do not have easy solutions. For instance, should state bodies be given equal opportunity and right to be registered as manufacturers and distributors of marijuana products? This is in addition to the fact that no legalization is in place to govern the production of consumable marijuana products. Financial institutions such as banks and bankruptcy protection agencies are also at a crossroad. Should funds from marijuana sales be accepted seeing that they violate federal laws?
American Nurses Association (2015) states that should the above be resolved, the issue of legitimate users still stands. The choice to deny marijuana therapy to former drug addicts or criminals must be supported by the law. Restrictions applicable to users must be legislated as well. They include the right to drive, operate machinery, or participate in gainful employment opportunities. Domestic concerns that include children's access to marijuana or its products or its use in public places is still to be determined. Some countries such as Uruguay, Canada, India, Israel, Costa Rico, and Australia among others have very lax laws governing the use of marijuana. Others have laws but weak directions on enforcement (Chawla & Sood, 2016).
Current trends show that the focus of scholars is on the legalization of marijuana. However, the focus should shift to performing further research on the different plant species of marijuana. Philipsen et al. (2017) points out that this will help pharmaceutical companies determine which plant strains can provide the best combination of compounds for medical use. The exhaustive research will also outline the side effects of various strains and forms of marijuana. The studies can be supported by clinical trials done with larger sample sizes than any of the earlier studies done. The findings from such activities will provide a factual basis for the medical and legal fraternity to make decisions. They will give doctors the necessary information to guide dosage and prescription. There will also be enough information to determine which method of administering marijuana will be most useful and with the fewest side effects. From the above points, it is clear that the ethical and legal issues that hinder the medical use of marijuana can only be addressed by carrying out comprehensive research.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD retrieved from www.nursingworld.org/Code-of-Ethics.
Chawla, N., " Sood, M. (2016). Medical marijuana laws and marijuana use in the USA: Any lessons.
Compton, W. M., Han, B., Hughes, A., Jones, C. M., " Blanco, C. (2017). Use of marijuana for medical purposes among adults in the United States. Jama, 317(2), 209-211.
De Boer, H. D., Detriche, O., " Forget, P. (2017). Opioid-related side effects: postoperative ileus, urinary retention, nausea and vomiting and shivering. A review of the literature. Best Practice " Research Clinical Anaesthesiology.
Philipsen, N., McMullen, P. C., " Wood, C. M. (2017). Medical Marijuana: A 2014-2016 Update on Law and Policy for Nurse Practitioners. The Journal for Nurse Practitioners, 13(2), 145-149.
