CANNABIS has a long history as a medicine, in spiritual use, and for recreational use. Currently, 33 states, the District of Columbia, Guam, and Puerto Rico allow medical cannabis use under specific qualifying conditions, and 11 states (and the District of Columbia) allow adult recreational use.

Nurses frequently care for patients who use or are considering using medical cannabis. In 2018, the National Council of State Boards of Nursing (NCSBN) released guidelines for nurses who care for patients who use medical cannabis, stating, “Nurses need practical information to care for the increasing number of patients who utilize cannabis…who self-administer cannabis as a treatment for various symptomatology or for recreational purposes. Individuals are using cannabis and nurses will care for these patients.” (See Cannabis: 6 essential principles.)

Because cannabis science isn’t taught in most nursing schools (except in the context of misuse), nurses must find information about cannabis on their own. And because healthcare professionals typically possess little knowledge about cannabis therapeutics, patients frequently seek information from other patients, cannabis industry workers, and the internet. However, a recent article by Boatwright and Sperry found that 90% of the information on the top 10 cannabis websites was based on low quality studies and only one website used a medical professional to write about cannabis health claims. Finding and validating information can be challenging—proper and timely research, however, can inform clinical practice for nurses.

The endocannabinoid system

The main function of the endocannabinoid system (ECS) is to maintain homeostasis, which makes it a unique target for medical applications. This molecular signaling system consists of cannabinoid receptors (CB1 and CB2 are the most common and well studied), ligands, and enzymes that regulate sleep, pain perception, memory, mood, and appetite. The receptors can be stimulated by our own endogenous cannabinoids, by plant-derived cannabinoids (phytocannabinoids), and by synthetic cannabinoids. Ligands act as chemical messengers to get cannabinoids to interact at the receptor site, while enzymes break down cannabinoids after they’ve completed their function.

Cannabinoid receptors

CB1 and CB2 are G-protein-coupled receptors. CB1 receptors are predominantly found in the central and peripheral nervous systems, in the heart, lungs, adrenal glands, kidneys, pancreas, testes, ovaries, liver, colon, and prostate. When activated, CB1 receptors can help mitigate anxiety and stress, pain and inflammation, depression, post-traumatic stress, symptoms related to multiple sclerosis, and neurodegenerative disorders. Very few CB1 receptors are found in the brainstem or the cardiorespiratory centers, making a lethal dose of cannabis impossible.