California Center Finds Few Barriers to Implementing In-Clinic Cannabis Palliation

California state law requires cancer centers to allow patients with terminal disease to use cannabis, contradicting federal law. That has left some oncology nurses uneasy and uncertain about their roles and responsibilities, but a survey-based pilot study suggests most will be comfortable overseeing patient self-administration of cannabis in clinical settings, and that they will see palliative benefits for their patients.

Amanda McKaig, BSN, RN, OCN, and Alyssa Ridad, BSN, RN, OCN, of the UCLA Medical Center in Santa Monica, California, reviewed the legal situation in California and findings from their small, single-institution pilot survey in a poster presentation at the 48th Annual Oncology Nursing Society (ONS) Congress.

Early research suggests cannabis “has the potential to palliate some of the most limiting side effects of cancer and cancer treatments,” McKaig and Ridad reported. “Research has strongly supported medical cannabis in the management of chronic pain, nausea, vomiting, and anorexia. There is [also] emerging evidence to support its use for chemotherapy induced peripheral neuropathy, and sleep disorders.

“Research shows that THC/CBD used in conjunction with standard antiemetic regimens can be used to treat refractory CINV [chemotherapy induced nausea and vomiting].”

Recreational cannabis was legalized in California in 2016 but hospitals routinely denied patient access until “Ryan’s Law” (Senate Bill 305) was signed into state law in September 2021, requiring that patients with terminal disease be permitted to use cannabis at healthcare facilities.

“It is important to note that under Ryan’s law hospitals are allowing access to medical cannabis but are not supplying it — the supply remains the patient’s responsibility,” the authors noted.

Cancer centers and hospitals are implementing new policies and procedures to comply with Ryan’s Law. McKaig and Ridad undertook a pilot study to anonymously measure oncology nurses’ comfort helping medical-surgical oncology in-patients use medical cannabis, and their views on its potential benefits for patients, following completion of an education module describing their institution’s Ryan’s Law policy and procedure, patient eligibility, and self-administration procedures.

“The procedure involves interdisciplinary collaboration between nursing and pharmacy,” McKaig and Ridad reported. “Pharmacy provides the patient with a combination lock box, the patient stores and self-administers their own cannabis products, and the nurse records the administration in the electronic medical record.”

Anonymous surveys were sent to 7 nurses. More than half (3 [60%]) reported feeling comfortable implementing Ryan’s Law in clinical practice. Six of 7 respondents reported feeling that cannabis helped their patients manage their symptoms after symptoms were reassessed, and had a positive impact on the patient. They reported cannabis as beneficial for management of patients’ pain, anxiety, nausea, anorexia, and insomnia. Anxiety and insomnia were the most frequent indications cited for patient self-administration of cannabis.

Respondents reported no barriers to implementation of Ryan’s Law. The results are informing development of a new educational module for nursing staff.

“While medical cannabis continues to be illegal under federal law, our goal is to allow oncology patients to have access to all treatment modalities available to them while practicing under institutional guidelines and state laws,” they concluded.

Reference

McKaig A, Ridad A. Nurses’ perspectives on compassionate access to medical cannabis. Poster presentation at: 48th Annual ONS Congress; April 26-30, 2023; San Antonio, TX.