The emerging specialty of cannabis nursing: 'We've risked our careers'

Medical cannabis has been approved for use in 38 states as of 2023, but right now there is no certification or credentialing for nurses who want to specialize in this type of medicine. However, that will soon change because of a group of dedicated nurse volunteers with the American Cannabis Nurses Association.

Because marijuana is still illegal at a federal level, practicing it openly as a nurse, or even relaying knowledge of medical cannabis, is something that continues to hold a stigma. Even volunteering with the ACNA to further expand this area of nursing is something Rachel Parmelee, MSN, RN, president of the ACNA told Becker's nurses do with a risk to their professional careers — a cause they deem worthy of that risk. 

"I do think that times are changing and people are becoming more open because of social movements," Ms. Parmelee said. "But we have to understand that there are generations of people who have been told that this is so bad, and this has been their worldview for quite some time. So it's really hard to change those types of worldviews… I would say don't push this on anybody that's not willing to or not wanting to change their mind about it, but certainly offer that as an opportunity to learn." 

After years of tireless work by Ms. Parmelee and her team to carve out a space for the specialty within the larger field of medicine and nursing, in September, the American Nurses Association formally announced the recognition of cannabis as a nursing specialty. 

"Recognition of this nursing specialty highlights to colleagues and the public the value of cannabis nurses helping change the ambulatory and acute care health care landscape by incorporating a diverse set of wellness modalities into practice," an ANA spokesperson told Becker's. "Such changes enable patients to benefit from the legal and safe use of cannabinoids for disease treatment and symptom management. Cannabis nurses lead in characterizing the urgency and efficacy of clinical research and regulatory reform associated with the use of cannabinoids."

Soon to follow this will come a formal credential that nurses can acquire through the ANA. 

Now, Ms. Parmelee and the ACNA are working to develop the scope and standards of what would be necessary to require as part of a formal certification. She expects these to be published in early 2024. Following that, ACNA will work to partner with another party to build out a robust credentialing process and examination. Once the exam is established, Ms. Parmelee and her team will apply for its formal accreditation through the American Nurses Credentialing Center.

"We are just so thankful that we could do this for all cannabis nurses and any nurse that wants to become a cannabis nurse…" Ms. Parmelee said. "We have really risked our careers by standing up for this and looking out for people that are trying to understand this more. We don't necessarily promote cannabis, just for patients to have access to safe information and safe access to it as a medical treatment. I think what this means is just that we're finally getting the recognition that we've been practicing for so long because this isn't necessarily a new role. It's just now recognized as a specialty so that's what is new."

Yet, what the credential cannot do is change the federal law. However, "the U.S. Department of Health and Human Services recently sent a formal request for the Drug Enforcement Agency to reschedule cannabis as a Schedule III drug, which would establish it has a legitimate medical use. If the Drug Enforcement Agency agrees to this change it would open pathways to more research and medical access," the ANA spokesperson told Becker's. "Cannabis nurses and other clinicians are challenged to carefully manage the associated tensions encountered in their practices between state and federal law."

Even if laws shift in time, some opinions may not, but for that Ms. Parmelee says promoting the education and science behind all that goes into the cannabis nursing profession is where RNs can lean in and share related expertise with hospitals and health systems even if marijuana is not involved. 

"Of course, there's people that are going to, you know, think probably poorly of that, 'Oh, they just get patients high.' That is not the case," Ms. Parmelee said, "That just comes from a lack of education," she said. "So as soon as we tell people, 'Hey, we have an endocannabinoid system. We have our own cannabinoids in our body. I'm an expert in that too.' It's more or less not necessarily promoting cannabis use, but rather understanding the endocannabinoid system, either dysregulation or bringing it back to homeostasis. So the more education out there, I think that stigma is going to continue to go away."

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