Drugs

[CRNAspa]

There is definitely a lack of education about substance misuse and addiction in all health care training programs (medical, nursing, pharmacy, etc.) As a result, most decisions about the recreational (or non-medical use if you prefer) of mood altering chemicals is based on what I call the "3M's"...myth, misbelief, and misinformation. We could add a 4th M, morality, since many of the 3M's are based on a moral view as opposed to scientific information. Research over the past 20 years has provided a significant increase in understanding how mood altering chemicals affect the brain. Those who misuse (misuse = chronic, non-medical use, or the use of a currently illegal substance) mood altering substances experience significant alterations in the brain, both structurally and chemically. Individuals with a genetic predisposition to chemical dependence (addiction) are at risk for developing this chronic, progressive, potentially fatal disease.

Marijuana is a relatively "mild" combination of mood altering chemicals as well as other substances that can lead to heart disease, lung disease, and mental health disorders other than chemical dependence.

The single most relevant reason not to engage in the use of marijuana at the present time is it's status as an illegal substance. Regardless of it's relative potency when compared to other chemicals, including alcohol, the use of marijuana is illegal in most states and therefore is a violation of the nurse practice act. Whether you agree or disagree with current law, the willful use of an illegal substance in your private life still violates the laws that allow you to practice nursing. This means discovery of your use is reason enough to suspend and/or revoke your license.

As a licensed health care professional, we are expected to make our decisions based on scientific principles, nursing principles, and professional/ethical principles. The willful use of illegal mood altering substances is evidence of a lack of professional and ethical decision making.

Information from the NIDA
InfoFacts - Marijuana

How is Marijuana Abused/Misused?

Marijuana is usually smoked as a cigarette (joint) or in a pipe. It is also smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana. Since the blunt retains the tobacco leaf used to wrap the cigar, this mode of delivery combines marijuana's active ingredients with nicotine and other harmful chemicals. Marijuana can also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish, and as a sticky black liquid, hash oil.* Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.

How Does Marijuana Affect the Brain?

Scientists have learned a great deal about how THC acts in the brain to produce its many effects. When someone smokes marijuana, THC rapidly passes from the lungs into the bloodstream, which carries the chemical to the brain and other organs throughout the body.

THC acts upon specific sites in the brain, called cannabinoid receptors, kicking off a series of cellular reactions that ultimately lead to the “high” that users experience when they smoke marijuana. Some brain areas have many cannabinoid receptors; others have few or none. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thoughts, concentration, sensory and time perception, and coordinated movement.1

Not surprisingly, marijuana intoxication can cause distorted perceptions, impaired coordination, difficulty in thinking and problem solving, and problems with learning and memory. Research has shown that marijuana’s adverse impact on learning and memory can last for days or weeks after the acute effects of the drug wear off.2 As a result, someone who smokes marijuana every day may be functioning at a suboptimal intellectual level all of the time.

Research on the long-term effects of marijuana abuse indicates some changes in the brain similar to those seen after long-term abuse of other major drugs. For example, cannabinoid withdrawal in chronically exposed animals leads to an increase in the activation of the stress-response system3 and changes in the activity of nerve cells containing dopamine.4 Dopamine neurons are involved in the regulation of motivation and reward, and are directly or indirectly affected by all drugs of abuse.

Addictive Potential

Long-term marijuana abuse can lead to addiction; that is, compulsive drug seeking and abuse despite its known harmful effects upon social functioning in the context of family, school, work, and recreational activities. Long-term marijuana abusers trying to quit report irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which make it difficult to quit. These withdrawal symptoms begin within about 1 day following abstinence, peak at 2–3 days, and subside within 1 or 2 weeks following drug cessation.5

Marijuana and Mental Health

A number of studies have shown an association between chronic marijuana use and increased rates of anxiety, depression, suicidal ideation, and schizophrenia. Some of these studies have shown age at first use to be a factor, where early use is a marker of vulnerability to later problems. However, at this time, it not clear whether marijuana use causes mental problems, exacerbates them, or is used in attempt to self-medicate symptoms already in existence. Chronic marijuana use, especially in a very young person, may also be a marker of risk for mental illnesses, including addiction, stemming from genetic or environmental vulnerabilities, such as early exposure to stress or violence. At the present time, the strongest evidence links marijuana use and schizophrenia and/or related disorders6. High doses of marijuana can produce an acute psychotic reaction, and research suggests that in vulnerable individuals, marijuana use may be a factor that increases risk for the disease.

What Other Adverse Effect Does Marijuana Have on Health?

Effects on the Heart

One study found that an abuser’s risk of heart attack more than quadruples in the first hour after smoking marijuana.7 The researchers suggest that such an outcome might occur from marijuana’s effects on blood pressure and heart rate (it increases both) and reduced oxygen-carrying capacity of blood.

Effects on the Lungs

Numerous studies have shown marijuana smoke to contain carcinogens and to be an irritant to the lungs. In fact, marijuana smoke contains 50 to 70 percent more carcinogenic hydrocarbons than tobacco smoke. Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which further increases the lungs’ exposure to carcinogenic smoke. Marijuana smokers show dysregulated growth of epithelial cells in their lung tissue, which could lead to cancer;8 however, a recent case-controlled study found no positive associations between marijuana use and lung, upper respiratory, or upper digestive tract cancers.9 Thus, the link between marijuana smoking and these cancers remains unsubstantiated at this time.

Nonetheless, marijuana smokers can have many of the same respiratory problems as tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, a heightened risk of lung infections, and a greater tendency toward obstructed airways. A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers.10 Many of the extra sick days among the marijuana smokers in the study were for respiratory illnesses.

Effects on Daily Life

Research clearly demonstrates that marijuana has the potential to cause problems in daily life or make a person’s existing problems worse. In one study, heavy marijuana abusers reported that the drug impaired several important measures of life achievement including physical and mental health, cognitive abilities, social life, and career status.11 Several studies associate workers’ marijuana smoking with increased absences, tardiness, accidents, workers’ compensation claims, and job turnover.

As a recovering addict and peer assistance advisor, I don't make decisions about substance misuse and chemical dependency based on morality. Substance misuse and chemical dependency are health care issues. Chemical dependency is a primary, chronic, progressive, UNNECESSARILY FATAL disease. It is prevented by refraining from recreational use of mood altering substances. It is treatable and long term recovery is possible with early recognition and intervention.

[RoninRN]

Good lord people, marijuana is a relatively benign drug. Spend a few years in the ER and ICU. However, the CRNA-artist-fellow was right – it is a scheduled substance, getting caught using it implies that one takes this classification lightly. This is not good when we juggle gallons of morphine, dilaudid and ativan in the course of a year. Occasional use won’t be a problem, just be aware of the risk.

[Robert F]

I am not going to speak on the ethics of drug use in the medical field, that has been done enough in the past. However, this post could not have come at a more perfect time. About a month ago, I was helping a friend of mine get on at my Ambulance service. She got through the fitness tests, etc; but failed the drug test for Marijuana. The state was notified and her license was placed on probation. She was then sent to Rehab by the TN Professional Assistance Program(TNPAP). Like an idiot, she continued to smoke. Mind you, she was working at another service as well. In light of these recent events, they drug tested her weekly to comply with the state board of EMS. Yesterday, I found out that she failed another test for Marijuana and her license is gone. I do not mean it shows up as "Inactive", I mean the damn thing disappeared from the registry all together.

We have put alot of time and effort into our education. We have busted our hind-ends and have went to hell and back. Would you throw it all away just for one little joint?

[RoninRN]

Yes, your friend is a moron. Her problem extends beyond the use of pot.

[Robert F]

I hate to break it to you, but a drug is a drug. Anyone who is working to become a nurse and doing any kind of drug is a fool. Period.

I am not speaking on the ethics of drugs. The fact is, they are illegal and it is in violation of the nurse practice act of any state to be caught with them. People constantly use working in the unit or trauma or the er or whatever to justify the use of illicit substances. I have worked all of them and am currently working all of them: Flight, Trauma Unit, Trauma ICU, Ambulance, and even floating to ER. Do I see things that disturb me? Every day. That does not justify me using drugs.

No, Ronin; my friend's problem does not extend beyond the use of pot and she certainly is not a moron. She can wipe the floor with any other paramedic I know in the pathophysiology and mechanisms of Trauma. She holds the same degree in Paramedicine that I do, from the same class. I have seen her manage multi victim trauma's without breaking a sweat. She simply failed for pot both times. I do not care if you are an EMT, Paramedic, RN, LPN, CNA, CRNA, MD; drugs are illegal and if you were in my unit and I knew you were on them; I would fire you in a heartbeat and would report you to the state board so quick it would make your head spin.

[cougarnurse]

Medic, I doubt Ron really meant your friend is a moron. I think I get his point, though....friend should know better.

True, I believe pot should have medicinal use: appetite stimulant in Aids pt's, glaucoma.... However, previous posts all point to pot causing slowness, etc. Honestly, if there is an emergency, I would NOT want someone who smokes it recreationally even near me/mine/my patient. Too many variables already hitting the fan to loose anything to chance.

OK....off my soapbox.

[AmandaWIRN]

I see it like this, maybe it shouldn't be illegal, but the fact of the matter is- it is illegal... So, if you can disregard the law to smoke pot, then what's to stop you from disregarding the law for other things, like diverting drugs from work, driving drunk, etc....

Working in the medical field and doing drugs don't go together- so if you want to smoke pot, you should find another field to work in- one where people's lives aren't on the line...

[LivingDeadNurse]

okay worried about drug test? you might want to research just how much damage it does to your brain. which mean you will be impaired when you take care of your pts. not to mention even if there isn't a drug tests there are people like me that won't think twice to rat you out when you accidently tell the wrong person what you do. my pts always come first. i am not saying your a bad person your just not making wise choices. please change fields if you want to do your hobby because i don't want u taking care of me or my pts under the influence...thanks and thats my 2 cents

[Ricu]

Don't you wish that there was some way to package coping skills into a form that could be taken in drink, pills or smoke? Just as easy as that- no work at all. Maybe we would see a little less chemical dependency out there.

Speaking of chemicals, Happy New Year everyone! I get to work tomorrow- can't wait for the morning after crowd, both patients and coworkers...

Cheers!

R