The disconnect between the state and federal governments on cannabis legislation is showing itself in the medical community as well. In late September, the American Nurses Association (ANA) announced its formal recognition of cannabis nursing as a nursing specialty, along with its support for the rescheduling of marijuana from a Schedule I drug. The stance of the American Medical Association (AMA), on the other hand, is less defined, with a recent AMA study finding that medical cannabis may be associated with improvements in health-related quality of life, but the AMA continues to oppose legalization.
The ANA recognition focuses on the specialized knowledge needed both for care and “to address the stigma associated with medical cannabis use to support a healthy society,” and notes ANA’s promotion of “enhanced integration of cannabis therapies for health care consumers across diverse health care settings,” The statement follows a 2021 Position Statement in which the ANA declared its support for cannabis rescheduling to “facilitate urgently needed clinical research to inform patients and providers on the efficacy of marijuana and related cannabinoids.” The ANA support, however, relates only to the health care use of cannabis.
While the AMA supported the Medical Marijuana and Cannabidiol Research Expansion Act of 2022 along with the clearing the records for cannabis convictions in states that have enacted marijuana policy reform, the AMA continues to oppose further efforts to legalize cannabis. Because the association sees significant public health and safety questions remaining, it advocates for comprehensive, well-controlled cannabis studies to determine its role in the treatment of disease.
The AMA’s position is that approval and use of any drug must be based on sound, evidence-based scientific research and that “in the case of cannabis, that burden has not yet been met.” Additionally the association references the National Academies of Sciences, Engineering and Medicine stance that the medical benefits of cannabis are largely unknown with not enough research conducted for most health conditions to know whether cannabis can help treat disease or improve associated symptoms.
Thus, while various publications are hyping the new study’s findings of “significant” improvements in the health-related quality of life among patients with a range of health conditions, many gloss over the study’s caveat that clinical evidence for cannabinoid efficacy remains limited, and further high-quality trials are required. Additionally, the study found a relatively high incidence of adverse events, which continues to affirm a need for caution with THC prescribing.
While the ANA and AMA may have disparate stances on the use of medical cannabis, both are in agreement with the federal government that continued research is needed. The late 2022 passage of the Research Enhancement Act should help to move this forward, but exactly what research will persuade federal lawmakers to move toward legalization is yet unknown. Meanwhile, although the count of states legalizing use – medical, adult-use, or both – continues to increase, with many leaving the decision to voters, such as Ohio’s upcoming November vote on adult-use, full legalization continues to elude the nation.