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KUDOS TO OHIO NURSES!

FaFalll 22010188 •• VoVolulumeme 116 6 IIssssueue 44

The NCSBN National Nursing Guidelines

for Medical Marijuana

The Use of Social Media

Official Publication of theeeee OOOOOhio BBBBBooooard of Nursing

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MOMENTUM is produced at no cost to Ohio taxpayers.

contentsFALL 2018 I Volume 16 Issue 4

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For Ar dvertisinrr g info co ontactCatherine Carter • 1-800-561-4686 ext.106

[email protected]

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Ohio Board of Nursing 3

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4 MOMENTUM

F R O M T H E P R E S I D E N T

Patriccia A. Sharpnack, DNP, RNPresident

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To address the lack of guidelines for nurses when caring for individuals utilizing cannabis, the National Council of State Boards of Nursing Board of Directors appointed members to the Medical Marijuana Nursing Guidelines Committee. In order to create the requested guidelines and recommendations for education and care, a review of the relevant statistics, current legislation, scientific literature, and clinical research on cannabis as a therapeutic agent was required. The Committee also consulted known experts in the area of medical marijuana, its use, safety, and legislation.

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6 MOMENTUM

F R O M T H E E X E C U T I V E D I R E C T O R

Betsy J. Houchen,RN, MS, JDExecutive Director

Each week since August, the Board emailed LPNs reminding them to renew and we frequently posted renewal information on the Board website.

LPN renewal started July 1, 2018 and ran smoothly. WWe e araree

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8 MOMENTUM

CERTIFIED COMMUNITY HEALTH WORKERS IN OHIO

In 2003 the 125th Ohio General Assembly passed HB

95 authorizing certification of CHWs and approval of CHW

training programs. See Sections 4723.81 through 4723.88, Ohio

Revised Code (ORC). Section 4723.82(A), ORC, authorizes an

individual holding a current, valid community health worker

certificate to use the title “certified community health worker”

or “community health worker” when providing services such as

education, role modeling, outreach, home visits, and referrals

for an individual, family, or entire community. There are over

600 certified CHWs in Ohio, with a majority of them being

certified in the last three years.

In September 2018, the Ohio Department of Health (ODH)

and the Ohio College of Medicine Government Resource

Center (GRC) completed and disseminated “The 2018

Ohio Community Health Worker Statewide Assessment Key

Findings (Assessment).” A GRC assessment team conducted

the Assessment with the assistance of a Community Health

Worker (CHW) Assessment Advisory Committee that included

the ODH, the Ohio Department of Medicaid, the Ohio Board

of Nursing (Board), the Ohio Community Health Workers

Association, Board approved CHW training programs, CHW

employers, and other health care entities.

The Assessment was designed to identify how CHWs are

currently being trained, certified, employed, and reimbursed.

To access the CHW Assessment and CHW information, please

click on the CHW page on the Board website at www.nursing.

ohio.gov/CommunityHealthWorkers.htm.

Certification Requirements

Section 4723.84, ORC, specifies certification requirements

for CHWs. CHW applicants must be at least eighteen years

of age, possess a high school diploma or equivalent and

successfully complete a Board approved CHW training

program. In addition, applicants must submit an online

application, criminal records check, and a $35 application

fee. See Rule 4723.26-02, OAC.

Practice and RN Delegation and Supervision

Section 4723.82(B)(1), ORC, states that holding a CHW

certificate does not authorize an individual to administer

medications or perform any other activity that requires

judgment based on nursing knowledge or expertise. The

statute requires that a registered nurse (RN) must supervise

a certified CHW “when performing delegated activities related

to nursing care.” The RN supervision and delegation must be in

accordance with Board administrative rules.

Chapter 4723-26, Ohio Administrative Code (OAC), sets

forth standards for RN delegation and supervision of nursing

tasks performed by a certified CHW. Rule 4723-26-09(A),

OAC, requires a RN to supervise the certified CHW when

delegating a nursing task. Supervision “includes initial and

ongoing direction, procedural guidance, and observation and

evaluation.” Rule 4723-26-09(B), OAC, requires that the RN

be continually accessible to the CHW in person or by some

form of telecommunication when supervising a delegated

nursing task. Rule 4723-26-09, OAC, limits the number of

certified community health workers who may be supervised

at one time to no more than five, and requires considerations

when determining the appropriate number of certified CHWs

that a RN may supervise. Rule 4723-26-07, OAC, prohibits the

delegation of the administration of medications to a certified

CHW, consistent with Section 4723.82(B)(1), ORC.

Rule 4723-26-07, OAC, prohibits a certified CHW from

delegating a nursing task to any other person. If a certified

CHW performs a nursing task and does not comply with the

applicable provisions of Rule 4723-26, OAC, the CHW may be

engaging in the unauthorized practice of nursing. Section

4723.03, OAC, also prohibits employing a certified CHW to

engage in the unauthorized practice of nursing. Additionally,

when certified CHWs perform “any other health-related

activities,” they must be under the supervision of a health care

professional acting within the professional’s scope of practice.

CHW Training Program Requirements

Section 4723-87, ORC, requires each CHW training program

to be approved by the Board. The program must provide a

curriculum that includes a minimum of 100 didactic classroom

hours and 130 clinical experience hours. Rule 4723-26-13(A)


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Continuing Education (CE)

Requirements for Renewal

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[email protected]. v •

Hunger Is® is a joint initiative of the Albertsons Companies Foundation and the Entertainment Industry Foundation, which are 501(c)(3) charitable organizations.

I was one of our nation’s hungry kids growing up. Today, 1 in 5 children in America struggle with hunger. But when they get breakfast, their days are bigger and brighter. Learning, attention, memory and mood improve. Together, we have the power to get breakfast to kids in your neighborhood — let’s make it happen. Go to hungeris.org and lend your time or your voice.

Viola Davis, Hunger Is Ambassador

MAKE BREAKFAST HAPPEN SO KIDS CAN BE HUNGRY FOR MORE

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12 MOMENTUM

THE NCSBN NATIONAL NURSING GUIDELINES FOR MEDICAL MARIJUANA

PrPrioior r toto 1193936,6, ccanannanabibiss wawas s sosoldld oovever rr thththe ee cococounununteteter rr ananand dd usususededed cccomomommomomonlnlnly y yfofor r a a vavaririetety y ofof iillllnenesssseses iin n ththee UnUnititeded SStatatetetesss (M(M(Marararijijijuauauananana PPPolololicicicy y y PrPrProjojojececect,t,t 20201414).). BBy y 19193636, , eveverery y ststatate e hahad d papasssseded aa llawaww ttto oo rererestststriririctctct pppososossesesessssssioioion nn ofofof cacannnnababisis,, ththusus eelilimiminanatitingng iitsts aavavaililababililitity y asas aann ovoverer-t-t-thehehe-c-couountntnterer dddrurug.g.g ThThenen iin n 19197070, , ththe e CoCompmprerehehensnsivivee DrDrugug AAbubusese PPrereveventntntioioion nn ananand dd CoCoContntntrororol llAcActt (1(197970)0) pprorovivideded d a a clclasassisificficatatioion n ofof cconontrtrololleled d susubsbstatancncnceseses; ; ; cacacannnnnnabababisisis wawas s ininclclududeded iin n ththee lilistst oof f ScSchehedudulele II CConontrtrololleled d SuSubsbstatancnceseses, , , thththerererebebeby y y cocontntininuiuingng tthehe pprorohihibibititionon ooff ththee ususee ofof ccanannanabibiss byby pprorohihibibititingng hhheaealtltlthh h cacac rere ppraractctititioionenersrs ffrorom m prpresescrcribibining g cacannnnababisis..

UsUsUse e ofof ccanannanabibis s reremamainineded rresestrtricicteted d ununtitil l ththe e firfirstst llegegalalizizatatioion n ofof mememedididicacacal ll mamam ririjujuanana a wawas s apapprprovoveded bby y vovotetersrs iin n CaCalilifofornrniaia iin n 19199696. EvEvenen afafafteteterr r thththee e vovovotetetersrs’’ apapprprovovalal,, ththee fefedederarall gogovevernrnmementnt ooppppososeded tthehe pproropoposisititionon ananand dd thththrerereatatatenenenededed ttto o rerevovokeke tthehe pprerescscririptptioion-n-wrwrititining g ababililititieies s ofof ddococtotorsrs wwhoho rerecocommmmenendedededd d oror ppprerescscriribebed d mamaririjujuanana.a. IIt t wawas s nonot t ununtitil l 20200000 tthahat t a a grgrououp p offof ppphyhyhysiisiciiciananans ss chhchallallellengngngedded ttthihis s popolilicycy aandnd pprerevavailileded iin n cocoururt,t, aandnd aa ddececisisioion nwawawass s mamamadedede tttoo o alalallololoww w phphphysysysiciciciaiaiansnsns ttoo rerecocommmmenend—d—bubutt nonott prpresescrcribibe—e—memedidicacall mamamariririjujujuananana aa (M(M(Marararijijijuauauananana PPPolololicicicy y y PrPrProjojojececect,t, 2201014)4). . SiSincnce e ththenen, , anan iincncrereasasining g cucultltururalal acacaccececeptptptananancecece ooff f cacannnnabababisisis hhhasas ppprorompmpptetetedd d 3131 jjururisisdidictctioionsns ((ininclclududining g ththe e DiDiststririctct ofofof CCColololumumumbibibia)a)a), , , GuGGuamamam, , , PuPPuererertototo RRRiciico oo (N(N(Natatatioiionananal l CoConfnfererenencece oof f StStatate e LeLegigislslataturureses [N[NCSCSCSL]L]L], ,, 202020171717),),), aaandndnd aaallllll ppprororovivivincncnceseses/t/t/terererririritototoriririeseses ooff CaCananadada ((GoGovevernrnmementnt ooff CaCananadadaa,, 202020161616) ) ) tototo pppasasass ss lelelegigigislslslatatatioioion nn lelelegagagalililizizizingngng mmmedede icicalal ccanannanabibis.s. IIn n ththesese elalawsws, , ththee jujuuriririsdsdsdicicictititiononon hhhasasas aadododoptptptededed eexexempmpptititiononss lelelegagag lililizizizingngg tthehe uusese oof f cacannnnababisis foforr memedidicacal l pupurprprposososeseses.. AnAnAn iiincncncrerereasasasiniing g g prprpropopopororortititiononon ooof ff jujujuriirisddsdicictitionons s hahaveve aalslso odedecrcrimimininalalizizeded aanddnd lllegegegalalalizizizededed rrrecececrerereatatatioioionananall l cacacannnnnnabababisisis uuusesese..

TThehe uusese oof f eieiththerer mmmedededicicicalalal ooor rr rererecrcrcreaeaeatititionononalalal cccananannananabibibis ss rararaisisiseseses eeevovovolvlvlvinini g g pupublblicic

hehehealala thth, , nunursrsining g prpracactiticece, , scscieiencnce,e, llegegalal, , ededucucatatioion,n, eeththicicalal, , anand d sosocicialal iissssueues.s OfOfOf sssigigigninin ficficanancece, , ththerere e isis aa cconontrtradadicictitionon bbetetweweenen tthehe ffededereralal llawaw cclalassssififyiyingng cacacannnnnnabababisisis aaas s a a ScSchehedudulele II CConontrtrololleled d SuSubsbstatancnce e anand d vavaririouous s ststatateses llegegalalizizining g itits sususee memedididicacalllllly,y,y, rrececrereatatioionanalllly,y, oor r bobothth. . ThThisis ffededereralal cclalassssifiificacatitionon hhasas pprereveventnteded opopopenenen aaandndnd uuunlnlnlimimimitititededed rreseseaearcrch h onon ccanannanabibis.s AAs s a a reresusultlt, , rereseseararchch oon n ththe e efefficficacacy y ofofof cccananannananabibibis s s fofofor r r trtrtreaeaeatmtmtmenenent t ofof ccerertatainin mmededicicalal cconondidititionons s isis llimimititeded aandnd llacackikingng..SpSpSpecececifiifiificacacalllllly,y,y, ttthehehe rrreseseseaeaearcrcrch hh hahah s s nonot t dedefinfinititivivelely y spspececifiifieded iindndicicatatioionsns,, dodosasagege, , roroututute,e,, ssafafafetetety,y,y, aadvdvdverersese eeffffffecectststs,,, anand d lolongng-t-tererm m efeffefectcts s ofof ccanannanabibis.s.

WiWiWithththououout tt evevevidididenenencecece ttthahahat tt isisis ssscicicienenentititificficalallyly rrigigororouous,s, sstatatitiststicicalallyly rrepeporortatablble,e, ananand d d bababasesesed d d ononon pppatatatieieientntnt pppopopopulululatatatioioionsnsns, , nununursrsr eses wwilill l fafacece iincncrereasasining g chchalallelengngeses cococoncncncererernininingngng mmmedededicicicalalal cccananannananabibibis.ss TTTo oo adadaddrdrdresesess ss ththt e e lalackck oof f guguididelelinineses fforor nnururseses swhwhenen ccararinining g g fofoforr ininindididivivividududualalalss utututilililizizizinining g g cacannnnabababisisis,,, ththee NaNatitiononalal CCououncncilil oof f StStatate e BoBoarardsds ooof ff NuNuNursrsrsinining g g BoBoBoararard dd ofofof DDDiririrececectototorsrsrs aaappppppoioiointntntededed mmmemembebersrs tto o ththe e MeMedidicacal lMaMaririjujuanana a NuNuNursrsrsinining g g GuGuGuidididelelelininineseses CCComomommimimitttttteeeeee (((sesesee e e ApApAppepependndixix AA).). IIn n orordeder r toto ccrereatatee ththe e rereequququesesesteteted dd guguguidididelelelininineseses aaandndnd rrrecececomomommememendndndatatatioioionsnsn fforor eeduducacatitionon anandd cacarere,, aa rereviviewew ooff f thththee rerelelelevavantntnt sstatatatititistststicicics,s,, ccururrerentntnt lllegeggisisislalalatititionon, , scscieientntifiific c liliteteraratuturere, , anand d clclininicicalal rrreseseseaeaearcrcrch hh ononon cccananannananabibibis ss asasas aaa tttheheherararapepepeutututicicic aaagegegentnt wwasas rereququirireded.. ThThe e CoCommmmititteteee alalalsososo ccconononsususultltltededed kkknononownwnwn eeexpxpxpererertststs iiin n n thththe e e ararareaeaea oof f memedidicacal l mamaririjujuanana,a, iitsts uusese,, sasafefetytyty, , , ananand dd lelelegigigislslslatatatioioion.nn TTThihihis ss rererepopoportrtrt dddocococumumumenenentststs ththee reresusultltss ofof tthihiss woworkrk aandnd ppreresesentntntss thththisisis iiimpmpporortatatantntnt iiinfnfnforormamatititionon iiinn twtwtwoo papartrts.s. PParartt I I prpresesenentsts tthehe rresesulultsts oof f ththesese e rerereviviviewewews ss ananand dd cococonsnsnsululultatatatititiononons;s;s; PPPararart tt IIIIII prpresesenentsts tthehe sspepecicificfic GGuiuidedelilinenes s crcreaeateted d byby ttthehehe CCComomommimimitttttteeeeee: : : nununursrsrsinining g g cacacarerere ooof f fththe e papatitienent t ususining g memedidicacal l mamaririjujuanana,a, mmededicicalal mmmarararijijijuauauananana eeedududucacacatititiononon iiin nn prprpre-e-elilicecensnsururee nunursrsining g prprogograramsms,, memedidicacall mamaririjujuananaa ededucucatatatioioionn ininin AAAPRPRPRNNN nunursrsinining g gprprogograramsms, , anand d APAPRNRNs s cecertrtififyiyingng aa mmededicicalal mmararijijuauanana qquauaalililifyfyfyinining g g cococondndnditititioioion.nn.

* In Australia, cannabis for medical use is fefedederaralllly y lelegagal,l, wwwitith h ststatateses aallllowoweded tto o imimplplememenentt asas tthehey y sesee e fitfit.. AlAlththououghgh BBerermumudada hahas s nonot t lelegigislslatateded uusese oof fmarijuana, their Supreme Court ruled that citizezensns ccououldld aappppplylyly fforor pperersosonanall lilicecensnseses ttoo popossssesesss cacannnnababisis fforor mmededicicalal uusese.. CaCannnnababisis fforor mmededicicalal uusese iiss federally legal in all provinces of Canada. In New Zeaalalandnd,, phphysysiciciaiaiansnsn mmayay pprerescscriribebe CCBDBD aandnd ccanannanabibis-s-babasesed d prprododucuctsts..

NURSING CARE OF THE PATIENT USING MEDICAL MARIJUANAPurpose of the Guidelines

OvOvererer 3311 USUS jjururisisdidictctioionsns ((ininclclududining g ththe e DiDiststririctct oof f CoColulumbmbiaia),), GGuauam,m,

anand d PuPuereertoto RRicicoo papasssseded llegegisislalatitionon llegegalalizizining g cacannnnababisis fforor mmededicicalal uusese..

SeSeveverarall ottotheheher r jujuririsdsdicictitiononss alalsoso hhavave e lelegagalilizezed d cacannnnababisis fforor mmededicicalal

usse.e.** EaEachch mmedededicicalal mmararijijuauanana pprorogrgramam hhasas uuniniquque e chchararacacteteririststicics.s.

In thehe UUniniteted d StStatattesees,, cacannnnababisis iiss aa ScSchehedudulele II CConontrtrololleled d SuSubsbstatancnce.e.

Therefore,e, mmededicicalal cccanana nanabibiss isis uunlnlikike e momostst ooththerer ttheherarapepeututicics s

in that provididerers s cacannnnottot ppprerescscriribebe ccanannanabibis,s, nnoror ccanan pphaharmrmacacieies s

dispense cannabiis.s. HHowoweveverer, , appapplplp icicabablele jjururisisdidictctioionn ststatatututeses aandnd rrululeses

provide for the manunufafactcturure,e, ddissistrtrtribibututioion,n, aandnd uusese oof f cacannnnababisis fforor

medical purposes.

These guidelines providede nnurursesess wiwiwiththt ppririncncipipleless ofof ssafafee anand d

knowledgeable practice to prommototee papatitienentt sasas fefetyty wwhehen n cacariringng fforor

patients using medical marijuana.

Definitions

CaCannnnababisis.. AnAny y raraw w prprepepararatatioion n ofof tthehe lleaeavevess oror flflowowerers s frfromom tthehe pplalantnt s

gegenunuss CaCannnnababisis.. ThThisis rrepeporort tt ususeses “““cacannnnababisis”” asas aa sshohortrthahandnd tthahat t alalsoso s

ininclclududeses ccanannanabibinonoidids.s

CaCannnnababididioiol l (C(CBDBD).). AA mmajajoror ccanannanabibinonoidid tthahat t inindidirerectctlyly aantntagagononizizeses

cacannnnababininoioid d rerececeptptorors,s, wwhihichch mmayay aattttttenenuauatetete ttthehehe ppsysychchoaoactctivivee efeffefectctss ofof

tetetrtrahahydydrorocacannnnababininolol.

CaCannnnababininoioidd.. AnAny y chchememicicalal ccomompopounund d ththatat aactctss onon ccanannanabibinonoidid rrececepeptotorsrs..dd

ThThesesee ininclclududee enendodogegenonousus aandnd eexoxogegenonousus ccanannanabibibinonoididids.s. CaCaCannnnababininolol

(C(CBNBN).). AA ccanannanabibinonoidid mmorore e cocommmmononlyly ffououndnd iin n agagededed ccanannanabibibis s asas aa

memetatabobolilitete oof f ototheher r cacannnnababininoioidsds. . ItIt iiss nononpnpsysychchoaoactctivive.e.

CeCertrtifify.y. ThThee acact t ofof ccononfirfirmimingng tthahat t aa papatitienent t hahass aa ququalalififyiyingng cconondididitititionon..

MaManyny jjururisisdidictctioionsns uusese aaltlterernanatitiveve pphrhrasaseses ssucuch h asas ““atattetestst”” oror ““auauththororizizize”e”e ; ;

hohowewevever,r, 113 3 ofof 229 9 jujuririsdsdicictitionons s ususe e “c“cerertitifyfy”” lalangnguauagege iin n ththeieir r ststatatututeses. .

The following article is reprinted with permission from the Journal of Nursing Regulation, Volume 9, Issue 2 – July 2018 Supplement, “The NCSBN National Nursing Guidelines for Medical Marijuana.”


Clinical research. An activity that involves studies that experimentally assign randomized human participants to one or more drug interventions to evaluate the effects on health outcomes.Designated caregiver. An individual who is selected by the Medical Marijuana Program qualifying patient and authorized by the Medical Marijuana Program to purchase and/or administer cannabis on the patient’s behalf. Also sometimes referred to as an “alternate caregiver.”Dronabinol. The generic name for synthetic tetrahydrocannabinol. It is the active ingredient in the U.S. Food & Drug Administration–approved drug Marinol.Endocannabinoid system. A system that consists of endocannabinoids, cannabinoid receptors, and the enzymes responsible for synthesis and degradation of endocannabinoids.Marijuana. A cultivated cannabis plant, whether for recreational or medicinal use. The words “marijuana” and “cannabis” are often used interchangeably in various lay and scientific literature. These guidelines will primarily use the word “cannabis.” When referring to a medical marijuana program, the guidelines will use the word “marijuana,” as it is often used within program references.Medical Marijuana Program (MMP). The official jurisdictional resource for the use of cannabis for medical purposes. Search the jurisdiction’s website or Department of Health for “medical cannabis program” or “medical marijuana program.”1

Nabilone. The generic name for a synthetic cannabinoid similar to tetrahydrocannabinol. It is the active ingredient in the U.S. Food & Drug Administration–approved drug Cesamet.Schedule I Controlled Substance. Defined in the federal Controlled Substances Act2 as those substances that have a high potential for abuse; no currently accepted medical use in treatment in the United States; and a lack of accepted safety for use of the substance under medical supervision.Tetrahydrocannabinol (THC). One of many cannabinoids found in cannabis. THC is the primary substance responsible for most of the characteristic psychoactive effects of cannabis.3

RecommendationsEssential Knowledge1. The nurse shall have a working knowledge of the current state of legalization of medical and recreational cannabis use. • The Drug Enforcement Agency (DEA) classifies cannabis as a Schedule I Controlled Substance. This classification not only prohibits practitioners from prescribing cannabis, it also prohibits most research using cannabis.4

• The process for obtaining cannabis for federally funded research purposes is cumbersome. Currently, the only legal source of cannabis for research purposes is grown in limited quantities at the University of Mississippi.5 The DEA sets an annual quota for cannabis grown for research purposes.6

• Over 31 jurisdictions (including the District of Columbia), Guam, and Puerto Rico passed legislation legalizing cannabis for medical purposes. In these laws, the jurisdiction has adopted exemptions legalizing the use of cannabis for medical purposes. Although the

use of marijuana pursuant to authorized MMPs conflicts with federal law and regulations, at present there is no controlling case law holding that Congress intended to preempt the field of regulation of cannabis use under its supremacy powers.7

• An increasing proportion of jurisdictions have also decriminalized or legalized recreational cannabis use.8

• The federal government’s position on prosecuting the use of cannabis that is legal under applicable jurisdiction law has been set out in U.S. Department of Justice position papers. In 2009, the U.S. Attorney General took a position that discourages federal prosecutors from prosecuting people who distribute or use cannabis or medical purposes in compliance with applicable jurisdiction law; further similar guidance was given in 2011, 2013, and 2014.9 In January 2018, the U.S. Office of the Attorney General rescinded the previous nationwide guidance specific to marijuana enforcement. The 2018 memorandum10 provides that federal prosecutors follow the well-established principles in deciding which cases to prosecute, namely, the prosecution is to weigh all relevant considerations, including priorities set by the attorneys general, seriousness of the crime, deterrent effect of criminal prosecution, and cumulative impact of particular crimes on the community.2. The nurse shall have general knowledge of the principles of an MMP. • MMPs are defined and described within the statute and rules of the specific jurisdiction. The relevant statute or rules are most easily located through the jurisdiction’s Department of Health and MMP.11 Laws and rules regarding MMPs are an evolving process. Always confirm use of the most recent versions. • A health care provider does not prescribe cannabis. • The MMP will specify the qualifying conditions and the certifying p rocess as well as the type of health care provider who can certify a qualifying condition.12

• The MMP will specify whether an advanced practice registered nurse can certify a qualifying condition and whether a specific course or training is required in order to participate in certifying an MMP qualifying condition.13

• After the qualifying condition is certified, the patient registers with the MMP. Once registered, the patient can obtain cannabis from a jurisdiction-authorized cannabis dispensary. • Procurement and administration of cannabis for medical purposes are limited to the patient and/or the patient’s designated caregiver. The MMPs will specify whether designated caregivers are permissible as well as the applicable process for registration as a designated caregiver.14

• In some jurisdictions, the MMP allows an employee of a hospice provider or nursing, or medical facility, or a visiting nurse, personal care attendant, or home health aide to act as a designated caregiver for the administration of medical marijuana.15

3. The nurse shall have a general understanding of the endocannabinoid system, cannabinoid receptors, cannabinoids, and the interactions between them.

14 MOMENTUM

• The endocannabinoid system consists of endocannabinoids, cannabinoid receptors, and the enzymes responsible for synthesis and degradation of endocannabinoids.16

• Discovered in 1973, this system includes a series of cannabinoid receptors throughout the body embedded in cell membranes that, when stimulated by endocannabinoids, are thought to promote homeostasis.17

• Endocannabinoids are naturally occurring substances within the body, while phytocannabinoids (plant substances that stimulate cannabinoid receptors) are found in cannabis.18

• The most well known of these cannabinoids is tetrahydrocannabinol (THC); however, cannabidiol (CBD) and cannabinol (CBN) are gaining interest in therapeutic use.19

4. The nurse shall have an understanding of cannabis pharmacology and the research associated with the medical use of cannabis. Due to government restrictions on research involving cannabis, the surge of legislation has outpaced research, leaving nurses with few resources when caring for patients who use medical cannabis. Therefore, information regarding medicinal use of cannabis must be derived from moderate- to high-quality evidence using randomized placebo-controlled studies. These particular studies are the most likely to elucidate causality in treatments and are the only trusted source of evidence for cannabis as a clinical intervention. Research on cannabis is an evolving body of work. As with any scientific literature, it is important to rely on the most recent high-quality evidence. a. Current scientific evidence exists for the use of cannabis for the following qualifying conditions

Moderate- to high-quality evidence exists for • cachexia • chemotherapy-induced nausea and vomiting • pain (resulting from cancer or rheumatoid arthritis) • chronic pain (resulting from fibromyalgia), • neuropathies (resulting from HIV/AIDS, Multiple Sclerosis [MS], or diabetes) • spasticity (from MS or spinal cord injury).20

b. Adverse effects of cannabis use are influenced by the patient’s condition and current medications

The patient’s propensity for the following may be exacerbated by cannabis: increased heart rate, increased appetite, sleepiness, dizziness, decreased blood pressure, dry mouth/dry eyes, decreased urination, hallucination, paranoia, anxiety, impaired attention, memory, and psychomotor performance.21

Cannabis may exacerbate symptoms associated with asthma, bronchitis, and emphysema; cardiac disease; and alcohol or other drug dependence.22

Cognitive impairment by cannabis may be dose- and age-dependent.23

It is highly likely that cannabis will exacerbate symptoms of poor balance and posture in patients with dyskinetic disorders. Similarly, cannabis may worsen mental faculties in conditions that cause cognitive deficits. Patients who suffer from diseases with neurologic symptomology may show greater cognitive impairment.24

Some participants report fatigue, suicidal ideation, nausea,

asthenia, and vertigo as adverse effects of cannabis.25

Cannabinoid receptors are effectively absent in the brainstem cardiorespiratory centers. This is believed to preclude the possibility of a fatal overdose from cannabinoid intake.26

Cannabis can be a drug of abuse. Cannabis use disorder is defined as a problematic pattern of cannabis use leading to clinically significant impairment or distress; the clinical indications are included in the DSM-5.27

Cannabis withdrawal syndrome has been identified as a syndrome seen in some patients whose cannabis use has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months). The withdrawal syndrome has varying symptomatology, including insomnia, loss of appetite, physical symptoms, and restlessness initially, then irritability/ anger, vivid and unpleasant dreams after a week.28

c. Variable effects of cannabis are dependent on type of product and route of administration Since medical cannabis is not an FDA drug, there is no recommended dosage. Instead medical cannabis is titrated by the patient, with the principle of “start low, go slow.” Continual patient assessment of perceived efficacy and adverse effects is recommended. Useful strategies include tracking dose, symptoms, relief, and adverse effects in a journal for review with the authorizing practitioner. FDA-approved synthetic THC drugs (dronabinol and nabilone) are administered orally or by an oromucosal route with a specific dosage. d. Risks to particular groups of patients Adolescence. Many studies show a correlation between cannabis use and poor grades, high dropout rates, lower income, lower percentage of college degree completion, greater need for economic assistance, unemployment, and use of other drugs. Although these trends are related to recreational rather than medicinal cannabis use, the trends cannot be ignored but should be balanced with the benefits of cannabis for medical use.29 Fertility. Two preclinical studies indicate that interference with endogenous cannabinoids might increase chances of failed embryo implantation30 and cannabinoids are capable of dysregulating hormones, which in turn can affect spermatogenesis.31

Neonates. Presently there are no reliable data for neurodevelopmental outcomes with early exposure to cannabis in neonatal life, or through either breastfeeding or secondhand inhalation.32,33,34

Cannabis can be a drug of abuse and precautions should be taken to minimize the risk of misuse and abuse. Cannabis use may exacerbate existing psychoses in those with a risk of suicide or history of suicide attempt, schizophrenia, bipolar disorder, or other psychotic conditions.35

5. The nurse shall be aware of the facility or agency policies regarding administration of medical marijuana. Always check with the facility and local Department of Health or MMP for more information on the facility policy when caring for a patient using cannabis medically.36


Clinical Encounter Considerations1. As part of the clinical encounter for a patient using cannabis for medical use, the nurse shall conduct an assessment related to the following: Signs and symptoms of cannabis adverse effects Increased heart rate, increased appetite, sleepiness, dizziness, decreased blood pressure, dry mouth/dry eyes, decreased urination, hallucination, paranoia, anxiety, impaired attention, memory, psychomotor performance37 as well as symptoms associated with asthma, bronchitis, and emphysema38 or exacerbation of poor balance and posture in patients with dyskinetic disorders.39

Less frequently: fatigue, suicidal ideation, nausea, asthenia, and vertigo. Hyperemesis syndrome caused by overconsumption of edible cannabis product that can cause higher than normal blood concentrations of cannabinoids.40

Variable effects of cannabis are dependent on type of product and r oute of administration. As medical cannabis dosage is titrated by the patient, with the principle of “start low, go slow,” continual patient assessment of perceived efficacy and adverse effects is recommended. Useful strategies include tracking dose, symptoms, relief, and adverse effects in a journal.2. The nurse shall communicate the findings of the clinical encounter to other health care providers and note such communication in documentation. Clear, complete, and accurate documentation in a health record ensures that all those involved in a patient’s care have access to information upon which to plan and evaluate their interventions.3. The nurse shall be able to identify the safety considerations for patient use of cannabis. • Administration of cannabis for medical use can only be carried out by the certified patient or designated caregivers registered to care f or the patient. • Cannabis storage considerations include: keeping cannabis out of the reach of children, minors, and nonregistered individuals

storing all cannabis products in a locked area keeping cannabis in the original child-resistant packaging storing raw cannabis in a cool, dry place following labeling guidelines for storage and expiration dates • Disposal of unused cannabis products should be completed according to the DEA’s Disposal Act.41 Generally, one can locate a collection receptacle via the DEA Registration Call Center (800-882-9539).

Medical Marijuana Administration Considerations1. A nurse shall not administer cannabis to a patient unless specifically authorized by jurisdiction law.42

2. Instances in which the nurse may administer cannabis or synthetic THC to a patient. • Administration of FDA-approved synthetic THC drugs (dronabinol and nabilone) as per facility formulary and policy • As a registered MMP-designated caregiver The majority of jurisdictions allow a designated caregiver to assist a patient with the medical use of cannabis. These caregivers must meet specific qualifications and be registered with the MMP and must not practice outside of the l imits of the caregiving statute.43

Some jurisdictions allow an employee of a hospice provider or nursing or medical facility, or a visiting nurse, to assist in the administration of medical marijuana. Check the most current MMP statute or rules.44

Check facility policy regarding medical marijuana administration.

Ethical ConsiderationsIn addition to ethical responsibilities under the nurse’s jurisdictional law, the nurse shall approach the patient without judgment regarding the patient’s choice of treatment or preferences in managing pain and other distressing symptoms. Awareness of one’s own beliefs and attitudes about any therapeutic intervention is vital, as nurses are expected to provide patient care without personal judgment of patients.

References1. National Conference of State Legislatures (NCSL). (2017). State Medical Marijuana Laws. Retrieved from http://www.ncsl.org research/health/state-medical-marijuana-laws.aspx2. Comprehensive Drug Abuse Prevention and Control Act. (1970). 21 U.S.C. § §801 – 904.3. U.S. Department of Transportation. National Highway Traffic Safety Administration (NHTSA). (2107). Marijuana-Impaired Driving A Report to Congress. Retrieved from https://

www.nhtsa.gov/ sites/nhtsa.dot.gov/files/documents/812440-marijuana impaireddriving- report-to-congress.pdf4. Comprehensive Drug Abuse Prevention and Control Act. (1970). 21 U.S.C. § §801 – 904.5. National Institute on Drug Abuse (NIDA). (May 2017). Information on Marijuana Farm Contract. Retrieved from https:/ www.drugabuse. gov/drugs-abuse/marijuana/ nidas-role-

in-providing marijuana-research/information-marijuanafarm-contract6. U.S. Department of Justice, Drug Enforcement Administration (DEA). (November 8, 2017). Established Aggregate Production Quotas for Schedule I and II Controlled

Substances and Assessment of Annual Needs for the List I Chemicals Ephedrine, Pseudoephedrine, and Phenylpropanolamine for 2018. 82 FR 51873. Retrieved from https://www.federalregister.gov/documents/2017/ 11/08/2017-24306/established-aggregate-production-quotas forschedule- i-and-ii-controlled-substances-and-assessment

7. Mikos. R.A. (December 12, 2012). On the Limits of Federal Supremacy: When States Relax (or Abandon) Marijuana Bans. Cato Institute. Policy Analysis, No. 714. Retrieved from https://object. cato.org/sites/cato.org/files/pubs/pdf/PA714.pdf; Beek v. City of Wyoming. (February 6, 2014) (Findlaw, Dist. 145816). Retrieved from http://caselaw.findlaw.com/mi-supreme-court/1656759.html

8. NCSL. (2017). State Medical Marijuana Laws. Retrieved from http://www.ncsl.org/research/health/state-medical-marijuana-laws. aspx9. U.S. Department of Justice, Office of Public Affairs (DOJ). (October 19, 2009). Attorney General Announces Formal Medical Marijuana Guidelines. Retrieved from https://

www.justice.gov/opa/pr/attorney-general-announces-formal-medical-marijuana guidelines; DOJ. (June 29, 2011). Guidance Regarding the Ogden Memo in Jurisdictions Seeking to Authorize Marijuana for Medical Use. Retrieved from https://www.justice.gov/sites/default/files/oip/legacy/ 2014/07/23/dag-guidance-2011-for-medical-marijuana-

16 MOMENTUM

use pdf; DOJ. (August 29, 2013). Guidance Regarding Marijuana Enforcement. Retrieved from https://www.justice.gov/iso/opa/resources/ 3052013829132756857467 pdf; DOJ. (February 14, 2013). Guidance Regarding Marijuana Related Financial Crimes. Retrieved from https://www.justice.gov/sites/default/files/usao-wdwa/legacy/ 2014/02/14/DAG%20Memo%20-%20Guidance%20Regarding% 20Marijuana%20Related%20Financial%20Crimes%202%20 14%2014%20%282%29.pdf; DOJ. (October 28, 2014). Policy Statement Regarding Marijuana Issues in Indian Country. Retrieved from https://www.justice.gov/sites/default/files/tribal/pages/attachments/ 2014/12/11 policystatementregardingmarijuanaissuesinindiancountry2. pdf

10. DOJ. (January 4, 2018). Marijuana Enforcement. Retrieved from https://www.justice.gov/opa/press-release/file/1022196/download11. NCSL. (2017). State Medical Marijuana Laws. Retrieved from http://www.ncsl.org/research/health/state-medical-marijuana-laws. spx12. Ibid.13. Ibid.14. Ibid.15. Ibid.16. Mackie K. Cannabinoid receptors: where they are and what they do. J Neuroendocrinol 2008; 20 Suppl 1: 10-4. http://onlinelibrary. wiley.com/doi/10.1111/j.1365-

2826.2008.01671.x/full17. Ibid.18. Ibid.19. Pacher et al. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacological Reviews 2006; 58: 389-462. https://www.ncbi.nlm.nih.gov/pmc/articles/

PMC2241751/20. National Academies of Sciences, Engineering, and Medicine (National Academies of Sciences). (2017). The Health Effects of Cannabis and Cannabinoids: The Current

Jurisdiction of Evidence and Recommendations for Research. Washington, D.C.: National Academy Press; Madras, B. (2015). Update of cannabis and its medical use. Retrieved from http://www.who.int/medicines/access/controlled- substances/6_2_cannabis_update.pdf

21. Federal Drug Administration. (September 2004). Marinol (Dronabinol) Capsules. Retrieved from https://www.fda.gov/ohrms/dockets/ dockets/05n0479/05N-0479-emc0004-04.pdf22. Hall, W., & Solowij, N. (1998). Adverse effects of cannabis. The Lancet, 352(9140), 1611-1616; Tashkin, D. P. (2013). Effects of marijuana smoking on the lung. Annals of the

American Thoracic Society, 10(3), 239-247; Federal Drug Administration (FDA). (September 2004). Marinol (Dronabinol) Capsules. Retrieved from https://www.fda.gov/ohrms/dockets/dockets/05n0479/05N-0479- emc0004-04.pdf

23. Crean, R. D., Crane, N. A., & Mason, B. J. (2011). An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions. Journal of addiction medicine, 5(1), 1; Solowij, N., & Pesa, N. (2012). Cannabis and cognition: short and long-term effects. Marijuana and madness, 2, 91-102.

24. Koppel, B. S., Brust, J. C., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., & Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556-1563.

25. Collin, C., Ehler, E., Waberzinek, G., Alsindi, Z., Davies, P., Powell, K., ... & Zapletalova, O. (2010). A double-blind, randomized, placebo- controlled, parallel-group study of Sativex, in subjects with symptoms of spasticity due to multiple sclerosis. Neurological research, 32(5), 451-459; National Academies of Sciences. (2017). The Health Effects of Cannabis and Cannabinoids: The Current Jurisdiction of Evidence and Recommendations for Research. Washington, D.C.: National Academy Press; Madras, B. (2015). Update of cannabis and its medical use. Retrieved from http://www.who.int/medicines/access/controlled-substances/6_2_cannabis_update.pdf

26. Glass, M., Faull, R. L. M., & Dragunow, M. (1997). Cannabinoid receptors in the human brain: a detailed anatomical and quantitative autoradiographic study in the fetal, neonatal and adult human brain. Neuroscience, 77(2), 299-318.

27. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.28. Hesse, M., & Thylstrup, B. (2013). Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers. BMC psychiatry, 13(1), 258; American Psychiatric

Association. (2013). American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author; Budney, A. J., Moore, B. A., Vandrey, R. G., & Hughes, J. R. (2003). The time course and significance of cannabis withdrawal. Journal of abnormal psychology, 112(3), 393.

29. Madras, B. (2015). Update of cannabis and its medical use. Retrieved from http://www.who.int/medicines/access controlledsubstances/ 6_2_cannabis_update.pdf; Crean, R. D., Crane, N. A., & Mason, B. J. (2011). An evidence based review of acute and longterm effects of cannabis use on executive cognitive functions. Journal of addiction medicine, 5(1), 1.

30. Park, B., McPartland, J. M., & Glass, M. (2004). Cannabis, cannabinoids and reproduction. Prostaglandins, leukotrienes and essential fatty acids, 70(2), 189-197.31. du Plessis, S. S., Agarwal, A., & Syriac, A. (2015). Marijuana, phytocannabinoids, the endocannabinoid system, and male fertility. Journal of assisted reproduction and genetics,

32(11), 1575-1588.32. Jaques, S. C., Kingsbury, A., Henshcke, P., Chomchai, C., Clews, S., Falconer, J., ... & Oei, J. L. (2014). Cannabis, the pregnant woman and her child: Weeding out the myths.

Journal of Perinatology, 34(6), 417.33. Jutras-Aswad, D., DiNieri, J. A., Harkany, T., & Hurd, Y. L. (2009). Neurobiological consequences of maternal cannabis on human fetal development and its neuropsychiatric

outcome. European Archives of Psychiatry and Clinical Neuroscience, 259(7), 395-412.34. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219-2227.35. Wilkinson, S. T., Radhakrishnan, R., & D’Souza, D. C. (2014). Impact of cannabis use on the development of psychotic disorders. Current addiction reports, 1(2), 115-128.36. NCSL. (2017). State Medical Marijuana Laws. Retrieved from http://www.ncsl.org/research/health/state-medical-marijuana-laws. aspx37. FDA. (September 2004). Marinol (Dronabinol) Capsules. Retrieved from https://www.fda.gov/ohrms/dockets dockets/05n0479/05N- 0479-emc0004-04.pdf38. Hall, W., & Solowij, N. (1998). Adverse effects of cannabis. The Lancet, 352(9140), 1611-1616; Tashkin, D. P. (2013). Effects of marijuana smoking on the lung. Annals of the

American Thoracic Society, 10(3), 239-24739. Koppel, B. S., Brust, J. C., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., & Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic

disorders Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556-1563. #40 Calabria, B., Degenhardt, L., Hall, W., & Lynskey, M. (2010). Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use. Drug and alcohol review, 29(3), 318-330. #41 DEA. (2014). Disposal Act: General Public Fact Sheet. Retrieved from https://www.deadiversion.usdoj.gov/drug_disposal/fact_sheets/ disposal_public.pdf

40. Calabria, B., Degenhardt, L., Hall, W., & Lynskey, M. (2010). Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use. Drug and alcohol review, 29(3), 318-330.

41. DEA. (2014). Disposal Act: General Public Fact Sheet. Retrieved from https://www.deadiversion.usdoj.gov/drug_disposal/fact_sheets/ disposal_public.pdf42. NCSL. (2017). State Medical Marijuana Laws. Retrieved from http://www.ncsl.org/research/health/state-medical-marijuana-laws. aspx43. Ibid.44. Ibid.


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18 MOMENTUM

MEDICAL MARIJUANA EDUCATION IN PRE-LICENSURE NURSING PROGRAMSPurpose of the GuidelinesOver 31 US jurisdictions (including the District of Columbia), Guam, and Puerto Rico passed legislation legalizing cannabis for medical use. Several other jurisdictions also have legalized cannabis for medical use.* Each medical marijuana program has unique characteristics. In the United States, cannabis is a Schedule I Controlled Substance. Therefore, medical cannabis is unlike most other therapeutics in that providers cannot prescribe cannabis, nor can pharmacies dispense cannabis. However, applicable jurisdiction statutes and rules provide for the manufacture, distribution, and use of cannabis for medical purposes.These recommendations for curriculum content provide nurses with principles of safe and knowledgeable practice to promote patient safety when caring for patients using medical marijuana.

DefinitionsCannabis. Any raw preparation of the leaves or flowers from the plant genus Cannabis. This report uses “cannabis” as a shorthand that also includes cannabinoids.Cannabidiol (CBD). A major cannabinoid that indirectly antagonizes cannabinoid receptors, which may attenuate the psychoactive effects of tetrahydrocannabinol.Cannabinoid. Any chemical compound that acts on cannabinoid receptors. These include endogenous and exogenous cannabinoids. Cannabinol (CBN). A cannabinoid more commonly found in aged cannabis as a metabolite of other cannabinoids. It is nonpsychoactive.Certify. The act of confirming that a patient has a qualifying condition. Many jurisdictions use alternative phrases such as “attest” or “authorize”; however, 13 of 29 jurisdictions use “certify” language in their statutes. Clinical research. An activity that involves studies that experimentally assign randomized human participants to one or more drug interventions to evaluate the effects on health outcomes.Designated caregiver. An individual who is selected by the Medical Marijuana Program qualifying patient and authorized by the Medical Marijuana Program to purchase and/or administer cannabis on the patient’s behalf. Also sometimes referred to as an “alternate caregiver.”Dronabinol. The generic name for synthetic tetrahydrocannabinol. It is the active ingredient in the U.S. Food & Drug Administration–approved drug Marinol.Endocannabinoid system. A system that consists of endocannabinoids, cannabinoid receptors, and the enzymes responsible for synthesis and degradation of endocannabinoids.Marijuana. A cultivated cannabis plant, whether for recreational or medicinal use. The words “marijuana” and “cannabis” are often used interchangeably in various lay and scientific literature. These guidelines will primarily use the word “cannabis.” When referring to a medical marijuana program, the guidelines will use the word “marijuana,” as it is often used within program references.Medical Marijuana Program (MMP). The official jurisdictional resource for the use of cannabis for medical purposes. Search the jurisdiction’s website

or Department of Health for “medical cannabis program” or “medical marijuana program.”1

Nabilone. The generic name for a synthetic cannabinoid similar to tetrahydrocannabinol. It is the active ingredient in the U.S. Food & Drug Administration–approved drug Cesamet.Schedule I Controlled Substance. Defined in the federal Controlled Substances Act2 as those substances that have a high potential for abuse; no currently accepted medical use in treatment in the United States; and a lack of accepted safety for use of the substance under medical supervision.Tetrahydrocannabinol (THC). One of many cannabinoids found in cannabis. THC is the primary substance responsible for most of the characteristic psychoactive effects of cannabis.3

Recommendations1. The nursing student shall have a working knowledge of the current state of legalization of medical and recreational cannabis use. • The Drug Enforcement Agency (DEA) classifies cannabis as a Schedule I Controlled Substance. This classification not only prohibits practitioners from prescribing cannabis, it also prohibits most research using cannabis.4

• The process for obtaining cannabis for federally funded research purposes is cumbersome. Currently, the only legal source of cannabis for research purposes is grown in limited quantities at the University of Mississippi.5 The DEA sets an annual quota for cannabis grown for research purposes.6

• Over 31 jurisdictions (including the District of Columbia), Guam, and Puerto Rico passed legislation legalizing cannabis for medical purposes. In these laws, the jurisdiction has adopted exemptions legalizing the use of cannabis for medical purposes. Although the use of marijuana pursuant to authorized MMPs conflicts with federal law and regulations, at present there is no controlling case law holding that Congress intended to preempt the field of regulation of cannabis use under its supremacy powers.7

• An increasing proportion of jurisdictions have also decriminalized or legalized recreational cannabis use.8

• The federal government’s position on prosecuting the use of cannabis that is legal under applicable jurisdiction law has been set out in U.S. Department of Justice position papers. In 2009, the U.S. Attorney General took a position that discourages federal prosecutors from prosecuting people who distribute or use cannabis for medical purposes in compliance with applicable jurisdiction law; further similar guidance was given in 2011, 2013, and 2014.9 In January 2018, the U.S. Office of the Attorney General rescinded the previous nationwide guidance specific to marijuana enforcement. The 2018 memorandum10 provides that federal prosecutors follow the well-established principles in deciding

* In Australia, cannabis for medical use is federally legal, with states allowed to implement as they see fit. Although Bermuda has not legislated use of marijuana, their Supreme Court ruled that citizens could apply for personal licenses to possess cannabis for medical use. Cannabis for medical use is federally legal in all provinces of Canada. In New Zealand, physicians may prescribe CBD and cannabis-based products.

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which cases to prosecute, namely, the prosecution is to weigh all relevant considerations, including priorities set by the attorneys g eneral, seriousness of the crime, deterrent effect of criminal prosecution, and cumulative impact of particular crimes on the community. 2. The nursing student shall have general knowledge of the principles of an MMP. • MMPs are defined and described within the statute and rules of the specific jurisdiction. The relevant statute or rules are most easily located through the jurisdiction’s Department of Health and MMP.11 Laws and rules regarding MMPs are an evolving process. Always confirm use of the most recent versions. • A health care provider does not prescribe cannabis. • The MMP will specify the qualifying conditions and the certifying process as well as the type of health care provider who can certify a qualifying condition.12

• The MMP will specify whether an APRN can certify a qualifying condition and whether a specific course or training is required in rder to participate in certifying an MMP qualifying condition.13

• After the qualifying condition is certified, the patient registers with the MMP. Once registered, the patient can obtain cannabis from a jurisdiction-authorized cannabis dispensary. • Procurement and administration of cannabis for medical purposes are limited to the patient and/or the patient’s designated caregiver. The MMPs will specify whether designated caregivers are permissible as well as the applicable process for registration as a designated caregiver.14

• In some jurisdictions, the MMP allows an employee of a hospice provider or nursing or medical facility, or a visiting nurse, personal are attendant, or home health aide to act as a designated caregiver for the administration of medical marijuana.15

3. The nursing student shall have a general understanding of the endocannabinoid system, cannabinoid receptors, cannabinoids, and the interactions between them. • The endocannabinoid system consists of endocannabinoids, cannabinoid receptors, and the enzymes responsible for synthesis and degradation of endocannabinoids.16

• Discovered in 1973, this system includes a series of cannabinoid r eceptors throughout the body embedded in cell membranes that, when stimulated by endocannabinoids, are thought to promote homeostasis.17

• Endocannabinoids are naturally occurring substances within the body, while phytocannabinoids (plant substances that stimulate annabinoid receptors) are found in cannabis.18

• The most well known of these cannabinoids is tetrahydrocannabinol (THC); however, cannabidiol (CBD) and cannabinol (CBN) are gaining interest in therapeutic use.19

4. The nursing student shall have an understanding of cannabis pharmacology and the research associated with the medical use of cannabis. Due to government restrictions on research involving cannabis, the surge of legislation has outpaced research, leaving nurses with a few

resources when caring for patients who use medical cannabis. Therefore, information regarding medicinal use of cannabis must be derived from moderate to high quality evidence using randomized placebo-controlled studies. These particular studies are the most likely to elucidate causality in treatments and are the only trusted source of evidence for cannabis as a clinical intervention. Research on cannabis is an evolving body of work. As with any scientific literature, it is important to rely on the most recent high quality evidence. a. Current scientific evidence exists for the use of cannabis for the following qualifying conditions Moderate- to high-quality evidence exists for • cachexia • chemotherapy-induced nausea and vomiting • pain (resulting from cancer or rheumatoid arthritis) • chronic pain (resulting from fibromyalgia), • neuropathies (resulting from HIV/AIDS, Multiple Sclerosis [MS], or diabetes) • spasticity (from MS or spinal cord injury).20

b. Adverse effects of cannabis use are influenced by the patient’s condition and current medications The patient’s propensity for the following may be exacerbated by cannabis: increased heart rate, increased appetite, sleepiness, dizziness, decreased blood pressure, dry mouth/dry eyes, decreased urination, hallucination, paranoia, anxiety, impaired attention, memory, and psychomotor performance.21

Cannabis may exacerbate symptoms associated with asthma, bronchitis, and emphysema; cardiac disease; and alcohol or other drug dependence.22

Cognitive impairment by cannabis may be dose- and age- dependent.23

It is highly likely that cannabis will exacerbate symptoms of poor b alance and posture in patients with dyskinetic disorders. Similarly, cannabis may worsen mental faculties in conditions that cause cognitive deficits. Patients who suffer from diseases with neurologic symptomology may show greater cognitive impairment.24

Some participants report fatigue, suicidal ideation, nausea, asthenia, and vertigo as adverse effects of cannabis.25

Cannabinoid receptors are effectively absent in the brainstem cardiorespiratory centers. This is believed to preclude the possibility of a fatal overdose from cannabinoid intake.26

Cannabis can be a drug of abuse. Cannabis use disorder is defined as a problematic pattern of cannabis use leading to clinically significant impairment or distress; the clinical indications are included in the DSM-5.27

Cannabis withdrawal syndrome has been identified as a syndrome seen in some patients whose cannabis use has been heavy and prolonged (i.e., usually daily or almost daily use over a period of at least a few months). The withdrawal syndrome has varying symptomatology, including insomnia, loss of appetite, physical symptoms, and restlessness initially, then irritability/ anger, vivid and unpleasant dreams after a week.28


20 MOMENTUM

c. Variable effects of cannabis are dependent on type of product and route of administration Since medical cannabis is not an FDA drug, there is no recommended dosage. Instead medical cannabis is titrated by the patient, with the principle of “start low, go slow.” Continual patient assessment of perceived efficacy and adverse effects is recommended. Useful strategies include tracking dose, symptoms, relief, and adverse effects in a journal for review with the authorizing practitioner. FDA-approved synthetic THC drugs (dronabinol and nabilone) are administered orally or by an oromucosal route with a specific dosage. d. Risks to particular groups of patients Adolescence. Many studies show a correlation between cannabis use and poor grades, high dropout rates, lower income, lower percentage of college degree completion, greater need for economic assistance, unemployment, and use of other drugs. Although these trends are related to recreational rather than medicinal cannabis use, the trends cannot be ignored but should be balanced with the benefits of cannabis for medical use.29

Fertility. Two preclinical studies indicate that interference with endogenous cannabinoids might increase chances of failed embryo implantation30 and cannabinoids are capable of dysregulating hormones, which in turn can affect spermatogenesis.31

Cannabis can be a drug of abuse and precautions should be taken to minimize the risk of misuse and abuse. Neonates. Presently there are no reliable data for neurodevelopmental outcomes with early exposure to cannabis in neonatal life, or through either breastfeeding or secondhand inhalation.32,33,34

Cannabis use may exacerbate existing psychoses in those with a risk of suicide or history of suicide attempt, schizophrenia, bipolar disorder, or other psychotic conditions.35

5. The nursing student shall be able to identify the safety considerations for patient use of cannabis. • Administration of cannabis for medical use can only be carried out by the certified patient or designated caregivers registered to care

for the patient. • Cannabis storage considerations include: keeping cannabis out of the reach of children, minors, and nonregistered individuals storing all cannabis products in a locked area keeping cannabis in the original child-resistant packaging storing raw cannabis in a cool, dry, place following labeling guidelines for storage and expiration dates • Disposal of unused cannabis products should be completed according to the DEA’s Disposal Act.36 Generally, one can locate a collection receptacle via the DEA Registration Call Center (800-882-9539).6. The nursing student shall approach the patient without judgment regarding the patient’s choice of treatment or preferences in managing pain and other distressing symptoms. • Awareness of one’s own beliefs and attitudes about any therapeutic intervention is vital as nurses are expected to provide patient care without personal judgment of patients.7. The nursing student shall be aware of medical marijuana administration considerations. • A nurse shall not administer cannabis to a patient unless specifically authorized by jurisdiction law.37

• Instances in which the nurse may administer cannabis or synthetic THC to a patient. Administration of FDA-approved synthetic THC drugs (dronabinol and nabilone) per facility formulary and policy As a registered MMP designated caregiver • The majority of jurisdictions allow a designated caregiver to assist a patient with the medical use of cannabis. • These caregivers must meet specific qualifications and be registered with the MMP and must not practice outside of the limits of the caregiving statute.38

• Some jurisdictions allow an employee of a hospice provider or nursing or medical facility, or a visiting nurse, to assist in the administration of medical marijuana.39

• Check the most current MMP statute or rules.40

• Check facility policy regarding medical marijuana administration.

References1. National Conference of State Legislatures (NCSL). (2017). State Medical Marijuana Laws. Retrieved from http://www.ncsl.org/ research/health/state-medical-marijuana-laws.aspx2. Comprehensive Drug Abuse Prevention and Control Act. (1970). 21 U.S.C. § §801 – 904.3. U.S. Department of Transportation. National Highway Traffic Safety Administration (NHTSA). (2107). Marijuana-Impaired Driving A Report to Congress. Retrieved from

https://www.nhtsa.gov/ sites/nhtsa.dot.gov/files/documents/812440-marijuana-impaireddriving- report-to-congress.pdf4. Comprehensive Drug Abuse Prevention and Control Act. (1970). 21 U.S.C. § §801 – 904.5. National Institute on Drug Abuse (NIDA). (May 2017). Information on Marijuana Farm Contract. Retrieved from https://www.drugabuse. gov/drugs-abuse/marijuana/6. nidas-role-in-providing-marijuana-research/information-marijuanafarm- contract U.S. Department of Justice, Drug Enforcement Administration (DEA). (November 8, 2017).

Established Aggregate Production Quotas for Schedule I and II Controlled Substances and Assessment of Annual Needs for the List I Chemicals Ephedrine, Pseudoephedrine, and Phenylpropanolamine for 2018. 82 FR 51873. Retrieved from https://www.federalregister.gov/documents/ 2017/11/08/2017-24306/established-aggregate-productionquotas- for-schedule-i-and-ii-controlled-substances-and-assessment

7. Mikos. R.A. (December 12, 2012). On the Limits of Federal Supremacy: When States Relax (or Abandon) Marijuana Bans. Cato Institute. Policy Analysis, No. 714. Retrieved from https://object. cato.org/sites/cato.org/files/pubs/pdf/PA714.pdf; Beek v. City of Wyoming. (February 6, 2014) (Findlaw, Dist. 145816). Retrieved from http://caselaw.findlaw.com/mi-supreme-court/1656759.html

20 MOMENTUM

8.8 NCSNCSL. L (20(2017)17). SStattate Me Mediedicalcal MaMarijrijuanuana La Lawsaws. RRetretrievieved ed frofrom hm httpttp://://wwwwww.ncncsl.sl orgorg/re/reseasearchhrch/he/h/healtltalth/sh/h/stattate-me-medidiedicallcal-ma-marijrijrijuanuana-lla-lawsaws. aaspxspx9.9. U.SU.S. D. Depaepartmrtmentent ofof JuJustistice,ce, OfOfOfficeficefice ofofof PuPublibliblic Ac Ac Affaffaffairsirsirs (D(D(DOJ)OJ)OJ). (. ((OctOctOctobeobeober 1r 1r 19, 9,9 20020020 9).9). AtAttortorneyney GeGeGenerneral alal AnnAnnAnnounouncesces FoFormarmal Ml Ml Mediediedicalcalcal MaMarijrijrijuuanaana GuGuGuideideidelinlinlines.es. ReRetritritrieveeved fd fd fromrom hththttpstps://:/://

wwwwww.ju.justistice.ce.govgov/op/opa/pa/pr/ar/attottornernerney-y-y gengengeneraeraeral-al-al annonnonnouncuncunces-es-es forforformalmalmal-me-memedicdicdical-al-al marmarmarijuijuijuanaanaa -gu-guideidelinlines;es; DODOJ.J. (Ju(June ne 29,29, 202011)11). G. Guiduidancance Re Regaegardirding ng thethe OgOgdenden MeMemo mo in in JurJurisdisdictictionions s SeeSeekinking tg to Ao Authuthoriorize ze MarMarijuijuanaana fofofor Mr Mr Mediediedicalcalcal UsUsUse.ee RetRetRetrierierievedvedved frfrfrom omom htthtthttps:ps:ps://w//w//www.wwww jusjusjustictict e.ge.gov/ov/sitsites/es/defdefaulault/fit/filesles/oi/oip/lp/legaegacy/cy/ 202014/14/07/07/23/23/dagdag-gu-guidaidancence-20-2011-11-forfor-me-medicdical-al-marmarijuijuanaana--useuse.pd.pdf; f; DOJDOJ. (. (AugAugustust 2929, 2, 2013013). ). GuiGuidandandance cece RegRegRegardardardinginging MaMaMarijrijrijuanuanuana Ea Ea Enfonfonforcercercemenmenment. t.t. RetRetRetrierierievedved frfrom om htthttps:ps://w//www.ww.jusjustictice.ge.gov/ov/isoiso/op/opa/ra/resoesour ur cesces/30/3052052013813829129132732756856857457467.67.pdfpdf; D; DOJ.OJ. (F(Febrebruaruary 1y 14, 4, 2012013).3). GuGuidaidancence ReRegargarg dindinding Mg Mg ariariarijuajuajuanana RelRelRelateated Fd Fd Finainainancincincial al al CriCriCrimesmes. R. Retretrievieved ed frofrom hm httpttps:/s://ww/www.jw.justusticeice.go.gov/sv/siteites/ds/defaefaultult/fil/files/es/usausao-wo-wdwadwa/le/legacgacy/ y/ 2012014/04/02/12/14/D4/DAG%AG%20M20Memoemo%20%20-%2-%20Gu0Guidaidancence%20%20%20RegRegRegardardardinginging% 2% 2% 20Ma0Ma0Marijrijrijuanuana%2a%2a%20Re0Re0Relatlatlated%ed%ed%20F20F20Finainain ncincial%al%20C20Crimrimes%es%202202%20%20 1414%20%2014%14%20%20%282282%29%29.pd.pdf;f; DOJDOJ. (O(Octoctoberber 2828, ,2012014).4). PoPoliclicy Sy Stattatemeement nt RegRegardardinging MaMarijrijuanuana Ia IIssussussues eses in inin IndIndIndianianian CoCoCountuntuntry.ry.ry ReReRetritritrieveeveeved fd fd fromromrom hththttpstpstps://://://wwwwwww .ju.justistice.ce.govgov/si/sitestes/de/defaufault/lt/filefiles/ts/tribribal/al/pagpages/es/attattachachmenments/ts/ 202014/14/12/12/11/11/polpolicyicystastatemtemententregregardardingingmarmarijuijuanaanaississuesuesiniinindindiancanccounounountrytrytry2. 2. 2. pdfpdfpdf

10.10 DOJDOJ. (. (JanJanuaruary 4y 4, 2, 2018018). ). MarMarijuijuanaana EnEnforforcemcementent. RRetretrievieveved eded frofrofrom hm hm httpttpttps:/s:/s://ww/ww/www.jw.jw justustusticeiceice.go.gogov/ov/ov/opa/pa/pa/preprepress-ss-ss-relrelreleasease e/fie/file/le/1021022192196/d6/downownloaloadd11.11. IbiIbid.d.12.12. IbiIbid.d.13.13 IbiIbid.d14.14. 1Ib1Ibid.id.15.15. IbiIbid.d.16.1616 MacMackiekie K.K CaCannannabinbinoidoid rerecepceptortors: s: whewhere re thethey ay are re andand whwhat at thethey dy do. o J NJ Neureuroenoendocdocdocrinrinrinol olol 2002002008; 8; 8; 20 2020 SupSupSuppl pl pl 1: 1:1: 10-10-10-4.44 htthtthttp:/p:/p://on/on/onlinlinlinelielielibrabrabrarrry. y. y wilwiley.ey.comcom/do/doi/1i/10.10 1111111/j./j.1361365-25-2826826.202008.08 01601671.71 x/fx/fullullrrrr17.17.17 IbiIbid.d.18.18.18 IbiIbiIbid.d.d19.1919 PacPacPacherhher etet alal. TThe he endendocaocannannabinbinoidoid sysystestem am as as an en emermerginging tg targarget et of of phapharmarmacotcotherherapyapy. PPPharharharmacmacolooloologicgicgical alal RevRevR iewiewiews 2s 2s 2006006006; 5; 5; 58: 8:8: 389389389-46-46-462.22 htthtthttps:ps:p //w//www.ww ncbncbi.ni nlm.lm nihnih.go.gov/pv/pmc/mc/artarticlicles/es/

PMCPMCPMC224224224175171751/1/2020.20. NatNationionional alal AcaAcaAcademdemdemiesies ofof ScScieniencesces, E, Engingineeneerinring, g, andand MeMedicdicineine (N(Natiationaonal Al Acadcademiemies es of of SciSciencences)es). (. ((2012012017).7).7). ThThThe He He Healealealth th th EffEffEffectectects os os of Cf Cf Cannannannaaabisbisbis ananand Cd Cd Cannannan abiabinoinoids:ds: ThThe Ce Currurrentent

JurJurJ isdisdi dicticti tionioni ofoff EvEvE ideidei ncence anand Rd Recoecommemmendandatiotions ns forfor ReReseasearchrch. WWashashingingtonton, D, D.C.C : N: Natiationaonal Al Acadcademyemy PrPrPressessess; M; M; Madradradras,as,as B.BB (2(2(2015015015). ). ) UpdUpdUpdateateate ofofof cacacannannannabisbisbis ananand id its ts medmedicaical ul use.se ReRetritrieveeved dfrofrofrom hm hm httpttpttp://://://wwwwwwwww.wh.whwho.io.io int/nt/medmediciicinesnes/ac/accescess/cs/contontrolrolledled- s- subsubstantancesces/6_/6 2_c2 cannannabiabis_us updapdate.te.pdfpdf

21.21.21. FedFedFederaeraeral Dl Dl Drugrugrug AdAdAdminminministististratratrationioni . (. (SepSeptemtemberber 202004)04). M. Mariarinolnol (D(Dronronabiabinolnol) C) Capsapsuleules.s. RetRetrierievedved frfromom htthttps:ps://w//www.ww.fdafdafda.go.gog v/ov/ov/ohrmhrmhrms/ds/ds/dockockocketsets/ d/ d/ dockockocketsets/05/05/05n04n04n0479/79/79/05N05N05N-04-04-0479-79-emcemc0000004-04-04.p4.pdfdf22.2222 HalH lHall, l, l, W.,W.,W & && SolS lSolowiiowij, j, j, N. NN (19(19(1998)98)98). AAdvedverserse efeffecfects ts of of cancannabnabis.is ThThe Le Lancancet,et, 35352(92(9140140), ), 1611611-11-1616616; T; Tashashkinkin, D, D. PP. (. (201201013).3).3) EfEfEffecfecfects tst of ofof marmarijuijuijuanaana smsmokiokioking ng g on on thethethe lululung.ng.g AnAnA nalnals os of tf the he

AmeAmeAmericirican anan ThoThThoracracracic iic SocSSocieti tiety, y,y, 10(10(10(3),3),3), 23239-29-247;47; FeFederderal al DruDrug Ag Admidminisnistratratiotion (n (FDAFDA).). (Se(Septeptembember 2r 2004004). ). MarMarinoinol (l (DroDroonabnabnabinoinoinol)l)l) CapCapCapsulsulsules.es.es ReReRetritritrieveeveeved fd fd fromromrom hththttpstpstps://://://wwwwwwwww.fd.fdfda.ga.gov/ov/ohrohrohrms/ms/ms/docdocdocketketkets/ds/ds/dockockocketsets/05/05/05n04n04n0479/79/79/05N05N05N-04-0479-79- ememc00c0004-04-04.04.pdfpdf

23.2323 CreCreCrean,an,an, R.RR D.DD , C, C, Cranrane,e,, N.NN A.,A.,A., & && MasMasM on,on,, B.BB J.JJ (2(2( 011011).). An An evievidendence ce basbased ed revreviewiew ofof acacuteute anand ld longong-te-term rm effeffectects os of cf cannannabiabis us use see on onon eeexecxecxecutiutiutive veve cogcogcognitnitnitiveiveive fufufunctnctnctionionions. ss JouJouJournarnarnal ol ol of ffaddaddaddictictictionionion mememedicdicdicineineine, 5, 55(1)(1)(1), 1, 11; S; S; Solooloolowijwijwij, N, NN., ., & P& P& Pesaesae , N, N. (. (2012012).2). CaCannannabisbis anand cd cognognitiition:on: shshortort anand ld longong-te-term rm effeffectects. s. MarMarijuijuanaana ananddd mamamadnednedness,ss,ss, 2,2,2, 919191-10-10102.2.2.

24.24. KopKopKoppelpelpel, B, B, B. S. S. S., .,., BruBruBrust,st,st J.J.J C.C.C , F, FFifeifeife, T, TT.,., BroBroBronstnstnsteineinein, J, JJ., ., YouYouY ssossof, f, S.,S., GrGronsonsetheth, G, G.,., & G& Glosloss,s, D.D. (20(2014)14). S. Systystemaematictic rerevieview:w: EffiEfficaccacy ay and nd saffsafetyetyy ofofof memedicdicdical al al marmarijuijuijuanaana ininin seselecleclectedtedted neneurourologloglogic ic icdisdisordordordersersers ReReReporporport ot ot of tf tf the hhe GuiG iGuideld ldelineiine DeDeDevellvelopmopmopmententent SuSSubcobbcommimmittettee oe of tf the he AmeAmericrican an AcaAcademdemy oy of Nf Neureuroloology.gy. NeNeurourologlogy, y, 82(82(17)17), 1, 1556556-15-1563.63

25.25. ColCollinlin, C, C C.,.,., EhlEhlEhler,er,er, E.E.E., W, W, Wabeabeaberziirzinekknek, G, G, G., .,., AlsAlAlsindi dindi, i, i, Z.,Z.,Z., DaDaDavieivies, s,s, P.,P.,P. PoPowelwell, l, K.,K., ..... &. & ZaZaplepletaltalovaova, O, O. (. (2012010).0). A A doudoubleble-bl-blindind, r, randandomiomizedzed, p, placlaceboebo- c- ccontontontrolrolrolledledled, p, pparaaraarallellellel-gl-gl grourouroup sp sp studtudtudy oy oy of ffSatSativeivex, x, in nin subsubsubjecjecjectsts ts witwitwith sh sh sympympymptomtoms os of sf sf spaspasp ticticticityityity dududue te to mo multultultipliple se scleclerosrosis.is. NeNeurourologlogicaical rl reseesearcarch, h, 32(32(5),5), 45451-41-459;59; NaNatiotionalnal AcAcaademdemiesies ofof ScScienienncescesces. (. (. (2012012017).7).7). ThThThe He He Healealealth th th EffEffEffectectects os os of f fCanCannabnabis is andand CaCaCannannannabinbinbinoidoidoids:s:s: TheTheThe CuCuC rrerrent ntt JurJurJ isdisdi dicticti tionioni ofoff EvEvE ideideid ncence anand Rd Recoecommemmendandatiotions ns forfor ReReseasearchrch. WWashashingingtonton, D, D.C.C : N: Natiationaonal Al Acadcademyemy PrPrressessess; M; M; Madradradras,as,as B.BB (2(2(2015015015). ). ) UpdUpdUpdateateate of of cancannabnabis is andand itits ms ms mediediedicalcalcal usususe.e.e RetRetRetrierierievedvedved frfrfrom omom htthtthttp:/p:/p://ww/ww/www.ww.ww who.ho.ho intintin /me/medicdicineines/as/acceccess/ss/ cocontrntrollolled-ed-subsubstastancences/6s/6_2_2 cancannabnabis_is updupdateate.pd.pdff

26.26. GlaGlass,ss, M.M., F, Faulaull, l, R.R. L.L. M.,M.,M., & && DraDraDragungungunow,ow,ow, M.M.M. (1(1(1997997997).).) CanCanCannabnabnabinoinoinoid idid recrecreceptepteptorsorso inin ththe he humauman bn brairain:n: a da detaetaileiled ad anatnatomiomicalcal anand qd quanuantittitatiativeve autautoraoradiodiogragraphiphic sc studtudtudy iy iy in tn the he he fetfetfetal,al,al, neoneonatnatal al andand adadultult huhumanmann brbrbrainainain NN. Neureureuroscoscoscienienience,ce,ce 777777(2)(2)(2), 2, 2, 299-9999-318318318.

27.27. AmeAmericricanan PsyPsychichiatratric ic AssAssociociiatiatiation.on.on. (2(2(2013013013). ).). DiaDiaDiagnognognostitistic ac ac and dnd stastastatistitistictitical lal manmanmanualual ofof mementantal dl disoisorderders rs (5t(5th eh ed.)d.). W. Washashingingtonton, D, DC: C: AutAuthorhor..28.28. HesHesse,se, M.M., &, & ThThylsylstrutrup, p, B.B. (20(2013)13). T. Timeime-co-coursurse oe of tf the he DSMDSM-5 -5 cancannabnabis is witwithdrhdrawaawal sl sympymptomtoms is in pn polyolyoly-su-substbstbstancance ae abusbubusersers. B. BMC MC psypsychichiatratry, y, 13(13(1),1), 25258;8; AmeAmericricanan PsyPsychichiatratric ic

AssAssociociatiation.on (2(2013013). ). AmeAmericrican an PsyPsychichiatratric ic AssAssociociatiation.on (2(2013013).). DiaDiagnognostistic ac and nd stastatististictical al manmanualual ofof mementantal dl disoisorderders rs (5t(5th eh ed.)d.). WaWashishingtngton,on, DCDC: A: Authuthor;or; BuBudnedney, y, A. A J.,J., MoMooreore,,B. B. A.,A., VaVandrndrey,ey, R.R. G.G., &, & HuHugheghes, s, J.J. R.R. (20(2003)03). T. The he timtime ce courourse se andand sisignignificaficancence ofof cacannannabisbis wiwithdthdrawrawal.al. JoJournurnal al of of abnabnormormal al psypsychochologlogy,y, 112112(3)(3), 3, 393.93.

29.29.29. MadMadrasras, B, B. (. (2012015).5). UpUpdatdate oe of cf cannannabiabis as and nd itsits memedicdical al useuse. R. Retretrievieved ed frofrom hm httpttp://://wwwwww.wh.who.io.int/nt/medmediciicinesnes/ac/accescess/cs/contontrolrolledledsubsubstastancences/ s/ 6 26_2_cacannannabisbis_upupdatdate.pe.pdf;df; CrCreanean, , R. RR D.,D., CrCraneane, N, N. AA., , & M& Masoason, n, B. B J. J (20(2011)11). AAn en evidvidencence be baseased rd revieview ew of of acuacute te andand lolongtngtermerm efeffecfects ts of of cancannabnabis is useuse onon exexecuecutivtivtivee cocognignitivtive fe funcunctiotions.ns JoJournurnal al of of addaddictictionion mededmediciicine,ne, 5(5(1),1), 1.1.

30.30. ParPark,k, B.,B.,B., McMcParPartlatland,nd, J.J. M.M., &, & GlGlassass, M, M. (. (2002004).4). CaCannannabisbis, c, cannannabiabinoinoids ds andand rereproproducductiotion.n. ProProstastaglaglandindins,ns, leleukoukotritrieneenes as and ndnd essesseentintintial alal fatfatfatty ty aciacids,ds, 7070(2)(2), 1, 189-89-197197..31.31. du du PlePlessissis, s, S. SS S.,S., AgAgarwarwal,al, A.A , &, & SySyriariac, c, A. A (20(2015)15). MMariarijuajuana,na, phphytoytocancannabnabinoinoidsids, t, the he endendocaocannannabinbinoidoid sysystestem, m, andand mamale le ferfertiltiliity.ty. JoJournurnal al of of assassististed ed repreprodroductuctionion anand gd geneenetictics, s,

32(32(11)11), 1, 1575575-1515-1588.88.32. JaqJaquesues, S, S. C. C., ., KinKingsbgsbgsburyury, A, A., ., HenHenshcshcke,ke, P.P., C, Chomhomchachai, i, C.,C., ClClews SS FalFalconconer,er, J.J., ., ..... & O& Oei,ei, J.J. L.L. (2(2014014). ). CanCannabnabis,is, ththe pe pregregnannant wt womaoman an and nd herher chchildild: W: Weedeedinging ouout tt the he mytmyths.hs. C.,C.,C.,C.,C.,C.C.,C ClClClClClClClC ewsewsewsewsewswsewsews, S, S, S, S, S, SSS., ., .,., ..,, FalFalFalFalFalFalFaFalF ccococococo

Journanal ol of Pf Perierinatnatolooology,gygy, 3434(6)(6), 4, 417.17

33. Jutras-Aswadwad, D, D.,., DiNDiNierieri, ii, J. J.J A.,A., HaHarkarkany,ny, T.T.T.T.T.T.T.T.TT., &, &, &, &, &, &&, & HuHuHuHuHuHuHurd,rd,rd,rd,rdrd,rd, Y.Y.Y.Y.Y.Y.YY L.L.L.L.L.L.L.L (2(2(2(2(2(2(200900900900900900900900 ).).).).).).). calcal coconsensequequencences os of mf mateaternarnal cl cannannabiabis os on hn humauman fn fetaetal dl deveeveloplopmenment at and nd itsits neneurouropsypsychichiatratricicNeuNeuNeuNeuNeuNeuNeuNeuN robrobrobrobrobrobrobbiolioliolioliololiolo ogigigigiogigigicacacacacacacacaoutcome. Europeopean an ArcArchivhives es of of of PsyPsychichiatratryy 412.12.rrrrry ay ay ay ay ay ay ay aand nd nd nd nd nd nd CliClCliCliCliCliCliCl nicnicnicnicnicnicicnicalal al al al al alal NeuNeuNeuNeuNeuNeuNNe rosrosrosrosrosrosr srosciecieciecieciecieciec ncencencencencencence, 2, 2, 2, 2, 2, 2, 2259(59(59(59(59(59(59(599 7),7),7),7),7),7),)) 333933333 5-45-45-45-45-4-4-4441111111

34. Volkow, N. D., Baller,er, R.R. D.D., C, Compomptontonton, W, W. M. M ctscts ofof mamarijrijuanuana ua use.se. NeNew Ew Englnglandand JoJournurnal al of of MedMediciicine,ne, 37370(20(23),3), 222219-19-2222227.7.MMMMMMM., & W& W& W& W& W& WW& WWeiseiseiseiseiseiseisiss, s, s, s, s, s,s, S. SS. S. S. S. S. SS. S R. R. R. R. R.R. R. R (20(20(20(20(20(20(20014)14)14)14)14)1414)4). A. A. A. A. A. A. Advedvedvedvedvedvedveev rsersersersersersersersers hehehehehehehehh altaaaaa h effefefefefeeeecctccccc35. Wilkinson, S. T., Radhakhakrisrishnahnan,n, R.,R., & && DDD nn ththe de deveeveloplopmenment ot of pf psycsychothotic ic disdisordordersers. C. Currurrentent adaddicdictiotion rn repoeportsrts, 1, 1(2)(2), 1, 115-15-128128..D’SD’SD’SD’SD’SD’SD’SD Souzuzuzuzuzuzuza, aaaaaa D. D. D. D. D. D.D.D. D C. C.C. CCC.C.C. (20(20(20(20(20(20(202 14)14)14)14)14)14)14)4)). I. I. I. I. I. II. I. Impampampampampampampampact ct ct ctct ctctctctcc of ofof of of of of ofoo cancancancancanacanacaca nabnabnabnabnabnabnabnabis useuseuseuuuseu ononononononon36. DEA. (2014). Disposal Acct: t: GenGeneraeral Pl Pubub aadivdiversersionion.us.usdojdoj.go.gov/dv/drugrug_didisposposalsal/fa/fact_ct shesheetsets/ d/ dispisposaosal_pl publublic.ic.pdfpdfblblblblblblblblliic ic i FacFacFacFacFacFacFact SSSSt SSSSheeheeheeheeheeheeheeheeh t.t.t.t.t.t.t.t. RetRetRetRetRetRetRetRetReRetrierierierierierierierieriierievedvedvedvedvedvedvedvedvevee frfrfrfrfrfrfrrrom om om om om om omomom oo htthtthtthtthtthtthtthtttht ps:ps:ps:ps:ps:ps:psps:p //w//w//w////w//w////w//www.ww.ww.ww.ww.ww.ww deadeadeadeadeadeadeaee37. NCSL. (2017). State Medicall MaMarijrijuanuana a eaearchrch/he/healtalth/sh/stattate-me-mediedicalcal-ma-marijrijuanuana-la-lawsaws.as.aspxpxLLa La La La La LLaws. Retretretretretretretretrtrrrrievievievievievievievievievievievved ed ed ed ed ed ededed edd d frofrofrofrofrofrofroffrofrofrof m hm hm hm hm hm hm hm hm hhttpttpttpttpttpttpttpttpttpppp://://://://://://:///:///////wwwwwwwwwwwwwwwwwwwwwwwwww w.nc.nc.nc.nc.nc.nc.ncnc.nc.n sl.sl.sl.sl.sl.sl.slsl.org/reseseseseseseses38. Ibid.39. Ibid.40. Ibid.

OhOhioio BBoaoardrd oof f NuNursrsining g 2121

22 MOMENTUM

Clarification on Cannabidiol (CBD) Oil The Board continues to receive questions about cannabidiol (CBD) oil (derived from hemp or derived from marijuana). HB 523,

which created the state’s Medical Marijuana Control Program, made no exception for possession or sale of CBD oil. HB 523 includes CBD oil in the definition of marijuana, regardless of whether it is a plant extract or synthetic product.

All marijuana products, including CBD oil, can only be dispensed in a licensed Medical Marijuana Control Program dispensary. Those marijuana products will have to comply with the rules and regulations of the program. All products must have a known source, as well as known quantities of active ingredients. Testing procedures will be conducted by testing laboratories licensed by the Ohio Department of Commerce.

The State of Ohio Board of Pharmacy announced the award of 56 provisional medical marijuana dispensary licensees in June. All provisional licensees will have six months to demonstrate compliance with the dispensary operational requirements to obtain a certificate of operation. As the Medical Marijuana Control Program becomes operational this fall, the Board will continue to provide updates through the program’s website: https://www.medicalmarijuana.ohio.gov/.

Until dispensaries are operational, no one, including board licensees, may possess or sell CBD oil or other marijuana related products. Violation of Ohio Revised Code or Ohio Administrative Code can subject a licensee (person or entity) to administrative or criminal action.

24 MOMENTUM

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FoFoForr ququesestititionons,s, cconontatactct OOOnlnlininee SySyststemem SSupuppoportrt aatt 61614-4-46466-6-39394747 aandnd sselelecectt “O“Optptioionn 1”1” ((weweekekekdadadaysys 888amam-5-5-5pmpm,, exexceceptpt ffforor hohoholililidadadaysys).).). IfIfIf yyouou nneeeedd d asassisisiststanancece aaftfterer bbususininesesss hohoururs,s, eemamailil nunursrsining.g.reregigiststraratitionon@[email protected] g g aandndnd iiincnclululudedede aa bbbriririefefef vvdededescscscriririptptptioioionn ofofof tthehehe iiissssueue, , yoyourur fififirsrstt anand d lalastst nnamame,e, ttelelepephohonene nnumumbeber,r, eemamailil aaddddreressss, , anand d lilicecensnsee nunumbmbmberer, , ififif yyouou hhhavavee ititit..

How Do I Change My NAME with the Board?

Current MembersOhio Board of Nursing City Term Expires

Patricia A. Sharpnack, DNP, RN PresidentChardon 2021

Brenda K. Boggs, LPN, Vice PresidentGermantown 2019

Sandra Beidelschies, RNUpper Sandusky 2021

Matthew Carle, Consumer MemberBlacklick 2019

Barbara Douglas, RN, APRN-CRNAChardon 2020


Nancy Fellows, RNWilloughby Hills 2020

Erin Keels, RN, APRN-CNPColumbus 2018

Lisa Klenke, RNColdwater 2019

Deborah Knueve, LPNColumbus Grove 2021

Lauralee Krabill, RNSandusky 2021


Daniel Lehmann, LPNDayton 2020

Sandra A. Ranck, RN Supervising MemberAshtabula 2018

Joanna Ridgeway, LPNHilliard 2018

Advisory Groups and Committees

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How Do I Change My ADDRESS with the Board?

26 MOMENTUM

The use of social media continues to grow and the Board receives

a large number of social media-related complaints. Frequently the

questions are about social media comments directed at co-workers,

patients, employers, and sometimes within the context of social issues

or newsworthy events. Nurses should be mindful of their professional

obligations and understand the implications of using social media. In

the 2018 Spring issue of Momentum, the National Council of State

Boards of Nursing (NCSBN) “White Paper: A Nurse’s Guide to the Use

of Social Media” was published in its entirety. You can access past

issues of Momentum on the Board website at www.nursing.ohio.gov

under the “Publications” link.

The NCSBN White Paper summarizes the promise and pitfalls of

using social media:

Nurses are increasingly using blogs, forums and social

networking sites to share workplace experiences particularly

events that have been challenging or emotionally charged.

These outlets provide a venue for the nurse to express his or her

feelings, and reflect or seek support from friends, colleagues,

peers or virtually anyone on the Internet. Journaling and

reflective practice have been identified as effective tools in

nursing practice. The Internet provides an alternative media

for nurses to engage in these helpful activities. Without a sense

of caution, however, these understandable needs and potential

benefits may result in the nurse disclosing too much information

and violating patient privacy and confidentiality.

The NCSBN White Paper offers further guidance on a range of

social media issues, including common myths and misunderstandings.

Further, it provides suggestions to avoid problems and minimize

risks when using social media, including several useful examples

depicting inappropriate uses of social and electronic media.

In addition, the American Nurses Association (ANA) has

published documents addressing social media such as the ANA

Principles for Social Networking and the Nurse. (See https://www.

nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/social-

networking.pdf.)

Principle 3 of the “ANA’s Principles for Social Networking and

the Nurse” states “Nurses should evaluate all their postings with the

understanding that a patient, colleague, educational institution, or

employer could potentially view those postings. Online content and

behavior has the potential to either enhance or undermine not only

the individual nurse’s career, but also the nursing profession.”

ANA identifies “ANA’s 6 Tips for Nurses Using Social Media:”

1. Nurses must not transmit or place online individually identifiable

patient information.

2. Nurses must observe ethically prescribed professional patient-

nurse boundaries.

3. Nurses should understand that patients, colleagues, institutions,

and employers may view postings.

4. Nurses should take advantage of privacy settings and seek to

separate personal and professional information online.

5. Nurses should bring content that could harm a patient’s privacy,

rights, or welfare to the attention of appropriate authorities.

6. Nurses should participate in developing institutional policies

governing online conduct.

The Use of Social Media

26 MOMENTUM


ANA also provides “ANA’s 6 Tips to Avoid Problems:”

1. Remember that standards of professionalism are the same online

as in any other circumstance.

2. Do not share or post information or photos gained through the

nurse-patient relationship.

3. Maintain professional boundaries in the use of electronic media.

Online contact with patients blurs this boundary.

4. Do not make disparaging remarks about patients, employers or

co-workers, even if they are not identified.

5. Do not take photos or videos of patients on personal devices,

including cell phones.

6. Promptly report a breach of confidentiality or privacy.

In summary, ANA provides an overview of social networking in

nursing in the ANA’s Principles for Social Networking and the Nurse

and provides the following guidance:

Social networks and the Internet provide unparalleled

opportunities for rapid knowledge exchange and dissemination

among many people….At the same time, information contained

on a social network has the capacity to propagate itself, taking on

a life of its own in cyberspace. Inaccuracies become “fact” by

mere repetition, creating confusion that is particularly dangerous

in discussions regarding the public’s health needs. Nurses must

be aware that social networking venues are shared by their

patients and colleagues…Employers and educational institutions

may also monitor social networking sites and make judgments–

positive or negative–about a nurse’s professional suitability...

Despite the common perception that personal comments,

videos, photos, or other online materials are short-lived or

confined to a designated group of viewers, the nature of the

Internet is that such materials are public and permanent. Just

about anyone can, with a little effort, view these postings. Thus,

although nurses certainly deserve a life apart from their

professional duties, it is essential to understand that one’s

conduct on social networks is a public act that can be scrutinized

and judged in the same way as any other public act.

The use of social media carries with it much responsibility.

Please be aware of your responsibilities and professional obligations

and how its use may impact you. •

28 MOMENTUM


For AdvertisingC O N T A C TCatherine Carter

[email protected]

1-800-561-4686 ext. 106

30 MOMENTUM

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inini ttthehehe SSStatatatete oof f OhOhioio. ReRefefer r toto tthehe llisist t ofof tthehe OOBNBN AApppproroveversrs aandnd tthehe OOn-n-LiLinene RResesouourcrceses ffforor OOOhihihio o LaLaLaw w anand d d RuRuRuleleles s onon ttthehehe CCConontititinunuining g EdEducucatatioion n

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6.66 QuQuQuesestititionons?s?s? PPPleleleasase e ememaiaiail l [email protected]

Ohio Board of NursingRN/LPN Reactivation/Reinstatement

CoContntininuiuingng EEduducacatitionon ((CECE))

Has your Ohio license been inactive or lapsed less than 2 years?

OR

Do you have a current, valid license in another jurisdication?

If you answer yes to either one of these questions,

then the following 24 Contact Hours of CE are required:

Category A – Ohio Law and Rule – 1 hour

General Nursing Practice – 23 hours

All CEs must have been completed during the 24-month period

immediately BEFORE the date of the reinstatement or

reactivation application.

Has your Ohio license been inactive or lapsed 2 years or more?

AND

You do not have a current, valid license in another jurisdiction?

If you answer yes to both of these questions,

then the following 24 Contact Hours of CE are required:

Category A – Ohio Law and Rule – 2 hours

Critical Thinking, Nursing Process, or Nursing Judgment – 6 hours

Pharmacology – 6 hours

Clinical or Organizational Ethical Principles – 2 hours

Content relevant to Nurse’s Practice – 8 hours

All CEs must have been completed during the 24-month

period immediately BEFORE the date of the reinstatement or

reactivation application.

CrCrimimininalal RRececorordsds CCheheckck RReqequiuireremementntss

Has your Ohio license been inactive or lapsed 5 years or more?

If you answer yes, complete the BCI (Civilian) and FBI (Federal) Criminal Records Checks

Ohio Applicants: Go to your local law enforcement office or BMV to have the records checks completed. Please tell them that a copy of your

results is to be provided directly to the Ohio Board of Nursing.

Out of State Applicants: Request fingerprint cards and instructions by emailing [email protected] g . When you receive the cards and vv

instructions in the mail, take them to a local law enforcement office for fingerprinting to be completed.

32 MOMENTUM

34 MOMENTUM

Last Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1

July 2018 Monitoring Actions

board disciplinary actionsThe following includes lists of Board disciplinary actions taken at public meetings regarding licensed nurses or certificate holders. You can review the type of action taken by checking the individual’s credential at the Ohio eLicense Center at: http://www.nursing.ohio.gov/Verifica-tion.htm#VERInfo, or by clicking on License and Certificate Verification on the Board of Nursing’s website (www.nursing.ohio.gov). You may also request a copy of a public disciplinary record by completing the electronic form on the Board’s website at: http://www.nursing.ohio.gov/iw-DisciplineRecReq.htm or by clicking on Discipline Records Requests on the Board’s website.

Adams Nancy P.N. 155049Adedipe Adebimpe R.N. 262813 CNS applicantAlexander Nicole P.N. 131115Allen Kimberly P.N. 139267Andrews Suleta P.N. 146658Archbold Cassidy P.N. 134078Arnold Julie R.N. 261904

Azbell Charlotte R.N. 344137Bacon Amanda R.N. 395407Baker Amanda R.N. 332538Ballinger Amber P.N. 103184Barlas Carolyn P.N. 152313Barton Ciara P.N. 164863Basel Mary P.N. 152342Bates Tonya P.N. 101666

Baus Jill R.N. 361988Baxter Aaron R.N. 407645Beach Dionna P.N. 126622Bell Christopher R.N. 396083Beni Matthew R.N. 355024Berry Michelle R.N. 334081Bish Lynn P.N. 105113Biviano Faith P.N. 090484

Abramovich Caitlin R.N. 311914Alexander Javona P.N. 167883Allen Lisa R.N. 446043 P.N. 109854Azbell Jennifer R.N. 383923Bair Jeffrey R.N. 279787Ball Joshua P.N. 155030Basham Kamberlyn R.N. 376048Bentley Christine R.N. 402246Binegar Cali P.N. 168045Binion LaWanda R.N. 424815Brashear Tyler P.N. 164206Breheim Yvonne R.N. 401387Brown John P.N. 119471Burga Tracy R.N. 316982Burkholder Ryan P.N. 166276Camacho-Berson Dana R.N. 335129Cardona Isabel P.N. 164798Carlyon Melissa R.N. 345124Carroll LaTisha R.N. 357419Carter Danielle P.N. 154512Church Kristee R.N. 260055 P.N. 079415Clayton Beverly R.N. 207605 CNP 11218Cohen Gloria R.N. 157148Cox Kristina R.N. 344237Creer Kimberly P.N. 124590Cupps Rita R.N. 233002Curry Kathy R.N. 378255Davis Adrianna P.N. 167219Davis Alyssa R.N. 392367Deel Mindy R.N. 318950Docs Sheryl R.N. 185690Elahee-Lee Loree R.N. 277899 CNP 10764 P.N. 091169Esquivel-Rodriguez Amanda R.N. 445637 P.N. 114304Evans Tina P.N. 164561Fields Jasarriel R.N. 379637Flood Thomas R.N. 345846 CNP 15238 P.N. 124229Foos Jamie P.N. 128294Fox Julie R.N. 342795

Garrini Deborah R.N. 166198Geer Tonya P.N. 144607George Taaffe P.N. 137474Giesey Crystal R.N. 406292 P.N. 131473Grady Jennifer P.N. 138893Grunden Jason R.N. 341833Harless Elizabeth P.N. 120959Harr Christine P.N. 103583Hartman Katie R.N. 402153Hilen Deborah R.N. 294854Hutchinson Marian P.N. 095939Inal Jennifer R.N. 337878James Denise R.N. 231344 P.N. 059255Jones Danielle P.N. 152693Keith Amber R.N. 348273Koshar Maria R.N. 278003Koviak Christopher R.N. 347635Lamancusa Brenda P.N. 119213Latham Lori P.N. 163685Lawrence Charles R.N. 318418Leister Lauretta R.N. 349835Liebling Rebecca R.N. 303504Lomas Norman R.N. 280692Love Genell R.N. 336531Love Jentle R.N. 397935Luning Beth R.N. 431944 P.N. 154307Matusiak Alicja R.N. 359101 CNP 16032Maurath Tracy P.N. 146524Mayle Lisa P.N. 129867Meager Alison R.N. 319760 CNP 17048Metz Holly R.N. 396310Meyer Thomas R.N. 234905 CRNA 04300Miano Bonnie R.N. 379298Moore Valerie R.N. 303185Moore Sims Barbara P.N. 079504Naxer Margaret R.N. 197203Norton Malissa R.N. 279600Nyika-Makore Angela R.N. 262095ODonnell Alison R.N. 350441 CRNA 15172

Oliver Breon P.N. 162942Pickens Nicole P.N. 142878Ragland Kristin R.N. 369666Reeves Shaunta R.N. 345456Renny Andrea R.N. 412321Ricci Jessica R.N. 341181Rice Jamie R.N. 250045Richardson Stephanie R.N. 437715 P.N. 154464Roberts Michael R.N. 382834Robinson Keena P.N. 155256Sanzen Jessica R.N. 315813Schlegel Michael R.N. 404660Sellers Miyoung R.N. 215420Sexton Ashley P.N. 136326Shannon Justin R.N. 424821Siaw Sincere P.N. 164210Smith Jeremy R.N. 382473 P.N. 145226Smith Patricia R.N. 194412Sprague Troy R.N. 351953Starrett Amanda P.N. 131330Sterling Candace P.N. 133502Stevenson James R.N. 362785 P.N. 112949Stewart Lindsey R.N. 365282Stone Melissa R.N. 378536Stout Erin R.N. 173314Tackett Nicole R.N. 369182Takacs Starla R.N. 272619Taylor Stephanie P.N. 150727Thoma Heather R.N. 372935Vanorder Angela R.N. 369865Walker Mala P.N. 128592 D.T. 001627Warman Daphne R.N. 341375Warner Beth P.N. 116813Wash Jennifer R.N. 283968Whisner Stacy R.N. 268932 CNP 06117White Amber P.N. 168254Willoughby Rebecca R.N. 419118 P.N. 104380Wilms Jennifer R.N. 228818Yeagley Diane P.N. 136740Yonkers Melissa P.N. 113804

July 2018 Disciplinary ActionsLast Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1


July 2018 Disciplinary ActionsLast Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1Blakley Kelli R.N. NCLEX P.N 149336Blue Rebekah R.N. 389178Boggs Cheryl R.N. 312260Bohme Melissa R.N. 227352Bosner Kelsie P.N. 159951Bowling Mary Beth P.N. 107906Bradley, Jr. John P.N. 134616Brown Angelia DTI applicantBucce Kristin P.N. 154105Buck Mickey R.N. 311291Buescher Lysa R.N. 243517Burroughs Lori R.N. 214054Calhoon Natalie R.N. 357418Cameron Kathleen R.N. 410836Carroll Alyssa R.N. 406374Caserta Amy R.N. NCLEXCaskey Traci R.N. 330378Chambers Megan R.N. 310299Chandler Jessica R.N. 377211 P.N. 123298Chase Linda R.N. 330058Chin Rita R.N. endorseChristner Ashley P.N. 155932Colborn Joann R.N. 413873Collins Samantha P.N. 121264Comer Amanda P.N. 150598Coppess Jennifer R.N. 410319Cordell William R.N. 296100Cox Sandra P.N. 088247Craft Agnes R.N. 231840Crayton John R.N. 354634Cvijanovic Carol R.N. 241646Dalrymple Rebekah R.N. 366604Daniels Yvette P.N. 108596Dayton Kolleen R.N. 263301 CNP 05431Dean Elizabeth P.N. 145035Dees Monica R.N. 414955 P.N. 129911Dejene Yenealem R.N. 333890Delong Sandra R.N. 309066Deran Jennifer P.N. 137078DesRosiers Henri R.N. 153936Dillon Heather R.N. 407113Domineck Doneka P.N. 153051Donchess Sheri R.N. 260078Drummond Sheila R.N. 405721 P.N. 106738Dubose Austi P.N. 140117Dunlap Stephanie P.N. 112454Eicher Nicole R.N. 408877Eisentrager Stephanie R.N. 372036 P.N. 128255Eiserman Shannon R.N. 338104Ellis Danielle P.N. 160671Flaherty Tamara P.N. 155406Fombo Stephania R.N. 433740 P.N. 138384Fontana Jennifer R.N. 285344Ford Dawn R.N. 252282Fosnot Alyson R.N. NCLEXFowler Katelyn R.N. 359797Frazer Susan P.N. 140824Freeman Brandi P.N. 138226Freshwater Jacquline P.N. NCLEXFuentes John R.N. 283214Gabbard Michelle P.N. endorseGetz Pamela P.N. 107593Gifford Brian R.N. 329467Gill Rebecca P.N. 132549

Gillfillan Codylynn R.N. 390813Gochenauer Christina R.N. 323846Gonzales Jennifer P.N. 134740Goodman Carrie R.N. 365141Greene Amanda R.N. 368825Greenwald Jennifer P.N. 122070Grueser Stacy P.N. NCLEXGuenther Becky R.N. 270737Halley Angel R.N. 319627Harless Nakoshua R.N. 350863Harley Amy R.N. 296503Harrison Mary R.N. 232726 CNS 06845Harter Roxanne P.N. NCLEXHauser Jennifer P.N. 135558Hayes Angela P.N. 103662Hearing Christine R.N. 216859Henderson Amanda R.N. NCLEXHennon Bridget R.N. 402853 CRNA 019436Henry Mark P.N. 147147Hill Falon R.N. 328422Holmes Camille R.N. 384238Holt Stefanie R.N. 407537Hoover John P.N. 117252Hosking Mary P.N. 093998Hudson Towyanna P.N. 114306Hull Heather R.N. endorseHull Johonna R.N. 372979Huls Joni R.N. 208188 P.N. 057467Humphrey Deanna P.N. 162239Isaac Tonya P.N. 156478Jansen Carole R.N. 145518Jarc Lauren R.N. 417673Jenkins Keith R.N. 442040 CNP 021771Jeter Christian P.N. 166934Jewell Heather P.N. 127141Jimenez Melissa R.N. 337511 P.N. 104015Jones Dana P.N. 129895Jones India P.N. 158849Jones Leslie R.N. 366274Kautzman Randi R.N. 374172Kavanagh Stacey P.N. 132249Keith Alyshia R.N. 383626Kenton Celia P.N. 139328Kilbarger Audra R.N. 406263 P.N. 151098Kirk Angel P.N. 147619Kirkendall Angela P.N. 121383Knabel, II Roger P.N. 157299Knibbe Brynn R.N. 409756Knight Natalie R.N. 266691Krupar Natalie R.N. 374321Lang Alicia P.N. 113701Lapaugh Kiana P.N. 153533Lavender Leoma R.N. 159421 CNP 04046Lawhorn Brandy P.N. 139972Le Blanc Scarlett R.N. 331412 CNP 019675Licastro Mary R.N. 180193Lindsey Timothy R.N. NCLEX P.N. 160335Lloyd Rachel P.N. 151317Lohr Elise P.N. 110835Lovell Cindy R.N. 297999Lyman Pamela R.N. 241898Lynch Kenya R.N. 422153 P.N. 123408

Macri Diane R.N. 298529Maczuga Andrea R.N. 373720Manchester Erica P.N. 123435Mancini Rita R.N. 414724Markelonis Stacey R.N. 320101Markovich Peter R.N. 222650Marks Jessica R.N. 345764Marston Angela P.N. 143163Mash Olivia R.N. 420795Mason Michelle P.N. 095378Mayer Samantha R.N. 400811McBride Jodi R.N. 364906McCann Jennifer P.N. 150814McCleskey Ashley P.N. 161177McCormick Emily P.N. 155006McDonald Kristen R.N. 385753McGlone Deborah R.N. 179188McGrady Midge P.N. 116133McMillan Teresa R.N. 361127Meagher Jason P.N. 167355Mehlman Andrea R.N. 305991Melley Charles P.N. 150579Middleton Sarah R.N. 333901 P.N. 109853Milledge Daron R.N. 351227Miller Jennifer P.N. 068723Miller Nylea P.N. 110022Miller Stacy R.N. 367358 CRNA 019460Moore Keasandra R.N. 386646Morehart Ryian R.N. 405257Muncy Catherine R.N. 288597Napier Jessica P.N. 150108Nelson Shelbi R.N. 402915Newman Lesile R.N. 437668Nolta, Jr. Everett R.N. 398596 P.N. 143688Norman Sheryl R.N. 235931Norris Stacy P.N. 154628Northup Mary R.N. endorseNunnally Courtney R.N. 367244Nussbaum Jennifer R.N. 316626Nutting John P.N. 130932Nzisabira Nicodeme R.N. 425395 P.N. 141635O’Donnell Melanie R.N. 336749O’Mara Emily R.N. 369200Osborn Stacy P.N. 116270Osting Amber P.N. 124301Owens Susan R.N. 305127Palmer Karen R.N. 424388Patterson Traci P.N. 140838Pauley Myra R.N. 275720Payne Janet R.N. 296318Payne Linda R.N. 280722Payne-Booker Heidi P.N. 133534Perakovic Sherry R.N. 267740 P.N. 094709Perkins Lori R.N. 342765Perrin Lakeisha R.N. 435104Peters Teresa R.N. 209611Petonic Renee P.N. 097248Platek Christopher R.N. 353869Price Tara P.N. 103887Purcell Cassandra P.N. 116567Puthoff Scott P.N. 133807Radina Kimberly R.N. 335858Radtke Michael P.N. 101525Ramsey Morgan R.N. 421728Randolph Samantha R.N. endorseReak Ann P.N. 086326Reid Patrick R.N. 413307

36 MOMENTUM

July 2018 Disciplinary ActionsLast Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1Roberts Christine P.N. 159602Roberts Felicia R.N. 372638Ronyak Jill R.N. 220161Rose Travis R.N. 361460 P.N. 131690Russell Brenda R.N. 304695Rutherford Christina R.N. 323227Salak Diane R.N. 176621Samoylicz Jennifer R.N. NCLEXSantangelo Tricia P.N. 126578Schenck Jason R.N. 287926Scheurenbrand Stephanie R.N. 364503Schlater Samantha R.N. 372068 CNP 020468Schlueter Kristen R.N. 395905Scroggs Zachary P.N. 129831Seckel Teresa R.N. 185216Sedivy Linda R.N. 228625 P.N. 063853Sherwood Jennifer R.N. 170038Shimandle Sharon R.N. 168537Shortland Morgan R.N. 402748Siembieda Pamela R.N. 247907

Simpson Caresta P.N. NCLEXSizemore Sharon R.N. 160133Skufca Cherise R.N. 373489Smith Ashlie P.N. 160368Smith Brenda R.N. 208222Smith Erica R.N. 411500Smith Samara P.N. 140354Smith Theodore P.N. NCLEXSpildener Victoria R.N. 371349Stack Kathryn R.N. 383195Steele Gina R.N. 425481Stewart Juana R.N. 239244Streisel John R.N. 363304Swails Shinita R.N. 350202Swartz Hannah R.N. 412850 P.N. 150611Tanner Andrea R.N. 350013Tatum Shawna R.N. 424661Thomas Sharlene R.N. 420644 P.N. 118115Tighe Shannon R.N. 411466Todd Tracie R.N. 424229Trice Lois DTI applicant

Triplett Jami R.N. 416092Vasquez Diana P.N. 118550Vela Lynn P.N. 155849Vermillion Patricia R.N. 345781 P.N. 119195Walls Shelia P.N. 107091Wenner Frank R.N. 378069Whelan Emily R.N. 358005Whetsel Shannon P.N. 117072White Michael R.N. 309838Williams Kimberly P.N. 142867Williams Lori P.N. 117136Williams Melissa P.N. 134980Williams Monica R.N. 366228 P.N. 121106Worthington Elaina P.N. 154761Wyatt Karen R.N. 222909 P.N. 050917Yoder Katie P.N. 133341Zaleski Michael P.N. 141959Zellers Cynthia R.N. 217133

September 2018 Monitoring ActionsLast Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1 Last Name First Name LT1 Lic. #1

Adams Lisa P.N. 094210Adedipe Adebimpe R.N. 262813 CNS 019387Anderson Ella R.N. 302050Ash Briahna P.N. 157592Baker Lori P.N. 107187Baldwin Tharner P.N. 130754Beach Dionna P.N. 126622Berenics Sherri P.N. 089007Binion LaWanda R.N. 424815Bjorling Benjamin R.N. 412395Bond Chambrell R.N. 409499 P.N. 147739Booker Mark R.N. 311649 CRNA 16616Bosner Kelsie P.N. 159951Brannon Sabrina P.N. 156022Breuer Carl R.N. 414766Buescher Lysa R.N. 243517Burgess Patricia R.N. 261520Butzer Candas P.N. 129524Buyer Ann P.N. 097138Buzon Stacy R.N. 367358 CRNA 019460Cameron Kathleen R.N. 410836Caraveo Dawn D.T. 001054Carte Leslie P.N. 128088Casas Irma R.N. 444760 P.N. 147135Case Kimberly R.N. 394852Caserta Amy R.N. 454311Chandler Jessica R.N. 377211 P.N. 123298Christner Ashley P.N. 155932Clayton Beverly R.N. 207605 CNP 11218Clifford Hayley R.N. 450185Cope Misti P.N. 128229Cornell Gregory P.N. 160772Craft Agnes R.N. 231840Curry Kathy R.N. 378255Deck Brooke R.N. 363335Deran Jennifer P.N. 137078Doe Bernadette R.N. 285770

Drapola Kristin R.N. 242459Durinka Kelly P.N. 102412Eller Deanna R.N. 385020Fannon Elyn R.N. 352186Flynn Maureen R.N. 322587Flynn Natalie R.N. 266263 CNP 09772Fowler Mary P.N. 137260Griggs Holly P.N. 145855Haas-Dugan Marylynn R.N. 196980Hidalgo Kathleen R.N. 201746Hill Edward R.N. 373519Holmes Camille R.N. 384238Hoppes Tiffany R.N. 287099 P.N. 102487Hosking Mary P.N. 093998Hutchinson Marian P.N. 095939Johnson Dawn R.N. 291264Johnson Simone R.N. 322175 P.N. 106593Jones Diane R.N. 418441Jones Leslie R.N. 366274Kimmet Mary R.N. 265081Krohmer Lydia P.N. 079137LaCourse Shannon R.N. 324795Le Blanc Scarlett R.N. 331412 CNP 019675Leeson Cara R.N. 390608Lemaster Andrew R.N. 359743 P.N. 129167Leonard Michelle P.N. 103586Lynch Kenya R.N. 422153 P.N. 123408Martin Brenda R.N. 228582Matusiak Alicja R.N. 359101 CNP 16032McGinty Jacqueline R.N. 334186Mendenhall Kari R.N. 322321Mihalek Shannon R.N. 376721Milburn, II John R.N. 341255 CNP 15213Moeritz April R.N. 394551 P.N. 123898Moline Sara R.N. 355719

Monroe Erica P.N. 121893Moore Valerie R.N. 303185Moore Sims Barbara P.N. 079504Morrison April R.N. 294508Munn Susan P.N. 106305Nelson Shelbi R.N. 402915Nzisabira Nicodeme R.N. 425395 P.N. 141635Pack Heather R.N. 410859Payette Pamela R.N. 387015 P.N. 141894Peirson Staci R.N. 319684Pierce Tammy P.N. 111308Powell Aubrey R.N. 398306Rankin Pamela R.N. 320541Reid Patrick R.N. 413307Reising Tamara R.N. 358390Reynolds Kristine R.N. 340514Ricci Jessica R.N. 341181Richardson Lakeasha P.N. 167884Rimac Helen R.N. 269159Rogers LaShonda P.N. 153566Roth Jennifer R.N. 304789Samoylicz Jennifer R.N. 454310Schaefer Olivia R.N. 382155Sheets Meghan R.N. 351498Shick Roxanne P.N. 165216Skufca Cherise R.N. 373489Smith Teaninau P.N. 135944Smith Theodore P.N. 168854Sowinski Jessica R.N. 418264 P.N. 154513Spicer Kelly R.N. 284402Sprague Troy R.N. 351953Starrett Amanda P.N. 131330Stratton Cody R.N. 315060Stuhldreher Stacey R.N. 403393Sturdivant Sharlonn P.N. 152978Swartz Hannah R.N. 412850 P.N. 150611Terrell Ashley P.N. 148126Thier Penny R.N. 178450Vierling Jessica MAC 000611Ward Jessica R.N. 362748


Warner Alison R.N. 389768Waters Latasha P.N. 160369Weatherford Paulette R.N. 410025

Webber Rosalia P.N. 152160Wiczen Sarah R.N. 369828 P.N. 112802

Williams Melissa P.N. 134980Wilson Crystall R.N. 364682Yost Yvonne R.N. 351267


September 2018 Monitoring Actions

Abramovich Caitlin R.N. 311914Adams David R.N. 276320Adamson Leanne R.N. 282433Alexander Lori R.N. 301880Allan Amy R.N. 357747Alnoubani Muna R.N. 304829Anderson Laura R.N. 286413Anderson Sandy R.N. 254376 CNP 07003Azbell Jennifer R.N. 383923Bailey Jeffery R.N. 165192 CRNA 02885Baker Kitzi R.N. 418049Ballou Meredith R.N. endorseBalog Maegan R.N. 391457Balogh Dina P.N. 122620Barger Kelly P.N. 105131Bennett Eric R.N. 314669Beverly Stefanie P.N. 119494Billings Jesse P.N. 141906Binegar Cali R.N. NCLEXBivens Christopher R.N. 358371Boggs Cheryl R.N. 312260Bowman Beth R.N. 204356Braham Ginny P.N. 134908Brenner Cynthia R.N. 369789Brewer Paul R.N. 401733Bricker Brandi R.N. 341483Bryant Timothy DTI applicantBucce Kristin P.N. 154105Buchinger Nathan R.N. 437386 CRNA 019478Buescher Lysa R.N. 243517Burga Tracy R.N. 316982Byer Stephanie R.N. 323337Cadwell Jason R.N. 369622Cahal Karen R.N. 219535Callahan Bobbie P.N. 089984Calloway Amy P.N. 103540Capell Wilburn DTI 005258Carmichael Crystalee P.N. 119499Carnes Christopher R.N. 246881Carrico Timothy P.N. 128082Carroll Alyssa R.N. 406374Carroll Brenda R.N. 301641 P.N. 098514Causey Cynthia R.N. 400678Centifanti Christine R.N. 181134Chandler-Arthur Jillian R.N. 345188 P.N. 125732Chanowski Kevin P.N. 129150Chevraux Angela P.N. 109615Chiody Christina P.N. 123398Cittadino Mary R.N. NCLEXClair Janice R.N. 352926Clark Amanda R.N. 349436Clark Melissa R.N. 455492Clark Nancy P.N. 156040Clark Richard R.N. 422170Collins Gloria P.N. NCLEXCooper Jessica R.N. 432591Cowden Sara R.N. 396316 P.N. 139489Cox Miriam R.N. 259077Cross David R.N. 409728Cross Veronica R.N. 430641Daria Jeanette R.N. 413759

Davis Alisa R.N. 279196Dekoning Angie P.N. 122857Diem Natalie P.N. 111492DiLeonardo Darlene P.N. 122459Dock Amy R.N. 344179Doniver James P.N. 140679Donnally Anna P.N. 146170Dosztal Debra R.N. 304725Dudsak Jamee R.N. 335825Duncan Nicole R.N. 349249Duncil Melissa P.N. 147241Dupoint Dawn P.N. 145697Durham Crystal R.N. 207663Dykes Michelle R.N. 384217Edge Alisa R.N. 414218Eicher Nicole R.N. 408877Eisentrager Stephanie R.N. 372036 P.N. 128255Elliott Melanie P.N. 120461Esquivel-Rodriguez Amanda R.N. 445637 P.N. 114304Estavillo Brian R.N. 287120Faulkner Michael R.N. 379920 P.N. 141915Ferguson Richard P.N. NCLEXFolczynski Michael R.N. 378556Folliett-Vranic Kimberly R.N. 326335Ford Windell P.N. NCLEXForward-Evans Aneisha P.N. 165676Fouts Abbie P.N. 128565Frazier Crystal P.N. 097744French Megan R.N. 348755Friend Leada P.N. 143191Fry Melissa R.N. 357423Galloway Joyce R.N. 174493Gibson Lori R.N. 369619Gilbert Amy R.N. 368843 P.N. 106408Girts Ruth R.N. 198460Glambin Angela P.N. NCLEXGoins Lisa R.N. 324772 CNP 13621Gory Judith R.N. 258156Goss Shawn R.N. 375963Graber Kathleen R.N. 326472 CNP 11036Griffin Kaveo P.N. 164600Gulich Mark R.N. 176961Haas Cara P.N. 122447Haggerty Nicholl R.N. 316678Hambleton Thomas R.N. 231352Hameed Sybil P.N. 136935Hammond Eric P.N. 139430Hand Katie P.N. 166285Hans Nicole R.N. 272801Hastings Aubrey R.N. 285780Havens Holly P.N. 155590Hayman Janice R.N. 344593Haynes Jasmine P.N. 146607Hempfling Ruth R.N. 221696Hilbert Thomas R.N. 382271Hildebrand Joell R.N. endorseHobbs Elizabeth P.N. 121847Holbrook Jaime R.N. 364526Holland Amy P.N. 130842Horn Connie P.N. 114508Howard Toni R.N. 418245

Hubler Regina R.N. 423376Hugebeck Kristen P.N. 144033Husske Julie R.N. 385900Isaac Shauntae P.N. 122893Ives Angela R.N. NCLEX P.N. 155155Jarosz Jennifer R.N. 248050Jenkins Joshua P.N. 113542Johnson Doreen R.N. 225473Johnson Toya P.N. 160985Jones Jeffrey R.N. 413823Jones Jolisha P.N. NCLEXJurovcik Carrie R.N. 363249Kallai Ambra P.N. 143574Keith Alyshia R.N. 383626Keith Eileen R.N. 364056 P.N. 118457Keith Jennifer P.N. 116175Kerns Ryan R.N. NCLEXKlacza Boguslaw P.N. 098446Knight Natalie R.N. 266691Kolanko Lindsay R.N. 333176Krensavage David R.N. 270163LaRue Denise MAC 000092Lee Sheena R.N. 380597 CNP 020753 P.N. 133447Lisec Dawn R.N. 241039Lokar Brian R.N. 312846Luedemann Shelley R.N. NCLEXLute Amanda R.N. 309646Lyell Christine R.N. 369615Lynch Kenya R.N. 422153 P.N. 123408Lyons Kimberly P.N. 128493Maddox Laura R.N. 400710 CNP 019958Mallett Renee R.N. 247106Malone Leslie P.N. 083339Mangol Rebecca R.N. 430791 P.N. 103910Mann Andrea CHW applicantManning Krystal R.N. 340268Manz Catherine P.N. 123734Marolf Heidi P.N. 163426Martin Kristi P.N. 147901Maxwell Margaret R.N. 270927 P.N. 063902Mayerchak Mason R.N. 409322 P.N. 151968McDermott Angela R.N. 283817McDonald Kristen R.N. 385753Metz Bobbie R.N. 355960Middleton Kerri R.N. 281266 P.N. 095852Miller Michael R.N. 257094Moreno Jessica R.N. 445391Moreno Lindsay P.N. 131966Morgan Angelina P.N. 150873Morley Erin P.N. 137703Morris Ashley R.N. 407944Morris Keri R.N. 285552Morse Melani R.N. 411320Muetzel Megan P.N. 167366Muntean Jade R.N. 439206 P.N. 088930Murphy Sade R.N. 387224


September 2018 Disciplinary Actions

38 MOMENTUM

Murphy Thuy R.N. 416141Neu Frances R.N. 162372New Ladeea P.N. 132563Newman Leslie R.N. 437668Nincevic-Omeragic Maria P.N. 154702Noall Kelly R.N. 396397 CRNA 15247Noggle Mary P.N. 131533Nogueira Rae R.N. 304847Noll Brittany P.N. 114431Norwood Shareese P.N. NCLEXOpoku-Gyamfi Gloria R.N. 288898Ouedraogo Zama R.N. 446288Page Tammy P.N. 109984Painter Tara R.N. 312190Palmer Karen R.N. 424388Paoloni Heather R.N. 367813 P.N. 113835Paugh Gina P.N. 110685Paul Angela P.N. 103345Peiffer Laurel R.N. 179002Pernell Cristy P.N. NCLEXPicciano Barbie R.N. 276162Plaster Christine P.N. 113853Poling Jennifer R.N. 283384Porter Mara R.N. 412935Porter Pamela P.N. 089708Prather Michelle R.N. 345830Provitt Teletha P.N. 148847Razeeq Ayesha R.N. 390150Reiter Stephanie R.N. 396047Rhoads Colleen R.N. 282936Ripley Kristen P.N. NCLEXRobbins Abbey P.N. NCLEXRoberts Michael R.N. 382834Romanini Robin P.N. 089993Ruiz Megan P.N. 101531Russell Kimberly P.N. 151259Rutan Amanda MAC applicantRyerson Michelle P.N. 126049Saghafi Jaleh R.N. 234512Sakian Cynthia P.N. 156056Salak Diane R.N. 176621Sapp Bethany R.N. 308189Shackelford Hollyn R.N. 396081Shade Sarah R.N. 354856 P.N. 112584Shaw Marlena P.N. endorseSheridan Deanna R.N. 143118Shie Charmyn P.N. 109799Shirley Dawn P.N. 149677Sichina Annette R.N. 240797Siebert Michelle P.N. 113026Sierra Genevieve P.N. 139485Sim Phyllis R.N. 214125 CNP 10316Simpson Caresta P.N. NCLEXSmalcer Nanette P.N. 136484Smith Brenda R.N. 208222Smith Richard R.N. 290242Smith Ronda P.N. 159677Smith Sherita P.N. 130628Smith Tiffany P.N. 127805Soltwedel Mackenzie R.N. 401295Sone Martin R.N. 387535Stamler Tatum P.N. 134463Staton Amanda R.N. 334135Sterling Brittany R.N. 405125Stevens Erin R.N. 362740Stover Lori R.N. 332470Stover Pamela P.N. 144299Strohm Shane DTI applicantSullivan Olivia R.N. 441081Swails Shinita R.N. 350202

Tanner Gregory R.N. 270002Tarantino Frank R.N. 376286Thomas Kari P.N. 124958Thornton Shelby R.N. 225222Threatt Jamsaina P.N. NCLEXTodd Teia P.N. 139597Tomlinson Lisa P.N. 096180Townsend Jamie P.N. 111083Unger Jacqueline R.N. 216315Viju Mariamma R.N. 436526Wagel Amber P.N. 141934Wagner Debra R.N. 259145Walker Bobbie R.N. 356537Ward Kelly R.N. 376604

Watson Victoria P.N. 148673Wears Tonya P.N. 108768Weaver Paulette P.N. 143033Weber Anthony P.N. 151232Weber Delores P.N. 145278Weberding Eric R.N. 352610Wells Emily R.N. 347555Wills Jessica P.N. 134981Wilson Steven R.N. 327272Wood David R.N. 205123 P.N. 076307Workman Julia R.N. 414239Zientek Karen R.N. 227062


September 2018 Disciplinary Actions

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