May 22, 2019
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‘This is medicine’: Maine nurse practitioners can recommend marijuana starting Aug. 1

PORTLAND, Maine — Nurse practitioners in Maine can legally certify patients to use medical cannabis beginning Friday.

Nurse practitioners will join physicians as medical professionals who can legally recommend marijuana to patients suffering from qualifying conditions approved by state government, including cancer, glaucoma, HIV, post-traumatic stress disorder and others.

Wellness Connection of Maine, the state’s largest medical marijuana dispensary group, is hosting informational sessions so medical professionals know the ins and outs of medicinal marijuana treatment, science and regulation.

“We feel it’s very important to provide education like this,” said Catherine Cobb, a member of the group’s board of directors and a former Department of Health and Human Services official who oversaw Maine’s medical marijuana program. “We’ve been working for the last few months to try to put on more sessions so that the information is out there, and we get rid of some of the stigma attached to people who use marijuana for medical reasons.”

Becky DeKeuster, director of community and education at Wellness Connection of Maine, said negative stereotypes have been attached to marijuana because of the psychoactive effects.

Those effects, caused by the compound THC, became more visible when marijuana was banned nationwide even for medicinal use, she said.

“During prohibition, marijuana was used only recreationally, so there was this drive among growers to breed plants with higher THC levels,” DeKeuster said. “Now we have professionals working to breed plants where other compounds are prominent.”

While THC is the most commonly known compound, hundreds of other compounds are active in the marijuana plant.

“This is medicine to people,” DeKeuster said, adding that the most common helpful side effects include muscle-soothing relaxation, suppression of unpleasant memories and appetite control.

With certification, a qualifying patient will be able to grow their own marijuana, or designate a dispensary or caregiver to provide it for them.

“It’s not a prescription, it’s a recommendation,” Cobb said.

A certification will state that a patient has a qualifying condition, a bona fide relationship with their primary health care provider, and that they may benefit from using medicinal marijuana, she said.

Medical professionals will not be permitted to assist with obtaining, cultivating or using the medicine, however, and will only provide educational resources.

Patients must have had a continuous relationship with their provider for at least six months before being certified.

Cobb said the requirement will not only help patients access medicinal marijuana, as many Mainers see a nurse practitioner instead of a physician as their primary health care provider, but also create continuity of care.

“It’s to raise access and find more people who can certify, but also for those folks who can stay with their nurse practitioner for ongoing treatment, it’s good for their ongoing quality of care,” Cobb said.

At an informational session in Portland on Friday, the group discussed how nurse practitioners could help “optimize a patient’s therapeutic relationship with cannabis,” reporting on how different strains of marijuana can help different conditions and which delivery methods are best.

Jay Reighly, a South Portland nurse practitioner specializing in women’s health and holistic methods, was invited to discuss the science of marijuana.

“We discovered in the ‘80s that we are born hardwired to interact with the active compounds in this plant,” she said.

The endocannabinoid system is a network of receptors throughout the central and peripheral nervous systems involved with many psychological processes, including mood, memory and pain sensations, she said. The system mediates the compounds found in marijuana.

“We used to think the endorphin system was something that kicked-in after we exercised well, saw a really great movie or had beautiful sex, but now we know those feelings can be altered in other ways,” Reighly said.

According to Reighly, the endocannabinoid system had only six scholarly citations in 1993, but over 6,000 last year.

While more research is being done, Cobb says it’s slow because marijuana is still outlawed on the federal level.

Marijuana is labeled a Schedule I drug by the U.S. Drug Enforcement Administration, meaning it has been noted for high abuse potential and severe physical and psychological dependence rates. It is grouped with drugs such as heroin, LSD and ecstasy. Cocaine and methamphetamines are listed as Schedule II drugs and are considered to be less dangerous by the DEA.

“It’s an outdated analysis,” Cobb said, noting many campaigns across the country working to list marijuana at a lower schedule or remove it altogether.

“You can’t get human trials approved as long as the federal government has it as a Schedule I,” she said. “They just aren’t going to allow it.”

Use of marijuana for medicinal purposes has been legal in Maine since 1999. Larger-scale dispensaries of medical marijuana became legal a decade later.

In 2009, when Cobb worked for DHHS, she wrote regulations for marijuana dispensaries, before she knew much about the plant.

“I was a novice then,” Cobb said. “I can’t tell you how many hours a week I just spend learning about this whole plant now.”

 



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