About the legalization of marijuana, it is safe to say that is a trend, that it is controversial, and that the landscape is changing fast. Indeed as I searched for data that I could use to help give context for this column, I found almost nothing at the time of the publication deadline that was likely still to be true by the time it is published. As nurse practitioners, we have a particular relationship to the issue of marijuana legalization. Marijuana has well documented therapeutic effects. Just as well documented is are its recreational use and therefore its diversion and abuse potential. It is a drug, after all, and like all drugs, it comes with risks and benefits that we must help our patients weigh to see if therapy with marijuana is likely to help them. I am grateful to Dr. Susan Apold and her students and colleagues at New York University for participating in what she and I hope will become an ongoing partnership to foster a focus on opinion writing on health care and policy issues among our students and faculty.NONurse Practitioners have a responsibility to advocate against the legalization of marijuana due to its harmful health effects. Marijuana is composed of hundreds of chemical substances, many of which have not been investigated. The main psycho-altering pharmacologic ingredient, known as Delta-9-tetrahydrocannabinol THC, is thought to act directly on cannabinoid receptors, while interacting with multiple others, including opioid, benzodiazepine, GABAergic and dopaminergic receptors. The psychodynamic effects on perception, cognition, and memory, may range from a feeling of euphoria and relaxation to difficulty concentrating, impaired thinking, and altered problem-solving. Heavy users may experience panic attacks, hallucinations, and depression. Some imaging studies have documented a smaller brain volume in chronic users.Marijuana smoke consists of multiple chemicals and carcinogens, contributing to a more direct, toxic effect on lungs than cigarette smoke. Although marijuana can be eaten, inhaled or consumed as a liquid, once it is absorbed THC has a long half-life. It remains in the body for several weeks, exerting pharmacodynamics effects for a prolonged time.Marijuana may pose risks to users across the lifespan. Pregnant women who ingest or inhale marijuana jeopardize the development of their fetus’s brain, with their children at risk for poor learning and attention deficits. The widespread availability of marijuana in high schools exposes adolescents to the deleterious cognitive effects of THC at a time when their brains are still developing. The use of marijuana in adolescence may lead to dependence and addiction in young adulthood, particularly in genetically predisposed individuals.Until the impact of ingesting or inhaling a drug on one’s physical and emotional health is known, it is premature to consider legalization. While legalization should be opposed, decriminalization of the possession and use of marijuana must be enacted. We need to educate individuals about the harmful health effects of marijuana, not jail or criminalize them.YESIt is time to legalize marijuana for both medicinal and recreational use across the United States. As a nurse practitioner deeply committed to patient advocacy, there are too many known beneficial uses of marijuana for legalization to be suppressed any longer. Clearly, the use of medical marijuana is essential. Patients need options for relief of debilitating or refractory pain-either physical or mental. Failure to legalize marijuana for medical purposes is outdated. For example, if cannabidiol oil can help a patient more than what we currently have on the market for pain or seizure control, then it’s our duty as healthcare providers to enter new territory in treatment regimes. Indeed, we need to become more educated on this topic and study cannabis appropriately. However, regardless of our rigid algorithms, patients are finding their relief elsewhere. This poses serious safety issues that could be avoided with legalization and FDA regulation.But this controversy is not about medicinal uses alone. Fiscally, our nation is in need of a fresh pathway for revenue. Prohibition of marijuana is diverting money away from our country and into improper and dangerous hands. Legalizing marijuana would allow for appropriate taxation and a marketplace for creative enterprise. We are in dire need of this revenue and with it, its competitive sales market and job creation platform.Agriculturally and environmentally, hemp is a sustainable crop that is incredibly resourceful. There are thousands of products that are produced from hemp and it can be grown almost anywhere and quickly. With other countries cultivating hemp, this is another import/export opportunity for our country.Lastly, being more open-minded about this topic is where so many of us need to begin. That’s where I needed to begin. It was the honest conversations with patients that changed my mind. For me, this is the best part of being an NP.
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