The rise of the cannabis nurse
April Hatch PHOTO/ZACHARY COBB
Missouri’s medical marijuana program is in full swing, with retail sales open for patients across our home state. The ability to purchase cannabis as a patient is a hard-won victory, but being able to purchase in a dispensary doesn’t automatically mean patients know what to look for when they decide to shop. Patients are required to have a physician certification for their application for a card in Missouri’s program, yet the physician performing the certification rarely provides recommendations for how to consume, what different types of cannabis could be used for various ailments or the appropriate dosage for an individual. This is where the need for a cannabis nurse comes in.
A cannabis nurse? What makes a cannabis nurse different from an RN? Many cannabis nurses are RNs, but the cannabis designation for nurses is typically attained by additional and continued learning and certification for the specifics of cannabis as medicine.
Here in Missouri, cannabis nurses are helping patients each and every day by providing consultations that can help determine what conditions the patient hopes to address, as well as what types of consumption and dosage might be appropriate. When did cannabis nurses become a thing?
In the US, there are multiple states which boast either a medical, recreational, or both legalized program for cannabis purchases. The benefits of talking with a cannabis nurse extend into both medical and recreational markets because those who are wanting to consume cannabis have questions. Unfortunately, despite the legalization of cannabis as medicine has done little to provide cannabis education to those physicians who practice “traditional” medicine. Health systems and large healthcare conglomerates are loath to discuss cannabis and as a result, many will refuse to talk with patients about cannabis as medicine or endorse the use of cannabis by their patients. This is a primary reason why cannabis clinicians, such as cannabis nurses, have begun to grow in numbers across the nation.
When a physician is closed-minded or directed by their affiliated health system to avoid discussions about cannabis, what’s a person to do to learn more about the appropriate use of the medicine? For those clinicians who have experience with cannabis as medicine, the frustration with traditional physicians has increased exponentially. Groups of clinicians have banded together to form industry groups that not only support the use of cannabis clinicians but also provide forums and research to aid in continual education for these practitioners. Those groups include those such as the American Cannabis Nurses Association, the Society of Cannabis Clinicians, the Hospice & Palliative Nurses Association, and the American Holistic Nurses Association. Members of these organizations can collaborate and share information with other clinicians about patient experiences and stay abreast of learning and research that impact patients with regards to cannabis.
Studies and research are showing us in increasing numbers that more of the patient majority are unlikely to attempt to talk about cannabis as medicine with their “regular” physicians. A study conducted by the Journal of Cannabis Research in 2021 found that overall, 64 percent of participants initiated medical cannabis use based on their own experiences vs. 24 percent citing advice from their PCP. Although 80 percent reported that their PCP knew they currently used medical cannabis, 41 percent reported that their PCP had not always known. Only 14 percent obtained their medical cannabis authorization from their PCP. Only 18 percent of participants rated their PCP’s knowledge about medical cannabis as very good or excellent and only 21 percent were very or completely confident in their PCP’s ability to integrate medical cannabis into their treatment. Although 86 percent had substituted cannabis for pharmaceutical medications, 69 percent (n =134) of those who substituted reported some gap in their PCP’s knowledge of their substitution, and 44 percent (n = 86) reported that their PCP was currently unaware of their substitution (Data/Journal of Cannabis Research).
With physicians facing a lack of credibility and knowledge of cannabis, where do patients turn to receive science-backed information about treating their conditions? Cannabis clinicians are attempting to fill this gap. Here in Missouri, cannabis nurses are taking on the challenge of patient education, as well as spreading the word among traditional clinicians that cannabis IS medicine and that education exists if clinicians want to be educated. Not only are they providing patient and clinician education, but are also increasingly being called on to train dispensary staff for working with patients.
The Missouri legislation that passed contains an important distinction for employees that indicate that if they are selling cannabis in a retail setting, they must not communicate information in a way that could be perceived as medical guidance or advice. This is a slippery slope, as many patients enter a dispensary looking for help and guidance on what product types, what potency, and what consumption methods might be the best solution for them as well as hoping that the person helping them will know about any potential risks or drug interactions. Enter the cannabis nurse. He or she has the clinical training for traditional medicine, but additionally, is well versed in cannabis and its use as a medicine.
Alice Mangan couldn’t find the high-quality products she knew could be used to treat her multiple sclerosis and was frustrated by traditional medicine’s typical cycle of adding more pharmaceuticals or ever-increasing dosage changes to find relief. Around the same time, her sister was in a catastrophic car accident and after following her doctor’s orders, not only found that she wasn’t recovering, but she didn’t want to continue the use of opioids and their negative side effects. Mangan knew that cannabis could be extremely effective as medicine, but unable to find the top quality locally, decided she would find a way to make it herself.
Fast forward to today and Mangan is a well-known cannabis clinician in southern Missouri and sells CBD products in her retail locations in both Webb City and Joplin under the name of AliceCBD. Mangan, like other cannabis clinicians, values the time spent with patients doing consultations to educate them about the endocannabinoid system and how cannabis medicine can be used to treat a range of conditions. GoAskAliceRN is an app under development by Mangan and will provide a new way for people to connect with cannabis clinicians – for resources, learning, certifications – all to teach patients to take control of their healthcare.
DeDee Culley, another southern Missouri groundbreaker, has her own story of how she evolved her nursing career into a cannabis nursing specialty. In 2014, she searched for a way to better manage the chronic pain and anxiety she’d dealt with for years and discovered that more holistic and naturopathic therapies, including cannabis, offered more hope than prescription medications had and began her secondary education on the plant’s anatomy and use as treatment. During this part of her journey, she learned in 2018 that cannabis was proving itself as a great help to children with various forms of epilepsy. Later that year came her biggest personal challenge: her husband was diagnosed with glioblastoma, a terminal brain tumor. “While we were beyond devastated, I knew first that God had a plan,” she said. “I researched day and night to find what would provide the best hope. Again, I found cannabis. I also found other nurses doing what I knew I was called to do as well: be a cannabis nurse. Like Mangan and others in the emerging specialty, Culley says “We didn’t go looking for cannabis, cannabis found us.”
Patient consultations are the driving force behind Culley’s company, 2Leaf Nurses. But she’d like to do more ongoing training and education in the industry, not just staff training to start a dispensary team off for opening, but ongoing training. “People in the initial training time have experience, but that doesn’t translate into professionalism or expertise. That doesn’t teach how to talk to patients, as much as I love talking with patients themselves, the industry has to learn more about cannabis and patients than THC content,” she said. 2Leaf Nurses follows a business model in which dispensaries engage with her and her staff to spend an allotted amount of time in a dispensary, which is beneficial, but she prefers to utilize telehealth, stating that it allows her to support multiple patients in multiple dispensaries more efficiently. “Using telehealth, I can support multiple dispensaries and multiple patients. The dispensary that engages me is who pays for the consultation, not the patient.”
Culley is helping to engage more traditional clinicians in Missouri via the Missouri Nurses Association, which she’s working with on a 4-part program of education for clinicians that is receiving receptive support from the organization. She’s passionate about public speaking and loves to talk in large groups about her journey with cannabis as medicine.
April Hatch, featured on this issue’s cover, is co-founder of the Cannabis Care Team (CCT) and a cannabis nurse with a vision for patients and the industry. Hatch is a registered nurse with a Master’s in Public Health Nursing and has extensive experience in acute care. Cannabis “found” her when her son suffered a traumatic brain injury (TBI) on the football field and she saw firsthand the positive impact cannabis had on his life. Traumatic brain injuries not only upend a person’s entire life but are also notoriously difficult to treat. New research suggests that medical marijuana treatments may be able to prevent further damage and relieve ongoing symptoms.
Concussions are the most common type of injury, but any severity of TBI can disrupt a patient’s life, possibly leading to long-term, debilitating symptoms. The initial trauma of a TBI causes instant and ongoing changes in the brain, including the release of compounds that can cause swelling, dysfunction, neurotoxicity, cell death, and more, leading to neurological issues that can plague patients for months or even years. Those who have experienced a TBI may experience a feeling that their personality has changed, or that their moods are out of their control, which can manifest in anxiety and depression. TBI can also cause ongoing spasticity, leading to mobility issues or loss of speech. Yet, despite all of these various effects, effective treatments are limited. The typical initial treatment for mild cases is simply physical and mental rest, while more severe cases call for controlling oxygen and blood pressure, removing blood clots, and even surgically relieving pressure in the skull.
Rehabilitation therapy is the main way patients recover function. Typical medication options may reduce associated anxiety, clotting, or seizures, but don’t necessarily aid recovery at the molecular level. A lack of sustainable and effective pharmaceutical treatments for TBI means that many sufferers, including professional athletes, are curious about the potential of CBD and THC, the chemical compounds found in medical cannabis. While positive research has focused on treatments soon after the initial injury, a growing number of patients are also considering medical marijuana as a way to manage ongoing issues and having success.
This was the case for Hatch’s son. As a clinician, she sought out scientific evidence that could assist in trying to find relief for a patient, as a Mom, she became impassioned to help her oldest child have a better and more promising quality of life. This is how Hatch and cannabis found each other. Hatch and her mother, Heidi Trout, decided the power of the people’s plant was something that needed to be heralded and talked about – even when it wasn’t comfortable. They began CCT as a patient consultation service that dedicates efforts to talking with patients one on one to determine if they have conditions and/or symptoms that might be managed or treated with cannabis as medicine. “Working with patients, especially seniors, is one of the most gratifying and rewarding things I do every day, these are people who we are helping and to see them find relief and help them learn about options is the best job in the world,” said Hatch.
Over the past six years, Hatch’s immersion in cannabis as medicine has increased exponentially. She has been a tireless advocate for providing education, support, and advocacy to patients and the cannabis industry in multiple states. A frequent public speaker, Hatch has been asked to talk to groups both large and small at conferences, events, and advocacy initiatives.
When asked about the importance of cannabis nurses in Missouri’s market, Hatch said, “Patients overwhelmingly state they want to talk to healthcare professionals about medical cannabis but as we know there are very few healthcare professionals who can have this conversation due to lack of knowledge, restrictions placed by their organization, stigma, and reefer madness rhetoric.
“Cannabis nurses have a deep understanding of medical cannabis along with their knowledge of the medical conditions patients may be considering it for and the medications they may be taking. Cannabis nurses are often the ones to point out that a particular medication may interact with cannabis and help a patient with how to have a conversation with their doctor. The patients we talk to have often been failed by the healthcare system and when they get to us they feel a new sense of confidence and trust in healthcare professionals. We want only the best for them and that is providing the education they need to confidently make their own healthcare decisions.
“Unfortunately, nurses are overworked, tired, and don’t have time and the greatest gift cannabis nurses can give patients is to sometimes just to be present and listen. A lot of these patients have suffered for years, decades, tried dozens of medications, surgery after surgery and we allow them to share their story without judgment.”
Patient consultations are still a large part of the work of CCT, and Hatch isn’t the only RN on the team, she’s joined by Matt Cascio, who is a cannabis nurse with the shared passion of everyone in this feature – he’s a believer in the therapeutic benefits of cannabis and brings the enthusiasm to the CCT events that they’re known for. Matt’s goal is to help patients meet theirs. He is dedicated to providing education on dosing, methods of administration, potentially therapeutic strains, side effects, and drug interactions. He does this best when he works with the patients to create individualized treatment plans that promote long-term success. Matt’s resume also boasts Certified Compassion Fatigue Professional designation, which has allowed him to help first responders and medical professionals – who are the very people that might benefit from the use of cannabis as medicine themselves even if they can’t publicly support it.
CCT also partners with other clinicians who hope to advance the industry for patients – including Elevate Holistics who provide physician certifications, and Dawn Privett, a registered, licensed dietitian who has been working with patients for 25 years. She has obtained specialty certifications in adult weight management, food hypersensitivity, and is a certified Holistic Cannabis Practitioner. Dawn has witnessed patients with pain, cancer, anxiety, and autism benefit from cannabis.
While CCT began with patient consultations, that’s far from where they are today and where they strive to be tomorrow. The team works tirelessly to continually improve the education of everyone they encounter – patients, providers, cannabis industry players, and students. Hatch has expanded their offerings in the past two years to include dispensary staff training, with a strong foundation and focus on how to best help dispensary staff understand the importance of talking with patients, versus simply selling whatever the store hopes to promote. Their dispensary training bears the mark of clinical knowledge and experience in dealing with people of all sizes, shapes, sexes, and ages; all sorts of conditions, all sorts of symptoms.
“Cannabis nurses can do a lot more too. We’ve worked with sick people our whole careers, we know what doctors and insurance companies like to hear, we’ve had jobs in management, legal consulting, we’ve advocated for patients and nurses at the state and federal level… so if there is a need the industry has, there is a cannabis nurse who could provide a lot of value,” added Hatch.
Trout says of their dispensary training, “We’ve learned a lot from budtenders ourselves and we want to make sure we can give back, and we do that by providing the evidence-based cannabis basics and the experience we have working with patients all over the country. We were honestly surprised when we started getting calls from patients in CA. We had just assumed that an industry from the longest-running medical program would understand how important education is for a patient’s success. It’s so much more than indica vs. sativa and THC percentages. We don’t read a bunch of Powerpoints and the training sessions are very interactive. We care and love what we do. We want to ensure each individual who attends our training feels confident after they’ve spent the day with us. We know they do because they tell us! There are so many courses out there people trying to get into this industry take to learn more about the plant or more about the role as a budtender and we hear ours ‘blows theirs out of the water,’ so that’s some pretty good feedback we are proud of.”
CCT also offers patients resources – their Treatment Journals are available to help patients understand the basics of things like consumption methods, terpenes, and a foundational guide to supplement their journey. The journals are offered as-is with CCT branding, or co-branded with brands should the operators want to provide to patients with their logos as giveaways or to sell. Individuals have access to the journals on Amazon, and sample pages are available, as are shopping guides, on the CCT website. While cannabis as medicine might not be for everyone, it’s something that CCT wants to make sure people are given valid and relevant information about – which is where the team’s slogan comes from – Education Before Medication.
Missouri’s market is in a transition right now – we’re all aware of shortages and delays in companies becoming operational, while patients are frustrated about prices and product availability – spend any time on social media in conversations about the market and you’ll find there are plenty of additional frustrations that aren’t related to operators – there’s a real need for education. Among the recurring questions posed to all of our cannabis nurses show some trends – and easily the most popular are these three:
“Can I do this without smoking or getting high?”
“How do I use this product I just purchased?”
“Do you think this will help my condition?”
During this time, with Missouri’s new market forming and solidifying over the next 12 months, patients are the priority of the industry and as we look at a future with adult-use almost certainly on the ballot for 2022, the time for patient education is now and cannabis nurses are proving to be valuable resources to both industry and patients.