Nurses Report Positive Patient Experiences After Allowing Cannabis in the Inpatient Cancer Unit

With the roll-out of the Senate Bill (CA SB) 311, also known as Ryan’s Law, in 2022, California hospitals are now required to allow patients with terminal illness to access medical cannabis therapy if admitted.^1,2 According to results of a survey of oncology nurses at UCLA, patients had demonstrable improvements in insomnia and anxiety after cannabis use. Further, no nurses reported any negative experience with the new protocol.¹

Amanda McKaig, BSN-RN, OCN

According to Amanda McKaig, BSN-RN, OCN; and Alyssa Ridad, BSN-RN, OCN, who presented the survey findings during the 48th Annual Oncology Nursing Society Congress, institutions in California have updated their policies and procedures to allow patients to bring their own cannabis products to the hospital. At UCLA Health, following the implementation of Ryan’s Law, after doctors identify patients who meet the criteria for cannabis use, patients mut supply their own products which are then stored in a personal lockbox provided by the hospital pharmacy. Patients are then permitted to self-administer cannabis as needed. An RN documents the administrations. According to the 2 nurse investigators, survey respondents noted that the new protocol helped patients with their insomnia and anxiety, highlighting the potential value of alternative pain medications in supportive care.

Alyssa Ridad, BSN-RN, OCN

“The main thing that we found very interesting was there have been a lot of studies that [demonstrated that] cannabis can help with chronic pain and especially cancer-related pain, but we found through our survey that nurses felt that it helped patients [handle] with insomnia and anxiety the most,” McKaig said. “There wasn’t a lot of literature to support [that], but that’s what nurses [responded] was most helpful in the inpatient setting for.”

In an interview with Oncology Nursing News®, McKaig, a clinical nurse at UCLA Medical Center, and Ridad, a registered nurse at UCLA Health in Santa Monica, discussed how they evaluated cannabis use in the inpatient setting and how nurses can continue to support patients with terminal illnesses.

Oncology Nursing News: Please describe Ryan’s Law and how it has affected care in California.

Ridad: Ryan’s Law was put in place in the beginning of 2022, and it was named after Ryan Bartel. He was diagnosed with stage IV pancreatic cancer and was prescribed heavy doses of opioids [such as] morphine and fentanyl but didn’t want to take them—he asked his dad if he could take him off the fentanyl so that he could spend his last few weeks lucid and pain free.²

They moved Ryan to a facility that would allow him to self-medicate with cannabis and he was able to spend his last few days lucid and pain free like he wanted. After that, his father, Jim Bartel, made it his mission to ensure that other families had this option. That led him to write Ryan’s Law [which in California requires] that health care facilities now allow cannabis on their premises for terminally ill patients.

What was the rationale for investigating cannabis use in the hospital?

McKaig: We were interested in this topic because a lot of our patients were using cannabis products at home and then when they came into the hospital, suddenly they were not allowed to use it anymore. There was a disconnect between how patients are managing their symptoms at home vs how they’re managing it in the hospital. Now it is nice that we are able to let them continue that treatment when they’re in the hospital so that they’re having access to everything that they normally use.¹

How did you evaluate cannabis use at your institution?

Ridad: Because we couldn't gauge the patients' [experience] by interviewing them, instead we interviewed the nurse’s [to gain perspective] on what their patient’s symptom management looked like or how comfortable they thought their patients were. For every patient who used [cannabis], we would give the nurse a survey, [which had] approximately 5 questions that gauged their perception on symptom management.

What are the overall implications for oncology nursing practice?

McKaig: This opens a lot of doors for looking at other methods to manage symptoms besides opioids or [products] that have a lot of bad adverse events. [Ryan’s Law] is starting a lot of conversations—especially between patients and their family, or nurses and the patients, [about] things that we don’t normally talk about [which has] been exciting.

Ridad: It’s important for us to be aware that [cannabis] is something that patients with cancer can benefit from because it’s proven is that it helps with chemotherapy induced nausea/vomiting, chemotherapy induced peripheral neuropathy, and anorexia, [which are] all things that our patients suffer from.

It should be our due diligence to educate ourselves and be aware of those symptoms so that we can educate our patients who are curious about what [cannabis] can help them with. To be able to empower nurses to educate them and create an open environment for them to want to talk about [cannabis] is important. I have had numerous conversations with patients who are curious about [cannabis] but didn’t know how to go about it or where to get it, [and asked] ‘can I bring it in the hospital?’ Having that conversation with patients who are curious and having that open environment where they can talk about it is important.

References

1. McKaig A, Ridad A. Nurses’ perspectives on compassionate access to medical cannabis. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed June 2, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12684
2. West M. Ryan’s Law—legislation that permits access to medical cannabis for terminally-ill patients. American Bar Association. May 11, 2022. Accessed June 13, 2023. https://www.americanbar.org/groups/tort_trial_insurance_practice/publications/tortsource/2022/spring/ryans-lawlegislation-permits-access/