Although medical cannabis is legal in 36 states, the District of Columbia, and four US territories, it continues to remain illegal as a Schedule I drug under federal law. This federal illegality not only limits research and development of medical cannabis within the United States but also contributes to the lack of awareness among healthcare providers and patients about medical cannabis as a frontline treatment option or therapeutic recourse, creates a chilling effect on healthcare practitioners who might otherwise recommend it to their patients, and impedes access in healthcare facilities that might otherwise permit patient use.
Medical cannabis can benefit the terminally ill patient in several ways. One benefit of medical cannabis recognized by many healthcare providers is its ability to offer pain relief. In the case of terminally ill patients, morphine and fentanyl are frequently prescribed to help manage pain. However, a common side effect of these drugs is they typically cause patients to exist in a semi-comatose state. Medical cannabis can be used as an alternate or complementary treatment option to these medications, providing gentler side effects that allow terminally ill patients to stay awake and spend more of their remaining precious moments with family and friends.
Additional benefits of medical cannabis include its ability to increase appetite and reduce anxiety. Particularly for terminally ill patients, even a small meal or a bit of soup can help the patient be more comfortable. Anxiety experienced by terminally ill patients can be relieved at least for a short while by medical cannabis. Other important benefits of medical cannabis include its effectiveness in reducing nausea and vomiting.
Yet, despite these benefits, health care providers who want to recommend medical cannabis as a therapeutic for their terminally ill patients don’t dare to because of the risk that their professional license will be sanctioned by a regulatory board. Unfortunately, many state medical and nursing board members who are the decisionmakers over professional licensing issues rely upon their subjective perception about medical cannabis rather than fact-based data derived from scientific research. Although lifting federal prohibitions on cannabis research would enable more research, plenty of international, credible, peer-reviewed research exists about the benefits of medical cannabis.
Healthcare facilities also have their hands tied because of current federal rules and regulations that prohibit the use of medical cannabis within a healthcare facility. This is particularly unfortunate for terminally ill patients who previously used medical cannabis in their homes with good results before being transferred to a healthcare facility.
One state has taken a stand on facilitating access to medical cannabis for terminally ill patients. It is hoped that other states will follow suit. As of January 1, 2022, the state of California created access to medical cannabis for terminally ill patients by enacting the Compassionate Access to Medical Cannabis Act or “Ryan’s Law.” See Cal. Health & Safety Code § 1649¬1649.6. Truly good and meaningful legislation such as Ryan’s Law is often triggered by human experiences and the desire to effectuate change. The story behind the law is that of Ryan Bartel, a former athlete and member of the US Coast Guard who was diagnosed with terminal pancreatic cancer. Having only weeks to live, Ryan expressed to his father that he wanted to discontinue the fentanyl prescribed for palliative relief because it was causing him to sleep. In response, Ryan’s father, Jim Bartel, embarked on a mission to find a healthcare facility where Ryan would have access to medical cannabis. Naturally, Jim wanted his son to be as comfortable as possible. At the same time, he wanted to afford Ryan the opportunity to stay awake as much as possible during his final weeks. After several disappointing rejections from healthcare facilities, Jim succeeded in finding a facility that permitted Ryan’s use of medical cannabis. This option made all of the difference for Ryan and his family and friends. During his final days, Ryan was able to be awake and communicative to the point where he was able to send text messages to his friends.
Ryan’s Law is a straightforward piece of legislation. Its legislative intent is to support the ability of terminally-ill patients to safely use medical cannabis within specified “healthcare facilities,” including acute care hospitals, special hospitals, skilled nursing facilities, congregate living health facilities, and hospice providers. State hospitals and chemical dependency recovery hospitals fall outside of the legislative definition of a “healthcare facility” and do not permit access to medical cannabis. Regarding how a patient qualifies under Ryan’s Law, the term “terminally ill” is defined as a medical condition resulting in a prognosis of life of one year or less, if the disease follows its natural course.
Another important aspect of Ryan’s Law is that it prohibits specified criminal penalties from being imposed on a patient or a patient’s primary caregiver who possesses or cultivates cannabis for the personal medicinal purposes of the terminally-ill patient upon the written or oral recommendation or approval of a physician. Other criteria under Ryan’s Law include the following:
- terminally-ill patients who want access to medical cannabis must provide to the healthcare facility either a copy of their medical marijuana card or written documentation that the use of medicinal cannabis is recommended by a physician;
- healthcare facilities can reasonably restrict the manner in which a patient stores and uses medical cannabis to ensure the safety of other patients, guests, and employees of the facility;
- healthcare facilities must prohibit smoking or vaping as methods of using medical cannabis;
- use of medical cannabis must be entered into a patient’s medical records; and
- each healthcare facility must develop and disseminate written guidelines for the use of medical cannabis within the facility.
Given today’s current political climate, it’s heartwarming to find sensible legislation where legislators from both sides of the aisle demonstrated their ability to come together for the greater good. The first version of the bill, SB 405, passed unanimously until it was vetoed by Governor Newsom. The second version, passed 36-1 in the Senate and 71-1 in the Assembly. Ryan’s father Jim Bartel, Cannabis Nurses Network’s Heather Manus, RN, and Ken Sobel, Esq. were all directly involved and influential in the authorship, lobbying, and passage of Ryan’s Law in California.
The time for medical cannabis to be recognized as a legitimate therapeutic for patient use has arrived. The need for sensible laws that don’t place healthcare providers in jeopardy for recommending medical cannabis is long overdue. Ryan’s Law is an important step in this direction by improving access to medical cannabis for terminally-ill patients. Lawyers, physicians, nurses, or anyone with a sincere desire to help enact legislation similar to Ryan’s Law in their own state are invited to visit the Cannabis Nurses Network website at https://www.cannabisnursesnetwork.com.