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Some nursing professionals "are fighting" a healthcare system that quickly "labels" any patient with the psychoactive cannabinoid THC-9 in their system as having cannabis use disorder, regardless of whether a psychiatric disorder or other condition may be affecting them, said Heather Manus, RN, addressing a group of about 200 people during a session.

While the National Council of State Boards of Nursing (NCSBN) in 2018 regarding medical cannabis, "are they teaching it in nursing schools?" the San Diego-based advocate asked rhetorically, her voice rising an octave. Many in the crowd at the Baltimore Convention Center murmured and shook their heads.

In 2015, Manus founded , a national organization that helps nursing professionals work within the medical cannabis space, mirroring a suddenly surging trend. Some treat patients, others counsel them and liaison with their providers, and still others -- such as Manus -- have carved out advocacy and leadership roles.

More and more nursing professionals are turning to cannabis work, especially over the last few years, sources told MedPage Today. And while they were doing so before COVID-19, their burgeoning burnout, and frustration with traditional healthcare settings and employers during the pandemic, have caused even more to consider this career change.

"COVID has changed a lot of the landscape of what nurses want our profession to look like," said Ashley Wynn-Grimes, RN, who runs a medical cannabis consultancy in the Baltimore area.

"People go in [to a dispensary] and have no idea what they're doing, no idea how these products work, and could really use that support," said Laura Barrett-Nutting, RN, who also runs a Maryland-based consultancy.

Nursing professionals are indeed filling care gaps, sources agreed. However, others questioned how effectively and safely they are treating patients.

"We just have to be sure the people in this space are playing the role they were set up to play," said Jordan Tishler, MD, president of the (ACS), who runs a Boston private practice.

He said many physicians are cautious about nursing professionals within the medical cannabis space, and that ACS is skeptical of some of the nurse associations' educational programming.

"Nurses in general don't have the deep scientific training that is necessary at the moment," Tishler explained. "I think there's a role for everyone within this industry," including pharmacists, he added. "Right now it's topsy-turvy and people are trying to stake out territory that normally would be reserved for physicians and advanced practice nurses. ... I think that's problematic."

Cultivating a Nursing Trend

Nurses have been working with medical cannabis throughout this century, and a handful for longer, sources said.

The had 1,500 members as of 2019 and has grown since then, said president Eloise Theisen, NP. She gets about a dozen emails weekly asking how to become a cannabis nurse.

Nearly 70% of the 2019 members were in their first year of membership, according to an internal survey she partially shared with MedPage Today. Nearly half had been practicing nurses for more than 25 years, which was three times the portion of members with 0 to 5 years of nursing experience. (MedPage Today could not find other industry data on this trend.) Meanwhile, niche associations such as have also recently emerged.

The broader trend has surged recently for several reasons:

• Nurses have treated themselves and family members with cannabis, and want to take their newfound knowledge to patient care
• Nurses are fed up with working in what they see as increasingly corporatized traditional medicine, and are looking for other career avenues
• New evidence continues to emerge regarding the effectiveness and safety of cannabis, and organizations such as the NCSBN have offered practice guidelines
• Higher education is starting to offer educational programming, such as launched last year by the University of Maryland's School of Pharmacy; in addition, associations offer their own educational programs
• Physicians have been loathe overall to accept medical cannabis, while patients and states are increasingly embracing it, leaving much more patient demand than physician supply -- nursing professionals have capitalized
• The much-ballyhooed cannabidiol and its derivatives (such as delta-8 THC) have flooded the market since Congress passed the

These factors have allowed nursing professionals to thrive. Theisen started a practice outside Oakland, California in 2014, often treating geriatric patients. "It started out with people laughing at me, not taking me seriously," she said. But acceptance has since grown among other healthcare professionals, who often now refer patients to her to help them navigate cannabis products and dosing. "I really try to do a lot of hand-holding, because most people who come to cannabis are very naive," she added.

Many RN's are following similar paths as Wynn-Grimes and Barrett-Nutting, who started consulting businesses. Wynn-Grimes offers training sessions for other nursing professionals, connects patients with providers, and writes publicly about her work. She also counsels patients as a clinical director for dispensaries. "I don't then talk with their doctor, but I do recommend they then talk with their doctor," she noted.

Barrett-Nutting educates patients and their caregivers about cannabis, and sometimes relays her conversations to their providers. "I have to be careful because I'm not a doctor. I don't want to tell a doctor how to take care of a patient," she said. She has, however, advised physicians to prescribe cannabis instead of opioids for pain and shares emerging research with them. "I've been a nurse for 25-plus years and I feel like I'm making a difference in people's lives now more than ever," she added.

Resistance From Physicians, Culture

Despite their successes, these nursing professionals often face resistance in this space. Wynn-Grimes's account with a credit card processing company was declined, while Theisen has not been able to establish a bank account or business license under her name because her practice features the word "cannabis," she said.

In addition, dispensaries typically prefer "budtenders" to nursing professionals because they are much cheaper ($15 hourly, according to estimates). Workplace drug testing has also slowed the growth of this trend, Theisen said, as has the threat of being disciplined by nursing boards, according to Manus. Cannabis's status as an illegal substance federally prevents many healthcare professionals from embracing or even trying to learn about it, they said.

"You have to have thick skin and be willing to hear 'no' a lot," Theisen noted. "And the cannabis industry hasn't really adopted the notion that nurses have value in this space. We've really been trying to fight for inclusion."

That fight has extended to dealing with physicians. Many still lack understanding of the endocannabinoid system, and are uncomfortable working with the plant in any fashion.

"It's good these other professional groups are interested in trying to meet these unmet needs of people, but ultimately we need to get physicians more involved," Tishler said.

Regardless, sources agreed that nurses will continue to contribute to medical cannabis care in some fashion. At the least, physicians prefer them to the players ignoring healthcare professionals altogether, whom they said play too large a role now.

A recent found that only 40% of 434 dispensary staff members surveyed (including only 5% who self-identified as physicians, nurse practitioners, or physician assistants) "relied on clinician input" when making recommendations to customers compared with 70% who drew from others' experiences and 63% who drew from their own.

This study suggests that most patients "may not be receiving balanced information and advice" on cannabis from dispensaries, according to the authors of an . "Clinicians can meet this need by asking patients about their cannabis use and offering patients shared decision-making."

"We've come really far, but we've still got a long way to go," said Manus.

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