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Understanding state, federal laws crucial for inpatient medical marijuana use

NATIONAL HARBOR, Md. — Before dispensing medical marijuana to inpatients, hospitalists should examine their state and federal laws to protect themselves, according to a presentation at Hospital Medicine 2019.

“The Drug Enforcement Agency still maintains that cannabis has no approved medical use,” Charles Reznikoff, MD, assistant professor at the University of Minnesota, said during his presentation. “The agency has been pretty clear that they are not intending to change that, so there is going to be a rift between state and federal laws somewhat long-term.”

Reznikoff advised hospitalists to familiarize themselves with their state law, as well as the federal law, on dispensing medical cannabis in hospital-based settings to make sure it contains protections.

The list of qualifying conditions for medical marijuana differs by state, but may include cancer, HIV/AIDS, inflammatory bowel disease, seizures, PTSD and chronic pain, he said.

There is conflicting preliminary evidence about cannabis and opioids: While past research has suggested that medical marijuana is a safe alternative to opioids, other research found that patients with marijuana use disorder have a higher risk for ongoing opioid use, he said.

“It is too early to promise that medical marijuana is opioid-sparing,” Reznikoff said.

Many inpatients may experience cannabis withdrawal, he said. It is often mild and appears 2 to 3 days after cessation in heavy users, he said. Symptoms of withdrawal include irritability, loss of appetite and poor sleep. Cannabis withdrawal requires no treatment other than supportive care and reassurance, but is important to recognize, he said.

Rates of marijuana use are stable among young people but is increasing among middle aged and older people, according to Reznikoff.

Hospitalists should be aware of other risks of cannabis, such as vasodilation, compensatory tachycardia, mild impairment, orthostasis, falls and anxiety/panic, he said. More rare risks include cannabis hyperemesis, psychosis and drug interactions at P450 enzyme. – by Alaina Tedesco

Reference:

Rezniknoff C, et al. Medical cannabis for inpatients. Presented at: Hospital Medicine 2019. March 25-27; National Harbor, Md.

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