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1 VOLUME 9, ISSUE 2 JULY 2018 SUPPLEMENT. JOURNAL OF nursing REGULATION . T H E O F F I C I A L J O U R N A L O F T H E N AT I O N A L C O U N C I L O F S TAT E B O A R D S O F N U R S I N G. JOURNAL. nursing . Volume 9, Issue 2 July 2018 Supplement OF. REGULATION . Advancing nursing Excellence for Public Protection The NCSBN National nursing Guidelines for Medical Marijuana Current Legislation, Scientific Literature Review, and nursing Implications nursing Care of the Patient Using Medical Marijuana Medical Marijuana Education in Pre-Licensure nursing Programs Medical Marijuana Education in APRN nursing Programs APRNs Certifying a Medical Marijuana Qualifying Condition Pages S1 S60.

2 Supplement The NCSBN National nursing Guidelines for Medical Marijuana JOURNAL. OF nursing . REGULATION . Official publication of the National Council of State Boards of nursing Editor-in-Chief Editorial Advisory board Maryann Alexander, PhD, RN, FAAN Mohammed A. Arsiwala, MD Patty Knecht, PhD, RN, ANEF. Chief Officer, nursing REGULATION President Vice President, Integration Services National Council of State Boards of nursing Michigan Urgent Care ATI nursing Education/Ascend Learning Chicago, Illinois Livonia, Michigan Leawood, Kansas Chief Executive Officer David C. Benton, RGN, PhD, FFNF, FRCN, Kathy Bettinardi-Angres, APN-BC, MS, MT Meadows, DNP, RN, MS, MBA.

3 FAAN RN, CADC Director of Professional Practice, AONE. Professional Assessment Coordinator, Executive Director, AONE Foundation Contributing Editors Positive Sobriety Institute Chicago, Illinois Nancy Spector, PhD, RN. Kathy Russell, JD, MN, RN. Adjunct Faculty, Rush University Allison Squires, PhD, RN, FAAN Department of nursing Paula R. Meyer, MSN, RN. Chicago, Illinois Executive Director NCSBN board of Directors Washington State Department of Health President Shirley A. Brekken, MS, RN, FAAN nursing Care Quality Assurance Katherine Thomas, MN, RN, FAAN. Executive Director Commission President-elect Minnesota board of nursing Olympia, Washington Julia George, MSN, RN, FRE.

4 Minneapolis, Minnesota Treasurer Barbara Morvant, MN, RN. Gloria Damgaard, MS, RN, FRE. Nancy J. Brent, MS, JD, RN Regulatory Policy Consultant Area I Director Attorney At Law Baton Rouge, Louisiana Cynthia LaBonde, MN, RN. Wilmette, Illinois Area II Director Ann L. O'Sullivan, PhD, CRNP, FAAN. Adrian Guerrero, CPM Sean Clarke, RN, PhD, FAAN Professor of Primary Care nursing Area III Director Professor and Associate Dean, Undergraduate Dr. Hildegarde Reynolds Endowed Term Jim Cleghorn, MA. Program Professor of Primary Care nursing Area IV Director William F. Connell School of nursing University of Pennsylvania Valerie J. Fuller, PhD, DNP, AGACNP-BC, FNP-BC, FAANP, FNAP Boston College Philadelphia, Pennsylvania Chestnut Hill, Massachusetts Director-at-Large Pamela J.

5 Para, RN, MPH, CPHRM, Elizabeth Lund, MSN, RN. Anne Coghlan, MScN, RN ARM, DFASHRM. Director-at-Large Executive Director and Chief Executive Risk and Regulatory Specialist Karen Scipio-Skinner, MSN, RN. Officer Chicago, Illinois Director-at-Large Valerie Smith, MS, RN, FRE. College of Nurses of Ontario Toronto, Ontario, Canada Carolyn Reed RN, MA, FCNA. Director-at-Large Chief Executive/Registrar Lori Scheidt, MBA-HCM. Sandra Evans, MA Ed, RN nursing Council of New Zealand The Journal of nursing REGULATION is a quarterly, peer-reviewed Executive Director Wellington, New Zealand professional journal published by Elsevier and supported by the National Council of State Boards of nursing ( NCSBN ), a not-for-profit Idaho board of nursing organization.

6 NCSBN can be contacted at: Boise, Idaho Carol A. Romano, PhD, RN, FACMI, 111 East Wacker Drive, Suite 2900. Chicago, IL 60601-4277. FAAN. Telephone: 1-312-525-3600 Suzanne Feetham, PhD, RN, FAAN Dean and Professor Fax: 1-312-279-1032. nursing Research Consultant Uniformed Services University of the Health Copyright 2018. Produced and printed in the USA. All rights reserved. Children's National Medical Center Sciences, Daniel K. Inouye Graduate No part of this publication may be reproduced or transmitted in any form, whole or in part, without the permission of the copyright holder, Washington, DC School of nursing the National Council of State Boards of nursing .

7 Visiting Professor Bethesda, Maryland Disclaimer University of Wisconsin The Journal of nursing REGULATION is a peer-reviewed journal. Statements, views, and opinions are solely those of the authors and Milwaukee, Wisconsin Linda R. Rounds, PhD, RN, FNP, persons quoted. Such views do not necessarily reflect those of the FAANP. publisher. The publisher disclaims all responsibility for any errors or any injuries to persons or properties resulting from the use of information Professor/Betty Lee Evans Distinguished or advertisements contained in the journal. Professor of nursing University of texas Subscription, advertising, reprints Go to or Medical Branch School of nursing ISSN 2155-8256 Galveston, texas S2 Journal of nursing REGULATION The NCSBN National nursing Guidelines for Medical Marijuana Current Legislation, Scientific Literature Review, and nursing Implications nursing Care of the Patient Using Medical Marijuana Medical Marijuana Education in Pre-Licensure nursing Programs Medical Marijuana Education in APRN nursing Programs APRNs Certifying a Medical Marijuana Qualifying Condition The NCSBN Medical Marijuana Guidelines Committee: Kathleen Russell, JD, MN, RN; Maureen Cahill, MSN, APN-CNS, RN.

8 Kent Gowen, MA;. Rene Cronquist, JD, RN; Valerie Smith, MS, RN, FRE; Cathy Borris-Hale, MHA, RN; Holly Fischer, JD;. Diana Heywood, MN, RN; James (Dusty) Johnston, JD; Sherri Sutton-Johnson, MSN, RN. Volume 9/Issue 2 Supplement July 2018 S3. CONTENTS. July 2018 Volume 9 Issue 2 Supplement PART I Current Legislation, Scientific Literature Review, and nursing Implications .. S6. Federal and State Legislation Through 2018 .. S7. Federal Legislation and Actions .. S7. State Legislation and Actions .. S8. Literature Review .. S9. Gaps in Comprehensive Reviews .. S10. Therapeutic Effects of Cannabis (Literature last updated February 2018) .. S10. Clinical evidence supporting cannabis for medical conditions.

9 S10. Qualifying Conditions Without Clinical Evidence .. S11. Effects of Cannabis That May Influence Treatment Decisions .. S12. Advancing nursing excellence Physiologic Effects of Cannabis .. S12. for public protection Adjunctive Use of Cannabis With Opiates, Antidepressants, and Benzodiazepines.. S13. Neurologic Symptoms .. S13. Subjective Measures vs Objective Measures for Spasticity and Pain .. S13. Adverse Effects of Cannabis.. S14. Described Adverse Effects of Major Cannabinoids.. S14. Specific patient groups.. S14. Overdose, abuse, dependence, and withdrawal .. S16. Drug-drug interactions .. S16. Methods of Administration .. S17. Dosing Considerations.

10 S18. The Entourage Effect .. S18. Price Consideration.. S18. nursing Implications.. S19. Six Principles of Essential Knowledge.. S19. Conclusion .. S21. References .. S52. PART II The NCSBN National nursing Guidelines for Medical Marijuana nursing Care of the Patient Using Medical Marijuana .. S23. Mission Purpose of the Guidelines .. S23. The Journal of nursing REGULATION provides a Definitions .. S23. worldwide forum for sharing research, evidence-based practice, and innovative Recommendations .. S24. strategies and solutions related to nursing References.. S26. REGULATION , with the ultimate goal of Medical Marijuana Education in Pre-Licensure nursing Programs.