BRUNSWICK — Allowing medical marijuana to be used in hospitals may sound like a good idea, but it’s not. This has nothing to do with pros and cons of medical marijuana, but rather has to do with patient safety. This should be our biggest concern. There are also issues with logistical management.

Hospitals have policies based on standards set by The Joint Commission, a major accreditation organization, as well as by the state and by various safety and professional groups. Physicians cannot write an order to override a policy. Should it be acceptable for the Maine Legislature to do so, as they discussed last session?

• One policy calls for no medications at the patient’s bedside. Providers need to know not only what the patient is taking, but also the dose.

Someone may take too little or too much. Or they may take the wrong thing – as in a case I recall from the 1990s (before this policy was mandated), where someone brushed their teeth not with toothpaste, but with a cream derived from hot peppers!

There is also the matter of other patients (confused or not) or visitors coming into the room while the patient is absent or sleeping and taking the medication.

If patients bring in their own medication, it is either sent home with family or kept in the pharmacy. In those cases where someone takes a medication not on the hospital’s formulary and the patient’s medication must be used, it is sent to the pharmacy for verification (yes, this is the right medication) and then kept in the medication machine until the patient is discharged.

• Scientific literature and research have not kept up with the availability of medical marijuana. We don’t know how to dose, what a safe dose is, what the adverse effects are and, very importantly, the possibility of interactions with other medications and what they would be.

In many facilities, when we are talking about child patients, not only do the prescriber and pharmacy verify the medication and the dose, but nurses also have to verify, using a known reference, that this medication is approved for children and the dose is correct for the child’s age or weight. Doses need to be verified by two nurses. This will be impossible to do with medical marijuana.

• When giving medication, health care providers need to verify whether it’s the right patient, the right medication, the right dose, the right time and the right route (by mouth, topical or IV). Once again: How do we verify these things with medical marijuana?

• Concerns for hospital pharmacists include criminal and civil penalties as well as the loss of their right to distribute legal controlled medications if an illegal medication such as marijuana is being used by a patient in their facility (or even kept in the pharmacy). This is a federal issue, not a state one.

Introduced by U.S. Sens. Cory Booker, D-N.J., Rand Paul, R-Ky., and Kirsten Gillibrand, D-N.Y., the Compassionate Access, Research Expansion and Respect States Act would, among other things, change marijuana to a Schedule II medication, which would allow doctors to prescribe the drug and pharmacists to dispense it. This would open it up to more research to find out about medication dosing, verification and interactions.

But making marijuana a Schedule II medication would also present many problems. A Schedule II medication has to be prescribed according to federal guidelines. The rules currently in place for medical marijuana at the state level would likely no longer be applicable.

A Schedule II medication prescription must include the prescriber’s Drug Enforcement Administration registration number, as well as strength, frequency and dosage. Writing orders for it in the hospital would bring up similar issues – and medical marijuana is not Food and Drug Administration-approved, so some health care professionals also would be concerned there.

Medical marijuana definitely needs to be legalized at the federal level; however, it is going to be a complicated project.

The Portland Press Herald’s compassion for the gentleman in pain who wasn’t allowed his marijuana ointment is to be commended (“Our View: Ending federal ban on medical marijuana would help Mainers,” Aug. 26). However, this compassion is lacking when it comes to the millions of people with persistent pain.

People with persistent pain face bigotry and prejudice, many times because of misunderstandings regarding opioids. Studies show that only 4 percent to 5 percent of the people prescribed opioids for pain become addicted, and much research has shown that the drugs are an effective treatment. Compassion should be for all with persistent pain.

— Special to the Press Herald

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