Laura Kinsella, BSN, RN, CEN, is an emergency room nurse in Washington, DC. Professional license lawyer explains when nurses and doctors can smoke weed in legal states, and use CBD oil products. Nursing is physically and emotionally taxing. Can CBD, or cannabidiol, help relieve the aches, pains, and anxiety many nurses experience? Some say yes.
The Nurse’s Guide to CBD
CBD (cannabidiol) oil is a popular cure-all that you may have seen hyped or scrutinized by the media. But what exactly is it, is it safe, and how is it different from the use of medical marijuana?
THC, CBD, and Hemp
Marijuana comes from the leaves of the Cannabis plant, which produces a variety of active chemical compounds referred to as cannabinoids. There are dozens of cannabinoids; THC ( tetrahydrocannabinol ) and CBD are two of the more widely studied. THC is the psychoactive compound in marijuana that causes intoxication, or a high, by activating the brain’s reward and pleasure center, causing the release of dopamine. By contrast, CBD is not psychoactive and therefore does not cause a high. It is also not believed to be addictive.
Hemp also derives from Cannabis , but generally refers to plants cultivated for non-drug use. Hemp also contains much higher concentrations of CBD and a much lower concentration of THC (<0.3%). Historically, hemp has been used to make rope, fabrics, or textiles.
Medical marijuana is now legal in 33 states and the District of Columbia. For recreational use, marijuana is legal in 10 US states and in DC. In recent years, the number of patients who are turning to Cannabis for medical treatment is increasing. Marijuana has been a therapeutic treatment for cancer patients; it has been shown to treat pain, nausea, and cachexia. Marijuana is also now used as a treatment for Alzheimer’s disease, chronic pain, Crohn’s disease, and many other conditions.
CBD is generally sold formulated into an oil and has been touted as a solution to pain, insomnia, anxiety, and a wide range of other medical conditions. CBD oil is expected to become a billion-dollar industry in coming years. It is important to note, however, that despite the oil’s growing popularity, it remains largely unstudied and unregulated.
CBD is readily available for purchase online, but it has varying levels of legality in the United States. Although several US states have specific laws regarding CBD, it remains a controlled substance by the Drug Enforcement Agency, and is classified as a Schedule I drug. This designation remains despite the passage of the 2018 Farm Bill (which legalized the broad cultivation of hemp, under outlined restrictions).
There is a lack of high-quality, large-population studies on CBD use in humans. Large-scale, randomized clinical trials are needed, but it has been proposed as a potential therapy for a range of conditions, including anxiety, Parkinson’s, chronic pain, schizophrenia, and multiple sclerosis. Many users anecdotally claim it has pain-relieving benefits and use it as a treatment for muscle aches, inflammation, and pain. Other people use it to ease anxiety and insomnia.
There currently exists only one FDA approved medication that contains CBD: a seizure medication called Epidiolex, which is used to treat two particularly severe seizure disorders in children.
CBD is most commonly available in the form of an oil or drops. It may also be formulated into a balm, patch, or topical. There are also edible formulations, such as chewing gum, gummies, cookies, and brownies.
It is not likely that a patient will mention the use of CBD oil during a medication reconciliation, so it is important to ask patients about all products they use, including herbs, supplements, and oils. Patients should know that CBD oil may interact with other medications (such as blood thinners), and it could potentially increase the level of certain drugs in the bloodstream. Although side effects are anecdotally infrequent, it may cause sedation, fatigue, or nausea or diarrhea.
Can Doctors, Nurses Smoke Marijuana? (License FAQ)
Recreational and medical use of marijuana, CBD, and cannabis products are legal in many states across the US. However, there are issues that doctors, nurses, and other healthcare license holders should be aware of before they do smoke weed, pot, hash oil, honey oil, or use medical marijuana or other psychoactive THC products.
Licensed healthcare workers are subject to more restrictive marijuana use standards than the general public, even with a medical card and even in legal states, such as California, Colorado, and Washington. Our professional license defense attorney published this guide to help you avoid triggering license board or employer disciplinary actions that put your career at risk.
Marijuana, CBD, medical, and nursing license FAQ
Here our nursing license defense attorney reviews seven common questions professionals have about cannabis, cannabidiol (CBD), tetrahydrocannabinol (THC) and medical marijuana:
1) Can nurses smoke weed?
Nurses can smoke weed in legal states, like California and Colorado, as long as:
- the nurse is not impaired when treating patients,
- they follow their employer drug policies,
- they do not work for the federal government, and
- they do not violate DUI or other drug criminal laws.
The primary issue for nurses is that most nurse employers prohibit marijuana use, even when legal. Even if recreational or medicinal marijuana use is permitted under a state’s laws, employers have the right to maintain a drug-free workplace for safety-sensitive positions. They can terminate nurses who smoke weed for failing a drug test, even when they have a medical card. Each employer establishes their workplace policy for drug usage, and you should consult HR to understand yours. Employers are entitled to require a pre-employment nurse drug test as a condition to employment.
The federal government still categorizes marijuana as a Schedule I controlled substance. Federal employees are not permitted to use medicinal or recreational marijuana regardless of state laws, nor whether they have a medical card. The Veteran’s Health Administration, Department of Health and Human Services, and other federal agencies can fire nurses for using marijuana.
Testing for THC impairment is complex since no drug tests reliably measure whether someone is currently impaired. Unlike alcohol usage, a nurse can test positive for marijuana use weeks after their last usage.
Arguing that THC impairs someone typically requires combining drug test results with other objective signs of impairment to establish a totality of evidence. Using cannabis can add risk for nurses that if a workplace incident occurs, the employer or nursing board could argue that the incident was due to drug impairment at work.
Multi-state travel nurses must take extra care to be aware of the marijuana laws in every state they are licensed to practice. Legal use in one state can trigger a failed drug screening test at a new assignment in another.
If the level of marijuana usage turns into a substance abuse problem that interferes with a nurse’s work performance, the Board of Nursing can initiate nurse license disciplinary actions.
2) Can doctors smoke weed?
Doctors can smoke weed in legal states, like California and Colorado, if:
- they do not practice medicine while impaired,
- they follow their employer drug policies,
- they do not violate DUI or other drug criminal laws, and
- they do not work for the federal government.
State medical boards essentially treat legal cannabis use like alcohol; they only care about it when a physician is impaired while working. For example, the Medical Board of California (MBC) does not have rules regarding a doctor’s use of cannabis for recreational or medicinal purposes. But the MBC has strict rules about practicing while impaired and patient safety. If the MBC receives an impaired physician complaint, an investigation and medical evaluation can be ordered (BPC § 820).
Doctors that smoke weed can cause a workplace violation if their employer has a drug-free workplace policy. Physicians are considered safety-sensitive positions. Employers have the right to require pre-employment drug tests and establish a drug-free workplace. If you are not self-employed, it is essential to understand what your employer’s policies are.
The federal government still defines marijuana as a Schedule I controlled substance, even when legal under state laws. As a result, the federal government prohibits its employees from using medicinal and recreational marijuana. The US Department of Veterans Affairs, Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), National Institutes of Health (NIH), and other federal agencies can fire doctors for failing federal workplace drug testing.
Given the hassle, expense, and serious potential risks of medical board investigations, physicians need to consult with a medical license defense attorney for guidance whenever contacted by their board. Having THC in your system can add practice risk if a patient incident occurs that triggers in-depth scrutiny; the patient or board could allege it was due to drug impairment. As a result of the risks, many physicians err on the conservative side and avoid THC.
3) Do doctors smoke weed?
Three percent of doctors smoke weed, according to a Medscape physician survey of prior 12 months marijuana usage (1). In contrast, 12% of the general population reported that they currently used marijuana in a nationwide Gallup poll in 2019 (2). Therefore, doctors use marijuana at about one-quarter the rate of the general population.
A doctor’s history of ever using marijuana varies by medical specialty. The Medscape survey found emergency medicine physicians report the highest historical rate of marijuana use at 31%, followed by plastic surgery at 29%. The lowest reported rates of historical marijuana usage are for nephrology at 15% and endocrinology at 16%. In comparison, 38% of Americans overall report they’ve tried marijuana, according to the 2019 Gallup poll.
Doctor marijuana use by specialty
Source: Medscape Lifestyle Report Survey on Physician Marijuana Use
4) Can doctors or nurses use CBD oil?
Cannabidiol (CBD) oil is widely available and marketed as beneficial for arthritis, glaucoma, insomnia, anxiety, and other medical conditions. Since the 2018 Farm Bill became effective January 1, 2019, all 50 states have legalized the use of hemp-based CBD products. Industrial hemp plants, by definition, must have a delta-9 THC content of not more than 0.3 percent by dry weight.
Nurses and doctors can use hemp-based CBD oil in all 50 states, so long as the oil is THC-free. But many CBD oils can contain THC, even when labeled THC-free. A 2017 study published in JAMA by Dr. Marcel Bonn-Miller, a substance abuse specialist at the University of Pennsylvania Perelman School of Medicine found that 18 out of 84 different CBD oils tested contained THC.
If a doctor or nurse consumes CBD oil with THC, there is a risk of a positive drug test. If your employer or state bans THC use, you could be terminated, refused employment, or disciplined for a failed drug test.
Physicians and nurses need to do their research and be careful about the CBD they consume and trust. Even though most CBD products claim to have less than 0.3% THC content, these claims can be unreliable. The FDA does not regulate CBD, and THC levels are usually not listed on the bottle. Vaping or otherwise consuming certain CBD oils can put your job and license at risk.
5) Where is marijuana legal in the U.S.?
Marijuana laws are changing rapidly across the United States. Possession and recreational use of marijuana are currently legal for individuals over 21 in 15 states and Washington, D.C.: Alaska, Arizona, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Montana, Nevada, New Jersey, Oregon, South Dakota, Vermont, Washington and the District of Columbia.
The medical use of cannabis with a physician’s recommendation is legal in 35 states, including the states listed above, plus: Arkansas, Connecticut, Delaware, Florida, Hawaii, Louisiana, Maryland, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Utah, and West Virginia.
Under the Controlled Substances Act of 1970, the possession and use of cannabis remain illegal under federal law. Some derivative compounds such as Cesamet (nabilone), Epididiolex (cannabidiol), Marinol, and Syndros (THC), have been approved for prescription use by the FDA.
6) Do nursing and medical schools require drug tests?
Most nursing and medical school programs require drug screen testing during the admission enrollment process. The requirement stems from the fact that schools must maintain compliance with health care organization rules, regulations, and accreditation standards.
Since medical school programs include clinical immersion experiences that involve students in the delivery of health care, medical students are subject to pre-clinical testing through urine drug screening (UDS). Each schools’ drug screening requirements must comply with their affiliated healthcare organizations’ accreditation and regulatory requirements.
Nursing and medical school urine drug screening typically tests for the following drugs: amphetamine (methamphetamine), barbiturates, benzodiazepine, cocaine, marijuana, methadone, methaqualone, opiates (codeine & morphine), phencyclidine, propoxyphene, and oxycodone. Some schools perform hair follicle drug testing in order to determine longer term drug use. Positive tests for prescribed medications usually require a review of the supporting prescription documentation.
7) Can a nurse or doctor with a green card or visa use marijuana?
Doctors and nurses that are visa or green card holders cannot legally use marijuana due to federal immigration laws, even if it is legal under their state laws. Non-US citizens are subject to federal laws that consider the possession and use of cannabis illegal, even for medical purposes.
States that have legalized marijuana do not require that you be a U.S. citizen to use marijuana. But marijuana use can put your federal permanent resident status at risk. If convicted for a violation of federal law relating to marijuana use or any other controlled substance (except simple possession of 30g or less of marijuana), visa and green card holders can become deportable. (USCIS policy)
About Chudnovsky Law
Chudnovsky Law is an award-winning California criminal defense and professional license defense law firm. The firm’s three defense attorneys Robert K. Weinberg, Suzanne Crouts, and Tsion Chudnovsky, have a combined 65+ years of experience practicing law.
The firm provides effective and vigorous license defense for licensed businesses and all health care professionals, including physicians, nurses, dentists, pharmacists, and chiropractors.
Attorney Robert K. Weinberg is a former prosecutor with more than 30 years of experience handling professional license defense, federal, DEA, and state criminal defense matters. Robert is an authority in the complex intersection of licensing and criminal law for professional licensees and healthcare corporations. He has handled over 5,000 cases, licensure administrative hearings and jury trials.
To learn more, call (844) 325-1444 to set up a consultation.
This information does not constitute legal advice and does not create an attorney/client relationship. No representations are made as to the accuracy of this information, and appropriate legal counsel should be consulted before taking any actions. Contact us for a consultation regarding your case facts.
3 Potential Benefits of CBD for Nurses
Being a nurse is physically and emotionally taxing. Many nurses experience pain and soreness in their back, legs, and feet from long shifts. Nurses must also contend with the stress, anxiety, and even sleep disturbances that have become more prevalent since the COVID-19 pandemic began.
In recent years, the use of cannabis products to treat medical or physical ailments has seen growing acceptance in the health care and scientific community. Cannabidiol, or CBD, a type of cannabinoid derived from oil in hemp plants, was legalized at the federal level in the 2018 Farm Bill. Since its legalization, CBD use has grown in popularity.
To comply with federal law, hemp-derived CBD products must contain less than 0.3% of THC, the main psychoactive ingredient found in cannabis plants that causes people to feel high.
Although human trials still need to be ramped up on CBD’s uses and effectiveness, some research and anecdotal evidence indicate there are at least three potential benefits for nurses from the use of CBD.
Relieving Muscle Pain and Joint Inflammation
Nurses frequently work long hours and do a lot of heavy lifting when helping patients or moving equipment during their shifts, often resulting in a variety of aches and pains.
CBD has been shown to be a natural anti-inflammatory that can help reduce neck, back, and muscle pain that nurses experience, according to Morgan Cox, co-owner of CBD Stat, a LGBTQ- and family-owned company that sells products made from CBD, such as oils, topical creams, and muscle roll-ons and is co-owned by her spouse Leah Greenwood, RN, and her father William Cox.
While research on the topic remains somewhat limited, some studies support the anti-inflammatory and antioxidant effects of CBD in reducing pain and inflammation.
Morgan Cox, who has a bachelor’s degree in exercise science and has spent much of her career in athletics, movement, anatomy, and nutrition, said cannabidiol may appeal to nurses and others who don’t want to rely on prescription drugs or painkillers to alleviate pain.
“It’s pretty much a healthier alternative than having to take acetaminophen or ibuprofen every day,” she said. “We’re trying to create a more natural option [for pain relief].”
Tina Vinsant, a travel nurse from Tennessee, has been using CBD products for more than a year to alleviate foot and heel pain caused by plantar fasciitis. She learned about the potential benefits of CBD from a nurse podcast she runs and from a friend, who is also a nurse.
“I’ve had terrible foot pain for years from standing on my feet for long periods of time during my shifts,” she said. “I was just incredibly shocked by how effective it is.”
Vinsant said she applies a CBD ointment to her feet before she goes to bed at night, which helps relieve the muscle tightness and pain she often experienced. “It relaxes the tissue so that it’s not so tight. I’m just happy it works. I really love it.”
Greenwood, who works full time as a nurse in addition to being part owner of CBD Stat, said using CBD topicals has helped her with the aches and pains that come with her nursing career.
“When I would come home, I would have horrible shin and arch pain, and I would have to elevate my leg for an hour,” she said. “Now I massage the topicals into the bottom of my feet at the end of each shift, and I haven’t had to elevate my feet since. I no longer have arch pain after a long shift and have noticed a massive reduction in the number of aches and pains I face each day.”
While CBD is used in topical products to relieve common neck, back, and other pains, Morgan Cox said many of their customers also have given feedback about how it helps them with chronic pain symptoms from conditions such as arthritis, fibromyalgia, and sciatica.
Some research also suggests CBD may help alleviate chronic pain. A new study in the July 16 issue of the journal Cureus involved a systematic review of research on the efficacy and safety of CBD for chronic pain over the past five years.
The study’s authors concluded that, “CBD is an excellent alternative to an opioid in [addressing] chronic pain because CBD is non-intoxicating in its pure form. More clinical trials should be done to prove CBD’s significance clinically and statistically.”
Easing the Effects of Stress and Anxiety
Anxiety, stress, and burnout are common among nurses, and the COVID-19 pandemic has only exacerbated those issues.
William Cox who, in addition to being co-founder of CBD Stat, is also a chemical engineer and vice president of business development at IMPACT Technology Development, the firm that developed the proprietary hemp extraction process for CBD Stat products, said CBD may stimulate the body’s endocannabinoid system (ECS), which a mood study recognized as a “prominent promoter of emotional homeostasis, mediating the neurophysiological and behavioral consequences of stress.”
The stimulation of the ECS can promote improved sleep quality and reduce stress, anxiety, and depression, which can be helpful to nurses, he said.
The study acknowledged, however, that more research would be useful to help understand how genetic variability and psychosocial factors could affect an individual’s response to cannabinoid-based drugs.
Another study suggests that CBD may reduce stress and anxiety among nurses and other healthcare workers.
In 2021, Brazilian researchers conducted a randomized trial to study the effectiveness of CBD in alleviating stress among physicians, nurses, and therapists who were treating COVID-19 patients at a Brazilian hospital over a four-week period. A total of 120 healthcare workers were randomized into two groups, with about half receiving a 300-milligram dose of CBD twice a day plus standard care and the rest receiving only standard care.
The study found the daily administration of CBD, combined with standard care, “reduced the symptoms and diagnoses of anxiety, depression, and emotional exhaustion among frontline healthcare professionals working with patients with COVID-19.”
“Cannabidiol may act as an effective agent for the reduction of burnout symptoms among a population with important mental health needs worldwide,” the authors wrote. The study did note, however, that a small number of participants treated with CBD experienced severe side effects and cited the need for further study of the benefits and potential adverse effects.
Improving Sleep and Alleviating Insomnia
Another potential benefit of CBD for nurses is improved sleep and reduced insomnia.
Greenwood said she started taking CBD oil before going to bed after long nursing shifts to help with the quality of her sleep, and it has helped her tremendously.
“I wanted something that would help me fall asleep quickly and not have me feel groggy the next day,” she said. “When I started taking it, I had been working the night shift for years, and the CBD oil helped me get uninterrupted sleep during the day. My sleep quality has been great since using CBD oil, whether I’m on day or night shift.”
William Cox said research indicates that CBD can help with a number of sleep disorders including insomnia, REM sleep behavior disorder, and excessive daytime sleepiness disorder. “Determining the exact mechanism of how CBD helps with sleep is still being studied,” he said. “Experiences and results are varied and appear to be dose dependent for each individual.”
Other Considerations of CBD Use for Nurses
Because CBD is a cannabinoid, some nurses fear it may show up during pre-employment or other drug testing by their employers. But William Cox noted that since CBD oil is now legal for use at the federal level, it should not be an issue for nurses in most cases.
“Since CBD is not psychoactive, it should not interfere with normal work activity or cognitive abilities, particularly with transdermal topical CBD used for inflammation reduction,” he said.
Since most CBD products are not federally regulated, nurses should check the labeling to make sure the products they are using are THC-free, as some products contain small amounts of THC that can show up in drug tests.
“Typically, healthcare workers who do get tested prefer the THC-free option,” said Morgan Cox, noting that all of CBD Stat’s products are 100% THC-free.
To date, the U.S. Food and Drug Administration has approved only one CBD product — a prescription drug product that treats seizures — and is watching for illegal marketing practices in which products containing cannabis or its compounds violate federal law or put consumers at risk.
While hemp-derived cannabidiol containing no more than 0.3% of THC is now legal at the federal level, some states and local municipalities may have their own laws and regulations regarding the use of cannabis products. William Cox encourages nurses to review these regulations and to seek prior approval from their employers before using CBD products, if they have concerns.
“If they’re concerned, we advise people to go to their supervisor and ask them if it’s okay to use the product,” he said. “I would think they would welcome the use of all natural products that would help their employees work better and feel better.”
While CBD is generally safe, William Cox said, it can cause drowsiness in some people and diarrhea when taken in large quantities. He said it’s important for nurses to follow dosing guidelines, be cognizant of potential side effects, and consult with a physician before use to avoid negative interactions with other medications.
We understand the aches and pains of a stressful and challenging job. Our goal is to keep you naturally strong with our line of THC-Free, extra-strength CBD products formulated for hard-working nurses & healthcare workers. Try us today.
WHAT’S NEW AT NURSE.COM
Nurse.com Job Seeker
Discover how Nurse.com can help you find your next dream job.
Just sign up and wait to be paired with your perfect match.