Pubdate: Nov-Dec, 2000 Source: The American Nurse Issue: Volume 32, No. 6 (ISSN 0098-1486) Copyright: 2001 American Nurses Association Fax: (202) 651-7005 Contact: Website: Address: 600 Maryland Ave., S.W., Suite 100 West, Washington, D.C. 20024-2571 Author: Susan Trossman, RN Note: Susan Trossman is the senior reporter for The American Nurse

Cited: Patients Out of Time Also: Photos from the first historic national conference on the medical use of marijuana are at Bookmark: (Cannabis - Medicinal)


(Working Toward A Good Nights Sleep-At end of document)

It has been reported to relieve muscle spasms in people with spinal cord injuries, stave off blindness in glaucoma patients and prevent wasting in those living with cancer and AIDS.

It might be a highly touted, widely used wonder drug, if it wasn't for one significant drawback: In most states, it's illegal.

The branding of marijuana as an illegal substance, according to Mary Lynn Mathre, is causing many people with chronic diseases to suffer needlessly or secretly use the drug and live with the fear that they could lose their job, home or freedom at any time. And that's why she's at the forefront of a movement promoting patients' access to medical marijuana.

The Virginia Nurses Association member is calling on her health care colleagues to convince policy-makers that marijuana can be the key to enhancing certain patients' quality of life. But first she must convince many of those same colleagues that marijuana should be viewed as an acceptable palliative and preventive medication and not as a "gateway" drug D one that leads to hard-core drugs like cocaine and heroin.

So far, only a handful of states have laws allowing the medical use of marijuana, and only eight people still benefit from a now-defunct federal program, called Compassionate IND, which gives them access to federally supplied medical marijuana. ( Seven of the original 15 program participants have died from their illnesses. )

But times could be changing.

Mathre, MSN, RN, CARN, and Iowa Nurses Association member Melanie Dreher, PhD, RN, FAAN, recently co-directed a historic national conference on the medical use of marijuana attended by about 250 patients, physicians, nurses and attorneys held at the University of Iowa and telecast to seven medical centers in the United States and Canada. In addition, through Patients Out of Time, an organization she started with her husband in 1995, Mathre has won the support of several dozen health care organizations, including 10 state nurses associations and the American Public Health Association, which endorsed position statements promoting the therapeutic use of marijuana.

And in a March 1999 report, the Institute of Medicine found that marijuana has medical value and is not addictive nor a gateway drug, Mathre said. There's even an oral prescription drug, Marinol, currently on the market that uses the marijuana component "THC" in its formula, although many people with severe nausea and vomiting prefer natural marijuana.

But the politics surrounding marijuana, which used to be prescribed as "tincture of cannabis" six decades ago for a number of maladies, remains.

"There are sick people out there for whom marijuana has made a world of difference, and a number are being monitored by physicians who are aware of the use," Mathre said. Through her role in Patients Out of Time, she can offer numerous examples of people who have benefitted from taking the drug covertly or who are in government-sanctioned programs.

She recalled the case of a young mother who fractured her back after being pinned between her car and a tree. "Her activities were limited because she couldn't stand the pain, even though she was taking large doses of narcotics," Mathre said.

Her only hope was further surgery. But before it was scheduled, the woman began using marijuana medicinally -- only a few inhalations a day. When her orthopedic surgeon and her pain management doctor saw her again, they were impressed with her new-found mobility.

"Her quality of life was clearly different,' Mathre said. "She could do the dishes and take long walks. She reduced her use of narcotics and was able to do flexibility exercises to improve her back to the point where she no longer needed surgery."

Another case involved a spinal cord injury patient with severe pressure ulcers who needed skin grafts but suffered from severe spasticity, which could compromise healing of the grafts. The only remedy he found that controlled his spasticity was marijuana. One day, staff discovered him smoking marijuana in the hospital parking lot, and their initial reaction was to have him discharged. But their ultimate decision was to look the other way if it meant the skin grafting would be successful.

For Mathre, health care professionals' continuing silence is the crime.

"We give meds that can kill people, or ruin their liver. We put in feeding tubes for people who can't eat," she said. "We should be advocating for the rights of a patient to use this medication if it's helping them."

Some may view Mathre's cause and her role as an addictions consult nurse at the University of Virginia in Charlottesville as incongruous. But it's her background -- first as a med-surg and critical care nurse and then as a certified addictions specialist -- that has helped her understand the connection between diseases and symptom relief, and the distinct difference between dependence on a medication and addiction.

"People using marijuana to ease their symptoms generally don't become addicted to it -- meaning that the drug isn't controlling every aspect of their lives," she said. "Rather, medical marijuana use allows people to live their lives more fully.

"Morphine, a highly addictive drug, is an excellent painkiller and is successfully administered to patients without causing addiction. Marijuana, on the other hand, is far less addictive, yet is prohibited. This is not right."

Mathre is equally as passionate about her work in substance abuse prevention and treatment.

Marion Kyner, MSN, RN, CS, describes her friend and former co-worker as "fighting for people who can't fight for themselves -- poor people and people who have addictions."

"Addiction is a brain disease," Mathre said. "In America, we've made substance abuse a moral issue, a legal issue. In Europe, it is treated as a public health problem."

In her role as an addictions consult nurse, Mathre sees anywhere from 15 to 20 patients a week who are referred to her by physicians, nurses and other hospital staff.

"I would describe what I do as 'harm-reduction,'" Mathre said. "When patients come into the hospital with pancreatitis, or trauma or a heart attack, what the staff focuses on is the admitting diagnosis and not the underlying cause." Mathre's job is to look beyond the diagnosis and help patients see the connection between their unhealthy practices -- be it smoking, alcohol abuse or narcotics addictions -- and their overall health. Her job is a mix of roles: medical manager, social worker, psychosocial therapist, patient educator.

With the bulk of referrals, she assesses for abuse, dependency and addiction and then makes recommendations, which can include further follow-ups on her part or referrals for treatment in the community.

For example, she might assess patients to see if they are "med-seeking." If they are, she'll try to determine if the behavior is the result of substance abuse or pain that hasn't been adequately addressed by health care professionals.

She also helps other health care professionals better work with patients who have addictions and are considered "difficult" and non-complying.

"Addiction and alcoholism have such a negative social stigma, and doctors and nurses treating these patients are often influenced by the stigma," said Kyner. "Mary Lynn has confidence in herself. She knows her area of expertise, but she's willing to listen to all sides before she says anything. She's willing to understand the difficulties of the patient, and she helps staff understand where the patient is.

"I also think she is one of the easiest people to work with, and she's a very down-to-earth, flexible and empathetic person," Kyner said. "There aren't many people out there doing what she does, and patients often don't realize all that she does for them."

According to Marlene Bond, MSN, RN, chief clinical officer at the University of Virginia, "Nursing staff know they can call on her at any time, and they rely on her. Because of their own lack of knowledge or biases, staff can have difficulty working with alcoholics and drug addicts. Mary Lynn is a true patient advocate who educates house staff, physicians and nursing staff in empathetic detox, and teaches them to regard these patients as worthy individuals.

"She's very compassionate, but minces no words about what the disease is and what the outcomes are when she's working with patients and their families." Both Bond and Kyner are aware of Mathre's work in the area of medical marijuana, but it's not common knowledge around the university.

"Mary Lynn doesn't talk about it ( medical marijuana use ) around patients. You wouldn't even know this was her position," Kyner said. "She's an activist, but not the type you'd see marching on Washington. She's an activist on a personal level. She's gone to court to testify on the behalf of people who use medical marijuana, and many of them have become her friends. And she's respectful of other people's opinions on this issue."

Mathre, however, is known as an expert in the medical benefits of marijuana in certain circles. She edited a book, "Cannabis in Medical Practice: A Legal, Historical, and Pharmacological Overview of Therapeutic Marijuana," which was referenced in the 1999 IOM report and brings together other experts in various fields and countries to tackle this subject.

"I think Mary Lynn is a role model for nurses in political action," said Dreher, dean of the College of Nursing at the University of Iowa and a long-time colleague of Mathre. "She's fighting a battle all the way on the issue of medical marijuana, but she stays upbeat and undaunted. She's definitely one of my heroes."

Dreher also has nothing but the best to say of Mathre as a person.

"When my son was graduating from the University of Virginia, we found it impossible to find a hotel room. I remembered that Mary Lynn and her husband ran a bed and breakfast, so I gave her a call. I also invited lots of family and friends to stay with us -- and they all had to be in separate rooms."

It wasn't until Mathre was giving her "guests" a tour of the house that Dreher made a surprising discovery.

Said Dreher, "I mentioned to her that I thought running a bed and breakfast was a great idea, and Mary Lynn said to me, 'Oh, we haven't done that in years.' "She was so gracious about letting all these people stay at her house. That's the kind of person she is."

Although Mathre can talk about the history and the politics of marijuana, the main points she tries to get across hinge on patients' rights.

It goes to the reason behind the name of her organization "Patients Out of Time."

"Patients don't have time to wait," Mathre said. "They need to be able to use medical marijuana right now."


Working Toward A Better Night's Sleep

University of Florida College of Nursing Associate Professor Helene J. Krouse, PhD, ARNP, RNCS, is leading a group of researchers to determine why hay fever and allergic rhinitis symptoms worsen at night.

The Florida Nurses Association member specifically wants to see if there is a connection between sleep cycles, allergy symptoms and cytokine levels produced during sleep. Cytokines are hormone-like proteins produced by various cells to help regulate the intensity and duration of the body's immune response to allergens. They also help cells communicate with each other.

To help her in her research, she and her team received a $36,000 grant from the American Academy of Otolaryngic Allergy Foundation.

"We know that asthma patients and people with allergies wake up at night, because they can't breathe well," said Krouse, a certified otolaryngology nurse practitioner and the first nurse to receive a grant from the foundation. "It is not well understood why the nighttime swelling occurs."

Further, she said, "Allergic rhinitis affects about 40 million people each year. It results in about $4.5 billion per year in estimated total direct health care costs and 3.8 million missed work and school days annually."

Did You Know...that eight states have medical marijuana laws? Hawaii became the first state to use legislation to decriminalize the use of medical marijuana in June. The other seven states D Alaska, Arizona, California, Maine, Nevada, Oregon and Washington D gained their medical marijuana laws through ballot measures.