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Police entered Nolan Sousley's hospital room to search for cannabis following a tipoff from a hospital security guard. Sousley has stage IV pancreatic cancer and sometimes takes capsules containing THC to help alleviate his pain and nausea.

The police entered the Missouri hospital with a warrant to conduct the search but found nothing that violated state law.

Despite expanding efforts to legalize cannabis, the use of medicinal marijuana currently operates in an uneasy limbo. Even in legal states, hospitals' policies are either ambiguous or staunchly against the administration of medical cannabis in hospitals. There is also an absence of clear guidelines regarding what is acceptable with respect to visitors bringing cannabis-infused products to their loved ones.

The search took place on March 7, 2018. Had Sousley been in possession of cannabis, he would have been given a citation, even though medical marijuana has been legal in Missouri since December 2018. Video footage of the incident had provoked outrage among advocates of medicinal marijuana and had been viewed more than 964,000 times.

Federal Law Governs Hospital Marijuana Policy

The central issue underpinning this incongruence is that most hospitals choose to operate under federal law, even if their state law permits the use of medicinal cannabis.

“It is important to remember that marijuana is still a Schedule I narcotic (under federal law) and as such, many hospitals do not permit its presence or use in the hospital,” said Julie Lonborg, a spokesperson for the Colorado Hospital Association. Lonborg notes that this is true even in Colorado, where medical marijuana became legal under Initiative 20 in 2000.

The restrictive policy most hospitals take toward cannabis has been borne of fear of loss of federal licensure. Although the risk may be minimal, the consequences for a hospital that loses its license are significant, with the possibility of crippling financial losses or even being forced to close down.

Photo by Richard Johnson

Because of this threat, most hospitals maintain an extremely conservative stance toward patients self-administering cannabis or products containing cannabinoids, and generally emphatically discourage visitors from bringing such products to patients.

The Consequences for Cannabis-Using Patients

For those who depend on medical cannabis to alleviate their symptoms, the conservative stance most hospitals take when it comes to onsite possession can cause serious consequences for the management of their condition. According to Matthew, who asked his last name be withheld from publication, his partner was recently hospitalized in a New York City hospital for two weeks, hindered access to cannabis significantly affected his partner's well-being during his stay.

“My partner is a daily medical cannabis user,” said Matthew. “He had his vape with him during the stay, and I would bring him cannabis-infused caramels every day. He was in a great deal of pain during his visit, and the cannabis was the only thing that would take care of his pain, help him sleep and give him any comfort. We were cautious and secretive about his vape, as smoking is not allowed in the hospital.”

Photo by Gina Coleman

Matthew explained that he and his partner were upfront with the hospital staff about the edibles. In response, the hospital staff made it clear that edibles were considered outside medicine, and were therefore not permitted. A member of staff searched Matthew's partner's backpack after he was admitted to his room.

Clinical Uncertainty for Administration of Cannabis

According to an American College of Physicians report published in January 2017 on the ACP Hospitalist website, another reason that hospital staff may refrain from incorporating cannabis into patient care is due to a lack of understanding or clinical knowledge about the interaction of cannabis with other medicines. For patients who have been taking medical marijuana prior to their hospital stay, it is imperative that they disclose this to the doctor or surgeon who is caring for them in the hospital.

“From a medical perspective, using any medication, cannabis included, without the knowledge of the treating team is potentially dangerous,” said Dr. Jordan Tishler, a Harvard-trained physician and president of the Association of Cannabis Specialists. “There are many medical conditions and treatments with which cannabis would not be safe or appropriate. Unless the care team knows what someone is taking, they cannot properly care for them. This is the most important reason not to sneak in cannabis.”  

Unless the care team knows what someone is taking, they cannot properly care for them. This is the most important reason not to sneak in cannabis. Click To Tweet

According to Tishler, patients taking blood thinning medications, heart medications, or immunologic medications may be at increased risk if they are also consuming products containing cannabidiol (CBD). Certain heart conditions, respiratory conditions or mental illnesses may also be exacerbated by cannabis use.

Photo by Sharon McCutcheon

“In most cases, if the patient has been using cannabis previous to the hospital visit, the team can/will prescribe Marinol while they are admitted,” said Tishler. Marinol is a synthetic form of THC.  “This is not ideal, but it can work. In other cases, they may let you bring cannabis on the down-low, but don't expect it.”

The Need for Informed Policy and Clear Guidelines

For patients such as Matthew's partner, hospital attitudes towards cannabis are far from ideal. “It's frustrating that state-registered medical marijuana patients still have to jump through these hoops just to get the medicine they need. The federal law has got to change,” he said.

It's frustrating that state-registered medical marijuana patients still have to jump through these hoops just to get the medicine they need. Click To Tweet

The American College of Physicians has pointed out that it is time to start thinking about what an inpatient medical marijuana policy would look like, by addressing key questions such as who should be permitted to receive medical marijuana, where it should be stored, and who should administer it.

Until clear guidelines are developed and put in place, however, cannabis-users who spend time in hospitals should familiarize themselves with the hospital's stance towards cannabis, which can vary from facility to facility. Knowing the position of the hospital can help with assessing the risk and making an informed decision about cannabis use when undergoing treatment.