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Health Policy Issue – Position Paper
Vicki L. Thompson
NURS 501: Health Policy and Ethics
Liberty University
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Abstract
Acute and chronic pain is not objective. There are many illnesses that can be treated without the
use of prescription medication. Cannabis, also known as marijuana, can have many useful
purposes. It has been proven that the effects of medical marijuana have had positive lasting
effects on patients, while treating their pain or chronic illness. Many states have made medical
marijuana legal, while states have opened it up for recreational use. The State of Tennessee is
still trying to pass a bill that will allow for medical marijuana. I plan to discuss Tennessee Senate
Bill 0118 (TN SB0118), which is relative to the regulation of how cannabis is used for medical
use.
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Health Policy Issue – Position Paper
Through the years, marijuana has been seen by others to carry this huge stigma of
something horrible, something that distorts the brain and creates lack of responsible judgement.
However, through medical science and research, marijuana has been found to have natural
properties for not only pain control, but to help in relief of chronic illnesses. Many states have
approved this law for medical marijuana; however, some states are still having a hard time
passing the law. The State of Tennessee is one of those states that has brought this bill for
regulation of cannabis to the Senate floor, multiple times. Due to the political stance in the issue,
we shall see if this will ever be accepted by our state.
Introduction of Issue and Bill
The purpose of Tennessee Senate Bill 0118 (TN SB0118) is to develop a Tennessee
medical cannabis commission to serve in a study of federal and state laws pertaining to how
medical cannabis can be an effective, patient-focused program after rescheduling marijuana from
a Schedule I Controlled Substance (Tennessee General Assembly, 2021). TN SB0118 was
introduced by Senator Ferrell Haile on January 14, 2021, and passed on first consideration
(Tennessee General Assembly, 2021). Actions on the bill are as follows:
01/13/2021: Bill filed for introduction
01/14/2021: Bill introduced and Passed on First Consideration
01/15/2021: Bill Passed on Second Consideration
02/10/2021: Bill Placed on Senate Government Operations Committee
Calendar for 02/17/2021
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02/17/2021: Bill Placed on Senate Government Operations Committee calendar
for 02/24/2021 (Tennessee General Assembly, 2021).
This bill, not only involving the scheduling of its current Schedule 1 drug status, but will
involve the commission, which in turn, will “examine federal laws, the effectiveness of other
states’ laws and legislation and laws and legislation in this state relating to the medical use of
cannabis, specifically considering issues relating to, among other things, patient qualification, the
role of pharmacists in medical cannabis program for recommending, prescribing, and dispensing
medical cannabis, and licensing and regulation of facilities and providers of medical cannabis
services” (Tennessee General Assembly, 2021). The commission will prepare recommendations
and proposed legislation to include provisions that crease a self-sufficient commission to
administer the program. This will be governed by its appointed members (Tennessee General
Assembly, 2021).
The next step to the process would be that this self-sufficient commission will then report
their “findings and recommendation to the general assembly relating to the medical use of
cannabis in this state” (Tennessee General Assembly, 2021). This reporting will be submitted to
the senate and house of representatives by January 1 of each year, commencing in 2022.
Although this is relating to the Tennessee Senate Bill 0118, the House of Representatives
is also operating this bill as HB0490 (Tennessee General Assembly, 2021). This bill was
introduced on February 8, 2021, by Representative Bryan Terry and was assigned to a Health
Subcommittee on February 10, 2021 (Tennessee General Assembly, 2021).
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Background/Significance and Scope of the Problem
Here is where it all begins…… A law starts as an idea. A representative introduces the
bill. In this case, it was Senator Ferrell Haile. The bill then gets assigned to a committee to
study. If approved by the committee, it is put up for vote, debate or amendment. If the bill
passes majority, it then moves to the Senate. The bill is then assigned to another committee in
the Senate. If that committee approves, it is again voted on. If passed, it goes to a committee of
House and Senate members to work out any differences between both the House versions and the
Senate versions. It then returns to the House and Senate which will vote on the final approval of
the bill (United States House of Representatives, 2021).
Although medical marijuana (medical cannabis) is legal in 33 states, Tennessee is not one
of them (WebMD, 2021). Currently, the state of Tennessee does not allow the use of medical
marijuana (medical cannabis). However, “CBD derived from the hemp plant (<0.3% THC) is
legal under federal law to consume” (WebMD, 2021).
According to the Mayo Clinic, there are studies that show medical cannabis contains
possible benefits for several conditions:
Alzheimer’s Disease
Amyotrophic lateral sclerosis (ALS)
HIV/Aids
Cancer
Crohn’s disease
Epilepsy and seizures
Glaucoma
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Multiple sclerosis and muscle spasms
Severe and chronic pain
Severe nausea (Mayo Clinic, 2021)
I have always heard that medical marijuana is used for the treatment of nausea and
vomiting caused by chemo. But also, to halt progression of glaucoma. Cannabidiol, (Epidiolex),
“can be prescribed for treatment of severe forms of childhood epilepsy” (Mayo Clinic, 2021).
The Mayo Clinic does list several possible side effects of using medical marijuana.
These include:
Increased heart rate
Dizziness
Impaired concentration and memory
Slower reaction times
Negative drug-to-drug interactions
Increased risk of heart attack and stroke
Increased appetite (Mayo Clinic, 2021)
As this is not the whole list from WebMD, there are quite a few contraindications.
Medical marijuana comes in: Oil for vaporizing, pill, topical applications, oral solution
and dried leaves and buds (Mayo Clinic, 2021).
After some research on the implications of medical marijuana, I found a great article
regarding the effects of marijuana and how it actually works on the body. I have no doubt that
scholars, politicians and those individuals that study the effects of drugs on the body had a lot,
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years ago, to give them input on whether the use of marijuana, whether for recreational or for
medical purposes, was even a good idea.
According to an article written by H.G. Taylor and published in the Journal of the
American Pharmaceutical Association, “The most prominent effects of marijuana are mediated
by receptors in the brain” (Taylor, 1998). This can result in short-term memory loss, being in a
state of happiness, senses are stimulated, and it can lead to impaired thinking (Taylor, 1998).
Unlike addiction to cocaine, heroin and other drugs, marijuana has shown to have little addictive
properties and may only produce very mild withdrawal symptoms (Taylor, 1998). “Marijuana
shows clinical promise for glaucoma, nausea and vomiting, analgesia, spasticity, multiple
sclerosis, and AIDS wasting syndrome” (Taylor, 1998).
As far as the social and emotional aspect of marijuana, when used recreationally,
“marijuana poses dangers, particularly to social and emotional development during adolescence
and young adulthood. As a medical drug, marijuana should be available for patients who do not
adequately respond to currently available therapies” (Taylor, 1998).
According to the Journal of Medical Ethics, an article written by Glickman, A., & Sisti,
D. (2020), “Cannabis occupies a unique social and cultural position in the USA. Marijuana was
used as a treatment for a variety of physical and mental ailments as early as the 1850s.”
Glickman & Sisti also believe that the social, political and stigma history of cannabis is what
continues to stall the passing, research, and regulation of cannabis. Cannabis use does carry
risks, especially those with behavioral health issues, more so because of the way it works in the
brain (Glickman & Sisti, 2020).
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Proponent and Opponent Arguments
There are many arguments to be had on the position of this bill, as far as the House and
Senate go. According to Brett Kelman, with the Nashville Tennessean, Representative Bryan
Terry and Senator Steve Dickerson, who are both physicians, along with Senator Bo Watson,
who is a physical therapist, “have backed medical marijuana legislation in prior years but those
efforts have failed due to lack of support” (Kelman, 2020). During a phone interview with
Representative Bryan Terry, he did state, in part, that “Tennesseans are putting their lives and
livelihood at risk by buying marijuana on the black market. I don’t believe our legislators want
patients to be in jail. They want there to be a safe manner with which they can get these
medicines” (Kelman, 2020). It was also mentioned in this article written by Brett Kelman, that
the public is standing in support of the passing of medical marijuana.
In opposition, you have the Governor of Tennessee. “Prior efforts to legalize medical
marijuana have been killed by conservative opposition in the General Assembly. Gov. Bill Lee
has also said previously that he is not in favor of medical marijuana or marijuana
decriminalization” (Kelman, 2020). The currently bill that was introduced by the Senate (SB
0118) on January 14, 2001, has not been voted on yet as it is still up for assigning a committee
(Tennessee General Assembly, 2021).
Nursing or Human Services Perspective
When it comes to ethics of the use of cannabis for patients, there is still a lot of missing
evidence, in my opinion, that state governments want to see. I believe they want to see this
evidence in the form of a study, something in black and white that has evidently helped a
patient’s condition or illness, or to see evidence of medical marijuana work long term for
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everyone. It does come with a stigma of drug use. Even in the 1980’s, as I remember, those who
smoked marijuana were labeled as drug users, or those who were going “against the grain,” per
say. “While it may be illegal to recommend cannabis for conditions other than those specified by
state law, it is ethically justifiable for providers to do so if available evidence supports cannabis
use for a particular patient’s condition” (Glickman & Sisti, 2020). I believe that ethically, being
in healthcare, we are upheld by the standards of care and took an oath to do what is best for our
patients and for the best possible outcome, according to the code of ethic for nurses (ANA,
2015).
There is a biblical verse that comes to mind when I think about caring for the sick and the
ill: Matthew 10:8 states: “Heal the sick, cleanse the lepers, raise the dead, cast out devils: freely
ye have received, freely give” (King James Bible, 1769/2017). I believe that, ethically, there is
something more I can do, or something I am supposed to do in order to help with the outcome of
patient’s around the world. I am, without a doubt, completely for the passing of this bill just
because of the studies and research that has already been done around the world, specifically on
patients with acute and chronic illnesses, those in pain, those experiencing uncontrollable nausea,
especially with chemotherapy medication and it has been proven that it does assist the worsening
of adult glaucoma. Medical marijuana, by no means, is a cure all for all ailments, but it does
help to control the worsening of many conditions. As a nurse, I truly believe it is my ethical duty
to do what is best for my patients. “Nurses must lead collaborative partnerships to develop
effective public health legislation, policies, projects, and programs that promote and restore
health, prevent illness, and alleviate suffering” (ANA, 2015, pp. 32).
As far as the legality and financial aspect this would bring into the state, it would be a
win win. From a financial standpoint, I believe more jobs would be created and money revenue
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into the State of Tennessee. From the legal standpoint, since a majority of people purchasing
marijuana from the streets and black market for pain, they would be able to do it safely and
legally. Meaning, patients would be sure of what they are taking. With what is being distributed
now, and the use of synthetic on the street, you really don’t know where the marijuana is coming
from or what it is made of. With the passing of medical marijuana bill, it would also free up the
court systems and jail authorities because of those going through the correct process of obtaining
it the right way. The court system would have less congestion and create greater vacancy within
the jails, which in turns, saves the taxpayers money.
There is an organization that leads the country in fighting for the legalization of cannabis.
This organization is known as the Marijuana Policy Project (MPP). They fight for the passing of
laws in each state regarding cannabis. When referencing above the legality issues of not passing
this bill, the MPP also stated that, as far as the Tennessee laws go, “Possession of any amount is a
misdemeanor, punishable by up to 11 months, 29 days in prison and up to a $2,500 fine.
Cultivation of 10 plants or less is a felony, punishable by one to six years in prison and the
penalties increase significantly for each additional plant being grown” (MPP, 2020). As stated
previously, the use of marijuana, whether it is for medical use or recreational use, remains illegal
in the state of Tennessee. “However, there is an exception that allows the use of high-CBD, low
-THC cannabis oil for seizure patients” (MPP, 2020).
According to the National Academies of Sciences, Engineering, and Medicine, “Shifting
public sentiment, conflicting and impeded scientific research, and legislative battles have fueled
the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its
derivatives and this lack of aggregated knowledge has broad public health implications” (2017).
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Policy/Bill Recommendations
In regards to expanding on SB 0118, let me be clear in stating that the State of Tennessee
will in no way be able to pass this bill for the use of medical marijuana “until marijuana is
removed from Schedule 1 of the federal Controlled Substance Act” (Tennessee General
Assembly, 2021).
Timeline of Marijuana Policy Reform in Tennessee
The Marijuana Policy Project (MPP) has followed the bills through the Tennessee General
Assembly. Here is what the tracking looks like:
1981: In 1981, HB 314 created a therapeutic research program — which was
operational — for cancer chemotherapy or radiology or glaucoma (marijuana or
THC). The program was administered by a Patient Qualification Review Board
within the Board of Pharmacy, which was authorized to contract with the federal
government for marijuana. The program was repealed by SB 1818 in 1992.
2015: Tennessee Governor Bill Haslam signed SB 280 into law, against his earlier
opposition. The bill legalized the possession and use of marijuana to treat a
limited number of severe conditions, including epilepsy. The bill has no
provisions for legal sale, thus requiring patients to acquire the drug outside the
state of Tennessee; possession of CBD oil without proof that it was obtained
legally outside of Tennessee is a misdemeanor.
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2016: Tennessee tweaked its ineffective low-THC law by enacting HB 2144 on
May 20, 2016. The law provides that patients may possess CBD oils with no more
than 0.9% THC if they have “a legal order or recommendation” for the oil and
they or an immediate family member have been diagnosed with epilepsy by a
Tennessee doctor.
2017: The legislature enacted HB 1164, modifying Tennessee’s industrial hemp
law to allow the production of hemp with 0.3% THC or less. The law requires
hemp growers to be licensed by the Department of Agriculture. It also provides
that hemp is not marijuana under the state’s controlled substances act if it is either
(a) viable and possessed by a licensed hemp grower, or (b) nonviable and is
procured in accordance with department rules. (MPP, 2020)
This brings us to the current HB0490 and SB0118, that were introduced in January 2021
(Tennessee General Assembly, 2021). To expand on the SB0118, there were some additional
recommendations made within the bill:
(a) The commission consists of nine (9) members appointed as follows: (1) The
speaker of the senate shall appoint three (3) members, with one (1) from each
grand division and at least one (1) member being a physician - 2 - 000787
licensed under title 63, chapter 6 or 9 and one (1) member being a pharmacist
licensed under title 63, chapter 10; (2) The speaker of the house of
representatives shall appoint three (3) members, with one (1) from each grand
division and at least one (1) member being a physician licensed under title 63,
chapter 6 or 9 and one (1) member being a pharmacist licensed under title 63,
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chapter 10; and (3) The governor shall appoint three (3) at-large members. (b)
(1) Initial appointments begin July 1, 2021, and expire as follows: (A) Terms
for members appointed by the governor expire on June 30, 2023; (B) Terms
for members appointed by the speaker of the senate expire on June 30, 2024;
and (C) Terms for members appointed by the speaker of the house of
representatives expire on June 30, 2025. (Tennessee General Assembly, 2021).
Conclusion
As I was starting my research for this paper and trying to make some sort of sense of how
bills and policies actually make their way through legislation, I realized that we do, indeed, have
a voice in this. Our voice should be heard in the introductions of these bills that affect our health
care system, our patients, and the livelihood of such. Our senators and representatives, that are
voted in by the public, are just that…... representatives of us. If we were not supposed to be
making our voices heard, then who are they representing after all? THEY are our voice. Just as
I sat in the balcony of the chamber in the State of West Virginia in 2001, when they passed the
bill that nurses cannot be required to work more than a 12-hour shift in a 23-hour period and
cannot be required to work mandatory overtime, unless they choose to do so, I was overcome
with respect and knowledge of how our senators and representatives take our voice in
consideration. There were thousands of nurses there to witness this bill passing, while all of the
house turned around to say thank you to us all after the final vote was read.
So with that said, I find that this bill is just as important. One that requires we fight for. I
am not speaking of recreational marijuana use, but the use of medical marijuana (medical
cannabis) to be used for acute/chronic illnesses. I completely agree with the additional
recommendations made within this bill that involves the nomination of a commission, which
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involves, in addition, a physician and a licensed pharmacist. To me, this is the exact way to do it.
Let them study the process, the legality portion, who will qualify for it medically? How will
they actually determine what symptoms or illness is considered medically necessary? There are
all kinds of structural dynamics that need to be put into place before our legislators can just hand
this over and say, “ok, let’s pass this bill because it seems like a great idea!”
I definitely think having medical professionals on this assigned commission gives
healthcare a voice. They are the experts on how this will run, how the cannabis would be
prescribed and delivered out. What risks to look for.
So to conclude, yes, I am backing this bill 100 percent, and I hope that very soon, patients
that truly need this for pain, nausea and vomiting that comes with chemotherapy treatment,
seizures and patients with diagnosed glaucoma will soon have some relief.
References
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American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive
statements. https:www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-
ethics-for-nurses/coe-view-only/
Glickman, A., & Sisti, D. (2020). Prescribing medical cannabis: ethical considerations for
primary care providers. Journal of Medical Ethics. 46:227-230.
http://dx.doi.org/10.1136/medethics-2019-105759
Kelman, B. (2020). New medical marijuana legislation would allow oils and tinctures, not joints
and vapes. Nashville Tennessean. https://www.tennessean.com/story/news/health/
2020/03/02/tennessee-medical-marijuana-bill-would-allow-oils-pills-and-
tinctures/4907783002/
King James Bible. (2017). King James Bible Online. https://www.kingjamesbibleonline.org/
(Original work published 1769)
Marijuana Policy Project (MPP). (2020). Tennessee’s cannabis laws lag behind other states.
https://www.mpp.org/states/tennessee/?state=TN
Mayo Foundation for Medical Education and Research (1998-2021). Medical marijuana.
https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-
marijuana/art-20137855
National Academies of Sciences, Engineering, and Medicine (2017). The Health Effects of
Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for
Research. The National Academies Press. https://doi.org/10.17226/24625
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Taylor H. G. (1998). Analysis of the medical use of marijuana and its societal
implications. Journal of the American Pharmaceutical Association.
https://doi.org/10.1016/s1086-5802(16)30318-7
United States House of Representatives (2021). https://www.house.gov/the-house-explained/the
legislative-process
WebMD (2005-2021). What are the medical benefits of cannabinoids? WebMD, LLC.
https://www.webmd.com/a-to-z-guides/qa/what-are-the-medical-benefits-of-cannabinoids
