Cannabis has been long misunderstood as a dangerous narcotic by federal regulators and has medicinal value for patients with chronic kidney disease, a speaker at the American Nephrology Nurses Association’s National Symposium said.

“We have been terribly and systemically misled in the United States for the last 70 years” about the dangers of cannabis, Lisa Miller Hedin, BSN, RN, told attendees. “We are in a paradigm shift, and I can tell you [cannabis] is not going away.”

“As nurses, we need to be responsible and find out if our patients are taking it and how we can treat them safely,” she said.

Cannabis was first used as a popular medicine by people in China in 1900 BC, she told attendees. Egyptians used it for glaucoma, inflammation and enemas, and in India, around 1000 BC, a drink of cannabis and milk called bhang was used as an anesthetic.

Lisa Miller Hedin

Due to its historical connection to Mexican immigrants after the Mexican Revolution of 1910, when immigrants came into the United States in large numbers, “we really try to stay away from use of the word ‘marijuana,’ unless we are talking about the marijuana plant,” Miller Hedin said. “It really is a racist word.”

Recent studies, including NIH-funded research, have shown the value of cannabis use among patients with CKD, Miller Hedin said. She cited a March 2020 article in Nephrology & Hypertension that cannabis may have medicinal benefits for treating symptoms of advanced CKD and end-stage kidney disease. The study also suggested cannabis could be used to relieve pain, replacing use of the more addictive opioids, Miller Hedin said.

“Cannabis does not seem to affect kidney function in healthy individuals,” she read from the Nephrology & Hypertension article. “However, renal function should be closely monitored in those with CKD, the lowest effective dose should be used, and smoking should be avoided.”

Miller Hedin, the founder and CEO of the Medical Cannabis Training Academy, has been involved for 25 years in nephrology nursing and has spent the last 5 years researching cannabis treatment options.

Use of cannabis has also been endorsed by the American Nurses Association, Hedin said. In a position statement cited by Miller Hedin, the organization said, “Marijuana and its derivatives continue to be used to alleviate disease-related symptoms and side effects. The findings of anecdotal and controlled studies regarding the efficacy for patient use are mixed. Current federal regulations impede the research necessary to evaluate and determine the therapeutic use of marijuana and related cannabinoids … The goal is to develop an evidence-based approach to its use in the treatment of disease and symptom management.”

She told attendees it is important that nurses learn about the nuances of the law in their state regarding cannabis use. In 1996, California became the first state to approve medical marijuana. Today, that legalization has expanded to 33 states. Marijuana for recreational use has been approved in 11 states, she said.

Cannabis comes in two forms with varying degrees of potency: marijuana and hemp.

Marijuana comes from plants that contain more than 0.3% THC and its use can lead to psychotropic or euphoric effects, Miller Hedin said. Patients need to inform staff that they use cannabis so that they can be monitored when other dialysis-related drugs are administered. “Patients may feel embarrassed to tell staff that they are using cannabis,” Miller Hedin said.

Cannabis is mostly eliminated by the liver and excreted into stool, Miller Hedin said. “Very little is eliminated by kidneys or dialysis.” Cannabis is lipid soluble and can stay in a patient’s system for 80 days, she said.

Hedin said monitoring cannabidiol (CBD) levels – the second most prevalent of the active ingredients of cannabis – in important to prevent drug interactions. “CBD is a hot spot for your CKD patients because it is not regulated and there are so many bad products out there,” Miller Hedin said. “Our patients can truly get into trouble if they are using a bad product.”

Patients also should research where the hemp used in the cannabis comes from because of the potential of earth-based additives in the plant. “You want to make sure a lab test has been done to show that they have extracted the heavy metals, the toxins, the bacteria – anything that was in the earth where the hemp was grown,” Hedin said. “You want to see a lab report that these materials have been removed.”

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American Nephrology Nurses Association National Symposium