How SNFs Can Reduce the Stigma Around Legal Marijuana

Marijuana usage among the elderly has become a growing trend, as more and more states decriminalize the use of the substance — creating a delicate situation for many skilled nursing facilities (SNFs) and senior living providers.

To date, 29 states, including Washington, D.C., have legalized the medical use of marijuana, and California recently joined a smaller group of states that allow the recreational sale and consumption of the drug.

In terms of the growth in usage among the older adult demographic, findings by researchers from the New York University School of Medicine and Columbia University indicated a 250% relative increase of cannabis usage by adults age 65 and older.

With medical usage on the rise among the elderly — particularly for those who take the drug to manage pain — SNFs and senior living providers must work hard to not only comply with state and federal laws, but to also combat the stigma associated with marijuana, according to Dr. Zachary Palace, chief medical officer at Hebrew Home at Riverdale.

Based in the Bronx, New York, Hebrew Home at Riverdale is a SNF owned and managed by New York-based RiverSpring Health.

“Looking at medical cannabis as a recreational drug can limit people’s objectivity of the real benefits it can have when it’s used as a pharmacological agent [and] to treat specific diagnoses,” Palace told Skilled Nursing News. “The stigma associated with it, due to its … abuse recreationally — we need to try to remove that stigma.”

State and federal laws

Removing the stigma attached to marijuana can be a difficult undertaking, as each state has its own individual laws mandating the medical use of the drug.

In New York, for example, patients must first be certified by a physician to obtain the drug. Afterwards, they must apply with the New York Department of Health to obtain a registry identification card.

At Hebrew Home at Riverdale, the only two formats in which patients can take the drug is either in tincture form — an oil-based solution that is administered under the patient’s tongue — or in oil-filled capsule form, Palace explained.

But in addition to complying with state laws, Hebrew Home at Riverdale must also navigate through strict federal laws.

“As a SNF, we are required to follow federal guidelines in order to be able to accept Medicare and Medicaid funds for providing services for our patients, so we are held to the federal guidelines for which cannabis is a Schedule-I substance,” Palace said. “As such, having a Schedule-I [substance] in our facility’s possession would be in violation of the federal law, as well as the facility administering medicinal cannabis.”

To circumvent these federal concerns, the facility had to address how the substance was stored, and how it was administered, Palace explained.

“Our policies and procedures provide that for patients who qualify for medicinal cannabis, that they are required to maintain it in an area that is deemed to be their own personal property,” Palace said.

These patients are provided with a lockbox in their room to which only they have the key, making the storage unit their own personal possession.

With respect to administering the controlled substance, the facility requires that the patient self-administer the medical cannabis.

“If they’re not capable of self-administering the medical cannabis, then they are, by New York State law, allowed to designate up to two caregivers who would administer it for them,” Palace said.

These designated caregivers can be a family member or friend, who must also register with the New York Department of Health.

Managing and tracking

Because patients at Hebrew Home at Riverdale are self-administering the drug, the facility does not monitor the patient as they consume the controlled substance. However, staff are trained to make assessments, according to Palace.

“We do follow-up with the patient in terms of how they perceive they’re doing, if they feel a benefit from it, whether they want to continue with it or not, and their own subject to feeling of medicinal benefit,” he said.

To prevent abuse, staff are also trained to spot unusual behavior among patients who use the drug.

“If nurses observe anything out of the ordinary … that would be reported to the physician on the floor,” Palace said.

At Balfour Senior Living, medical marijuana is administered by nursing staff following a doctor’s order for the treatment.

There, staffers track usage through medication administration records (MAR), and the substance is stored and locked in medical carts at nurses’ stations, according to Eric Meyer.

Meyer serves as the executive director for the Louisville, Colo.-based  operator of continuing care retirement communities (CCRCs).

“The MAR indicates how to administer [and] how much to administer to that resident,” Meyer told SNN. “The nurse administers [the substance] and then documents how much is given to the resident, so it’s pretty much measured out.”

Providing tools similar to MARs is one of the services PDI Medical provides to patients and nursing staff. The Buffalo Grove, Ill.-based medical marijuana dispensary has become a supplier for senior care providers, and continues to make partnerships within the industry.

“I have a medication flow sheet that gets filled out and orders for products … how it’s given, and how often it’s dosed for the nurses to adhere to — very similar to a medication flow sheet for any kind of medication that gets administered,” Joseph Friedman, chief operations officer at PDI Medical, told SNN. “We do that and then we also have all of the necessary processes in place for patients and caregivers to become registered with the state.”

A furious outcry

For Friedman, education is key to combatting the stigma that persists with the usage of marijuana in the medical setting. This is especially true as U.S. Attorney General Jeff Sessions has doubled down on the Trump administration’s opposition to recreational use of the drug, and as the Rohrbacher-Blumenauer Amendment — a provision protecting medical marijuana programs in states from federal interference — is set to expire on January 19.

“If [the government] rescinds [the amendment] and removes protections for these 70-year-old ladies that are walking into my dispensary, or moms that have these kids whose seizures are being controlled with medical cannabis, I think that’s going to create a great, furious outcry from [those who] are getting a benefit,” Friedman said.

However, the medical and long-term care industries realize the medicinal benefits of the drug, as a study published in the Journal of Post-Acute and Long-Term Care Medicine suggests that legal access to cannabis may reduce the use of multiple classes of dangerous prescription medications.

“I think there’s a lot of validity to the use of medical cannabis for its indicated diagnoses,” Palace said. “Any medication can be abused, and medical cannabis is clearly no different. But when it’s prescribed for its approved indication, it can be a very effective alternative.”

Written by Carlo Calma