2026 Annual Meeting of the ANA Membership Assembly
Dialogue Forum
Topic
Friday, June 26,
2026
Integrating
Cannabis Nursing Competencies Through Education and Policy to Advance Patient
Safety and Compassionate Care in Practice
BACKGROUND
DOCUMENT
Submitted by: Deanna Collins Sommers, PhD, MSN, RN, Janice
Putnam, PhD, RN, and Llewellyn Dawn Smith, MSN, RN, CNEcl
Overview:
This proposal addresses the critical intersection of nursing
education, clinical practice, and health policy in response to the increasing
use of cannabis for therapeutic purposes across the United States
(Congressional Research Service [CRS], 2023). Cannabis is widely utilized by
patients for symptom management in a variety of acute and chronic conditions,
including pain, cancer-related symptoms, neurological disorders, and palliative
care needs (Bryan, 2025; Centers for Disease Control and Prevention [CDC],
2025; National Academies of Sciences, Engineering, and Medicine [NASEM], 2017).
Despite this growth, corresponding advancements in nursing education,
institutional policies, and regulatory frameworks have not progressed
proportionately.
In 1996, California became the first state to permit the
medical use of cannabis. As of March 1, 2026, 40 states, the District of
Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands have enacted
comprehensive medical cannabis laws. An additional eight states allow
limited-access cannabis use, typically restricted to low-THC or cannabidiol
(CBD) products. Many states have also enacted adult-use cannabis policies,
further contributing to a complex and evolving regulatory environment for
health care providers and patients (CRS, 2023). While the legal landscape
continues to evolve rapidly, a small number of jurisdictions still prohibit
medical cannabis use entirely (CRS, 2023).
As a result, nurses are frequently placed in complex
clinical situations without the foundational knowledge, institutional support,
or policy guidance necessary to provide safe, ethical, and evidence-informed
care. These gaps have significant implications for patient safety, nursing
practice, and health care equity.
Grounded in the Code of Ethics for Nurses (American Nurses
Association [ANA], 2025), this proposal affirms nursing’s ethical obligations
to practice with compassion; prioritize patient-centered care; and advocate for
the health, safety, and rights of individuals and communities. Nursing also has
a responsibility to advance knowledge, inform policy, and address health
inequities through leadership and advocacy (ANA, 2025). Integrating cannabis
nursing competencies with compassionate care policies represents a unified
approach to addressing current gaps in practice (Parmelee, 2025; Parmelee,
2022).
Background:
Cannabis and cannabinoid-based therapies are widely utilized
by patients for symptom management; however, nursing education has not kept
pace with this evolving area of clinical practice. Evidence supports the
therapeutic benefits of medical cannabis for conditions such as chronic pain,
chemotherapy-induced nausea and vomiting, and multiple sclerosis-related
spasticity (NASEM, 2017; Parmelee et al., 2021; Russo, 2016). Persistent gaps
in knowledge related to dosing, pharmacology, drug interactions, and longterm
outcomes underscore the need for evidence-informed clinical guidance.
Despite increasing patient use, most nursing curricula lack
foundational education on the endocannabinoid system, cannabis pharmacology,
and clinical considerations for therapeutic use (King, 2024; Parmelee, 2022;
NCSBN, 2018). This lack of standardized education leaves nurses underprepared
to assess, educate, and safely care for patients who use cannabis for
treatment.
These gaps are particularly evident in long-term care,
hospice, oncology, and communitybased settings. Licensed practical/vocational
nurses (LPNs/LVNs), who provide a substantial portion of direct patient care in
these settings, may be disproportionately impacted due to more limited access
to advanced education and continuing professional development opportunities
(Kurtzman et al., 2022). This disparity has important diversity, equity, and
inclusion implications, as LPNs/LVNs often represent more diverse segments of
the nursing workforce and serve populations experiencing structural inequities.
This educational gap contributes to uncertainty in clinical
decision-making, as nurses navigate conflicting legal, ethical, and
institutional expectations without clear guidance. Federal classification of
cannabis as a Schedule I controlled substance, defined as having no accepted
medical use and a high potential for abuse, continues to conflict with
statelevel legalization, resulting in regulatory ambiguity that puts nurses at
risk for professional, legal, and ethical consequences (Perlman et al., 2021).
Recent federal actions to expand research and reconsider scheduling further
underscore the evolving regulatory landscape and the need for clarity to
support safe nursing practice (Trump, 2025).
The Code of Ethics for Nurses provides a clear framework for
addressing these challenges. Nurses are obligated to practice with compassion
(Provision 1), maintain commitment to the patient (Provision 2), and advocate
for patient safety and rights (Provision 3) (ANA, 2025). These responsibilities
are difficult to fulfill when nurses lack the education and institutional
support needed to address cannabis use safely.
Patient autonomy is central to nursing practice. Patients
have the right to make informed decisions regarding their care, including the
use of cannabis for therapeutic purposes. Nurses are ethically obligated to
provide accurate, evidence-based information; however, without adequate
education and policy guidance, they cannot fully support informed
decision-making (ANA, 2025; NCSBN, 2018).
The absence of standardized institutional policies further
complicates practice. Compassionate care legislation, such as California’s
Ryan’s Law, allows terminally ill patients to use medical cannabis within
health care facilities under defined conditions, demonstrating that structured,
patient-centered approaches are feasible (Americans for Safe Access, 2025;
McKaig et al., 2025). However, these models are not widely implemented or
standardized. In the absence of such models, nurses must navigate competing
obligations between patient advocacy and organizational or legal constraints.
This disconnect contributes to moral distress among nurses by limiting their
ability to fully meet ethical obligations to relieve suffering and provide
compassionate care. Moral distress is associated with burnout, job
dissatisfaction, and workforce instability (Brennan et al., 2019).
At a systems level, the lack of alignment between education,
policy, and practice undermines patient safety and contributes to inequities in
care delivery. Nurses must be equipped with the competencies, knowledge, and
institutional support necessary to provide safe, ethical, and equitable care
(ANA & ACNA, 2024). Consistent with ANA’s commitment to evidence-based
practice and stigma reduction, there is a critical need for a unified approach
that integrates education, clinical standards, and policy development (ANA
& ACNA, 2024; ANA, 2022; NCSBN, 2018).
Proposed Recommendations:
1. Support
Development of Model Clinical Guidance
Support development of clinical
and ethical guidance for cannabis use in patient care.
• Urge ANA to conduct a free webinar promoting equitable
access and highlighting best practices, stigma, laws, and resources.
2. Promote
Policy Alignment and Practice Support
Advance efforts that support
clarity and alignment across regulatory environments.
• Support federal and state policies that reduce legal,
regulatory, practice, and licensure risk for integrating cannabis related to
nursing (ANA, 2022; NCSBN, 2018).
Conclusion:
The integration of cannabis
nursing education, compassionate care policies, and regulatory alignment is
essential to advancing safe, ethical, and patient-centered care. This proposal
reflects the ethical foundation of nursing practice and positions nurses as
leaders in addressing emerging clinical and policy challenges.
Aligning education, practice, and policy ensures that patients receive equitable, evidenceinformed care while supporting nurses in fulfilling their professional responsibilities.
Furthermore, advancing equity across the nursing workforce
remains essential. Ensuring access to consistent, evidence-informed education
across licensure levels and practice settings is critical to reducing
disparities in care and supporting safe, culturally responsive practice
(Kurtzman et al., 2022).
References:
American Nurses Association. (2025). Code of ethics for
nurses with interpretive statements. Silver Spring, MD: American Nurses
Association.
American Nurses Association. (2022). Therapeutic use of
marijuana and related cannabinoids. OJIN: The Online Journal of Issues in
Nursing, 27(1). https://doi.org/10.3912/OJIN.Vol27No01PoSCol01
American Nurses Association & American Cannabis Nurses
Association. (2024). Cannabis nursing: Scope and standards of practice. Silver
Spring, MD: American Nurses Association.
Americans for Safe Access. (2025). CA healthcare facility
implementation guide for the Compassionate Access to Medical Cannabis Act
(“Ryan’s Law”). https://www.safeaccessnow.org/ryanslaw_facilityresources#gsc.tab=0
Armentano, P. (2021, September 13). California lawmakers
advance legislation permitting medical cannabis use in hospitals. NORML. https://norml.org
Banerjee, S., & McCormack, S. (2019). Medical cannabis
for the treatment of chronic pain: A review of clinical effectiveness and
guidelines. CADTH. https://www.ncbi.nlm.nih.gov/books/NBK546424/
Bodine, M., & Kemp, A. K. (2023). Medical cannabis use
in oncology. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK572067/
Borgelt, L. M., & Franson, K. L. (2017). Considerations
for hospital policies regarding cannabis use. Hospital Pharmacy, 52(2), 89–90. https://doi.org/10.1310/hpj5202-89
Brennan, F., Lohman, D., & Gwyther, L. (2019). Access to
pain management as a human right. American Journal of Public Health, 109(1),
61–65. https://doi.org/10.2105/AJPH.2018.304743
Bryan, K. (2025). Cannabis overview. National Conference of
State Legislatures. https://www.ncsl.org
Centers for Disease Control and Prevention. (2025, March 7).
Cannabis and public health. https://www.cdc.gov/cannabis/about/what-cdc-is-doing.html
Clark, C. S. (2021). Cannabis: A handbook for nurses.
Wolters Kluwer.
Congressional Research Service. (2023). Medical marijuana:
State and federal policy overview (IF12270). https://www.congress.gov/crs-product/IF12270
King, D. D. (2024). The role of stigma in cannabis use
disclosure: an exploratory study. Harm Reduction Journal, 21(21), 1–13. https://doi.org/10.1186/s12954-024-00929-8
Kleckner, A. S., Kleckner, I. R., Kamen, C. S., Tejani, M.
A., Janelsins, M. C., Morrow, G. R., & Peppone, L. J. (2019). Opportunities
for cannabis in supportive care in cancer. Therapeutic Advances in Medical
Oncology, 11, 1–29. https://doi.org/10.1177/1758835919866362
Kurtzman, E. T., Greene, J., Begley, R., & Drenkard, K.
N. (2022). “We want what’s best for patients”: Nurse leaders’ attitudes about
medical cannabis. International Journal of Nursing Studies Advances, 4, 100065.
https://doi.org/10.1016/j.ijnsa.2022.100065
Lawler, Z. (2025). Medical cannabis & cannabinoid
regulation. Chambers Practice Guides.
McKaig, A., Ridad, A., Bell, A., McParlane, R., &
Quirch, M. (2025). Implementing Ryan’s Law on an inpatient oncology unit.
Clinical Journal of Oncology Nursing, 29(1), 86– 90. https://doi.org/10.1188/25.CJON.86-90
National Academies of Sciences, Engineering, and Medicine.
(2017). The health effects of cannabis and cannabinoids: The current state of
evidence and recommendations for research. National Academies Press. https://doi.org/10.17226/24625
National Council of State Boards of Nursing. (2018). The
NCSBN national nursing guidelines for medical marijuana. Journal of Nursing
Regulation, 9(2), 19–26. https://doi.org/10.1016/S2155-8256(18)30094-2
Parmelee, R. (2025). Nurse educators’ experiences with
medical cannabis education. Walden University, College of Nursing. Walden
University. Retrieved December 15, 2025.
Parmelee, R. A. (2022). Nursing students’ knowledge, skills, and attitudes regarding medicinal cannabis care. Journal of Nursing Regulation, 13(3), 13–23. https://doi.org/10.1016/S2155-8256(22)00082-5
Parmelee, R. C., Clark, C., & Sommers, D. C. (2021).
Cannabis pharmacology: From the whole plant to pharmaceutical applications. In
C. Clark, Cannabis: A handbook for nurses (pp. 115–160). Wolters Kluwer.
Russo, E. B. (2016). Cannabis and Cannabinoids:
Pharmacology, Toxicology, and Therapeutic Potential. Routledge.
Perlman, A. I., McLeod, H. M., Ventresca, E. C., Post, P.
J., Schuh, M. J., & Dabrah, M. A. (2021). Medical cannabis state and
federal regulations: Implications for U.S. healthcare entities. Mayo Clinic
Proceedings, 96(10), 2671–2681. https://doi.org/10.1016/j.mayocp.2021.05.005
7
Ryan, J. E., McCabe, S. E., & Boyd, C. J. (2021).
Medicinal cannabis: Policy, patients, and providers. Policy, Politics, &
Nursing Practice, 22(2), 126–135. https://doi.org/10.1177/1527154421989609
Spector, C. B. (2018). Medical marijuana: A national survey
of nursing education and practice. Journal of Nursing Regulation, 9(2), 36–43.
Trump, D. (2025, December 18). Increasing medical marijuana
and cannabidiol research (Executive Order 14370). The White House. https://www.whitehouse.gov
Wilbert, E., & Adinoff, B. (2023). Legislative and
administrative guidelines for regulating cannabis use in healthcare facilities.
Doctors for Cannabis Regulation
Ken's summary of DEA's move of medicinal cannabis to Schedule III:
The Justice Department and the Drug Enforcement Administration (DEA) announced on 4/23/26 the issuance of an order (published 4/28) immediately placing marijuana products regulated by a state medical marijuana license in Schedule III of the Controlled Substances Act (CSA), as well as a new administrative hearing beginning June 29, 2026 to consider the broader rescheduling of marijuana from Schedule I to Schedule III. www.justice.gov 4.23.26.6754-2026 PDF
“The new federal
scheduling action recognizes qualifying medical cannabis as medicine…The order moves certain medical cannabis products from
Schedule I to Schedule III. This includes Food and Drug Administration (FDA)-approved marijuana products and
marijuana products covered by qualifying state medical cannabis licenses.”
“The order also recognizes that state
medical cannabis programs are part of the medical access landscape. State
systems already regulate patient access, licensing, dispensing, labeling,
packaging, security, disposal, and recordkeeping. The order relies on this
existing state infrastructure to promote medical benefits and avoid unnecessary
disruption to patients and state systems. The order recognizes medical cannabis
patient registration as equivalent to a prescription.”
“State-authorized medical marijuana certifications or
similar documents are sufficient to permit the dispensing of medical marijuana
to users, provided they include the user's name and address, are dated and
signed on the day of issuance, and identify the issuing practitioner.”
“Under 21 U.S.C. 811(d)(l), if control of a substance
is required ‘by United States obligations under international treaties,
conventions, or protocols in effect on October 27, 1970’-which includes the
Single Convention-the Attorney General shall issue an order controlling such
drug under the schedule he deems most appropriate to carry out such
obligations.
4.23.26.6754-2026 PDF (www.justice.gov)
Ken’s rescheduling
suggestions:
In response to the federal government’s recognition of
marijuana as a Schedule III medicine when it comes from state medicinal
cannabis programs, several steps should be pursued immediately.
·
All RN/LPN nursing schools should
include the Endocannabinoid System (ECS) in their Anatomy and Physiology or
Health Services curricula. “The discovery of the
Endocannabinoid System (ECS) about 30 years ago provides the scientific basis
for how cannabis can help with so many diseases, symptoms, and medical
conditions. The ECS consists partly of a series of receptors throughout the
entire human body for the components of marijuana--the cannabinoids. Our own
body produces substances--endocannabinoids--that are identical to
phytocannabinoids, or the cannabinoids found in the cannabis plant. The purpose
of the ECS is to restore homeostasis, or balance, to the mind and body. Medical
cannabis can help where there is a deficiency in the production of the natural
endocannabinoids. ECS researchers say that this system may play a role in all
disease processes.” https://cmmnj.blogspot.com/2024/06/testimony-to-nj-cannabis-regulatory.html
·
Medicinal cannabis must be integrated
into the entire American healthcare system. Medication policies
must be updated, and medicinal cannabis must be added to the facility’s Controlled
Substances Policy. “Currently, most health care facilities forbid the use of
medical cannabis in the facility. This is a dangerous and potentially fatal
situation. A patient who suffers from seizures may be admitted to a health care
facility for a condition that is unrelated to the seizure condition. Then, when
the patient is denied access to the only medicine that controls their
seizures--medical cannabis--the result can be fatal.” https://cmmnj.blogspot.com/2024/06/testimony-to-nj-cannabis-regulatory.html
·
Medicinal cannabis must be available
in all government institutions that have patients with qualifying conditions
for medicinal cannabis in the state. As I told the NJ CRC in June 2024: “It is
my sincere hope that the state will recognize its responsibility to the
institutionalized patients in New Jersey. For 25 years, I have worked as a
registered nurse (RN) in state institutions. I know that many patients in these
institutions qualify for medical cannabis and could benefit greatly from it.
The staff in these institutions are trained to administer, account for, and
evaluate the effect of controlled substances. There is no reason to withhold
this important medical therapy from these patients. In fact, courts have
determined that inmates in New Jersey’s prison system are entitled to
“community standards” of healthcare. Edible and topical medical cannabis
products will improve health care in state institutions, group homes, hospices,
etc., and will reduce the costs of running these programs.” https://cmmnj.blogspot.com/2024/06/testimony-to-nj-cannabis-regulatory.html
·
Continuing education (CEUs) on the
ECS should be mandatory as a condition for continued licensure for nurses.
This will help to overcome the paucity of educational programs in nursing
schools. It will also serve as a model for other healthcare professions.
·
Support legislation that provides
insurance coverage for medicinal cannabis in the state’s
program. N.J. bill (S3984/A1023) Requires
workers' compensation, PIP, and health insurance coverage for the medical use
of cannabis under
certain circumstances.
·
Dosing and administration standards
should be adopted by the ANA. I recommended that the
NJ Cannabis Regulatory Commission (CRC) “should quickly adopt cannabis Dosing
and Administration guidelines and educational programs on the Endocannabinoid
System. The CRC must promulgate these guidelines and programs to the cannabis
consuming community and to the healthcare community to increase the safety and
appropriate use of cannabis products. In fact, the Jake Honig
Act required these guidelines, but they have yet to be adopted in New
Jersey:
“g. The commission shall establish, by regulation, curricula
for health care practitioners…:
(1) The curriculum for health care practitioners shall be designed
to assist practitioners in counseling patients with regard to the quantity,
dosing, and administration of medical cannabis as shall be appropriate to treat
the patient’s qualifying medical condition. Health care practitioners
shall complete the curriculum as a condition of authorizing patients for the
medical use of cannabis.”
Educational programs on the Endocannabinoid System for
medical providers in New Jersey, now including physicians, Advanced Practice
Nurses, and Physician Assistants, are required. Dosing and Administration
guidelines and ECS educational programs are readily available. Some of the best
resources on the ECS include:
·
Patients Out of Time: https://patientsoutoftime.com/
·
Americans for Safe Access: http://www.safeaccessnow.org/
·
Society of Cannabis Clinicians: http://cannabisclinicians.org/
·
American Cannabis Nurses
Association: https://www.cannabisnurses.org/
·
Project CBD https://www.projectcbd.org/
·
The Answer Page: https://www.theanswerpage.com/
·
National Organization for the Reform of
Marijuana Laws: https://norml.org/
The New Jersey Department
of Health’s Executive Order 6 Report on 3/23/2018:
The Department recognizes
the need to provide education and guidance to providers. To that end, the
Department is exploring the creation of an education program for all
physicians, with focus on the endocannabinoid system. The Department plans to
leverage the expertise of the Medicinal Marijuana Review Panel to oversee the
curriculum development for this program. This education program will serve to
create best practices for the safe and effective administration of medicinal
marijuana to the expanded universe of qualifying patients. In conjunction with
the provider education program, there is also a need to develop standardized
dosing and administrative protocols for medicinal marijuana products, including
information on expected effects, side effects, and adverse effects. 2018.03.23
EO6Report_Final.pdf
Americans for Safe Access comments:
For medical cannabis patients, this is federal
recognition of the medical value of cannabis. It gives patients in states with
medical cannabis programs a new legal platform for federal rights, protected
access, and integration of medical cannabis into U.S. healthcare systems.
For state-authorized patients, this means
advocates now have a stronger basis to assert:
- rights
and protections under the Americans with Disabilities Act, the Fair
Housing Act, and Section 504 of the Rehabilitation Act;
- protections
against being denied housing, employment, healthcare, or reasonable
accommodation solely because of patient status;
- protections
against being treated as criminals for possessing state-authorized medical
cannabis;
- protections
for parents and caregivers whose medical cannabis status has been used
against them;
- protections
for patients in federally subsidized housing, healthcare settings, federal
workplaces, veterans’ care, and other federal systems.
·
This does not mean every policy has
already been updated. It means the legal premise has changed. Federal
agencies now need to bring their policies into alignment with the recognition
that qualifying medical cannabis is legitimate medicine. https://www.safeaccessnow.org/is_cannabis_legal_now#gsc.tab=0
NORML Op-Ed: Reclassifying Medical
Marijuana Was Long Overdue, but It’s Still Not Enough:
“Specifically, this new order does not aid
patients residing in the 10 US states that do not yet regulate medical cannabis
use. They will continue to have to fend for themselves. And they will continue
to risk arrest and prosecution for doing so.”
“Further, this federal policy change provides no legal
remedies for either the thousands of businesses or the millions of consumers
who reside in the 24 states that have legalized recreational marijuana for
adults. Even with this change, adults who sell or consume cannabis in
accordance with their state laws are still technically breaking federal law.”
“To rectify this state/federal conflict — and to
provide state governments with the explicit authority to establish their own
adult-use cannabis regulatory policies, like they already do with
alcohol — cannabis must
be removed from the Controlled Substances Act altogether.”
Opponents
filed a lawsuit:
It
should be noted that marijuana opponents filed a lawsuit To
Block Trump Administration’s Federal Rescheduling Move.
SAM and the National Drug and Alcohol Screening Association (NDASA) on 5/4/26
asked the U.S. Court of Appeals for DC Circuit to set aside the cannabis
rescheduling action, alleging that they have been “aggrieved” by the reform. (Though
it seems hard to believe that the courts would agree that opponents of
marijuana would be more harmed by rescheduling than the millions of medical
cannabis patients would be by rescinding the rescheduling.)
Ken Wolski, RN, MPA
Executive
Director, Coalition for Medical Marijuana--New Jersey, Inc.
219 Woodside
Ave., Trenton, NJ 08618
609.394.2137 (home/office)
609.721.1658 (cell/text)
5/28/26
