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Employer Considerations and Concerns

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No single constituent determines the risks to public health from illicit marijuana use or misuse of medicinal marijuana. Apples, after all, are not removed from the market or banned from farms because the seeds contain cyanide. The risk is weighed against the benefit, which is often a matter of degree. The people and their state legislatures seem to be weighing risks against benefits as, one by one, states are voting to legalize marijuana in varying degrees after decades of prohibition. This section focuses on community health and education considerations and concerns related to the growth of the marijuana industry in American communities. When weighing the benefits and risks of using marijuana, some basic questions arise that are relevant to healthcare professionals as represented in professional white papers, position statements, and scientific discussions and publications:

  • What do people who use marijuana in their self-care practices need in order to do so safely?
  • What is the new role of government in protecting the public if it abandons marijuana prohibition?
  • What are the roles and responsibilities of healthcare professionals related to marijuana use?
  • What are emerging issues in states that have legalized marijuana related to widespread use?

It is important to consider some of the identified health considerations and concerns related to the growth of the marijuana industry in American communities. In general, healthcare professionals’ approach to shared decision making and person-centered care suggests that they will take a client’s personal experience into account. People have various reasons for choosing their self-care practices. Research has shown that they are often quite rational in their thought processes concerning their health choices, even when they seem to be making choices “alternative” to mainstream biomedical culture’s view of safe and effective care (O’Connor, 1995). They may request further information, but such requests should not be interpreted necessarily as a sign of ignorance. The medicinal marijuana culture is a dominant subculture of the larger self-care culture, identified by social scientists as the “hidden health care system” (Levin & Idler, 2010). Medicinal plants have been part of the foundation of healthcare systems for centuries (Libster, 2004), yet many people may feel disconnected from their environment and the plants that are responsible for their food, shelter, and medicine. They may have no knowledge of what it takes to grow the tomato and prepare the tomato sauce that is on their pizza, or what plant has been the prototype for the newest cancer drug. Then, lacking this knowledge, they are faced with the decision points that have always come with use of medicinal plants. Marijuana is a plant no different from any other. It has many uses and forms, as well as hundreds of constituents, all seemingly at odds when the plant is examined in its reduced parts – but with scientific evidence of an intricate and powerful synergy of substances, an “entourage of effects,” when examined as a whole (Russo, 2011). Herbalists, who are often community experts on the subject of the application of medicinal plants, are an excellent referral resource for healthcare professionals who are learning to counsel people considering or already taking plant medicines such as marijuana (Libster, 1999). Nurses, pharmacists, and behavioral health practitioners can forge partnerships with knowledgeable herbalists to begin to address existing and emerging public health considerations and concerns.

Screening instruments commonly employed in assessing marijuana-related problems because they are brief and easy to use are the Severity of Dependence Scale (SDS – symptoms of dependence), Cannabis Use Disorders Identification Test (CUDIT – motivational aspects of use), Cannabis Abuse Screening Test (CAST – social and health problems), and Problematic Use of Marijuana (PUM). All scales have shown moderate to high internal consistency (Cronbach’s alpha ranging from 0.72 to 0.92), which means that the scales are good at measuring what they are supposed to measure. The SDS is a five-item scale that measures the degree of psychological dependence, that is, the individual’s feeling of impaired control and anxiety toward drug taking. The CUDIT screens for current marijuana use disorders (abuse or dependence), whereas the PUM measures harmful use, problems in interpersonal relationships, and psychophysical functioning. Basically designed for adolescents or young adults, the CAST identifies patterns of marijuana use leading to social or health problems for the user or others in society (Piontek, Kraus, & Klempova, 2008).

Marijuana Drug Screening Issues 

Finally, while marijuana is legal for medical and recreational use in some U.S. states, under federal law, cannabis use is illegal, and employers in industries that are heavily regulated by the federal government screen their employees randomly and include drug testing as part of their hiring process. For non-federally regulated employers, federal law doesn’t require drug testing. However, there are state and local governments that enforce laws regulating drug testing. Employers have the legal right to maintain a drug- and alcohol-free work environment, and are allowed to test applicants and employees as long as the employer clearly informs those applicants and employees of the company’s drug testing policies, including pre-employment screening and random drug testing. In some cases, an offer of employment may be conditional pending the results of a drug test. These policies may be stated in the job description, but most often will be stated in a clearly written agreement within the application or employee handbook, which applicants and employees are required to agree to and sign in order to be hired or maintain employment. Some employers have a company policy that directly addresses marijuana use, while others do not.

Drug screening for marijuana has become a debated topic in states where medical and/or recreational use is legal. The biggest difference between alcohol and cannabis is how they are detected through testing. Alcohol does not linger in the bloodstream like marijuana does. Someone can fail a marijuana drug test weeks after using marijuana because THC takes a long time to leave the bloodstream. A positive test does not mean the person is impaired at that moment. Instead, it just shows that they used marijuana within the last few weeks.

On the other hand, there are on-the-spot tests like the breathalyzer to determine the alcohol level and subsequent impairment of an individual at that moment. This enables lawmakers to create laws regarding the consequences of having more than the legal limit of alcohol in your system. The technology to test marijuana levels with such accuracy has yet to be created. Without the ability to do accurate on-the-spot testing, it is challenging to determine what a legal level (the lowest level that does not cause impairment) of THC would be. Therefore, any trace can be considered exceeding the legal limit.

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