caution in recommending marijuana to older adults because of the plant’s ability to lower blood pressure and raise the heart rate. Older adults can experience postural hypotension, leading to falls. He remarks that he has found that his patients generally tolerate the mild euphoria that they feel as an effect of marijuana. Dr. Abrams (2016, p. 404) notes that, “If I have a single medicine that I can recommend to assist with nausea, anorexia, insomnia, depression, and pain rather than prescribing five or six pharmaceuticals that may interact with each other or the patient’s chemotherapy, I consider it an attractive option for my patients.” This experienced physician takes a pragmatic approach. He understands that a person who has been told to eat only a quarter of a marijuana cookie might then consume the rest of the cookie if his or her pain is not relieved quickly. However, the person may then suffer discomfort from the psychoactive effects of the plant. Helping a person who has had an experience such as this could be compared to guiding the behavior of someone who has been overeating or over-exercising to a level of discomfort or injury. Self-care is a vital part of a person’s healing process. It is a time when a person learns about his or her own body’s needs in new ways. Nurse-scientist Dorothea Orem wrote: Self-care is not the performance of this act or that act. Self- care requires the seeing of relationships among factors, for example, diet, activity, and insulin in the management of a diabetic condition. It requires the making of adjustments in care actions on a day-to-day basis or more frequently. It requires the incorporation of self-care into the pattern of daily living (Orem, Renpenning & Taylor, 2003, p. 213). Marijuana self-care compels a period of time spent adapting to its effects and titrating to the right dose as the person incorporates the plant into his or her lifestyle. Marijuana has also been used extensively by people who suffer from nausea and vomiting during chemotherapy treatment. Cotter (2009) conducted a systematic literature review to evaluate the efficacy of smoked marijuana and THC as treatment for chemotherapy-induced nausea and vomiting (CINV), a well-documented concern. A synthesis of the data in the review shows that marijuana and synthetic oral THC are more effective than placebo in treating CINV from unnamed chemotherapeutic drugs with a high emetic potential. When using drugs of a moderate to high potential for CINV, smoked marijuana and oral THC were found to be equally effective, and they displayed efficacy comparable to that of traditional anti-emetics. Oral THC and smoked marijuana have similar efficacy, but with smoked marijuana having the additional risk related to inhalation of smoke (Cotter, 2009). Whiting and colleagues (2015) published a systematic review considering 28 studies involving a total of 2,454 participants and preparations including inhaled marijuana, dronabinol, nabilone, and Sativex, among others. Twelve of the studies investigated neuropathic pain, three looked at patients with cancer pain, and the remainder looked more at spasticity. The studies generally showed improvement in pain measures, with an overall OR of 1.41 (95% CI, 0.99 to 2.00) for improvement in pain with the use of cannabinoids compared with placebo. An earlier systematic MRSA and antibacterial action Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant, gram-positive bacteria. Studies show that about one in three people in the United States carry S. aureus in their noses, usually without any signs of illness, and two in 100 people carry MRSA (Centers for Disease Control and Prevention, 2019). Terpenoids are aromatic compounds found in the essential oil molecules of plants that can act as a part of the broader immune response of a plant; they may be a protectant for a plant against a predator or an attractant for pollinators. Current research on the terpenoids in marijuana, such as alpha- pinene and limonene, could be explored to see if they, like the
review (Lynch & Campbell, 2011) of 18 randomized controlled trials of cannabinoids in 766 participants with chronic non-cancer pain found that 15 of the studies reported a significant analgesic effect for the cannabinoids compared with placebo, and a number of the studies also noted improvements in sleep. Neuropathic pain is also a concern in the care of patients with cancer. Boychuck and colleagues (2015) conducted a systematic review of the randomized controlled trials involving marijuana and cannabinoids for the treatment of chronic nonmalignant neuropathic pain. Analysis of the 13 included studies showed that cannabinoids may provide effective analgesia in chronic neuropathic pain that is unresponsive to other treatment. Another systematic review of six randomized, double-blind, placebo-controlled trials of cannabinoids (five specifically addressing neuropathic pain) found evidence for the use of low-dose medicinal marijuana in refractory neuropathic pain in conjunction with traditional analgesics (Deshpande et al., 2015). A randomized controlled trial of Sativex in 359 cancer patients with poorly controlled pain despite a stable opioid regimen found that the sublingual preparation (four, 10, or 16 sprays daily for five weeks) reduced both pain and sleep disruption (Portenoy et al., 2012). According to Donald Abrams (2016), “A pharmacokinetic interaction study of vaporized marijuana in 21 patients with chronic – mostly non- cancer – pain taking sustained-release morphine or sustained-release oxycodone showed no significant effect on plasma levels of the opiates” but did suggest enhanced analgesia (Abrams, 2016; Abrams et al., 2011). Dr. Abrams (2016) added anecdotal evidence for the decreasing need for opiates when patients began taking marijuana. In a randomized placebo-controlled trial, Sativex did not show a statistically significant improvement in symptoms in patients with intractable diabetic peripheral neuropathy pain. Participants were divided into those with and without a history of depression because people with depression have higher baseline pain scores. This study had a large placebo effect, possibly accounting for the failure to show differences between experimental and control groups (Selvarajah et al., 2010). A systematic review performed by Fitzcharles et al., in 2016 concluded that the finding that cannabinoids are superior to placebo in reducing chronic pain was valid only for neuropathic pain. The evidence for efficacy of cannabinoids reducing pain in people diagnosed with fibromyalgia syndrome (FMS) is inconsistent. However, many people with FMS do seem to think that marijuana is effective. In a study conducted by the U.S. National Pain Foundation, more than 1,339 people with FMS rated marijuana more effective than FDA-approved duloxetine, milnacipran, and pregabalin. The survey showed that only 8% of duloxetine users, 10% of pregabalin users, and 10% of milnacipran users found the prescribed medication to be “very effective,” while 60% of duloxetine users, 61% of pregabalin users, and 68% of milnacipran users replied that the medications “do not help at all.” In contrast, 62% of marijuana users rated the plant “very effective.” Only 5% said that marijuana did not help at all (Fitzcharles et al., 2016). alpha-pinene in Sideritis erythrantha essential oil, are effective against MRSA and other antibiotic-resistant bacterial strains (Köse et al., 2010). Pure CBD powerfully inhibits MRSA (minimum inhibitory concentration 0.5-2 mg/mL; Appendino et al., 2008). The ability of monoterpenoids to enhance skin permeability and entry of other drugs may further increase antibiotic benefits (Russo, 2011). A study tested hemp seed oil, as well as its emulsion, against the growth of selected bacteria using disk diffusion and broth microdilution methods. The antibacterial effect of hemp seed oil was documented against Micrococcus luteus, Staphylococcus
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