Can you use medical marijuana in a hospital or elder care?

Let’s say you (or your parent or grandparent) have been taking medical marijuana for one or more of the various conditions that are legal under Michigan law. But then an illness or injury requires you to become an in-patient at a hospital, rehab center or elder care facility (assisted living, adult foster care or nursing home). Can you and yours continue to use cannabis as an in-patient?

The short answer in Michigan is, sorry, but no - though maybe not for the reason you think. For most health facilities, the issue isn’t the cannabis but the smoking. Even since the Michigan Court of Appeals banned medical marijuana in anything but the smokable form a few weeks ago, the fact that all health facilities in Michigan are smoke-free means that they cannot allow patients to use the only form of the drug currently legal in the state.

Yet just as quickly at Michigan banned edible forms of the drug, the law could change back. The recent case or another case like it, under pressure to clarify the law, could decide to restore the right to medibles.

What then? Would Michigan hospitals and other health facilities allow patients to use ingestible forms of medical marijuana?

This time the short answer is no one knows. I made a quick round of phone calls asking officials in various facilities and organizations, and the question clearly caught all of them all off guard. None had a policy. All said that I was the first person ever to ask. And some sounded less than delighted at the prospect of having to make a decision about such a contentious issue.

The folks at Sparrow Hospital’s admitting office and emergency room were among those who said the issue has yet to come up. But hospitals may find it easier to deal with the issue than elder care facilities. The 1987 Nursing Home Reform Act brought nursing homes nationwide under federal scrutiny. An article by Liana Aghajanian in Alternet suggested elder facilities might therefore be reluctant to do anything to run afoul of federal drug law enforcement.

Nurse Jenifer Martinson of Bickford Assisted Living said that all medication decisions at their facility are made between the doctor and the patient. In elder care, every medication - even an aspirin - requires a doctor’s written order. The facilities typically establish protocols and provide secure locations to handle controlled substances prescribed for their patients. So part of the equation is whether the patient’s doctor would approve.

A representative of Delta Retirement Center in Lansing suggested that I talk with the Health Care Association of Michigan, since he expected administrators at his facility and others in Michigan would consult with them if the issue comes up. Even though it was late on Friday, Linda Lawther, President/CEO of the Michigan Center for Assisted Living, and Elizabeth Thomas, HCAM Director of Communications, set up a conference call to answer questions.

Again, they said that this was the first time the question had been raised. They explained that their role is not to guide or recommend, but to educate. “We help our members by providing them information they request on issues they care about,” said Lawther.

Viewed from a different perspective, the fact that none of the facilities or organizations have policies on medical marijuana and may be looking for answers could be an opportunity, not a problem. Many will be looking for information, and all were quick to say they are sincere in wanting to put patients first. HCAM’s motto, for example, is “promoting excellence in senior health care.”

Groups that are trying to ensure that patients at all stages of life have access to medical marijuana anything may want to start persuading the health-care industry to embrace its use. Nursing Home Alert breaks down the federal regulations that apply to elder care, and some could easily be interpreted as supportive of cannabis care:

• Develop a comprehensive care plan for each resident. (42 CFR §483.20)
• Prevent the deterioration of a resident’s ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to communicate. (42 CFR §483.25)
• Maintain acceptable parameters of nutritional status. (42 CFR §483.25)
• Promote each resident’s quality of life. (42 CFR §483.15)
• Maintain dignity and respect of each resident. (42 CFR §483.15)
• Ensure that the resident has the right to choose activities, schedules, and health care. (42 CFR §483.40)
• Provide pharmaceutical services to meet the needs of each resident. (42 CFR §483.60)
• Be administered in a manner that enables it [the nursing home] to use its resources effectively and efficiently. (42 CFR §483.75)

Michigan’s medical marijuana industry is at a crossroads, with its horizons narrowed by court decisions and continued federal and state raids on caregivers and their facilities. Yet as we learn more about the benefits of cannabis for many of the diseases of aging, perhaps this is an opportunity for the industry to take a pro-active approach to educate older citizens and those who support them about how they can help. And the good news is that seniors vote.