Medical Marijuana in a Hospital Setting

A hospital stay for a Rhode Island resident meant she was not able to use her physician-directed medical marijuana, which she said resulted in negative physical effects, only cured when she began using it again without hospital staff’s knowledge.

RI legalized medical marijuana in 2006, and since then, roughly 19,000 people statewide have received certifications from their physicians to allow them to use the substance for a limited number of conditions, including chronic pain, severe nausea and seizures.

The Medical Marijuana Act protects cultivation of a limited amount of marijuana, as well as its use and possession, for those card-carrying users.

There also exist provisions protecting primary caregiver cardholders, who are subject to a different set of regulations, but are legally allowed to possess and help a patient to use medical marijuana. These provisions are restricted to those who have been registered through the Rhode Island Department of Health (RIDOH).

A 54-year-old RI resident (who asked to remain anonymous) recently suffered an infection that required hospitalization at Miriam Hospital in Providence. She is a medical marijuana user, which her doctor recommended based on her chronic pain. She received her medical card three years ago.

She explained that although her diagnosis was for “ongoing issues that are uncomfortable,” her use of it has helped with other issues, including social anxiety, sleeplessness, depression and the facilitation of other medicines she uses.

“I use it to treat social anxiety more than anything,” she explained.

Having a medical card, she said, has “transformed” her experience with marijuana, which she said she had used before on and off throughout her life. Because the medical card allows her to access drugs from experienced medical marijuana growers, the drug is safer, and a “reliable medicine.”

“It’s rare that you [could] find people who were breeding for specific medical conditions [before medical marijuana],” she explained.

However, when she was admitted to Miriam Hospital in 2017, she said it was clear that her medical marijuana would not be considered a “maintenance drug” by hospital staff. Maintenance drugs are medicines that a patient has been taking long-term or for a chronic condition.

As a result, she became sicker in the hospital, nauseous from the medicine being given to her for her infection and vomiting frequently. Her stress and anxiety were also heightened, she said.

Under the Medical Marijuana Act, medical marijuana cards grant access to the drug in the same way that other medicines might be accessed.

“For the purposes of medical care, including organ transplants, a patient cardholder’s authorized use of marijuana shall be considered the equivalent of the authorized use of any other medication used at the direction of a physician, and shall not constitute the use of an illicit substance,” the law reads.

However, according to RIDOH, individual medical organizations have the right to administer medicine at their own discretion.

Andrea Bagnall Degos, communications director at the Rhode Island Department of Health, said hospitals have jurisdiction over patient treatment. Medication decisions are made at the hospital, by the doctors, nurses, pharmacy and any other members of specific hospitals’ treatment teams.

“RIDOH can’t compel a hospital or professional to use any specific treatment,” Bagnall Degos said.

Eventually, the hospitalized woman felt compelled to use medical marijuana while in the hospital. She first tried edibles, brought from home by her family, but said she could not keep them down, and so moved on to her vaporization pen, which she used in the bathroom. Because she was able to use the bathroom on her own, she said, she was able to use her pen in private, without hospital staff knowing.

“Within about three minutes, I felt incredibly better,” she said. The marijuana helped her to tolerate the medicine she was receiving, to be able to sleep, and to feel less stressed overall.

“It enabled me to tolerate being there … I just think it helped my overall well-being,” she said.

She explained that she continued to use it during the rest of her hospital stay, always in private, where she said it was easy to use it. She was not sure what would have happened if doctors or nurses discovered what she was doing. “For me, the risk of doing it was worth it.

“I felt like I needed to do it, to get the heck out of there,” she said.

Grace Hyde, a compassion care center coordinator and Motif’s cannabis columnist, explained that engaging in this activity without her medical staff’s knowledge carried significant health risks.

“THC is a vasodilator (lowers blood pressure and raises heart rate) and it could interact with other medications, but also could lead your medical team to thinking other medications or your illness that you’re hospitalized for are creating the effects,” Hyde wrote in an email.

“It’s generally best to be on the same page with your physician so there’s no confusion. You definitely don’t want to sneak it in and then have them find out from a toxicology report,” she explained.

Hyde said she did not recommend using medical marijuana while in the hospital without a doctor’s knowledge, and that use on hospital grounds was prohibited in most places. She said she would recommend talking to medical staff to determine a best route of care.

LifeSpan PR director David Levesque wrote the following to us on behalf of Miriam Hospital: “In compliance with state and federal law regarding medical marijuana. Lifespan hospital facilities strictly prohibit smoking or vaporizing of any kind, including the use of medical marijuana. Alternative drug therapies are made available to the patient for the duration of inpatient admission. Should the patient and his or her prescribing provider decide not to interrupt the therapeutic use of marijuana, alternative delivery methods such as edibles may be secured by the patient. Clinical staff will document the prescription as made by the prescribing third-party provider and oversee its use by the patient. Hospital staff does not store, prescribe, administer or dispense medical marijuana.” (That last sentence is in accordance with the same federal and state laws that affect pharmacies).

Bagnall Degos said she is not aware of any hospitals that are administering medical marijuana in RI. She also stated that several regulations related to licensing analytical labs for sampling and testing medical marijuana are currently in public review until January 18.

She said use in hospitals is something she would like to see become more accepted and accessible. “I would like to see medical cannabis treated the same as any other [medicine],” she said, making clear that she does not advocate for recreational use, but limits her discussion to medical marijuana specifically.

“People need to realize this is something people need access to,” she said.