My first 30 days as a CBD nurse: A tiny, unhealthy slice of American Pie

Over a year ago, I made a pivotal decision that would affect me and my family forever. I decided to disrupt my professional career path as a professor of nursing to embark upon the road less traveled. I went ‘all-in’ as a cannabis nurse and opened a retail CBD and hemp store here in the Hampton Roads area of Virginia.

I am a doctorally-prepared registered nurse with 35+ years who has practiced in clinical, administrative, and educational environments. I have seen it all and am horrified by what I have witnessed in health care and education over the past several decades; the ratio of patients to nurses continues to climb unchecked; incentives and reimbursements to health care organizations and professionals have plummeted; the prevalence of chronic, incurable diseases has skyrocketed in adults and children; and nursing education has become mired in red tape, bureaucracy, and incompetent micromanagement.

I wanted off the merry-go-round that positions nurses at the center of this chaos, a chaos that causes new nurses to burn out at alarming rates (most recently, a survey suggests even pediatric nurses are emotionally exhausted, with 30% of them wanting to either work somewhere else or change their career: Nurses burned out and want to quit). Motivated by meaning and a sense of purpose that supports my ethical responsibilities as a nurse, I wanted to share my knowledge and expertise as a cannabis nurse with my community.

Belonging to the most trusted profession is a heavy responsibility (Nurses Continue to Rate Highest in Honesty, Ethics). Nurses are entrusted with the public’s health and thus, we must do everything in our power to maintain the integrity associated with our professional role. Nurses work closely with patients and communities on a daily basis and must stay ahead of the curve when it comes to patient safety. Thus, nursing is the first health care profession to offer practice guidelines related to the new phenomenon of medicinal cannabis.

In July 2018, the National Council for the State Boards of Nursing published The NCSBN National Nursing Guidelines for Medical Marijuana (a free copy can be obtained here: https://ncsbn.org/The_NCSBN_National_Nursing_Guidelines_for_Medical_Marijuana_JNR_July_2018.pdf). Although there is debate regarding the use of the word ‘marijuana’ in the title of this publication (in lieu of its proper nomenclature, cannabis), we can appreciate that nurses now have guidelines to follow that support the health and safety of our population. Nurses know that even in states where cannabis is not yet legal, our patients are still using it in some form or another, for numerous physical and psychological reasons.

Mind you, I am a career nurse, not a business person. The entire process of opening my retail store was exhausting and intimidating from the start. I encountered discrimination and ignorance regarding the legal sale of hemp and its components. Then, COVID-19 hit, causing my store opening to be delayed by 6 months. I had resigned my home health and palliative care position in December 2019 to focus all my efforts on my new business venture. Living on limited income for half a year was not fun, but I kept thinking about how much I wanted to serve my community. I recognized just how unhealthy my community was, and I was tired of spending hours mired in paperwork demanded by our government for the privilege of receiving care at home. Through the support of my family and friends and the sheer will to survive, I opened my doors in August 2020.

And open I did. Hemp Haven Chesapeake, the first store of its kind on the East coast, opened on August 1, 2020. For the past 30 days, I have felt like a lone beacon of hope for people who have no where else to turn, individuals who have tried conventional medicine and who remain without any resolution to their health concerns. My tiny voice within the health care wilderness now reaches one person at a time through individual education and coaching.

At first, customers trickled in. “What is that?!” they exclaim as they spy raw hemp flower displayed on my counter top. Many have never seen a real live cannabis plant before, but they all recognize the familiar color and shape of the cannabis bud. “Hemp!” I reply with a big smile. (I still get a kick out of being called “The Weed Nurse”). Once the shock of seeing a legal, regulated plant wears off, education begins. Customers, who were once just a trickle, are starting to become a steady flow. Word-of-mouth is spreading throughout my community and repeat customers are already a foundation of my business. Individuals now seek out my store for the quality and variety of products I offer and, more significantly, for the education and coaching I provide to them. “I came to you because you are a nurse” is a frequent opening to a conversation that leads to education about CBD, hemp, and overall well-being.

Each individual who has passed through my doors has sought answers to questions left unresolved. Reflecting on those who visited my store, I realize that these individuals have been disregarded by modern medicine. My customers come in all shapes and sizes, ages, ethnicities, and levels of health. They are our co-workers, family members, friends, and neighbors. They are but a tiny, unhealthy slice of American Pie, who have taken it upon themselves to find their own path to wellness:

• An 87-year old woman with rheumatoid arthritis: This dear lady was accompanied by her 89-year old husband (who proudly stated he didn’t take any prescription drugs). She had read in Reader’s Digest (!) about CBD and its use for patients with rheumatoid arthritis. She even brought me a copy of the article (The Promise of CBD)! She is tired of taking chemotherapy drugs that give her so many adverse side effects. CBD has been shown to have anti-inflammatory benefits to decrease the inflammation associated with collagen-induced arthritis conditions, such as rheumatoid arthritis. (Cannabinoids in models of chronic inflammatory conditions)
• A young veteran experiencing post-traumatic stress disorder (PTSD): This young man entered the store exhibiting classic signs of anxiety – fidgety and hesitant, he was unable to remain in the store for more than 5 minutes at a time without feeling overwhelmed. Dr. Sue Sisley’s work with medicinal cannabis for veterans with PTSD has been nothing short of groundbreaking, and she continues to push the boundaries to allow military members and veterans the option to use medicinal forms of cannabis to treat their anxiety and stress brought on by years of service to our country. (Marijuana-PTSD study concludes after 10 years of planning, research)
• A mother of a young woman with a diagnosis of bipolar/schizophrenia: This individual had heard from her daughter’s psychologist that CBD could be an option for her treatment, as standard antipsychotic medications were not having the desired effect on her psychological well-being. Pre-clinical studies have suggested that cannabidiol may regulate serotonin levels. Serotonin and its receptors have been identified as dysfunctional in the development of schizophrenic psychoses. (Therapeutic potential of cannabinoids in schizophrenia)
• A young woman from California with systemic lupus erythematosus, who is unable to find compatible cannabis products in Virginia: While living in California, this individual was able to control her lupus outbreaks and she successfully transitioned from pharmaceutical medications that caused her to have allergic reactions to medicinal cannabis. Upon moving to Virginia, where the medical cannabis program is still not operational even 3 years after approval, she was forced to resume her prescription drugs. This sacrifice caused her to have adverse effects again to the point where she can no longer work. Autoimmune disorders are particularly related to improper functioning of the endocannabinoid system, and lupus therefore has been linked to a dysfunctional endocannabinoid system. There is a study currently underway that considers the effects of a new highly purified composition of synthetic non-psychoactive cannabinoid (ajulemic acid) as it modulates inflammatory responses and autoimmunity (Endocannabinoid system in systemic lupus erythematosus: First evidence for a deranged 2-arachidonoylglycerol metabolism). If a synthetic non-psychoactive cannabinoid can help moderate autoimmune responses, the natural plant can quite possibly do the same, without help from Big Pharma.
• An older woman with peritoneal cancer, who is terrified of her new immunotherapy drug: This lovely lady wants to stay alive long enough to bake a cake for her expected great-granddaughter. She was offered only one option – an immunologic treatment that lists so many potential adverse effects that it caused her to cry while showing them to me. Her daughter, a nurse in California, recommended that she seek out CBD to help lessen some of the effects of the treatment, specifically, nausea and vomiting. Almost 20 years ago, CBD was found to have anti-emetic effects in animal models of nausea and vomiting (Cannabidiol, a non-psychoactive component of cannabis and its synthetic dimethylheptyl homolog suppress nausea in an experimental model with rats). Why aren’t oncologists aware of the benefits of CBD on nausea and vomiting, and more importantly, why haven’t more studies been completed to determine the effectiveness of CBD as an anti-emetic?
• An older woman with plantar fasciitis, who returned a few days later with her husband, who has a history of bilateral knee replacements, who refuses to get any more cortisol injections: Upon her return, this sweet lady smiled and pointed to her feet. “See these sandals? I haven’t been able to wear these for years!” she exclaimed. Her husband’s health history included not only bilateral knee replacements but a 5-vessel cardiac bypass surgery for hereditary hypercholesterolemia. When educated about the benefits of CBD on not only inflammation (Cannabidiol (CBD) and its analogs: A review of their effects on inflammation) but cardiovascular health as well (A new face of endocannabinoids in pharmacotherapy. Part I: Protective role of endocannabinoids in hypertension and myocardial infarction; Inhibition of the endocannabinoid system alleviates dyslipidemia and attenuates atherosclerosis development), this couple opted for several CBD products to benefit from both local and systemic effects.
• A self-described, obese, diabetic African-American woman looking for healthy solutions for weight loss, anxiety, and stress: With the onset of COVID-19, this motivated individual states she wants to begin practicing a healthier lifestyle, as she recognizes how co-morbidities increase the risks associated with the virus. While she was aware that CBD could help reduce her anxiety and stress, she did not know about the abundance of research that supports the use of CBD as a method to regulate lipid and glucose metabolism, thereby modulating obesity and diabetes. (Peripheral modulation of the endocannabinoid system in metabolic disease)
• A frantic daughter, who brought her father in after a diagnosis of new-onset Raynaud’s Syndrome: These individuals were evaluated at the local emergency room. After diagnosing Raynaud’s Syndrome, her father was sent home with a prescription for Vicodin and an admonishment to ‘stop smoking’ because there was nothing else to offer him. They had heard from friends that CBD could help decrease the pain associated with his constricted blood vessels, but they were unaware of the vasorelaxant properties of CBD. CBD has been shown to have a direct action on arteries, causing both immediate and time-dependent blood vessel relaxation. (Is the cardiovascular system a therapeutic target for cannabidiol?)
• A young physically fit man seeking products for his friend who has ALS: This individual entered the store, wanting everything that would potentially help his friend with ALS (Amyotrophic Lateral Sclerosis, or Lou Gehrig’s disease). We sat and talked for hours about the multiple benefits CBD could offer when dealing with an autoimmune, inflammatory, painful, spastic, nerve- and muscle-killing disease such as ALS. A few days later, his friend’s wife informed him that his pain levels had decreased, his sleep was better, and his anxiety had lessened. (Real world experience of patients with amyotrophic lateral sclerosis (ALS) in the treatment of spasticity using tetrahydrocannabinol:cannabidiol (THC:CBD))
• Numerous men and women of all ages have come to the store for one specific purpose – they need something for sleep! In these crazy times, where the future is unwritten, stress and anxiety are playing havoc with our sleep habits. These individuals recognize that CBD can help lessen anxiety and help with stress. Published just last year, a large retrospective case series found that sleep scores improved within the first month in 66.7% of study subjects who used just 25 mg of CBD daily. (Cannabidiol in Anxiety and Sleep: A Large Case Series)
• And finally, this message from a Yelp customer: “I’m a 62 year old cancer patient with desmoplastic fibrocarcinoma and you people are my only hope.” Desmoplastic cancers are small round cell tumors that are a type of soft tissue sarcoma, which is a type of cancer that forms in the connective tissue of the body (think muscles and tendons). Research has demonstrated that cannabis oils are effective for the treatment of nausea and vomiting associated with chemotherapy and radiation, yet there remains a paucity of investigations into the actual tumor-killing and prevention of migration of cancer cells. Remarkably, one animal study has highlighted the use of cannabis oil in a cat model of sarcoma, where the tumor shrunk and then fell out. (Sarcoma Cancer Treatment using Extracted Cannabis Oil in Cat)

This last anecdote both saddens and inspires me. Through decades of modernized, evidence-based medical practice, our patients are still looking for hope outside of Western medicine. Cannabis has shown promise as a medical treatment and preventative. We cannot leave our patients without hope.

As you have probably deduced, once customers discover I am a nurse, they organically begin sharing their health details and medical concerns that might otherwise only be discussed in a health care practitioner’s office. Their willingness to share their health concerns only makes me more determined to support their quest for wellness. I am motivated by meaning, not by money. Like every practicing nurse past and present, I feel a caring connection to these individuals who seek answers but have been left unfulfilled by Western medicine.

I ask myself, “What can’t CBD do for these individuals?”

In 2018, the World Health Organization found that no adverse health outcomes were associated with CBD, but that there are several medical applications for cannabidiol (Cannabidiol (CBD): Critical Review). Instead of ignoring this report that highlights the safety and efficacy of CBD, the question that needs to be answered is, “Why shouldn’t these individuals have the option to use CBD, where conventional medicine has failed them?”

I am a woman-owned business in the cannabis space. It took my life savings to open this store and the courage to believe that I possessed the capability for success in business. But at my core, I am a nurse – a professional health care provider – in this cannabis space, an even rarer occurrence. Although patients must obtain a medicinal cannabis recommendation from a professional health care provider (i.e., physician or nurse practitioner), most cannabis dispensaries are staffed by bud tenders and retail workers who have no advanced medical knowledge or experience. I am among a minority of women cannabis dispensary owners who own and operate a retail store completely managed by a sole, licensed, certified health care practitioner. This cannabis nurse is determined to make a difference, one individual at a time.

As I consider the four concepts that are the foundation of our nursing metaparadigm – environment, health, nursing, and person – I am privileged to offer my services as a nurse in a safe, relaxing environment. I am able to focus on one individual at a time and work with them to achieve their wellness goals while understanding their unique challenges to meeting those goals. I understand the health needs of my customers and my community. I opened my store in spite of our government’s attempt to disparage cannabis as medicine, in a time when it is most vitally needed. Florence Nightingale gave nurses to the world in hopes of making the world a better place through holistic, patient-centered care.

Seeing the quagmire that nursing has become made me disillusioned with my choice of profession. However, when I made the daunting decision to step out of the predictable, heavily-regulated environments of education and health care, I believed a new era of nursing care was necessary. We must understand the medicinal properties of cannabis, and the only way to do that is to support its use in both research and practice.

I am a cannabis nurse, a renegade in my profession. I will continue to place the health of my customers and my community over profits and restrictive regulations. I like to imagine that Flo would be proud of my efforts to provide holistic, patient-centered care to my community through the use of a natural, well-researched plant. After all, Nightingale is recognized as one of the most prominent statisticians in history. The statistics in this case all point to one outcome: cannabis is medicine, and my community now has a healthier option for well-being.