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30 cannabis patient care | vol. 3 no. 1 cannapatientcare.com nurse focus Eyewitness: Cannabis Should Be the Chronic Pain Treatment Choice B Y D A V I D H O D E S One nurse sees that better patient care is possible, as she works to get cannabis on the list of treatments to help. S OMETIMES, WHEN WORKING in healthcare, an at- tentive nurse can see things that just aren't right. Treatments don't work, yet doctors persist in re- peating them. Pharmaceuticals, especially opioids, are prescribed that do more damage over time than the con- dition for which they were prescribed. Changing procedures for the better, changing treatments to better align with what the patient needs, or changing phar- maceuticals that do good things for the patient, don't happen fast—if at all. But other times, when a nurse sees things that should be changed, and has the motivation to do it based on what she sees, things can and do change for the patient. After all, that is what healthcare is designed to do—achieve the best out- come for the patient. The Power of Witness Linda Casale, MSN, RN, PMHN-BC, the CEO, president, and founder of Whole Health Action Management (WHAM) veterans program, providing whole health education and cannabis con- sulting, is one of those perceptive nurses who knew she could find better ways to assist her patients (1). She worked on the mental health unit at her local Veterans Administration (VA) for more than 25 years where she witnessed treatment she thought was "inhumane." "A lot of times the veterans were admitted for pancreatitis, gastritis, or something else. These are very painful conditions, and they are taking painkillers," she said. "When they get medi- cally stable, they transfer down to psych to finish their detox." She remembers when she had a patient transfer, and she called the doctor to get some pain meds for him. "The doctor called back and said, 'Why wasn't his Percocet just continued when he was transferred since it was an active order?' And I said I don't know," Casale said "The doctor ordered the Percocet (2), but one of the ward clerks clued me in and shared that, built into the VA system was the rule that if anyone is transferred to psych from an in- patient medical unit, all their narcotics are discontinued au- tomatically, even if it's an active order," Casale said. "They would just discontinue a patient's pain medications if they transferred to psych from an inpatient unit. There is no taper. They just cut them off. Nobody will give them anything." She recalled her conversation with a psychiatrist at the VA who had transferred from Puerto Rico where he was in private practice for years. He was a veteran. "He told me he had fallen from a helicopter in Afghanistan, and that he had healed him- self in Walter Reed for six months." But he works in integra- tive medicine, she explained, so he believes in cannabis very much, and was going to start his own practice. "We knew that patients were taking cannabis for their pain. But you can't say anything or even recommended it or any- thing, because of its status as a Schedule I drug," she said. "I just get so frustrated with it all. And doctors, unless they're re- ally integrative types or a have a holistic mentality, know noth- ing about cannabis because it's not taught in med school." Casale began her own exploration of integrative medicine using cannabis, looking for answers and trying to find a path- way to better healthcare for her patients. According to the National Center for Complementary and Integrative Health (NCCIH) (3), the use of integrative ap- proaches has grown within care settings across the US. Re- searchers are currently exploring the potential benefits of in- tegrative health in a variety of situations, including chronic pain management for military personnel and veterans (as in the case of Casale), relief of symptoms in cancer patients and survivors, and programs to promote healthy behaviors. Chronic pain is a common problem among active-duty mil- itary personnel and veterans. NCCIH, the US Department of Veterans Affairs, and other agencies are sponsoring research to see whether integrative approaches can help. For exam- ple, an NCCIH-funded study is developing an innovative, col- laborative treatment model involving chiropractors, primary