Proapoptotic effect of endocannabinoids in prostate cancer cells

Proapoptotic effect of endocannabinoids in prostate cancer cells


Assignment: Addressing Patient Safety and Quality of Care through Policy

NURS 4105: Advocacy through Healthcare Policy

Maria Pribe

Walden University

September 15, 2019

Addressing Patient Safety and Quality of Care through Policy

The legalization of the policy relating to the use of Marijuana in Michigan for adults aged 21 years and older removes criminal and monetary penalties for the possession, use, and supply of the drug for recreational purposes (Todd, 2018). The Michigan Medical Marihuana Act legalized the growth, possession, and use of marijuana. A 21 year and older will be allowed to possess 2.5 ounces of marijuana and grow up to 12 plants in an enclosed area (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). The aim of writing this paper is to address patient safety and quality of care through policy.

Ways that the Policy Addresses Safety, Quality, and its Implications Triple Aim Initiative

Medical cannabis products acquired from dispensaries and state programs follow the specified Michigan requirements of growing, formulation, manufacturing, marketing, and distribution (Thomas & ElSohly, 2016). In the United States (US), there is an increase in errors in the chemical content and inaccuracies in the labeling of products purchased from medical cannabis markets. According to Thomas and ElSohly (2016), an analysis of the tetrahydrocannabinol (THC) content on 75 products from 47 brands indicated that 17% were accurately labeled, 23% had inadequate descriptions, and 60% had an increase in classifications. Additionally, the FDA reported that in the US, firms were marketing cannabidiol-containing drugs that had not been approved thus indicating a decrease in quality control measures. Also, edibles that resemble sugars may increase intoxication or unintentional consumption. Therefore, the risk of overdosing is exacerbated by the absence of appropriate labeling and the lack of an FDA-approved antagonist that reverses the effects of the drug (Thomas & ElSohly, 2016).

States that have legalized the use of marijuana have laws requiring product safety testing for contaminants, pesticides, and cannabinoids before selling (Klieger et al., 2017). Consequently, the labeling rules outline the need to indicate the health risks, the strain of marijuana used, product potency, and proof of contaminant testing. Due to the concerns of accidental ingestions of edibles by children, manufacturers are required to have child-resistant packaging and labeling (Pacula & Smart, 2017).

To address safety and quality, the state of Michigan has regulations that outline the standards of testing, packaging, and labeling of products (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). It is also a requirement that for marihuana-infused products, the maximum level of THC and the amount of marihuana concentrate is specified on the product label. Also, a sample of the product needs to be tested by a marihuana safety compliance facility before distribution (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). Consequently, restrictions have been made on advertising, marketing, and display of marihuana to protect adolescents and children from early exposure to the drug.

The Institute for Healthcare Improvement (IHI) developed a framework that illustrates the efficient approach to optimizing health system performance (The IHI Triple Aim Initiative, n.d.). The objective of IHI Triple Aim is to improve the quality and experience of care offered to the patient, enhance the health of the population, and reduce the per capita cost of accessing health care. Communities that accomplish the Triple Aim have populations with improved health because of designing policies that identify healthcare problems and provide solutions to them.

The medical cannabis programs achieve the objectives of the IHI Triple Aim because the interdisciplinary services of medical cannabis programs improve the patient healthcare experience. Furthermore, medical cannabis was found to be effective in managing cancer and opioid addiction, therefore, it improves the health of the population because patients are offered coordinated care that decreases the illness (The IHI Triple Aim Initiative, n.d.). Additionally, economic benefits have been observed in states with medical cannabis programs such as reduced Medicare Part D spending and increased taxation profits. Hence, a reduction in the per capita cost of care for populations reduces publicly funded health care budgets.

The Effectiveness of the Policy on Improved Outcomes of Care for Patients

States that have legalized the use of medical marijuana to treat chronic pain have reduced opioid overdose deaths and untreated use disorder (Lucas & Walsh, 2017; Todd, 2018). In states that have legalized medical marijuana, the overdose death rates reduced by 25%. Legal access to marijuana has also caused a reduction in opioids dependence or hospitalization because of abusing the drug by 23% (Todd, 2018). Studies show that patients use marijuana to reduce the use of opioids for mental health and pain-related conditions (Todd, 2018). The increased rate of substitution for prescription drugs among the patients suggests that medical cannabis may be an effective treatment for the conditions (Lucas & Walsh, 2017).

Cannabinoids regulate crucial cell signaling pathways that are involved in its survival, angiogenesis, invasion, and metastasis. A research conducted by Orellana-Serradell et al. (2015) detected the presence of cannabinoid receptors on prostatic cancer and then assessed the effects of the in vitro use of synthetic cannabis analogs. The study established that there is a presence of a dose-dependent inhibitory effect that included an increase in the levels of activated caspase-3 and a decrease of Bcl-2, confirming the activation of apoptosis. The researchers also observed an endocannabinoid-modulated activation of the ERK path-way and a concurrent reduction in the AKT pathway activation. This observation suggests that endocannabinoids may impact the treatment of prostate cancer (Orellana-Serradell, 2015).

Role of the Nurse in Addressing the Quality and Safety Standards within the Policy

In the United States, the federal government classifies cannabis as a schedule 1 controlled substance with increased chances for abuse and no accepted medical valueNurses are important in providing quality care in the health care system because of their frequent interactions with patients (Mason, Gardner, Outlaw, & O’Grady, 2016). Therefore, nurses may influence practice standards and processes to ensure the quality of care through policy work. Nurses are required to have practical information to effectively care for the increasing number of patients using cannabis through the medical marijuana program and those who self-administer the drug for recreational purposes or treatment of different conditions (National Council of State Boards of Nursing [NCSBN], 2018).

A nurse requires to know the current state of legalization and the jurisdiction of medical and recreational cannabis (NCSBN, 2018). An understanding of the endocannabinoid system, cannabinoid receptors, pharmacology, and the research associated with the medical use of cannabis. Additionally, nurses need to identify the safety considerations for patient use of cannabis to treat the patient without judging their choice of treatment (NCSBN, 2018). These principles provide the nurse with the essential knowledge for providing safety and quality care for the patients using medical or recreational marijuana.

Opinion about the Policy

I support the policy on the legalization of Marijuana in Michigan state for adults 21 years and older because of its therapeutic benefits. Studies show that cannabinoid-based medications are effective in the treatment and management of chronic pain and cancer (Orellana-Serradell, 2015; Lucas & Walsh, 2017). However, nurses lack evidence-based resources when caring for patients who use medical or recreational marijuana because of its classification as a schedule 1 controlled substance (NCSBN, 2018).


Klieger, S. B., Gutman, A., Allen, L., Pacula, R. L., Ibrahim, J. K., & Burris, S. (2017). Mapping medical marijuana: State laws regulating patients, product safety, supply chains and dispensaries. Addiction, 112(12), 2206–2216. doi:10.1111/add.13910

Lucas, P., & Walsh, Z. (2017). Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. International Journal of Drug Policy, 42, 30–35. doi:10.1016/j.drugpo.2017.01.011

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and health care (7th ed.). St. Louis, MO: Elsevier.

Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1 (2018). Retrieved from

National Council of State Boards of Nursing (2018). The NCSBN national nursing guidelines for medical marijuana. Journal of Nursing Regulation, 9(2). Retrieved from

Orellana-Serradell, O., Poblete, C. E., Sanchez, C., Castellón, E. A., Gallegos, I., Huidobro, C., . . . Contreras, H. R. (2015). Proapoptotic effect of endocannabinoids in prostate cancer cells. Oncology Reports, 33(4), 1599–1608. doi:10.3892/or.2015.3746

Pacula, R. L., & Smart, R. (2017). Medical marijuana and marijuana legalization. Annual Review of Clinical Psychology, 13(1), 397–419. doi:10.1146/annurev-clinpsy-032816-045128

Institute for Healthcare Improvement. (n.d.). Retrieved from

Thomas, B. F., & ElSohly, M. A. (2016). The Analytical Chemistry of Cannabis: Quality Assessment, Assurance, and Regulation of Medicinal Marijuana and Cannabinoid Preparations (pp.83–99). St. Louis, MO: Elsevier.

Todd, T. (2018). The benefits of marijuana legalization and regulation. Berkeley Journal of Criminal Law, 23(1), Article 6.

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