High and Low: UA doctor set to study how stress, pain and depression can drive nurses to medicate with cannabis

Jessica Rainbow

Since the start of covid-19, nurses have been under a lot of pressure as they work long hours in hazardous conditions to care for victims of the novel coronavirus.

They’ve been celebrated as heroes by most and targeted for abuse by a smaller group of anti-vaxxers, anti-mask zealots and even some political commentators.

There are signs within the health care community that the stress has led to increased drug use and high rates of suicide in a profession that was already hard enough before the pandemic hit.

The data is thin on how nurses are coping with pain and stress, however, so University of Arizona assistant professor Jessica Rainbow, PhD. RN, has embarked on a study to find out the prevalence of drug use in the nursing community, focusing on cannabis and how it might affect nurses’ mental health and patient care.

“I was really interested in how nurses are using these substances in relation to when they’re working, because I think that’s a question we haven’t really explored,” Rainbow said. “We haven’t really done any studies of nurse cannabis use since it’s become more legal, so this is hopefully going to get at how prevalent it is.”

Rainbow hopes her study will lead to better working conditions for nurses, which would lead to improved care for patients.

Now that cannabis is legal in some form in 37 states with an estimated 3 million Americans using it medicinally, there are more opportunities for more Americans to have legal access to weed.

The two-year study that began in July is an extension of Rainbow’s prior work that sought to explore and quantify physical and emotional pain nurses experience due to their working conditions. That study surveyed and interviewed more than 3,000 respondents who reported that they were experiencing an average of three pain sites, including mental and emotional pain.

While back pain is common from a career spent moving patients, mental health is increasingly seen as a problem that has led to high turnover in the nursing community and compromised quality of life for some in the field.

“My research really focuses on how we can improve the hospital work environment to improve nurse health and safety,” Rainbow said. “It was really interesting, just the breadth of pain that nurses had, because a lot of the prior work is focused on back pain. I think we all know nurses have back pain from moving patients, but we had nurses complaining of everything from psychological pain to some of that more musculoskeletal stuff like pain in their feet.”

This study will not only focus on cannabis use, but other coping strategies nurses use to deal with stress and pain in the workplace.

The UA College of Nursing received a $207,924 grant from the National Council of State Boards of Nursing Center for Regulatory Excellence, an organization that “funds research that advances the science of nursing policy and regulation and builds regulatory expertise worldwide,” according to a UA press release announcing the study. 

“I think that the National Council of State Boards of Nursing is really interested in [knowing if] our nurses are going to work when they’re high,” Rainbow said. “What we kept hearing in the surveys in these interviews was that nurses were doing all kinds of things, such as taking prescription medications, the minute they got home from their shift in response to the pain that they got that was generally aggravated by their work.” 

The crisis in self-care has far-reaching implications, as suicide rates have been increasing in nurse populations, even while those in the profession deal with public perceptions that nurses, like members of the military, are superhuman and must soldier on despite constant pain and even despair in the workplace. Additionally, there is the stigmatization of mental health issues that keeps nurses from self-reporting that can also lead to more self-medication and substance abuse in order to cope.

Prior studies have found that nurses have similar rates of substance use as the general population and are more at risk for abuse due to stress and attitudes toward substance use. COVID-19 has only served to increase stress, anxiety, depression, fatigue and burnout among nurses, but the impact of the pandemic on nurse cannabis and other substance use is currently unknown. 

A recent study conducted at the University of Michigan analyzed data from the National Violent Death Reporting System regarding 159,372 suicides reported from 2007 to 2018, and found that there were 2,374 nurse-suicides during that time compared with 156,141 in the general population. Of those nurse suicides, 1,912 were women.

The suicide incidence rates per 100,000 in 2017-2018 among women were 17.1 for nurses, compared to 8.6 for the general population. Suicide incidence rates per 100,000 in 2017-2018 among men were 31.1 for nurses, compared to 32.6 for the general population, meaning that the suicide risk for female nurses was significantly higher.

“I’ve seen reports about how suicide rates are getting higher among nurses. It’s not really looking good,” Rainbow said. “I feel like it’s hard, because there’s so much discouraging news about continuing to not pass mask mandates and people not getting vaccinated, and the difficulties a lot of healthcare providers find themselves in. I do think it’s good in some ways that people are more aware of some of the work conditions that nurses work under.”

Rainbow has been a nurse since 2012 and earned her doctorate in 2018. She has been with UA for four years as an assistant professor and researcher. Her focus was as an ICU nurse during her “bedside” career, so she has not been subjected to the dynamics of the current situation, but she hopes her research results in substantive changes in the profession.

“I’m really hoping that this is something that leads to actually addressing some of these issues, because I think historically within nursing, it hasn’t been OK to not be mentally healthy,” she said. “If you have an issue, you’re not supposed to admit it. Some of the studies I cited in this grant talked about how few nurses are in active treatment programs for substance use: It’s like .03% or something. We estimate 6-7% of nurses have substance abuse issues, but they’re not in treatment.”

Rainbow thinks a big part of that comes from fear of talking about their own suffering for fear they will be castigated for admitting their issues.

“I’m hoping that we can reverse that stigma. We need to develop interventions to address the work issues that are often leading to these,” she said. “Whether it’s things in the work system that lead to pain, mental pain or mental exhaustion. That’s really where my program of research is focused.”

The study is a collaboration between the UA College of Nursing, the College of Medicine—Tucson and Health Sciences Comprehensive Pain and Addiction Center, and will utilize both a cross-sectional survey and one-on-one interviews with nurses who self-report using cannabis. 

News Nuggets

SOCIAL EQUITY BLUES: The Arizona Department of Health Services has announced the dates for mandatory training required for prospective marijuana social equity program applicants.

The training offered by ADHS is the only recognized training for those seeking a social equity license to own and operate adult-use marijuana establishments under the social equity program approved by the passage of Prop 207.

This free virtual Social Equity Ownership Training will be held live Sept. 20-21, and will be available as a recorded session with live Q&A on Oct. 12-13. ADHS also will offer computer-based training from mid-October through mid-December.

ADHS warns prospective applicants to be wary of other entities that falsely claim to offer approved training.

The classes will be taught by industry experts, and include two days of content and education focused on a number of aspects of operating an adult-use marijuana business, including legal requirements, business practices, regulatory compliance, and fundraising, as well as marketing and strategic growth.

In addition to these required classes, ADHS will offer one-on-one support and clinics to help potential licensees with the application process and the chance to meet with instructors to get questions answered.

Applications for the social equity ownership program will be from Dec. 1-14, and a random drawing will be held to award the 26 licenses available.  ν

For more information on the social equity program and to register for the required training, go to azdhs.gov/SocialEquity.