Your long-time patient has chronic pain secondary to injuries sustained in a serious motor vehicle accident. She has difficulty managing her pain, especially at night, and asks you about the possibility of trying marihuana*. She is currently working part-time as a nurse because she can’t manage full-time hours.
You have never authorized use of marihuana for a patient and are aware there is limited evidence to support its effectiveness as an analgesic. As much as possible you try to practise evidence-based medicine, so authorizing use of marihuana would be outside your usual practice. You are torn between wanting to help your patient and feeling very uncomfortable with the use of a substance that you are not comfortable “prescribing”. How do you balance your ethical obligation to your patient to try to alleviate her suffering and at the same time do no harm and offer treatments you feel will be effective? Does her job as a nurse caring for patients factor into your decision?