There are three shelves in my medicine cabinet. The top shelf is ibuprofen and acetaminophen — the stuff everybody has, the stuff nobody thinks about. The middle shelf is rizatriptan, 10 milligrams, in the blister pack my pharmacy fills every month. Prescribed by my neurologist, covered by my insurance, unremarkable. The bottom shelf, behind the kids' liquid Tylenol, is a small amber bottle of THC tincture. Five milligrams per dose. Also prescribed. Also legal. Also unremarkable — except that it's the one I don't mention at work.
I'm a registered nurse in a Fargo-area emergency department. I've worked the ED for thirteen years. I'm TNCC certified, CEN certified, and I precept new nurses. I have never had a medication error. I have never been disciplined. I have never shown up to a shift impaired. I state those facts the way you'd state your blood type before surgery — not bragging, just making sure it's in the chart before someone makes assumptions.
I also have a medical cannabis card. I got it in September 2021 after three months of research, a conversation with my neurologist, a call to the Board of Nursing, and a call to my hospital's HR department that I framed as a hypothetical because I wasn't sure yet whether honesty was safe. The answer I got was straightforward: a valid medical card is treated the same as any prescription for a controlled substance. Don't use before or during a shift. Don't come to work impaired. Same rules as hydrocodone or benzodiazepines.
Same rules. That part matters. Remember it.
I use the tincture when a migraine aura starts on a day off — five milligrams, sublingual, with a minimum sixteen-hour buffer before my next shift. That's more buffer than I need, and more than most of my colleagues apply to their prescribed Ambien the night before a day shift. I built in the extra hours because I am making a point nobody should need to make: I follow the same rules everyone else follows, and then some.
Here's what I want you to sit with. Last Tuesday in the ED, I handed discharge paperwork to a man going home with a prescription for fifteen tablets of hydrocodone, five milligrams each. He'd come in with a kidney stone. Straightforward. The attending wrote the script, I printed the discharge instructions, I went over the warnings: don't drive, don't operate machinery, don't drink alcohol. He nodded, took the paper, left. Nobody in that department blinked. Nobody questioned whether a hydrocodone prescription was appropriate for a kidney stone. It was medicine, dispensed by a system designed to dispense it.
Three days earlier, on my day off, I'd felt the shimmer start in my left visual field while I was folding laundry. I put five milligrams of THC under my tongue. The aura receded. The headache arrived at a three instead of the usual eight. I went to my daughter's basketball practice that afternoon and watched her miss fourteen out of fifteen free throws and I was there for every one of them — not on the couch, not wrapped in the post-triptan fog that steals a full day from me every time.
One of those choices, the hydrocodone, moves through the system without friction. Prescribed, dispensed, documented, accepted. The other — my five milligrams on a Saturday — is the one I write about under a fake name.
I want to be clear about what I'm not saying. I'm not against triptans. Rizatriptan still sits on my middle shelf and I take it when a migraine breaks through on a workday and cannabis isn't an option. I'm not against pharmaceuticals. I push medications every shift that save lives. I've watched Ativan stop a seizure in real time. I've seen what a well-timed dose of epinephrine does to a cardiac arrest. Pharmaceuticals are tools. I use them.
What I am against is the silence around a legal, prescribed medication that works for me while the system I work inside treats other controlled substances as routine. I am against the fact that a colleague can mention her Xanax prescription for flight anxiety in the break room and nobody lowers their voice, but my tincture stays behind the children's Tylenol like I'm hiding something. I am against being told, in practice if not in policy, that the acceptable response to a migraine is eighteen hours of post-triptan fog and a missed evening with my kids.
The policy is already where it should be. My HR department told me so. The Board of Nursing told me so. A medical cannabis card is a prescription. A prescription is a prescription. Same rules apply.
So why does only one of them require a pseudonym?
I don't have an answer. I have a medicine cabinet with three shelves, a sixteen-hour buffer I follow with the precision of a nurse who charts every milligram and every minute, and a question that nobody in my department has asked me out loud but that I can feel in every conversation we don't have.