Jay Z Caliva

Treating Pain Wisely: Cannabis and Palliative Care

A late-stage cancer patient in Chicago named Martha* recently spent the last few weeks of her life in a hospice, a common option for people who are not expected to recover and simply need end-of-life care. During her final days, Martha was largely in a morphine-induced haze, in and out of consciousness. She was mostly unavailable to the friends and family who had gathered to pay their last respects before she passed away.

Martha had an advanced form of pancreatic cancer, and to manage her pain, doctors had prescribed a heavy rotation of intravenous opioid painkillers. Her family understood the need to keep her comfortable, but were also deeply saddened that she was unable to interact with them consciously and coherently before she passed away.

Stories like Martha’s have been the norm for recent palliative care. However, things are changing.

The largest study to date on the use of cannabis in end-of-life care has indicated that a wide swath of caregivers is in support of using it for patients. In hospices throughout the country, medical marijuana is increasingly replacing opioid painkillers, allowing patients to experience their final days in comfort, without the mind-muddling side effects.

The study, recently published in the Journal of Palliative Care surveyed a total of 310 palliative care professionals, including physicians, nurses, and administrators in 40 different states on their opinions on medical cannabis.

An overwhelming 91 percent reported that they supported the use of medical marijuana for hospice patients. What’s more—those who practiced in a state where it wasn’t yet legal, wish that it were.

Claude Cyr, MD, of McGill University in Montreal, recently spoke to the Cancer Network about the topic: “When it comes to palliative care, I think suffering must be addressed with every tool we have at our disposition. Also, patient preference must be taken into consideration.” He went on to discuss why the matchup makes sense: “Palliative patients often have multiple symptoms, ranging from physical, like pain and nausea, to psychological, like anxiety and depression, and even existential or spiritual. While we’re always looking for new ways to better manage these symptoms, cannabis is one of those few compounds that addresses many of the most distressing symptoms encountered in palliative care, like pain, nausea control, insomnia, anxiety, depression, and even fatigue. It also has an enviable safety profile.”

Roadblocks to Treatment

Interestingly, the study also found that most doctors were not initiating the discussions about medical marijuana—patients were. This could be because, despite the obvious benefits, many clinicians still have concerns. Those who participated in the survey cited unease over the disparity between state and federal laws, as well as confusion on using medical marijuana due to their inadequate training with it, specifically when it came to questions of efficacy, safety, and actual products available to patients.

Although medical cannabis is growing in popularity throughout the hospice community, many institutions acknowledge they are poorly prepared for its use. Most don’t have an official policy, and there is an absence of agreed-upon best practices for using medical marijuana. Because of its illegal status at the federal level, many facilities have a hand-off policy, leaving loved ones in charge of obtaining and administering the medicine.

Hopefully, as consensus grows about cannabis as a safe and viable end-of-life option, state and federal regulators will work to address the policy shortcomings that prevent it from being used more confidently and regularly.

Christina Rock is a Seattle-based writer and photographer.


*Names have been changed for privacy purposes