Medical Cannabis as an Alternative in Hospice

Many of us have had an encounter with hospice at some point in our life. Whether it be a loved one or a friend, the philosophy of hospice is dignity at the end of life, education regarding the dying process, spiritual support, and living the last days with as much quality as possible. Medical therapies administered in hospice care focus on symptom management of advanced life-limiting illness and are not curative.

 

 

 

 

Medical cannabis has been legalized at the state level to treat many of the same symptoms we traditionally see in hospice and palliative care with fewer side effects. Additionally, cannabis can be administered in various ways eliminating the necessity to smoke or inhale the medication. The challenge in using cannabis in hospice stems from federal laws; medical professionals are encouraged to continue the current practice and treat with an arsenal of drugs versus adopting medical cannabis to promote comfort and quality at the end of life.

Upon admission to hospice, it is conventional for a “hospice comfort kit” to arrive in the patient’s home. The most basic hospice comfort kits contain medications for pain, anxiety, nausea, insomnia, and breathing issues that emerge during the last days of life. These medications’ side effects can also exacerbate other symptoms, such as constipation, requiring additional medications. The drugs typically found in a hospice comfort kit are as follows:

  • Morphine liquid — used to treat pain and shortness of breath.
  • Ativan (Lorazepam) — can be used to treat anxiety, nausea, or insomnia.
  • Haldol (Haloperidol) — can treat agitation and terminal restlessness.
  • Compazine (prochlorperazine) – can treat nausea and vomiting in either pill or rectal suppository form.
  • Phenergan (promethazine) — an anti-emetic like Compazine, Phenergan is used to treat nausea and vomiting
  • Dulcolax suppositories (Bisacodyl) — rectal suppositories to treat constipation
  • Senna — a plant-based laxative used to treat constipation
  • Fleet Enema — used to treat constipation if other treatments are ineffective.
  • Atropine drops — used to treat wet respirations, also known as the death rattle.

Other medications may be included depending on the hospice diagnosis or added depending on the trajectory of the patient’s requirements. For example, a patient with a risk for seizures may have valium suppositories included in the comfort kit. Hospice covers these medications’ costs during a patient’s time on service, and it is a significant expense.

The literature on the use of cannabis repeatedly references effects that improve the quality of life with minimal adverse side effects as an outcome of its use.1

  • Sleep improvement
  • Appetite improvement, reduction in nausea and vomiting
  • Reduction in depressive symptoms
  • Improvement with neurogenic bladder (urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination)
    • Neurogenic bladder is a symptom of multiple sclerosis, stroke, brain injury, Parkinson’s, or other neurodegenerative diseases.
  • Pain management – lessening opioid need and tolerance while lengthening the therapeutic effects of the opioid medications administered in many cases.

Patients report “euphoria” as a positive side effect of cannabis. The feelings of pleasure, well-being, and happiness at the end of life is welcomed by hospice patients and their families.

Many of the drugs used in hospice and palliative care belong to high toxicity categories and have potentially lethal effects. In contrast, THC and other cannabinoids have remarkably low toxicity, and lethal doses in humans have not been reported.1

Providers are reluctant to accept cannabis as an addition or alternative to traditional medical treatments. There is the concern of losing federal funding and placing their professional license in jeopardy. Suppose a family or patient chooses to utilize cannabis while in hospice; it is an out of pocket cost and typically without guidance from the medical community. Medical professionals have an opportunity to use a more natural plant-based solution with less known side effects, but federally their hands are tied.

Cannabis research is available in other countries but limited by the US government related to the plant’s schedule 1 status in the Controlled Substances Act. This shortage of clinical research regarding medical cannabis is a real problem for the medical community. Protocols around dosing, administration, and the consistency of components within the cannabis products are still unknown, which is a concern. While this may be a viable argument, cannabis is legal for medicinal use in many states, and the medical community’s involvement is needed.

Some medical professionals in the United States are taking on the risk and working with cannabis in medical settings, including hospice and palliative care, with success. However, most patients will continue to lack access to this guidance and oversight despite legalization in many states. Healthcare’s slow adoption of cannabis as a treatment impacts the safety and efficacy of its use for the medical patient. As healthcare experts, our lack of knowledge and involvement in medical cannabis ultimately puts our practice and patients at risk regardless of the care setting.

1 Green AJ, De-Vries K. Cannabis use in palliative care – an examination of the evidence and the implications for nurses. Journal of Clinical Nursing. 2010;19(17):2454-2462. doi:10.1111/j.1365-2702.2010.03274.x

 

About the Author

Darcey Trescone is a registered nurse and graduate student in cannabis therapeutics who has worked in the post-acute healthcare industry for over 20 years. Working with patients suffering debilitating and terminal illnesses, she recognized years ago that cannabis could often provide relief and is now an advocate for patient choice. As co-founder of Kintsugi Solutions, with Cynthia Northcutt, their focus is to support the growth of education, compliance, and safe access to medical cannabis within the industry.

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