The Potential and the Problems of using Medical Cannabis in Hospice and Palliative Care

Main Stage: Grand Ballroom May 1, 2016 11:00 am - 11:25 am

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Cathleen Graham, RN, CHPN

When cure is no longer possible, hospice provides services focused on pain relief, comfort and enhancing quality-of-life.

As a registered nurse case manager, I have been directly involved with the care of dozens of Michigan patients whose end-of-life journey was significantly helped by medical cannabis. From my personal experience with patients facing their final days, I have seen medical cannabis accomplish many things, including:

  • control nausea of a patient undergoing chemotherapy
  • stimulate appetite in a patient facing malnutrition
  • ease muscle spasms
  • decrease pain
  • improve ability to focus and interact

Many will be surprised, but during this time, I have had only one patient who smoked cannabis. They rest took medical cannabis in different ways:

  • drops under the tongue
  • a wide variety of edibles – from cake to pizza
  • topical application of gels and lotions
  • Tea, smoothies and other drinks
  • capsules and
  • vaporizers – including “e-cigarette devices”

The goal of comfort care is to balance symptom and pain control, with the ability to interact with others, and thus improve the quality of life for patients whose days are diminishing. While pharmaceuticals are available that reduce the symptoms which arise when the body goes through the natural process of shutting down, they are very sedating. A patient shouldn’t be medicated to the point of coma to manage these symptoms. Cannabis has been shown to help many patients achieve a balance of symptom relief and quality of life while allowing interacting with their extended family and friends.

With the proven benefits cannabis therapy offers end-of-life patients, there are also problems that stand in the way of cannabis being widely accepted by the health care system.

First, is the fact all medication (prescription or over-the-counter) given to a patient must be entered into the medical records with specifics of what was given and in what dosage along with the effects of that medication. Without accurate labels (validated by independent testing), that simply cannot be done with cannabis. Credible labels are essential to guide both medical professionals and patients in making informed decisions. Cannabis must be available in a form that will allow for a specific dosage to be taken and charted, like with all other medicine. Without that, it will be difficult for medical cannabis to be taken seriously as a medicine. Please understand: a “joint” is not a unit of measurement.

Our critical concern must be making sure approved patients have the option to purchase medicinal cannabis that comes with an assurance of purity, consistency of dosage and full disclosure of active ingredients. Patients should be able to have the same kind of confidence in knowing what is in that cannabis product as they do with other products such as herbal food supplements. This is exceptionally important for patients who have a compromised immune system or who need a therapeutic blood level to manage seizures.

Further, every patient who has been physician-certified as being eligible for hospice care, should automatically become eligible to take medical cannabis (currently they have to go through the entire application/physician exam/approval/card issuance process like all others). To be very blunt: this often takes longer than the patient has to live.

Finally, cannabis patients are treated by a healthcare system with little understanding of the medicinal uses for cannabis. However, all patients should have the right to impartial access to medical treatment regardless of his or her legal use of cannabis medicine. Today’s health care professionals were trained to see cannabis as a problem – not a potential solution. It is essential to have Continuing Medical Education that provides evidencebased information on how and when cannabis therapy can be beneficial. Spreading that knowledge will certainly expand the availability and quality of medical cannabis therapy in Michigan.