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Cannabis in Palliative Care

The goal of palliative care is to alleviate the suffering of patients with a chronic diagnosis. End-of-life care is not a curative approach but one focused on relief and quality of life. Palliative treatments typically target pain, depression, anxiety, and appetite loss. With a growing body of research demonstrating that cannabis and cannabinoids may target these same conditions, medical cannabis in palliative care warrants urgent attention.

 

According to the World Health Organization (WHO), approximately 40 million people need end-of-life care every year, but only 14 percent, or 5.6 million, receive it. Patients with cardiovascular diseases, cancer, chronic respiratory diseases, AIDS, and diabetes are most likely to require end-of-life care — however, this list is far from exclusive. 

 

How does cannabis fit into the larger scope of care for these patients? Already, several systematic reviews, national guidelines, and randomized clinical trials have approached medical cannabis for palliative care. Yet, despite the widespread use of cannabis during a patient’s final days and physician recommendations, the research is far from conclusive.

 

Potential Applications for Medical Cannabis in Palliative Care

 

As many patients have discovered through their chronic diagnosis journeys, cannabis seems to relieve some of the most challenging symptoms, like pain and appetite loss. What’s more, there is evidence that cannabis can replace opioid therapy or reduce opioid load as a suitable cotreatment. 

 

Palliative Pain

 

Out of all the possible applications for medical cannabis, pain relief is one of the most studied. Still, when it comes to palliative pain, the evidence is “low quality” and scarce. 

 

One meta-analysis of pain in cancer patients measured a 30 percent reduction in pain, with the evidence “favouring patients receiving cannabis experiencing greater pain relief” in a non-significant way. 

Another study, this time a systematic review, explored cannabinoids for pain among patients with malignant disease. This analysis determined a “significant analgesic effect” compared to placebo in a majority of included studies.

 

A recent survey of oncologists reported that 67 percent believed medical cannabis was a helpful treatment in conjunction with standard pain management approaches. 

 

Appetite and Weight Loss

 

Appetite loss and subsequent weight loss (cachexia) are common symptoms of palliative conditions. Interestingly, this is another case where the research and patient reality seem to differ. 

 

A recent systematic review reported no statistically significant differences between treatment with cannabinoids versus a placebo. Yet, the oncologist survey mentioned above determined that “65% thought [cannabinoid-based medicines] were equally or more effective than standard treatments for anorexia and cachexia.” 

 

Reducing Reliance on Opioids

 

Over the last decade, several significant studies have strongly suggested that access to medical cannabis decreases a population’s reliance and dependence on opioids. As a result, it may also reduce opioid mortality rates.

 

Medical cannabis may be helpful for some patients as an opioid replacement or a conjunctive therapy for pain relief during their final days or week. 

 

An Israeli study looked at medical cannabis among elderly patients and determined cannabis was not only safe, but after six months of treatment, “18.1% [of participants] stopped using opioid analgesics or reduced their dose. While other studies have affirmed cannabis’ “opioid-sparing potential “and “synergism effect with opioids.”

 

Considerations for Bringing Cannabis into Palliative Care

 

Unlike other areas of medical cannabis research, like pain and depression, there is less evidence about what percentage of patients in palliative care typically turn to cannabis for relief.

 

Making predictions about patient demands is challenging.

Without patient data, we can still understand what healthcare professionals are experiencing. In 2019, the Journal of Palliative Medicine published a survey of hospice professionals, including physicians, nurses, administrators, and aides, about medical cannabis in their sector. 

 

As per the survey results, “there is overwhelming support” for medical cannabis in hospice environments. Ninety-one percent approved of it during end-of-life care, and 90 percent reported answering questions from patients about its possible use. In addition, upwards of 50 percent of respondents answered questions about medical cannabis once to twice a month. 

 

Clearly, patients and their families are interested in the benefits of cannabis. How should physicians, nurses, and other professionals in this space approach it?

 

In “Cannabis in palliative care: current challenges and practical recommendations,” authors Claude Cyr and Maria Fernanda Arboleda et al. attempted to answer this urgent question.

First and foremost, healthcare professionals need to determine if cannabis is the right course of action. Will it provide relief without an adverse response? 

 

For example, Cry and Arboleda et al. explain, “Cannabis should be used with caution in patients with severe cardiac or pulmonary disease due to occasional hypotension (or possible hypertension), reflex tachycardia and syncope caused by THC-rich products.”

 

Other considerations mirror those that haunt other areas of medical cannabis recommendations: dose, titration, cannabis experience/tolerance, cannabinoid ratio, and consistency of product. 

 

RYAH Dose Control Technology Offers a Solution for Palliative Care

 

Ryah Group’s suite of precision dose-measuring devices for plant-based medicines is useful for palliative care and palliative care research. Smart devices offer a way for researchers and clinicians to develop well-controlled environments for study. 

 

With most clinical trials, system reviews, and guidelines not recommending cannabis due to “lack of evidence,” but with many patients and their physicians suggesting otherwise, new studies are urgently needed. RYAH’s Smart Inhaler is already in use for one of the most extensive medical cannabis studies ever undertaken. RYAH’s data-driven approach can capture millions of points of data in a controlled and safe manner.

 

RYAH’s Smart Inhaler, Patch, and Pen all help physicians and patients safely dose, titrate and manage medical cannabis treatment — even remotely. Every dose is consistent, tracked, and replicable.

 

Technology is one of the ways to bridge the information gap between patient use of medical cannabis in palliative care — and the lack of robust evidence in the research. Considering some research suggests medical cannabis may improve quality of life for patients with chronic conditions by as much as 50 percent, it is well worth renewed scientific attention.

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