Despite overwhelming public support for the use of medical cannabis in palliative care, official guidelines remain frustratingly rigid in their refusal to recommend cannabis products for those diagnosed with terminal illnesses. This is predominantly due to a lack of large-scale studies on the subject. However, as evidence continues to mount, doctors and patients alike are now increasingly in favour of using cannabis to treat symptoms such as pain, nausea, appetite loss, and anxiety in palliative settings.
Cannabis For Symptoms Control In Palliative Care
While studies are still a little thin on the ground, there is a growing body of data to support the efficacy of cannabis for symptom control in palliative care. For instance, several studies have highlighted the plant’s capacity to reduce chemotherapy-associated nausea in cancer patients. In contrast, others have shown that cannabinoids are effective at alleviating opioid-refractory cancer pain.
One such study involved 131 patients with a terminal cancer diagnosis, all of whom were treated with medical cannabis to manage the symptoms associated with their various treatments. According to the study authors, “all cancer-related or anticancer treatment-related symptoms were significantly improved, including nausea, vomiting, mood disorders, fatigue, weight loss, anorexia, constipation, sexual function, sleep disorders, itching, and pain[i].
Another study conducted in Israel examined the impact of medical cannabis on 50 children in palliative care, most of whom had been diagnosed with terminal cancers. By the end of the trial, 80 percent of participants had reported an improvement in symptoms such as nausea, vomiting, mood disturbance, pain, and insomnia[ii].
Findings like this have been replicated in numerous other studies, including one which found significant reductions in spasticity following the administration of cannabis products to children in palliative care with severe neurological conditions[iii]. Unsurprisingly, similar benefits have been noted in adults, although no major clinical trials have been conducted on the use of cannabis for palliative care.
Even without large-scale studies, though, the positive impact of cannabis for those with terminal illnesses is clear to see. For example, in 2016, Illinois introduced a fast-track scheme to allow those in palliative care to access medical cannabis. An analysis showed that those who signed up to the scheme were less likely to depend on hospice care and were instead able to remain at home[iv].
While research like this is necessary to pave the way for changes in official policy, it is worth remembering that the vast majority of people who use cannabis during their final weeks and months do not participate in studies. A wealth of knowledge can be attained by listening to the experiences of these individuals and their carers. To gain more insight, Seedsman recently spoke to the legendary Valerie Corral, founder of WAMM Phytotherapies and a pioneer of the use of cannabis during palliative care.
“We find that cannabis can effectively reduce the use of opiates and other pain, nausea, and anxiety among other supplemental medications,” explained Corral. “On the other hand, when THC is overused or applied too quickly, it may exacerbate anxiety. Moderate application, judiciously applied and guided by the individual patient is fundamental and mandatory.”
At the same time, Corral stresses the importance of compassion and humility from carers, explaining that “application requires a skilled practitioner who listens to the individual being served. When our presence is requested at bedside, we assume the role of a guest. We are participants, but we are not the knowers of the process of death itself.”
“It is not our position to assume, but to ask and listen deeply. People who are dying do know, however. We are only present to serve those in need. In fact, no one knows better what is right action than the person who is dying.”
Cannabis For Emotional Support In Palliative Care
In addition to helping control physical symptoms, cannabis has also been shown to significantly reduce the emotional burden of dealing with a terminal diagnosis. Studies have tentatively suggested that cannabinoids may play a role in the treatment of trauma by activating parts of the brain that are involved with the attenuation of aversive memories following difficult life events and reducing the anxiety associated with these memories[v].
Furthermore, it has been proposed that cannabis may heighten the senses, allowing those in palliative care to fully appreciate the richness of sounds, tastes, and scents, thereby resulting in improved quality of life and a more positive mindset during one’s final days, weeks or months. Based on these observations, it comes as little surprise that health professionals are now increasingly in favour of the use of cannabis in palliative care.
For example, a recent survey of more than 300 palliative care workers from across the US found that 91 percent support medical cannabis, with two-thirds having already assisted patients in using cannabinoids during end-of-life treatment. According to survey respondents, nausea, pain, and anxiety are the symptoms for which cannabis appears to be most effective[vi].
When asked for her thoughts on the matter, Corral replied: “in my opinion, the most profound “benefit” is in the ability of cannabis to alter consciousness.”
“It has been told to me many times that cannabis has opened a portal to accepting death and that it kicked open the door to what lay beyond.”
[i] Bar-Sela G, Vorobeichik M, Drawsheh S, Omer A, Goldberg V, Muller E. The medical necessity for medicinal cannabis: prospective, observational study evaluating treatment in cancer patients on supportive or palliative care. Evid Based Complement Alternat Med. 2013;2013:510392. – https://www.hindawi.com/journals/ecam/2013/510392/
[ii] Skrypek MM, Bostrom BC, Bendel AE. Medical cannabis certification in a large pediatric oncology center. Children (Basel) 2019;6(6):79. doi: 10.3390/children6060079. – https://www.mdpi.com/2227-9067/6/6/79
[iii] Kuhlen M, Hoell JI, Gagnon G, et al. Effective treatment of spasticity using dronabinol in pediatric palliative care. Eur J Paediatr Neurol 2016;20(6):898–903. doi: 10.1016/j.ejpn.2016.07.021 – https://www.ejpn-journal.com/article/S1090-3798(16)30127-1/fulltext
[iv] Croker III JA, Bobitt J, Sanders S, Arora K, Mueller K, Kaskie B. Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis. American Journal of Hospice and Palliative Medicine®. 2021 May 18:10499091211018655. – https://journals.sagepub.com/doi/10.1177/10499091211018655?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
[v] Aggarwal SK. Use of cannabinoids in cancer care: palliative care. Current Oncology. 2016 Feb;23(s1):33-6. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791145/
[vi] Costantino RC, Felten N, Todd M, Maxwell T, McPherson ML. A survey of hospice professionals regarding medical cannabis practices. Journal of palliative medicine. 2019 Oct 1;22(10):1208-12. – https://www.liebertpub.com/doi/full/10.1089/jpm.2018.0535