When the time of passing is close, emotions run high. When hospice if involved, it helps, but the pain of upcoming loss and all the unresolved issues are still left. In the US, people are taught to believe in happy endings. Generations have watched television shows and movies where in 30, 60 or 120 minutes all the issues are resolved and there is a last minute confession and a rebounding moment. Real life is neither as clean or as happy.
Does marijuana help in those final hours? In the moments with palliative or hospice care, anything that can help makes a difference.
Palliative care is medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness.
Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life. Hospice is prescribed when a path to cure has come to an end and the focus changes to focus making the patient comfortable until the end.
Two evidence-based guidelines address the use of medical marijuana in a palliative care setting. The first evidence-based guideline explicitly recommends against the use of medical cannabis as a first or second line option for palliative cancer pain. The guideline suggests that it could be considered in the case of refractory symptoms and with careful consideration of potential risks. The second evidence-based guideline similarly recommends that medical cannabis only be used in the palliative care setting when other treatments have failed, and after consideration of the potential for adverse events and drug interactions.
In study after study, medical marijuana can helps increase appetite, relieve painful constipation, and diminish pain. Hospice focuses on the focus well being, knowing there isn’t a long-term cure. Currently, most science shows medical marijuana manages systems but not resolve an serious ailment or injury.
Perhaps equally importantly, marijuana is used in the hospice care setting to ease spiritual and existential suffering. Some studies showing an important therapeutic role for patients faced with the despair of a terminal illness, loss of functions, and a lifetime of reflections. A mild euphoria or sense of well-being can ease a patient’s mind, body and spirit as they come to terms with their fate.
In 2019, a study was conducted among hospice professionals. About half of the respondents were nurses followed by administrators and physicians. Regardless of legal status, hospice staff members were overwhelmingly in agreement that medical marijuana is an important tool in supporting their patients.
Though medical marijuana is legal in 40 states, plus the District of Columbia, conflicting federal laws present a challenge for hospice and palliative care programs whose patients are interested in medical cannabis or already using it to manage pain and other symptoms.
The situation is particularly challenging for hospices, which are primarily funded by Medicare. Many hospices say they cannot legally prescribe medical marijuana because it remains a Schedule 1 controlled substance under federal law.