palliative care (end-of-life care, hospice care)

Palliative care is a specialized form of healthcare that helps people who have a serious or terminal illness manage symptoms. The goal is to ease discomfort and improve quality of life.

Medical cannabis can be a valuable part of palliative care. It can help provide symptom relief with minimal side effects.

Research on cannabis for palliative care

Medical cannabis may help manage some symptoms that people receiving palliative care may experience, such as:

• Pain
• Nausea
• Appetite loss
• Anxiety
• Inflammation
• Sleep problems

Research shows that cannabis is increasingly being used in palliative settings, especially for people with cancer and other chronic illnesses.

One report reviewed the effects of cannabis use in palliative care. It found promising results for symptom management, particularly pain and mental well-being.

Another study found that cannabis can help improve appetite, pain, and anxiety in older adults receiving palliative care.

And another review explored how cannabis impacts people in palliative care. The findings suggest that cannabis may improve sleep quality, pain relief, and overall well-being. However, the researchers emphasized the need for standardized guidelines to ensure safe and effective use.

While these findings are promising, more studies are needed to fully understand the risks and benefits of cannabis in palliative care settings and how it may interact with other treatments.

Using cannabis for palliative care

People receiving palliative care may find medical cannabis helpful to use in combination with traditional treatments. If you’re considering cannabis to manage symptoms, talk to your doctor about the benefits and risks.

Benefits

Compounds in cannabis, such as tetrahydrocannabinol (THC) andcannabidiol (CBD), offer a number of health benefits for people in palliative care.

• Pain relief: THC and CBD may help ease chronic pain and neuropathic (nerve) pain.
• Appetite stimulation: Cannabis can help prevent unnecessary weight loss due to health issues by increasing appetite.
• Nausea control:Cannabinoids like THC can help reduce nausea and vomiting.
• Anxiety and stress relief: Cannabis may help relieve anxiety and improve sleep.
• Medication reduction: Medical cannabis may help you rely less on potentially addictive medications like opioids and benzodiazepines.

Risks and side effects

As with any medication, cannabis comes with potential risks and side effects.

• Dizziness and drowsiness: High doses of THC may cause lightheadedness or sedation.
• Cognitive effects: You might experience short-term memory loss or confusion with cannabis use.
• Drug interactions: Cannabis may interact with certain medications, which is why it’s important to talk to your doctor before using it.

Is it legal?

Cannabis laws differ between states. Some states allow medical cannabis use for palliative care. Others do not. However, you may still qualify for medical cannabis if you have another qualifying health condition, such as chronic pain, cancer, HIV/AIDS, or any end-of-life condition.

Some states also allow state-approved caregivers to administer cannabis to minors who receive palliative care.

FDA-approved cannabis-based medications like dronabinol and nabilone are also available by prescription. They may help with symptoms like nausea and weight loss associated with cancer or HIV/AIDS treatment.

Best strains and products for palliative care

When choosing a cannabis strain or product, consider:

• Your age
• Your THC tolerance
• Your symptoms and health condition
• Whether you’re taking prescription medications

Strains (aka cultivars)

Consider using strains like:

• ACDC: This high-CBD strain may help with anxiety and inflammation.
• Bubba Kush: This high-THC strain may help with pain and inflammation.
• Granddaddy Purple: This high-THC strain may help with pain and sleep.
• Harlequin: This strain has equal parts THC and CBD, which may offer mild pain relief without strong psychoactive effects.

CBD:THC ratios

Strains and products that have a high-CBD ratio are more likely to help with anxiety and depression. Those that have a high-THC ratio may be better for treating pain and sleeping issues.

• 1:1 CBD:THC: Offers balanced relief for pain and relaxation
• 20:1 CBD:THC: Is best for reducing anxiety and inflammation without causing strong intoxication
• CBD:THC 1:2 or higher: Is helpful for pain, nausea, and appetite stimulation
• CBD:THC 5:2: May help reduce pain and improve mood

Terpenes

Terpenes are aromatic compounds that affect the smell and taste of cannabis. They may also offer therapeutic effects, and many can help lower inflammation.

• Beta-caryophyllene: May help reduce inflammation, pain, and anxiety
• Limonene: Can help improve mood, ease stress, and lower inflammation
• Myrcene: May promote relaxation, reduce pain, and relieve insomnia

Flavonoids

Flavonoids are cannabis compounds that contribute to the color and flavor of cannabis. Many also offer anti-inflammatory effects.

• Apigenin: Can help reduce anxiety
• Cannflavin A, B, and C: Can help lower inflammation
• Quercetin: May help reduce inflammation and pain

More about palliative care

Palliative care focuses on improving quality of life for people who have a serious illness such as cancer, heart disease, or neurodegenerative conditions like Alzheimer’s disease.

Treatment typically includes symptom management, emotional support, and, in some cases, end-of-life care.

Other treatments for palliative care

In most cases, palliative care aims to manage symptoms like chronic pain with medications and other forms of pain relief.

Palliative care can also involve treatment for psychological, emotional, and spiritual challenges people with certain health conditions may face, as well.

Palliative care specialists may also provide counseling to the family or caregiver of someone facing a difficult health issue.

Traditional therapies

Treatments for palliative care usually include:

• Anti-nausea drugs: This includes medications like ondansetron for nausea control.
• Pain medications: This can include both opioid and non-opioid pain relievers.
• Physical therapy: This form of therapy that helps maintain mobility and reduce discomfort.

Natural and alternative therapies

Natural and alternative therapies can complement traditional palliative care treatments, providing a holistic approach.

• Acupuncture: This traditional form of Chinese medicine may help relieve pain and nausea.
• Herbal remedies: Plants like chamomile and St. John’s wort may help reduce anxiety and depression.
• Massage therapy: Working with a licensed massage therapist can help reduce muscle tension and anxiety.
• Mindfulness and meditation: These practices can help boost emotional well-being.

Cannabis as part of your treatment plan for palliative care

Cannabis can be a useful part of a palliative care treatment plan. If you’re considering medical cannabis, speak with your doctor to see if it’s right for you.

Many states require you to get a medical cannabis card to access cannabis legally. To start the process of getting a card, contact Leafwell for a telehealth appointment with one of our licensed doctors.

Frequently asked questions

Get answers to some commonly asked questions about medical cannabis for palliative care.

Can cannabis replace pain medications in palliative care?

Cannabis may help you rely less on opioids and other pain medications. That said, it should be used under doctor supervision.

What forms of cannabis are best for palliative care?

Popular cannabis products include:

• Tinctures
• Edibles
• Transdermal (skin) patches
• Topical creams
• Vaporizers
• Suppositories

The best choice for you depends on your condition, symptoms, and personal preferences.

Edibles can take up to 2 hours to kick in but provide long-lasting symptom relief. Vaporizers and tinctures can provide faster symptom relief but may not last as long as edibles.

Topical creams and skin patches can be applied to the affected area and absorbed through the skin to provide relief for skin and joint pain.

Suppositories may be useful if you have trouble swallowing or deal with stomach issues.

Can you use cannabis in hospice care?

Some hospice providers may have rules about using medical cannabis in their facilities. It’s best to ask your hospice provider about their policies, including whether specific methods, like smoking cannabis, are prohibited.

Resources

• Advantages and disadvantages of using St. John’s wort as a treatment for depression. https://www.cureus.com/articles/94821-advantages-and-disadvantages-of-using-st-johns-wort-as-a-treatment-for-depression#!/
• Assessing the impact of acupuncture on pain, nausea, anxiety, and coping in women undergoing a mastectomy. https://onf.ons.org/publications-research/onf/43/6/assessing-impact-acupuncture-pain-nausea-anxiety-and-coping-women
• Beta-caryophyllene, a cannabinoid receptor type 2 selective agonist, in emotional and cognitive disorders. https://www.mdpi.com/1422-0067/25/6/3203
• Biosynthesis of cannflavins A and B from Cannabis sativa L. https://www.sciencedirect.com/science/article/pii/S0031942218303819
• Cannabis in palliative care: A systematic review of current evidence. https://www.jpsmjournal.com/article/S0885-3924(22)00760-6/fulltext
• Cannabis in palliative care: Current challenges and practical recommendations. https://apm.amegroups.org/article/view/20097/html
• Cannabis significantly reduces the use of prescription opioids and improves quality of life in authorized patients: results of a large prospective study. https://academic.oup.com/painmedicine/article/22/3/727/6053211
• Dame Cicely Saunders, founder of the modern hospice movement, dies. https://www.bmj.com/content/suppl/2005/07/18/331.7509.DC1
• Effectiveness of therapeutic massage for generalized anxiety disorder: A randomized controlled trial. https://onlinelibrary.wiley.com/doi/10.1002/da.20671
• Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00520-5
• Medical cannabis and utilization of nonhospice palliative care services: complements and alternatives at end of life. https://academic.oup.com/innovateage/article/6/1/igab048/6505237
• Medical cannabis is effective for cancer-related pain: Quebec Cannabis Registry results. https://spcare.bmj.com/content/13/e3/e1285
• Medical cannabis use in palliative care. https://www1.racgp.org.au/ajgp/2021/june/medicinal-cannabis-use-in-palliative-care
• Medical cannabis use in palliative care: Review of clinical effectiveness and guidelines – an update. https://www.ncbi.nlm.nih.gov/books/NBK551867/
• Mindfulness in palliative care – The healing effect of the present moment. https://pubmed.ncbi.nlm.nih.gov/33213158/
• Neuroprotective potential of limonene and limonene containing natural products. https://www.mdpi.com/1420-3049/26/15/4535
• Non-pharmacological interventions in primary care to improve the quality of life of older patients with palliative care needs: A systematic review of randomised controlled trials. https://bmjopen.bmj.com/content/13/12/e073950
• Pain management and symptom-oriented drug therapy in palliative care. https://karger.com/brc/article-abstract/6/1/27/53992/Pain-Management-and-Symptom-Oriented-Drug-Therapy
• Potential role of flavonoids in treating chronic inflammatory diseases with a special focus on the anti-inflammatory activity of apigenin. https://www.mdpi.com/2076-3921/8/2/35
• Protective effects of (E)-?-caryophyllene (BCP) in chronic inflammation. https://www.mdpi.com/2072-6643/12/11/3273
• Reduction of benzodiazepine use in patients prescribed medical cannabis. https://www.liebertpub.com/doi/10.1089/can.2018.0020
• Review of the use of medicinal cannabis products in palliative care. https://www.mdpi.com/2072-6694/16/7/1412
• The effect of oral chamomile on anxiety: A systematic review of clinical trials. https://e-cnr.org/DOIx.php?id=10.7762/cnr.2024.13.2.139
• The emerging role of quercetin in the treatment of chronic pain. https://www.eurekaselect.com/article/125448
• Therapeutic applications of terpenes on inflammatory diseases. https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.704197/full
• The therapeutic potential of apigenin. https://www.mdpi.com/1422-0067/20/6/1305
• ‘Total pain’: Reverence and reconsideration. https://www.frontiersin.org/journals/sociology/articles/10.3389/fsoc.2023.1286208/full
• UK Medical Cannabis Registry palliative care patients cohort: initial experience and outcomes. https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-021-00114-9

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