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Cannabis in Hospice Care:

An Analysis, A Question, A Concern, An Answer

First and foremost, as a hospice organization, it is illegal to furnish patients with cannabis. If your patient is taking marijuana for medical purposes, it should be documented and the patient should be offered evidence-based information regarding medical marijuana, but it cannot be provided by the hospice.

Second, this newsletter encourages thought-provoking information, dialogue, and messaging. We are not medical professionals and we do not provide medical advice. Medication protocols are subject to the patient’s medical provider’s authorization.

Introduction:

As the medical community continues to explore alternative pain management and comfort care options, CBD (cannabidiol) has emerged as a potential complementary treatment for hospice patients. This analysis examines the potential benefits, challenges, and legal considerations of introducing CBD products in end-of-life care.

Medical Benefits and Potential Applications:

1. Pain Management:

• CBD has shown promise in alleviating chronic pain, which is particularly crucial for hospice patients experiencing severe discomfort.

• Studies suggest CBD can interact with neurotransmitters to reduce inflammation and interrupt pain signaling.

• Potentially offers an alternative to traditional opioid-based pain management strategies.

2. Symptom Relief:

• May help mitigate symptoms commonly experienced by hospice patients, including:

  • Nausea and appetite loss.

  • Anxiety and emotional distress.

  • Sleep disruptions.

  • Potential reduction in medication-related side effects.

While producing this issue, we came across this post from Hospice Nurse Julie on TikTok. One of the most horrific deaths she was involved in was a patient who refused traditional Western medicines and went with alternatives. (Can’t guarantee the link to this TikTok will work).

Study: Cannabis/opioid Co-administration Effective For Hospice Patients

• by NORML

• Posted on January 11, 2024

New Haven, CT: Hospice patients administered plant-derived CBD-dominant capsules experience significant pain relief and reduce their daily opioid intake, according to data published in the American Journal of Hospice & Palliative Care.

Researchers affiliated with Yale University assessed the efficacy of the adjunctive use of cannabis products in a cohort of 66 hospice patients. Subjects in the study were administered oral capsules containing either 40mg CBD/1.5mg THC or 80mg CBD/3mg THC. All patients enrolled in the study were taking opioids for pain management.

Investigators reported: “Combination therapy led to a statistically significant reduction in pain intensity over time, aligning with previous research suggesting that cannabinoids … can modulate pain pathways and enhance the analgesic effects of opioids.”

They further acknowledged, “The average opioid dose used in combination with medical cannabis in our study decreased over time – while patients simultaneously showed statistically significant improved pain scores. While the decrease in opioid dose did not reach statistical significance, this trend may support a stabilizing effect of combination therapy on opioid dose.”

The study’s authors concluded: “Our study highlights the potential benefit of medical cannabis co-administration with opioid therapy for pain management in hospice inpatients, demonstrating statistically significant pain reduction over time with minimal adverse events. These findings contribute to the growing body of evidence supporting the use of medical cannabis as an adjunctive treatment for pain management.”

The findings are consistent with those of other studies reporting that the co-administration of either smoked cannabis or oral cannabinoids augments the pain-relieving effects of opioids, even when both substances are administered at subtherapeutic doses.

Full text of the study, “Medical marijuana for pain management in hospice care as a complementary approach to scheduled opioids: A single arm study,” appears in the American Journal of Hospice & Palliative Care. Additional information is available from the NORML Fact Sheet, ‘Relationship Between Marijuana and Opioids.’

72% of Americans Have Used Marijuana

According to a study by Sanctuary Wellness Institute: https://sanctuarywellnessinstitute.com/blog/marijuana-statistics-use-by-generation/

Perceptions surrounding marijuana are changing. As legal restrictions are easing across the nation people are thinking about the drug differently and this shift is not limited solely to younger generations. New survey data reveals that 94% of Americans think marijuana is more socially acceptable in 2024, and nearly half (48%) think marijuana is the new alcohol.

The survey of 1,000 Americans 18 years and older found that nearly 3 in 4 (72%) have used marijuana at some point in their lives. Currently, 1 in 3 (32%) adults use marijuana, and of those, 89% use it monthly or more. From Gen Z to Baby Boomers, cannabis consumption among generations varies from how and why it’s used to even where they get it from.

Legal Considerations:

• Federal Status: CBD derived from hemp (containing <0.3% THC) is legal under the 2018 Farm Bill

• State Variations: Legality differs significantly between states, requiring careful navigation

• Medical Cannabis Laws: 37 states have medical cannabis programs as of 2024

• Hospice-Specific Regulations: No uniform national policy for CBD use in hospice settings

Challenges and Considerations:

1. Regulatory Obstacles

• Lack of standardized dosing guidelines

• Limited FDA approval for specific medical conditions

• Potential conflicts with federal healthcare regulations

2. Medical Uncertainties

• Incomplete long-term research on CBD interactions with end-of-life medications

• Potential drug interactions require careful medical supervision

• Variability in product quality and consistency

3. Patient and Family Consent

• Requires comprehensive education and informed decision-making

• Potential stigma associated with cannabis-derived products

• Need for transparent communication about potential benefits and risks

Recommendations for Hospice Agencies if patients and families bring up the discussion:

1. Consult State Regulations

• Thoroughly review local and state laws regarding CBD usage

• Develop clear internal policies and protocols

• Ensure compliance with both state and federal guidelines

2. Medical Oversight

• Involve medical directors in developing CBD treatment protocols

• Conduct thorough patient assessments

• Monitor potential interactions with existing medications

3. Documentation and Consent

• Develop comprehensive consent forms

• Maintain detailed medical records

• Ensure patients and families understand the potential benefits and limitations

The answer - it’s clear there is no answer.  

We know that the use of cannabis can potentially assist when caring for terminally ill patients. But there is a line, many grey areas, philosophies as to the pros and cons, the absolute naysayers, and those who are open to the possibilities.

The question that you should be asking - as a hospice provider, are you and your associates prepared to have these discussions with your patients and their family members - if and when the topic arises?

This newsletter began about six months ago. Over 26,000 times this newsletter has been opened and engaged with in some way or another.

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