By Dr. Carey S. Clark PhD, RN, AHN-BC, RYT
“Is it rational to forbid patients who are dying from taking marijuana as a palliative to permit them to gain body weight and to get some food down? It seems madness to say, ‘We’re worried that they’re going to become addicted to marijuana’ — there’s no evidence whatever that it’s an addictive drug, but even if it were, these people are dying, what are we saving them from?”- Carl Sagan (https://www.youtube.com/watch?v=_JVOHgCFd-Q)
As a registered nurse with a background in hospice care, I have a vested interest in supporting peace and ease for patients and families facing the end of life process. I am currently teaching a thanatology (the study of death and dying) course for registered nurses, and these nurses often express their frustration with being unable to adequately address patients’ end of life and palliative care needs in hospital and skilled nursing facility settings. Despite the greater use of hospice care in the USA, sadly, the stats around having a “good death” experience for most Americans have not gotten better over the years. According to recent research where pain was evaluated at end of life, level of pain reported by patients within the dying population increased 11.9 percent from the years 1998 to 2010; incidents of depression and confusion at end of life also were increased by 4.7 percent..1
Medical use of cannabis at end of life has been shown to ease pain and anxiety for many folks facing this journey, while potentially decreasing the need for morphine1. While morphine is a very effective pain medication for most people approaching end of life, it is not without its side effects, including increased tolerance, constipation, anxiety, agitation and nausea.
Cannabis has been shown to be a synergistic medication when used with opiates. 2,3 Medical cannabis can potentially decrease the use of opioid medications at end of life. Considering what we now know about the body’s rapid development of tolerance to opioid medications requiring escalating doses for pain relief, this is particularly important.
In 2001, The American Medical Association recognized that medical cannabis provided great palliation and should be used compassionately with appropriate populations. The American Nurses Association (ANA) has long been a supporter of the therapeutic use of cannabis, and yet also recognizes openly that the federal government has stood in the way of the research process around the therapeutic benefits of medical cannabis. 4 The ANA calls for bridging the gap between the current positive body of evidence regarding therapeutic marijuana, and the outdated federal scheduling of marijuana as a Schedule I drug under the Controlled Substances Act, a designation that continues to wrongly label cannabis as a dangerous medication with no therapeutic value.
More studies need to be done around the other common end of life symptoms that medical cannabis may address, namely, nausea, lack of appetite and nutritional issues, increased secretions leading to the “death rattle” breathing sounds common at end of life, dyspnea (shortness of breath), weakness/fatigue, and agitation.
Despite the many restrictions the federal government has placed on researching the medical use of cannabis, we have enough supporting data at this point to acknowledge that medical cannabis potentially offers a great source of comfort for dying patients.2,3 And yet, even with our dire statistics about the state of care and comfort for the dying in America, there is resistance toward openly using cannabis at end of life, even within the seemingly more compassionate community of hospice care providers.
Part of the resistance around medical cannabis at end of life stems from the federal government issues around the legality of medical cannabis, the aforementioned scheduling of medication issues, and fear around the risks of Medicare or Medicaid de-funding if cannabis is allowed in the traditional or allopathic healthcare settings.
I recently spoke to an attorney in Arizona, Ryan Hurley, who works specifically with cannabis law and corporations in that state. In Arizona, several hospices have started following their specific state laws around use of medical cannabis, and supporting their end of life patients in getting the medicine they need to ease the pain and discomfort of dying or living with a terminal illness.
Mr. Hurley stated that given the current federal government stance on the use of medical cannabis, several hospices in Arizona have gone public with their efforts to support legal access to cannabis for their dying patients. Mr. Hurley confirmed that these hospices have not received any threats from the government regarding termination of funding due to the hospices’ compassionate care for this population. Federal Medicare dollars are most likely not spent on supplying medical cannabis to hospice patients; instead, patients either pay out of pocket for their medicine or dispensaries might donate the medical cannabis. If the federal government did reverse its stance and threaten to pull Medicare funding, Hurley believes a lawsuit would emerge pitting state law versus federal law in this area.
It’s time we overcome our fears around the use of medical cannabis in order to provide the most compassionate death and dying experience possible. Let us move forward together as a community and call for widespread use of medical cannabis for both palliation and at end of life, and see if we can change those statistics toward less pain, agitation, and confusion at end of life.
- Singer, A.E., Meeker, D., Teno, J.M., Lynn, J., Luney, J,R., & Lorenz, K.A. (2015). Symptom trends in the last year of life from 1998 to 2010: A cohort study. Annals of Internal Medicine, 162(3), 175-183.
- Leung, L. (2011). Cannabis use and its derivatives: Review of medical use. Journal of the American Board of Family Medicine, 24(4), 452-462.
- Kim, L. (2011). UCSF study finds medical marijuana could help patients reduce pain with opiates. Retrieved from http://www.ucsf.edu/news/2011/12/11077/ucsf-study-finds-medical-marijuana-could-help-patients-reduce-pain-opiates
- American Nurses Association. (2008). Position statement: In support of patients’ safe access to therapeutic marijuana. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/In-Support-of-Patients-Safe-Access-to-Therapeutic-Marijuana.pdf
Dr. Clark is a registered nurse of 21 years, with a wide background of clinical experience working in the medical-surgical, psychiatric, pediatric, home-health, and hospice settings. She is an Assistant Professor of Nursing, University of Maine Augusta, where she developed an award winning holistic RN-BSN curriculum. Dr. Clark strives to support patients in the use of medical cannabis for healing, and to educate providers around the safety and health benefits of medical cannabis. Contact information: firstname.lastname@example.org