Does Cannabis Help Patients in End of Life Care?

As medical cannabis is legally available in almost every state in America, healthcare providers have started to recognize the potential benefits for patient care. And while there are many types of medications that may help ease the difficult transition that terminally ill patients experience, cannabis is increasingly an option to consider.

Prior to the Anslinger era and the following “war on drugs,” cannabis was revered and used for centuries as a natural medicine. And it has a long history of documented therapeutic use. While scientific research into cannabinoids and human health has been legally limited for decades, we learn more every year about the treatment potential of cannabis-based medicines and products. And new clinical trials present evidence-based research that further expands healthcare services for patients.

When supporting a patient in end-of-life care, there are many challenges. The individual may require help with a variety of symptoms, from chronic pain to nausea, loss of appetite, and insomnia. Mental health needs also change in the late stages of hospice care. And many palliative care patients benefit from support for symptoms of anxiety or depression.

Families and caregivers can seek the advice of a medical cannabis healthcare provider to learn more about alternative medicine options. In this article, we will explore the potential role that cannabis can play (for eligible patients) in end-of-life care.

What is the History Behind Hospice Care for Patients?

The Connecticut Hospice was the first compassionate care treatment center, and it was founded in 1974 by Florence Wald. Medical professionals, including nurses, doctors, and other care providers. Dr. Cicely Saunders was the founder of St. Christopher’s Hospice, which is recognized as the first official medical hospice in the world, located in the United Kingdom.

In the early years, before hospice facilities and caregivers and family members were not considered part of the treatment plan. Today, the whole health of the patient (and close family) is considered part of delivering quality, compassionate care.

Understanding End-of-Life or Compassionate Care

Hospice care can be required by patients of all ages. Some chronic diseases like cancer are progressive, and the severity of the condition is marked by stages one through four. By comparison, there are seven distinct stages of Alzheimer’s disease, from no cognitive decline to very severe cognitive decline.

Even though stages of progression can vary according to the disease or disorder, terminal illness is diagnosed when no treatment modalities will provide a cure. But often, different treatments from the patient’s healthcare team can provide more time. And provide comfort to palliative care patients.

Solace and relief are the two major priorities for compassionate care. This helps create a supportive environment that will comfort not only the patient but loved ones as well. Part of compassionate care for patients is guiding caregivers and families toward decisions regarding end-of-life care.

Treatment Priorities for Patients: Different Types of Hospice Care

The type of symptoms you want to address will depend entirely on the patient’s medical conditions. Patients with similar diagnoses can have different symptoms. But the priority in compassionate care is to attempt to alleviate some of the disease or prescription medication side effects.

There are many different types of hospice care that are focused on the patient through the progressive stages of terminal illness. The types of treatments may also vary depending on whether the patient is in a healthcare setting (such as a hospital or hospice home) or transitioning while residing at home with medical support.

The different types of hospice care include:

Physician Services

From the diagnosis of the medical condition and health evaluation to treatment planning, prescribing medications, and more, physicians are integrally connected with both the patient and caregivers to provide quality care.

Some of the essential supports provided by a physician to a hospice patient include:

• Diagnosis and medical evaluation.
• Consulting with the patient to determine treatment goals and DNR (do not resuscitate orders) if the patient wishes to provide special instructions.
• Development and changes to treatment plans.
• Ongoing patient assessments to monitor changes in condition and address new symptoms.
• Prescribing medications and monitoring doses.
• Care coordination and authorization for other services, including specialists, physiotherapists, and sometimes social workers and psychotherapists, to provide both patient and caregiver (family) support and guidance.
• Bereavement support for the surviving family of the patient.

Because hospice care requires coordination of interdisciplinary health, pharmacological, and mental health care, there is close collaboration with all care providers. The needs of a patient in compassionate care evolve with each stage of progression. And treatment options are discussed with the guardian or family members to ensure consent for therapeutic services provided to the hospice patient.

Nursing and Home Health Aides

The cost of hospice care has been climbing steadily in the United States. The average cost per day in 2022 for at-home hospice care and medical support was $150 per day. Hospitalization of a patient in compassionate care can cost more than $500 per day.

But cost alone is not the only consideration. Many people with terminal illnesses are more comfortable at home, even temporarily, instead of living in a hospital. Nurses and home health aides make it possible to provide the health care services needed by that patient at home.

Hospice On Call

Family and home health providers may need support if the patient’s condition changes or symptoms become life-threatening, or the caregivers have a question about a medication or procedure; they may have access to hospice on-call services.

It is an after-hours telehealth service, but it is also important to help patients stay safe. Should the patient’s health begin to decline, an ambulance can be dispatched to take them to the nearest care facility. This transition from home care to hospitalization involves planning between the physician and family members or the legal guardian of the patient.

In-Patients Services for Hospice Patients

Sometimes caregivers are unable to provide supervision during the day. That could be a spouse or family member who has a job but is able to care for the patient after work hours. In-patient services can be arranged for daytime visits to ensure safety.

Sometimes the symptoms of chronic pain and other side effects of end-of-life care require short-term hospitalization. But after the emergency conditions have passed, the patient may return to at-home care.

Physical Therapy

Muscle wasting is a common symptom of both chronic and terminal illnesses. Certain conditions that may cause muscle pain include myalgic encephalomyelitis (chronic fatigue syndrome), lupus, myofascial pain syndrome,

Terminal illness can also cause loss of muscle strength. Polymyositis is an inflammatory disease that causes muscle weakness. Other conditions like Lyme disease, polymyalgia rheumatic, and more can cause muscle weakness.

Physiotherapy can help patients in compassionate care by:

• Designing a treatment plan including different massage, manual, heat or cold therapies, and exercises that help alleviate discomfort. And educating both the patient and caregiver on correct applications.
• Regularly massaging or using TENS on muscle groups that are contracting, stiff, and sore to help with range of motion and mobility. Muscle atrophy is a common symptom, and massage positioning helps to keep important muscle groups pliable.
• Providing relaxation and comfort can improve the patient’s general mood and sense of well-being. By helping the patient feel more comfortable, massage and other therapies can also help improve sleep quality for patients in end-of-life care.
• Assisting in respiratory care by providing respiratory exercises, chest physiotherapy, and integrated breathing techniques. This can help patients in compassionate care who have respiratory problems or obstructed breathing.

Patients who are on permanent bed care may develop high levels of lactic acid in major muscle groups and joints. Physical therapy also helps keep the patient’s body in motion and reduces lactic acid levels. This may slow the progression of muscle wasting for patients living with a terminal diagnosis.

Emotional Support and Counseling

The primary care provider can recommend free community support groups, educational events, and referrals to a licensed counselor. The transition through all the stages of a terminal diagnosis is emotionally painful and difficult for the patient and also for the loved ones around them.

Therapeutic counseling can help the patient process feelings of anger, loss, or fear. Often they do not wish to burden or worry their loved ones, and they may hide symptoms of anxiety or depression. A licensed emotional support counselor can help guide the patient into a mindset that is accepting and peaceful.

Family members who provide care for a loved one in hospice also face emotional trauma. It is very difficult to watch the effects of a terminal illness take someone who means so much to you. With the focus and energy on the patient, caregivers often neglect their own needs. They may suffer from insomnia, anxiety, and depression too.

Emotional support and counseling for patients and caregivers can help with the grief and healing process. And help create the peaceful, compassionate transition that families and patients deserve.

How Can Medical Cannabis Help Patients in Home Hospice Care?

Patients who have been in palliative care for a long time can develop resistance to certain pain medications. Prescription NSAIDs and opioids are commonly provided for patients in compassionate care. But some patients may not get adequate relief if they have developed a tolerance to pain drugs.

Doctor-supervised medical cannabis use has provided new opportunities to explore improved symptom control and management. Here are some of the potential benefits of medical cannabis for patients in hospice care:

1. Improved Sleep

The cannabinoids (including THC and CBD) in some strains of medical marijuana positively interact with receptors in the brain that regulate sleep. Strains that are low in THC but have high cannabidiol (CBD) content are thought to work best to help regulate sleep-wake cycles.

Moderate to severe anxiety can disrupt sleep. Individuals suffering from chronic pain frequently wake up during the night in discomfort, which prevents quality sleep. With guidance from a trusted medical cannabis dispensary, caregivers can research products that may help address insomnia.

2. May Assist with Anxiety and Depression

If low mood and emotional anxiety are having a negative impact on the patient, a caregiver may look for a daytime medicinal cannabis strain. Specific terpenes, when combined with cannabinoids, can provide relief and improve overall mood.

The effect that cannabis can have on mood is shared by patients online. Some patients describe the sensation of “knowing the anxiety is still there.” but being unable to recall the source of the anxiety. In that way, medical marijuana may provide a much-needed break to improve mental health care

3. Can Help With Muscle Spasms

Pain and muscle spasms are triggered by high levels of inflammation in the body. A combination of medical cannabis and high-quality CBD product may help provide relief for muscle cramps and pain. Cannabidiol (CBD) clinical trials have suggested it can help reduce inflammation.

4. May Help Reduce Nausea and Gastrointestinal Upset

In 2021, researchers at The University of New Mexico published findings about nausea and cannabis. The study reported that cannabis created a symptom improvement of 4 points on a scale of 0-10. Researchers also stated that symptom improvement happened quickly after consumption, with anti-nauseant benefits increasing.

Cancer chemotherapy-induced nausea occurs with statistically significant frequency. Patients diagnosed with stage four cancer receiving compassionate care may explore medicinal cannabis to help with symptom control and management.

5. Can Stimulate Appetite

For patients in compassionate care, medications, stress, and disease symptoms can all contribute to gastrointestinal upset. Inflammation in the GI tract is uncomfortable, but it can also further reduce the appetite of someone in palliative care.

Specific strains of cannabis are believed to help stimulate appetite. Medicinal cannabis may help settle the digestive tract and encourage patients to eat regularly. Medical cannabis with high cannabidiol (CBD) content may also help reduce inflammation.

6. It May Promote Calmness and Relaxation

When symptoms become difficult for patients in compassionate care, medical cannabis may provide some relaxation and relief. Strains with potent CBD ratios that are recommended for anxiety and pain relief may be a good choice. It can help with stress management.

When every day is precious, families want to share a moment-to-moment presence. Cannabinoids derived from the cannabis plant interact with the body’s CB1 and CB2 receptors. It can help reduce tension in the body and help moderate symptoms of anxiety, irritability, or grief.

7. Can Improve Communication With Loved Ones

Some strains of cannabis may encourage conversation. The unique blend of cannabinoids and terpenes can make people feel like talking. In the emotional difficulties stemming from a terminal diagnosis, medicinal cannabis can allow for more relaxed, calm, and open communication between patients and their loved ones.

Is Terminal Illness a Qualifying Health Condition?

In many U.S. states, a terminal diagnosis was the original qualifying health condition. The importance of compassionate care and the right to choose alternative medicines led states to make doctor-supervised marijuana legal.

A terminal diagnosis for an adult may be accepted as a qualifying health condition for medicinal cannabis use. Children in compassionate care may also qualify with the help of a legal guardian. The caregiver is a co-applicant and is registered to assist the patient with medical cannabis if a physician feels that medical cannabis can improve the patient’s quality of life.

How Do Terminally Ill Patients Get a Medical Cannabis Card?

Patients who require care, because they are debilitated by a disease or illness can get assistance from a family member. In some cases, a non-family member who is a legal guardian appointed by the patient may also qualify to become a caregiver.

The role of a caregiver is to follow the treatment advice provided by a licensed physician. A doctor who has consulted with the patient and determined that medical cannabis products may help with symptom management can recommend alternative medicine for a patient in hospice care.

Caregivers must apply first to the medicinal cannabis registry. If they are approved, the patient is registered as well. The caregiver can receive a medicinal cannabis card that identifies the patient’s name.

The patient does not have to visit a dispensary to purchase products; the caregiver may purchase them legally to provide to the patient they are assisting. Including any required equipment or supplies to consume medical cannabis.

What Are the Requirements to Become a Cannabis Caregiver?

Medical cannabis use for patients in end-of-life care may help with symptom management. After a systematic review of the patient’s current health conditions and symptoms, medicinal cannabis may be added to a palliative care treatment plan.

Most palliative care patients require assistance; a family member or guardian may be registered as a cannabis caregiver. Each state medicinal cannabis program has specific requirements to approve a caregiver to assist palliative care patients.

There are five general requirements that caregivers must meet in order to be registered to assist their loved ones with medical cannabis. Those requirements are as follows:

1. Residency and Active Patient Care

In order to qualify as a marijuana caregiver, you must reside in the same state as the patient. That is because caregivers are responsible for purchasing and administering medicinal cannabis to the patient. Caregivers cannot delegate to another person to purchase products or administer them.

Each caregiver is provided with a photo identification after registering with the state medical cannabis authority. And they must be present at the dispensary to legally purchase cannabis products for the patient.

To be approved as a medicinal cannabis caregiver, individuals must not only be in close proximity to the patient, but they must be conducting activities of daily living and caring for their loved one.

The focus of the caregiver program is to allow family members to assist with symptom control and improve the quality of life for the patient. And they must be actively caring for the individual on a daily basis to qualify.

2. Legal Age Requirement

Caregivers must be of adult age at the time of their application. The laws vary between states. However, caregivers usually need to be aged 18 to 21 years. In some cases, the state medical cannabis authority may grant caregiver status to someone under the age of eighteen years, but it requires a written request, and it is rarely granted.

3. Criminal Charges and Background Checks

Understandably, individuals who are authorized to purchase cannabis for a patient in their care are required to complete a background check. In some states, if you have any felony charge at all, you will not be permitted to become a caregiver. However, other states only choose to decline individuals who have a drug-related charge, including a felony or misdemeanor.

The background check will also reflect any potential for violence or abuse. Charges relating to domestic violence, child or elder neglect, or similar crimes will disqualify applicants who want to be a caregiver for hospice care patients.

4. Medical Certification in the Absence of a Familial Guardian

Some patients with terminal illnesses do not have friends or family members who can be legal guardians. In some cases, healthcare providers such as nurses or nursing assistants, and personal care workers may be designated to provide private healthcare services to the patient at home.

In those situations, confirmation of care in lieu of guardianship is required. The healthcare provider must provide registration or licensing information in order to register with the medical cannabis regulatory agency.

5. Knowledge of Medicinal Cannabis Laws and Regulations

The recommending or certifying physician is required for prescribing medical cannabinoids. However, the caregiver is responsible for understanding all the legal requirements of their role. For example, caregivers cannot consume medical cannabis purchased for a patient. And they must follow the treatment plan advice of the certifying physician in terms of quantity, potency, and route (cannabis product type) that is best for the patient.

Each state has established purchase and possession limits. Caregivers accepted into the medicinal cannabis registry must ensure that they are within the limits required. They must also purchase medicinal cannabis products only from a licensed dispensary, which records and tracks the amount allocated monthly for patient care.

In some states, medical cannabis caregivers are permitted to cultivate plants at home to help subsidize the cost for the patient. Caregivers in home-grow states must comply with the laws regarding how many plants they can propagate for patient use.

If one caregiver is not approved by the medicinal cannabis registry, another family member or legal guardian may apply. Caregivers can lose legal permission to purchase medical cannabis if they do not follow the regulatory requirements. And they can be charged for illegal cannabis use if they consume the medical marijuana intended for the patient.

Can There Be Adverse Effects Using Cannabis for Hospice Patients?

In other stages of patient care, physicians and caregivers may have concerns about sedatives and prescription medications with regard to the potential for addiction. However, the priority in hospice care is to provide physiological and emotional comfort to provide relief for the patient.

There can be some adverse effects caused by using cannabis, which may include:

Cognitive Effects of Cannabis

At the middle to advanced stages of many types of critical illnesses, there is the risk of developing a temporary cognitive impairment. This can cause problems in verbal communication. memory, and interfere with muscle messaging and coordination.

Cognitive decline can also make it harder for the patient to conduct activities of daily living and self-care. That means increased services and support may be required. Activities such as cooking, cleaning, eating, bathing, and dressing may require extra support.

The presence of dementia may also provide feelings of paranoia. When the individual does not recognize family, friends, or their designated caregiver(s), it can lead to agitation and sometimes even anger or violence.

How would you feel if you woke up in a strange place surrounded by people you did not know or remember? Cognitive decline makes patient care more challenging.

Some studies suggest that using cannabis can result in slower brain and central nervous system processing. Choosing a high-THC strain of medical marijuana or cannabis concentrates is common. But misuse of cannabis concentrates can result in harm.

Mood Variations

It is not abnormal for a patient in hospice care to experience mood variances ranging from anxiety to depression. The symptoms may become worse after a terminal diagnosis, especially if the patient suffered one or more mental health disorders previously.

According to online reviews, many patients find some Sativa strains can provide an uplifted or euphoric mood. While euphoria is a common psychoactive effect for both Indica and Sativa strains, Indica-dominant medical cannabis can act like a sedative and cause drowsiness. But Sativa-based products may help with low mood while allowing the patient to remain alert and focused.

Respiratory Problems and Choosing Non-Smokable Routes

Patients with pre-existing respiratory problems should choose non-smokable cannabis products. There are many options, including edibles, tinctures, capsules, and more. For a patient in palliative care or hospice, there are other more convenient ways to take medicinal cannabis.

Smoke inhaled from a pre-roll or pipe may cause irritation in the lungs and airways. This may cause wheezing and coughing and make a patient more prone to lung infections. The hot smoke of cannabis burns off small hairlike structures in the lungs, which help remove phlegm. That can make chest infections worse and increase the risk of developing pneumonia.

Drug Interactions and Adverse Events

Cannabis is well tolerated by most patients. However, if the individual is taking other prescription medications (regardless of the type of administration), medicinal marijuana can be contraindicated. There are some medications that conflict with cannabis.

In almost all cases, contraindicated medicine is a serious problem because it can reduce how well your medications will work. Some types of medicine combined with cannabis were 30% less effective. Both prescription medications and cannabinoids bind to the same receptors. But cannabinoids can block

Also, when medicinal cannabis is combined with sympathomimetics (for the treatment of hypertension or tachycardia), opioids, alcohol, or other nervous system depressants, the results can be life-threatening. While there are no known fatalities from marijuana use alone, when cannabis is mixed with prescription drugs, there is a great potential for harm.

Is Cannabis the Right Choice for Compassionate Care?

Whether or not doctor-supervised medicinal cannabis is the right choice for the patient requires consideration by the patient and the caregiver. While there are not enough research or clinical trials about cannabis-based medicines, many shared success stories exist.

Patients using medicinal cannabis, in conjunction with other treatments for end-of-life care, may find relief and increased quality of life by improving symptom management. Regular consultation with a cannabis healthcare provider like DocMJ provides expert advice and recommendations for the patient’s evolving needs in palliative care.

Aaron Bloom

Aaron Bloom, an experienced healthcare attorney, serves as the CEO, overseeing the mission and growth of DocMJ and Medwell Health and Wellness Centers since 2016. Aaron’s passion for improving patients’ lives comes from his experience in healthcare. For more than 20 years, Aaron has owned, operated, and represented traditional healthcare organizations. This experience created a passion for finding improved ways to relieve suffering. His goal as CEO is to work daily to provide relief to all patients who seek better health and wellness through the medicinal benefits of medical cannabis and evidence-based alternative medicines.