Hospice and medical marijuana, help at the end

When the time of death approaches, emotions run high. When a hospice is involved, that helps, but the pain of impending loss and all the unresolved issues remain. In the US, people are taught to believe in happy endings. Generations have watched TV shows and movies where in 30, 60 or 120 minutes all problems are solved and there is a last minute confession and a moment of respite. Real life is neither so clean nor so happy.

Does marijuana help in these final hours? In the moments of palliative or hospice care, anything that can help makes a difference.

RELATED: Science says medical marijuana improves quality of life

Palliative care is the medical care of people with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms or receive palliative care together with treatment to cure their serious illness.

Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness nearing the end of their life. A hospice visit is prescribed when a healing journey comes to an end and the focus changes to making the patient feel comfortable until the end.

Two evidence-based guidelines address the use of medical marijuana in palliative care. The first evidence-based guideline expressly advises against the use of medical cannabis as first or second-line therapy for palliative cancer pain. The guideline suggests that this could be considered in the case of refractory symptoms and with careful consideration of potential risks. The second evidence-based guideline also recommends that medicinal cannabis should only be used in palliative care after other treatments have failed and after considering possible adverse events and drug interactions.

In study after study, medical marijuana may help increase appetite, relieve painful constipation, and relieve pain. Hospice focuses on well-being, knowing that there is no long-term cure. Currently, most scientific evidence shows that medical marijuana soothes systems but does not heal any serious ailment or injury.

Perhaps just as importantly, marijuana is used in hospice care to alleviate spiritual and existential suffering. Some studies show an important therapeutic role for patients faced with the despair of a terminal illness, loss of function and lifelong reflection. A slight euphoria or sense of well-being can calm a patient’s mind, body, and spirit as they confront their fate.

In 2019, a study was conducted among hospice professionals. About half of the respondents were nurses, followed by administrators and doctors. Regardless of legal status, hospice workers overwhelmingly agreed that medical marijuana is an important tool to support their patients.

RELATED: Study: Cannabinoids (THC/CBD) beat opioids in treating chronic pain

Although medical marijuana is legal in 40 states and the District of Columbia, conflicting federal laws pose a challenge for hospice and palliative care programs whose patients are interested in medical cannabis or are already using it to treat 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.