Medical Marijuana for End-of-Life Care

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As a family doctor running a home-visit practice in 2016 when medical marijuana became legal, I quickly recognized that many of my patients could benefit from its use. My patients were all homebound by their illnesses: Parkinson’s, multiple sclerosis, cancer, many of which were terminal. Most patients had never touched marijuana before but were eager to try something outside the pharmaceutical industry as they were tired of taking one medication just to develop another bad side-effect. The results were mixed and very individual but have reaffirmed my opinion that this is a very reasonable option that should be considered for many diagnoses. (Related: What is Palliative Care?)

Marijuana has been used medically for thousands of years, including commonly in the United States in the 19th century. In the early 20th century, the use of medical marijuana was banned and became very rare until 1996, when California became the first state to legalize it. Currently, 29 states plus Washington DC have legalized medical marijuana for a number of conditions. Some of the most common diagnoses include:

  • Multiple sclerosis
  • Parkinson’s
  • Huntington’s chorea
  • Epilepsy
  • Inflammatory bowel disease
  • Cancer
  • Chronic pain
  • Glaucoma
  • HIV wasting syndrome
  • PTSD
  • ALS

Despite legalization on a state level, marijuana is still illegal on a federal level and is considered Class I drug by the DEA, meaning, “assumed to have a high potential for abuse and no accepted medical use.” In addition, because of the current classification, research is very limited in the use of medical marijuana. But there is overwhelming consensus by the medical community that there are clear benefits to using marijuana especially for its analgesic and anti-seizure properties.

What is medical marijuana?

In the state where I practice, medical marijuana is marijuana processed to extract tetrahydrocannabinol (THC) and cannabinoids (CBD). THC is the psychoactive element that gives people a mind-altering sensation. It is a strong pain reliever and anti-nausea agent. CBD can be extracted from both marijuana and hemp. If extracted from hemp, it is not an illegal product and it can be purchased from pharmacies, health stores, vape shops and on line without a medical marijuana certification. Because CBD is not regulated by the FDA, the purity of many of these products is not guaranteed. CBD does not typically cause any change in mental alertness. It is a potent anti-inflammatory and anti-anxiety agent. Typically, medical marijuana distributors will combine ratios of the CBD and the THC as the two products work well together and are synergistic, meaning they are more effective together than either are separately.

How medical marijuana is taken

States have different regulations on which products are available but it is often found as an elixir, a spray, an oil for a vape pen, capsules, creams, and edibles. It can also be smoked although there is less standardization of the product if smoked.

How to get certified to take medical marijuana

Getting certified to take medical marijuana, or “getting a card,” varies state to state. The general process is that a health practitioner, MD or nurse practitioner needs to verify that the person has a certifiable diagnosis. Then they are registered with the state and get a card that allows them to visit a dispensary, a shop that exclusively sells medical marijuana. (The cost varies widely from state to state.) Because many patients are too ill to visit the dispensary themselves they can usually designate someone as their caregiver who can then go to the dispensary for them. Many dispensaries have pharmacists who can give detailed consultations about which products are most suitable for which symptoms.

I believe that medical marijuana can be very helpful for end-of-life in managing symptoms such as pain, anxiety, insomnia, nausea and lack of appetite, and spasms. In general, the risk/benefit ratio is very favorable. There are no severe side effects nor any potential for overdosing. Depending on what one takes, the mind-altering component of THC can be interpreted as a positive or a negative, but in my experience it was usually the former. In many cases, it can lower the amount of other pain or anxiety medications needed, allowing for more alertness at the end of life. In one patient with terminal pancreatic cancer, a high CBD/low THC elixir gave him energy, decreased his nausea and decreased his need for other pain medications, which meant that he was better able to interact and spend time with loved ones without being overly fatigued in the last weeks of his life. (Related: What is Hospice Care?)

Maggie Carpenter, MD, is a doctor in New Paltz, NY, and the founder of Nightingale Medical.

 

 

 

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