Using cannabis can have a big impact on your physical and mental health—for better and, once in a while, for worse. That’s why it’s important to consult a healthcare provider before experimenting.
Here at GreenState, cannabis clinician Dr. Leigh Vinocur is here to answer your questions on healthy living with cannabis.
RELATED: Ask Dr. Leigh: can cannabis help ease chemo-related nausea?
Editor’s Note: The answer to this question is meant to supplement, not replace, advice, diagnoses, and treatment from a healthcare provider. Always consult a medical professional when using cannabis for medicinal purposes, and do not disregard the advice of your healthcare provider because of anything you may read in this article.
Q): I am a cancer patient receiving in-home hospice care, my family thinks I need more care than they can provide, and they want me to move to an inpatient hospice facility, but can I still use my medical cannabis?
This is a great question that many of my hospice patients have asked me. And while this is beginning to change, in many states it is still not allowed. In my state of Maryland, I am supporting a bill submitted to our state legislature this year that will allow this. It’s called HB 790; if passed, it will allow a qualifying medical cannabis patient to continue receiving their medical cannabis while they are in a hospice facility. I think it is critical that these patients have continuity of their care by receiving their cannabis therapy, especially at the end of their lives.
In my practice and experience, medical cannabis has been shown to improve the quality of life in both chronically ill patients, as well as improving the quality of their end-of-life care. Studies have corroborated this; a recent JAMA article found that medical cannabis patients reported improved health-related quality of life parameters on validated questionnaires.
Another study looking at hospice patients found that adding medical cannabis to an opioid regime, commonly used for cancer pain, showed a statistically significant reduction in pain relief while requiring fewer opioid medications, thereby mitigating some of the potential complications and toxicity associated with them. An Australian study this past year found patients with chronic illnesses using medical cannabis had clinically meaningful improvement in health-related quality of life with statistically significant improvement in pain, fatigue, anxiety, and depression associated with those medical conditions.
Additionally, because of these and other studies, a recent survey of hospice clinicians published in the Journal of Palliative Medicine overwhelmingly supported medical cannabis use in this setting. Despite the legality of medical cannabis at the state level, it’s still federally illegal, and many healthcare institutions have not thus far allowed these patients to continue their medical cannabis regime if they are hospitalized or require in-patient hospice care at the end of their lives. I have seen patients reluctant to be admitted because they are worried about not being allowed to use their medical cannabis.
A paper published in the Canadian Medical Association Journal (CMAJ) back in 2014 discussed a new policy for medical cannabis use during inpatient hospice care at Montréal’s Jewish General Hospital. Under their rules, patients with a valid Canadian prescription could use dried flower in their rooms with a hospital-provided vaporizer that does not create smoke and filters out the smell. The cannabis is held in the hospital pharmacy under the same controls used for opioids. Additionally, they stated that for ambulatory patients, there will be an area on the grounds, away from tobacco smokers, for traditional cannabis smoking.
The committee formed by the palliative care department that helped create the policy cited that their patients on cannabis used half the doses of opioid medications with better pain reduction and appetite stimulation, as well as fewer side effects like constipation, lethargy, and nausea. They also cited that they found much better results with natural plant-based cannabis than with the prescribed synthetic THC, such as dronabinol, that they had to use prior to this new policy.
Certain states changing laws to permit medical cannabis during end-of-life care
In September 2021, the state of California passed a law called Ryan’s Law. It was named after Ryan Bartell, a young man who had terminal pancreatic cancer and wanted to remain lucid to spend time with his family at the end while in hospice. This law allows the use of only oral medical cannabis, no inhaled cannabis of any kind, in specific healthcare facilities. It is not permitted in areas such as emergency departments or substance-use treatment facilities.
Healthcare facilities must develop written guidelines to address this issue. Its use must be documented in the patient’s medical records. Patients or caregivers must provide documentation of their medical cannabis certification/recommendation. Patients or their caregivers are the ones responsible for acquiring and administering medical cannabis. And they must maintain control of it while being used in the facility by storing it, at the bedside in a locked box.
Some facilities have the nursing staff maintain the keys to the locked box while the patient is hospitalized, opening it in accordance with the physician’s orders. Once the patient leaves the facility, the patient or caregiver is responsible for removing or disposing of the medical cannabis. And because the healthcare providers do not actually touch medical cannabis, the legal provisions designated in the law, which prohibit criminal penalties, are mainly applicable for the patients and their caregivers.
I absolutely support these initiatives, especially for those patients who are at the end of their life. This will allow their continuity of care so their symptoms do not worsen. Additionally, it may prevent some withdrawal symptoms. A study found up to two-thirds of patients taking medical cannabis daily who abruptly stop may have some uncomfortable cannabis withdrawal symptoms such as headaches, sleep problems, mood swings, decreased appetite, and stomach problems. However, it is most important to allow these hospice patients to avoid the more sedating medications commonly used in palliative medicine, such as benzodiazepines and opioids. Unfortunately, these drugs often make patients so sleepy that they cannot spend meaningful quality time interacting with their families at the end of their lives.
Got cannabis questions? Ask Doctor Leigh. Send your questions to GreenState’s Editor at editor@greenstate.com and keep an eye out for new answers from Dr. Leigh Vinocur every month.
Dr. Leigh Vinocur is a board-certified emergency physician who also has a cannabis consulting practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a graduate of the inaugural class, with the first Master of Science in the country in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.
The response to this question was not written or edited by Hearst. The author is solely responsible for the content.