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Cannabis in Hospice and Palliative Care

Herodotus, an ancient sive relaxation, guided someone who’s worked with dying people properties making it a natural choice for
Greek Historian, wrote imagery, music therapy, and and their families for many years, I see people nearing the end of life. It can help
about using cannabis as a art therapy, to name a few. euphoria as a welcomed “side effect” as with symptoms such as pain, weight loss,
“grieving ritual” in prepa- Hospice and palliative care one approaches death. nausea, insomnia, neuropathy, depression,
ration for purification pre- teams develop a plan of care The National Academy of Medicine and even the fear of death itself.
ceding the funeral of a that meets each person's reports that there is strong scientific evi- To achieve excellence in hospice and
loved one. As described in individual needs for pain dence indicating cannabis is an incredibly palliative care, the goal needs to be to man-
ancient texts, cannabis management and symptom effective treatment for chronic pain, some- age a person’s symptoms while still
was a botanical “medi- control. They work together, thing end of life patients regularly struggle enhancing the quality of life each individ-
cine”, used to help indi- focusing on all of a person’s with. We know that cannabis helps people ual still has ahead of them, whether that is
viduals move past trau- needs; physical, emotional, get a more restful night’s sleep, and that dis- 1 year, 1 month, 1 day or 1 hour. When a
matic experiences and and spiritual. The goal is to turbed sleeping patterns very often accom- person is able to eat, sleep, relax, protect
suffering, when a beloved help keep a person as pain- pany chronic pain. The pleiotropic proper- and forget, this can make all the difference
member of the Com - BY JOSEPHINE free as possible, with loved ties of cannabis make it a perfect option for in their world.
munity died. With these CANNELLA-KREHL ones nearby. Effective man- the chronic pain/sleep disturbance chal- As healthcare providers we need to be
“ancient roots”, it should agement requires that the lenge. One medication targeting multiple seeking out knowledge of new and emerg-
come as no surprise that team be thoroughly familiar issues as opposed to multiple medications ing therapies, it is both our moral and eth-
in modern times, we’re rediscovering the with the recommended interventions and for each condition requiring symptom ical responsibility to the patients we serve.
benefits cannabis affords patients and fam- medications. Frequent re-evaluation of a relief. This naturally leads to a reduction in Cannabis can be another “tool” in the end
ilies at the end of life. patient is critical. the use of multiple medications. of life “toolbox”. Opening these types of
Common challenges at the end of life A variety of opioids and other drugs are Cannabinoids can be used safely in con- conversations is essential in providing
include: Pain, both physical and emotion- commonly utilized to palliate symptoms in junction with opioids. Additionally, when excellent care to suffering people.
al, nausea, vomiting, anorexia (lack or loss hospice and palliative care, oftentimes they are used together, lower doses of opi-
of appetite), depression, dyspnea (short- additional medications are needed to com- oids are needed to achieve the desired out- For more information on how to bring qual-
ness of breath/difficulty breathing), bat the side effects of the primary medica- come than when opioids are used alone. ity cannabis therapeutics education, including
cachexia (wasting of the body), anxiety, tion. It’s quite common for end of life Prescribing lower levels of opioids trans- an overview of Florida’s new Medical
agitation, unresolved familial conflicts/ patients to be on a dozen combination of lates into a lower likelihood of accidental Cannabis program to your organization, con-
issues, feelings of helplessness, hopeless- drugs, all aimed at providing relief and overdose and increased patient safety. tact Josephine Cannella-Krehl at
ness and despair, anticipatory grief, prepar- increasing quality of life. Sadly, many times Cannabis holds amazing therapeutic jokrehl@gmail.com or (850) 653-6928.
ing for the dying process, and the biggest, we see these drugs doing more harm than
from my perspective … fear - fear of pain, good. Additionally, some of these medica-
fear of loss of control, of the loss of auton- tions produce “side effects” that resemble
omy, of mental and functional abilities, symptoms hospice care teams work so
fear related to the loss of dignity, of leaving hard to relieve. Symptoms such as;
loved ones behind and the fear of death tremors, shakiness, nervousness,
itself. headaches, restlessness, irritability, muscle
An Italian researcher by the name of aches/pains, throat or nasal irritation,
Vincenzo DiMarzo tells us that cannabi- rapid heart rate (tachycardia), and feelings
noids serve 5 essential functions; they help of fluttering or pounding heart (palpita-
us eat, sleep, relax, protect and forget … all tions).
of which are essential in increasing quality The most commonly reported side
of life. effects of cannabis include: dizziness (this
Cannabinoids have been shown to can be mitigated through the use of cbd in
enhance fear extinction in humans, this combination with thc), sedation (which
alone can impact the dying experience can be a welcomed side effect, especially in
immensely. People report their use of those who struggle to get a restful night’s
cannabis helps them accept things that sleep), dry mouth and euphoria. Merriam-
were difficult to accept before, such as Webster defines euphoria as a state of well
their impending death. Cannabis can also being or elation and the Cambridge
enhance adjunctive therapies commonly English dictionary defines it as a feeling of
utilized at the end of life, such as progres- extreme happiness or confidence. As

South Florida Hospital News southfloridahospitalnews.com November 2018 35