Since antiquity, people have known of the therapeutic benefits of the consumption of cannabis. It has become clear, with modern research, that our forefathers discovered a multipurpose medicine that eases the suffering of body and mind. In the United States, many states have legalized the usage of cannabis as a medicine, ranging from pain and nausea to anxiety and epilepsy. Although it is unclear exactly how cannabis works, many people have found relief when modern medicines have failed them. End of life care is a unique branch of medicine: people may be dying from a singular disease, but almost everyone experiences the same symptoms of death. Many comfort meds used in end of life care include Roxanol (pain and dyspnea), Zofran (nausea and vomiting), Haldol (agitation and restlessness), and Ativan (anxiety)–all of which treat individual symptoms that cannabis can treat collectively. In theory, cannabis can be used in tangent (or in some instances, replace entirely) with current medications used for patients that are at end of life and help provide comfort.
In the state of Illinois, individual symptoms are not approved for medical cannabis but individual diseases are (Verilife 2019). Many of the diseases on the approved list are life-long diseases, and some of them are diseases that will cause the patient to die eventually. The symptoms that comprise some of these diseases overlap; for example, HIV/AIDS and migraines, two unrelated diseases that are both included on this list, can have nausea and vomiting as a symptom. Even though these two diseases are not related to
each other and manifest differently, there are groups of symptoms that both diseases can express that are the same. End of life symptoms are very generalized in that death affects every part of the body; some of these symptoms can be due to the medications being administered to the patient to treat the disease itself, or they treat the symptoms caused by the disease. End of life is associated with pain, anxiety, agitation, nausea, vomiting, constipation, and anorexia, among others: all of which are symptoms of which cannabis can provide relief. It logically follows that if cannabis can be used to ease the symptoms of diseases approved by the state of Illinois for treatment, and some of these symptoms are shared with end of life, then using cannabis as an end of life comfort medication would be effective.
In addition to its broad treatment spectrum, cannabis is better tolerated than pharmaceuticals on the market. Sativex, a synthetic THC and CBD combination oromucosal spray, has been found to be well-tolerated in patients with MS and neuropathic pain when used in combination with other medications (Barnes 2006). This may be due to the rarity of a patient having an adverse reaction to cannabis. Additionally, patients may find that naturally occurring THC and CBD combinations may be even more tolerated and/or effective in the treatment of their symptoms. For example, a patient intolerant of Ativan may not be able
to take other benzodiazepines either, which limits the treatment options available for the patient. In hospice care, it may make more sense for the patient to take an anti-anxiety medication with sedating properties. Cannabis would be an optimal treatment option in this case, as it has the treatment profile optimal for the patient as well as being more tolerable.
Because of its legal status, cannabis may not be available to terminal patients regardless of their disease. In states and countries where medical cannabis is available, practitioners have found that cannabis can provide relief for many symptoms that patients can experience. It is generally accepted that cannabis should not be used on its own or as a first-line treatment for palliative care (Peat 2010), but treatment can be optimized when cannabis is used together with standard comfort medications. Pain medications, particularly opioids, are
one of the most common groups of drugs used in terminal illness. Patients in hospice care tend to take high doses of various different opioids which can lead to premature death caused by overdose. Studies have shown that cannabis use is associated with a decrease in the use of opioids (Boehnke et al. 2016), and cannabis can be used to help patients with opioid addictions. With a decreased need for opioids, terminal patients can be prescribed fewer pain meds, which not only reduces the risk for the patient, but also reduces drug diversion and opioid-associated death of family members who may use the terminal patient’s medicines.
In conclusion, cannabis is an ideal treatment option for palliative care in that it is generally well-tolerated by most users, it is effective in treating symptoms that occur at end of life, and it is relatively safer to use than standard treatment options like opioids for pain. In the state of Illinois, the approved condition list includes diseases of which some patients will die such as Parkinson’s and Alzheimer’s. Since they are already using cannabis as part of their palliative care, it makes sense that they would continue this treatment as they are actively dying. As cannabis use becomes more generally accepted by the public, it is likely that the success of cannabis treatment in diseases like these may yield more research into the use of cannabis in the terminally ill.