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Hospice care provides basic medical care and other services for those in the final stages of life. Research has shown cannabis can help manage the symptoms commonly faced by those under hospice care, including pain.
Overview of Hospice Care
Hospice care is the assistance given to those whose illnesses cannot be cured and who are in the last stages of life. Hospice programs offer medical services, emotional support and spiritual resources with the goal of keeping a person comfortable. Services can be provided in a person’s own home or in a nursing home or hospice center.
Hospice care provides an array of services, including counseling and social support, meal preparation, errand running, bathing services, medical supplies, and basic medical care. The program eases the burden of care for both the patient and family members. Typically, a family member services as the primary caregiver, but most care is provided by a team made up of doctors, nurses, social workers, aides, counselors, clergy, and therapists. The hospice team develops an individually-tailored care plan.
According to the National Hospice and Palliative Care Organization, an estimated 1.6 to 1.7 million patients in the United States received hospice services in 2014. Over 40 percent of hospice patients in 2014 were aged 85 years or older.
When a person is under hospice care, the focus of medical care is on pain and symptom control, rather than attempting to cure. Medications and basic services are provided to manage symptoms and access to a member of the hospice team is available 24 hours a day to help the person under care pass away pain-free and comfortably.
Findings: Effects of Cannabis on Hospice Care
Cannabis can help manage the pain, anxiety, spasms, nausea, and appetite and sleep problems that commonly affect those under hospice care.
Research has established cannabis effective for reducing pain. The major cannabinoids found in cannabis, including tetrahydrocannabinol (THC), have demonstrated efficacy at lowering pain levels that had previously shown refractory to traditional pain-relieving methods9. Studies have also shown medical cannabis offers significant improvements in muscle spasticity, thereby offering relief1.
Those under hospice care can struggle with the desire to eat, but studies have found that THC can significantly stimulate appetite6. Cannabinoids have shown efficacy and regulating nausea and vomiting8. THC has also shown to improve the quality and duration of sleep, allowing patients to fall asleep faster and wake up fewer times throughout the night2,3.
States That Have Approved Medical Marijuana for Hospice Care
Three states — Montana, New Mexico, and Vermont — have approved medical marijuana specifically for those under hospice care. Several other states will consider allowing hospice care patients access to medical marijuana, provided its recommended by a physician. These states include California, Connecticut, Massachusetts, Nevada, Oregon, Rhode Island and Washington.
In Utah, lawmakers are currently working on launching a “right to try” medical marijuana program for terminally ill patients with less than six months to live. As of July 2018, officials were still crafting rules for the program.
Additionally, nearly all states with comprehensive medical marijuana legislation allow cannabis for the treatment of pain. Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia have approved cannabis for the treatment of “chronic pain.” The states of Nevada, New Hampshire, North Dakota, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”
Seventeen states have approved medical marijuana for the treatment of spasms. These states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Oregon, Rhode Island and Washington.
Also, 19 states have approved medical marijuana specifically for the treatment of nausea. These states include: Alaska, Arizona, Arkansas, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, and Washington.
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Recent Studies on Cannabis’ Effect on Hospice Care
- Borgelt, L.M., Franson, K.L., Nussbaum, A.M., and Wang, G.S. (2013, February). The pharmacologic and clinical effects of medical cannabis. Pharmacotherapy, 33(2), 195-209. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/phar.1187/full.
- Cousens, K., and DiMascio, A. (1973). (−)δ9 THC as an hypnotic. Psychopharmacologia, 33, 355-364. Retrieved from http://link.springer.com/article/10.1007/BF00437513.
- Gorelick, D.A., Goodwin, R.S., Schwilke, E., Schroeder, J.R., Schwope, D.M., Kelly, D.L., Ortemann-Renon, C., Bonnett, D., and Huestis, M.A. (2013, September-October). Around-the-clock oral THC effects on sleep in male chronic daily cannabis smokers. The American Journal on Addictions, 22(5), 510-514. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537525/.
- Hospice care. (2016, February 6). MedlinePlus. Retrieved from https://medlineplus.gov/ency/patientinstructions/000467.htm.
- Hospice Care – Topic Overview. (n.d.). WebMD. Retrieved from http://www.webmd.com/balance/tc/hospice-care-topic-overview#1.
- Jatoi, A., Windschitl, H.E., Loprinzi, C.L., Sloan, J.A., Dakhil, SR., Mailliard, J.A., Pundaleeka, S., Kardinal, C.G., Fitch, T.R., Krook, J.E., Novotny, P.J., and Christensen, B. (2002). Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. Journal of Clinical Oncology, 20(2), 567-73. Retrieved from http://ascopubs.org/doi/abs/10.1200/jco.2002.20.2.567?journalCode=jco.
- NHPCO’s Facts and Figures – Hospice Care in America: 2015 Edition. (2015). National Hospice and Palliative Care Organization. Retrieved from https://www.nhpco.org/sites/default/files/public/quality/Pediatric_Facts-Figures.pdf.
- Parker, L.A., Mechoulam, R., Schlievert, C., Abbott, L., Fudge, M.L., and Burton, P. (2003, March). Effects of cannabinoids on lithium-induced conditioned rejection reactions in a rat model of nausea. Psychopharmacology, 166(2), 156-62. Retrieved from http://link.springer.com/article/10.1007/s00213-002-1329-2.
- Ware, M.A., Wang, T., Shapiro, S., and Collet, J.P. (2015, September 15). Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). The Journal of Pain. Retrieved from http://www.jpain.org/article/S1526-5900(15)00837-8/fulltext.