Cannabis and Palliative Care
Cannabis History
Cannabis has been used as medicine in palliative care since ancient times in India. William O’Shaughnessy, the 19th century physician who explored the use of cannabis medicines in India, described his palliative care of a patient with end-stage rabies using cannabis extract. Also, Dr. Sunil Aggawal wrote recently of a similar reduction in suffering achieved by using cannabis medicines with his late-stage cancer patients.
Cannabis has been used as medicine in palliative care since ancient times in India. William O’Shaughnessy, the 19th century physician who explored the use of cannabis medicines in India, described his palliative care of a patient with end-stage rabies using cannabis extract. Also, Dr. Sunil Aggawal wrote recently of a similar reduction in suffering achieved by using cannabis medicines with his late-stage cancer patients.
“A third area of potential benefit is enhancement of the
senses. Cannabis has long been used as an enhancer, heightening sensory
perceptions and awareness. That effect can have a role in optimizing primal
sensorial delights, or as Dr. B.J. Miller puts it, “tending to dignity by way
of the senses”13,
which could include increased appreciation of music, tastes, scents, or other
aesthetic pleasures. It could also help to heighten awareness of
moment-to-moment presence by allowing an individual to “stop and smell the
roses,” a state of being that is all the more critical when one’s days are
numbered. Such a state could also be facilitated by growing one’s own medicine
through Cannabis gardening, which could serve as a form of horticultural
therapy. Finally, increased awareness of the moment, coupled with the increased
introspection and meditation that cannabis can catalyze and for which it has
been used in various spiritual traditions, might lead to spiritual growth and
development, which can play a vital role in helping to create “a good death.””
Cannabis may be an effective treatment for the wellbeing of patients in Palliative Care.
Cannabis offers benefits of healing, or aid with many conditions and diseases, within the Endocannabinoid System. Cannabis may help Palliative Care Patients withAnxiety
Atherosclerosis
Arthritis
Cancer
Digestive Issues
Depression
Diabetes
Fibromyalgia
Glaucoma
Insomnia
Migraines
Multiple Sclerosis
Nausea
Pain
and so much more!
Hospice patients may understandably be depressed over an
uncertain future and anxious for the well-being of those they’re leaving
behind. Isolation and loneliness are common, as is fear surrounding pain, loss
of independence, and the ability to care for oneself.
Cannabis Education (Cannabinology)
The Endocannabinoid System regulates diverse functions such as memory, digestion, motor function, immune response and inflammation, appetite, pain, blood pressure, bone growth, and the protection of neural tissues, among others. The Endocannabinoid System take up cannabinoids and distributes them to receptors throughout your body. The two primary subtypes of cannabinoid receptors in the endocannabinoid system are CB1 and CB2. These receptors are distributed throughout the central nervous system, immune system, and within many other tissues including the brain, gastrointestinal system, reproductive and urinary tract, spleen, endocrine system, heart, and circulatory system.
Cannabinoids can be found naturally in your body. Some people are deficient in natural cannabinoids. Recent research has shown that a possible "Endocannabinoid Deficiency" may be the reason for many diseases and other conditions. Plant cannabinoids found in Cannabis are called Phytocannabinoids, such as THC, CBD, CBG, CBC, CBN, and more. The two most popular and most researched cannabinoids are THC (known to cause some psychoactivity) and CBD (non-psychoactive). CBD (cannabidiol) can help ease distress, while THC is more
effective for pain relief, for reducing the amount of opioids needed to treat,
and increasing the quality of sleep. Medicines with CBD and THC can lessen the psychoactivity feeling from THC.
It can be a disturbing experience for a cannabis-naive person to use a cannabis product with a high level of THC. Paranoia and anxiety are some side-effects that occur with high THC products. Products with combined ratio of THC and CBD are recommended. Cannabis products can interfere with specific prescription medications. A trusted physician can advise whether there are potential interactions between cannabis and current medications.
Cannabis Research:It can be a disturbing experience for a cannabis-naive person to use a cannabis product with a high level of THC. Paranoia and anxiety are some side-effects that occur with high THC products. Products with combined ratio of THC and CBD are recommended. Cannabis products can interfere with specific prescription medications. A trusted physician can advise whether there are potential interactions between cannabis and current medications.
There is a great amount of observational data and research that supports
the utility of cannabis in palliative care.
WAMM, the esteemed Santa Cruz medical cannabis collective,
has specialized in cannabis palliative care with a range of terminal illnesses
and reported remarkable success for over two decades.
CBD is quite effective in animal models for reducing
stress-related anxiety.
The ability of CBD to reduce stress-related anxiety
manifests in its ability to support neurogenesis (the production of new nerves)
within the hippocampus, a process linked to plasticity.
“Studies
conducted with hippocampal progenitor cells in culture showed that CBD promotes
progenitor proliferation and cell cycle progression and mimics the
proliferative effect of CB1 and CB2 cannabinoid receptor activation. Moreover, antagonists of
these two receptors or endocannabinoid depletion by fatty acid amide hydrolase
overexpression prevented CBD-induced cell proliferation. These findings support
that the anxiolytic effect of chronic CBD administration in stressed mice
depends on its proneurogenic action in the adult hippocampus by facilitating
endocannabinoid-mediated signalling.”
The endocannabinoid system regulates the creation,
consolidation, and extinguishing of emotional memories associated with stress.
“It became increasingly clear, however, that cannabinoid CB1
receptors are also abundantly expressed in the basolateral amygdala (BLA) and
other limbic regions where they modulate emotional arousal effects on memory.
Enhancing cannabinoids signaling using exogenous CB1 receptor agonists prevent
the effects of acute stress on emotional memory. I propose a model suggesting
that the ameliorating effects of exogenously administered cannabinoids on
emotional learning after acute stress are mediated by the decrease in the
activity of the HPA axis via GABAergic mechanisms in the amygdala.”
Cannabis Dosing Guidelines:
For those in Palliative care, when it comes to cannabis dosing, START LOW AND GO SLOW.
For those in Palliative care, when it comes to cannabis dosing, START LOW AND GO SLOW.
Please find a trusted Medical Professional who understands Cannabis and the Endocannabinoid System and can help the patient ease into cannabis medicine during end of life care.
It is recommended that 15mg of CBD taken twice daily can help. Or if they feel like trying THC they may take medicines with a ratio of THC and CBD to help ease pain and anxiety during the day, or THC alone (best for sleep when taken orally before bed). When CBD is taken with THC it has the ability to reduce THC psychoactive effects, and when these two main cannabinoids are combined, they create a trifecta of ease and wellness for the patient. 2.5 - 5 mg of CBD and THC may be a good starting place for patients, just to see how it makes them feel after 45 minutes. Titrate ONLY when necessary.
It is recommended that 15mg of CBD taken twice daily can help. Or if they feel like trying THC they may take medicines with a ratio of THC and CBD to help ease pain and anxiety during the day, or THC alone (best for sleep when taken orally before bed). When CBD is taken with THC it has the ability to reduce THC psychoactive effects, and when these two main cannabinoids are combined, they create a trifecta of ease and wellness for the patient. 2.5 - 5 mg of CBD and THC may be a good starting place for patients, just to see how it makes them feel after 45 minutes. Titrate ONLY when necessary.
There are many other types of Cannabinoids, such as CBG, CBN, CBC and Terpenes, such as limonene, myrcene, or beta-caryophyllene that may help with various conditions being treated. The only way to find out which variety works best for the patient, you would want to look up the condition being treated and try those Cannabinoid and Terpene recommendations. However, each patient is unique in which cannabis medicine, and dosing, works best for them, some trial and error may be needed.
For those caring for the terminally ill, CBD use throughout
the day may provide relief from the pressures experienced, allowing these
patients to achieve more restorative sleep and regain their balance more
quickly during and after the loss of a loved one. Information on Cannabis in Palliative Care was found in the amazing book Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes, Andrew Weil M.D., and Jack McCue M.D.
this book can be found Here.
If you work in hospice and Palliative Care and are interested in learning more about how cannabis may help your patients, we highly recommend the book Chronic Relief: A Guide to Cannabis for the Terminally and Chronically Ill. $20 on Amazon
"Chronic Relief: A Guide to Cannabis for the Terminally and Chronically Ill bridges the gap between the vast amounts of cannabis science and practical application for patients.
The book translates medical science into layman’s terms in a way that patients and their caregivers can understand and use to decide if cannabis is a fit for them, how to choose intake methods, understand risks and harm reduction strategies, and where to start in terms of establishing an effective dose. Where science does not exist, it provides the best possible anecdotal information compiled from experts and patients alike."
For more Research on Cannabis and Palliative Care:
Cannabis Can Be an Option in Palliative Care
"Cannabis is an effective and safe option to help patients cope with malignancy related symptoms, such as nausea, vomiting, sleep disorders, pain, anxiety, and depression. In a scenario where a physician often prescribes one medication for each symptom, cannabis becomes a desirable therapeutic option, as a comprehensive treatment. These are the conclusions of a study, published online March 5 on the European Journal of Internal Medicine. The analysis gives a representation of cannabis users for different types of cancers, analysing the benefits over an observational study in Israel lasted 6 months. 2.960 patients took part on the analysis, but only 1.742 had survived through the entire period: 60% of them achieved treatment success, according to Victor Novack, MD, PhD, director of the Cannabis Clinical Research Center and Research Authority, Soroka University Medical Center, Beersheba, Israel."
Cannabis in Palliative Care: current challenges and practical recommendations
"As this class of therapeutic agents are likely to play a major role in palliative medicine in the near future, clinicians would benefit from familiarizing themselves with Cannabis Based Medicine and we can expect that patients and their caregivers will appreciate receiving support in their search for safe and effective therapeutic alternatives."
Use of Cannabinoids in Cancer Care: Palliative Care
"Palliation of Spiritual and Existential Suffering
Moving now into more spiritual and existential suffering, concerns that are certainly ascendant in end-of-life care, cannabis medicine approaches afford some unique potential benefits known more through traditional medicinal and cultural uses and borne out in anecdotal reports from patients and caregivers. Consider euphoria, aversive memory extinction, sensorium enhancement, and spiritual insight catalysis. A mild euphoria or sense of well-being, if brought about through use of cannabinoid botanical products, could very well play an important therapeutic role for patients faced with the despair of a terminal malady and the loss of function that normally accompanies it."
Therapeutic Uses of Cannabis
