For those facing death, cannabis may give the option of dying at home in a coherent state.
For patients in severe pain confronting their final days, the choice of dying at home is becoming increasingly popular. But is cannabis enough for end-of-life care?
The biggest concern for terminal patients in deciding whether to choose hospice care is experiencing severe pain that cannot be treated at home, according to research published in Home Healthcare Now (2020). This is especially true for patients suffering from cancer and other progressive diseases that cause excruciating pain.
While many people who nearing the end prefer to choose dying at home in a familiar space with family nearby, the reality of facing unbearable pain in their final days makes many opt for the choice of a less-comfortable healthcare facility.
But with medicinal cannabis more readily available, perhaps dying patients may have a better option than choosing between excruciating pain and the comforts of home. And cannabis can play a vital role in that process.
How Widespread is Home Healthcare?
The demand for hospice services has exploded recently, as people live longer and become more educated about chronic diseases. And, for the older generations at least, people have more money to deal with end-of-life decisions.
In both Canada and the United States, more people than ever are choosing to receive healthcare services in their own homes. In America, 4.5 million people became clients of one of the country’s 12,000 plus home healthcare providers in 2016 alone. Since then, the number has only increased.
A significant portion of home healthcare services go to terminally ill patients.
The Preference for Dying at Home
Among terminally ill patients, the preference for dying at home is clear. A systematic review published in BMC Palliative Care (2013), 1)Gomes, B. (2013). Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliative Care. 2013 Feb 15;12:7. doi: 10.1186/1472-684X-12-7.found that seventy-five percent of terminal patients prefer end of life care to happen at home rather than in a facility.
This held true even as terminal illnesses progressed to the painful, end stages. This signals a massive and abrupt change in attitudes toward death in the modern era. While some people still wish to fight the inevitable at all costs with close access to hospital equipment, many more are preferring to face death on their own terms and in their own homes.
The shift in attitude requires changes in patient care, especially when it comes to patients’ chief complaint, pain. Patients who opt for home care during their final days do not want to be in pain, nor do they want to be in a drug-induced coma from opioid painkillers.
Instead, many terminal patients seek palliative care in order to be present with their families in their final days. That’s the spirit behind Ryan’s Law, which ensures that terminally ill patients have access to medical cannabis in California healthcare facilities.
Can Cannabis Help?
While Ryan’s Law helps patients access cannabis in hospitals, there are still concerns for patients at home who want access to the same level of service. Some have even been kicked out of their rental units or public housing for taking doctor-prescribed medicine. Additionally, hospice patients want better access and guidance on consuming cannabis to manage the pain associated with terminal illness.
Research by the Gerontological Society of America shows that it can. Cannabis has been specifically shown to treat chronic pain as well as nausea, sleep conditions, and mood in patients undergoing end-of-life care. According to the research, eighty percent of terminal older adults said they found significant relief after consuming cannabis medicine.
American Patients Have Trouble Accessing Cannabis
The biggest concern to stem from the research — which was published in the Public Policy & Aging Report (2019) 2)Croker, J. Alton, and Sanders, Sara. (2019). The Role of Cannabis in Improving Pain and Symptom Management in End-of-Life Care. Public Policy & Aging Report. Volume 29, Issue 3, 2019, Pages 95–100, https://doi.org/10.1093/ppar/prz014 — was the disconnect that home hospice patients and their doctors can experience over including cannabis treatment in their care.
While there’s a growing demand for, and acceptance of, cannabis for end of life care, there are still legal problems. A study published in the Journal of Palliative Medicine (2019), 3)Costantino, R.C. et al. (2019). A Survey of Hospice Professionals Regarding Medical Cannabis Practices. Journal of Palliative Medicine. 2019 Oct;22(10):1208-1212. doi: 10.1089/jpm.2018.0535. found the overwhelming majority (ninety-one percent) of hospice staffers believe that medical cannabis is beneficial for their patients. And that includes nurses, administrators, and physicians.
Yet, because many home healthcare patients receive money from federal programs like Medicare, it can become a tough legal spot. Unbelievable, some workers who are paid through Medicare, are not legally allowed to answer questions or authorize cannabis consumption — even when it could do a world of good to ease this transition.
Benefits of Cannabis for Dying at Home
Cannabis not only treats many disease symptoms afflicting people at the sunset of their lives, but it also has added benefits that make it unique.
For instance, cannabis can ease pain while boosting mood — an often-overlooked problem in patients dying at home. The mild euphoria cannabis brings can help dying patients deal with depressive thoughts and provide a kind of spiritual healing that pain pills don’t bring.
Additionally, cannabis can increase appetite, avoid constipation that comes from prescription painkillers, and ease mood and stress. Many terminal patients feel like a burden to their loved ones, but cannabis can help that perspective, by inducing a state of euphoria that allows the patient to enjoy moments and feel more accepting about their dying experience.
Is Cannabis Enough for Patients Dying at Home?
Cannabis can do many things for terminal patients, but it’s not a panacea. Consuming only cannabis may help a percentage of terminal patients, but end of life care pain management often requires more.
However, cannabis can help terminally ill patients cut back on the number of medicines they take. Many will use a combination of opioids and cannabis to reduce opioid consumption. The benefits for this practice, to the patient, are numerous. Namely, a greater awareness and ability to communicate with loved ones up until the final transition.
Interestingly, a study published in the journal Drug and Alcohol Dependence (2015), 4)Degenhardt, Louisa et al. (2015). Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study. Drug and Alcohol Dependence. Volume 147, 144-150: https://doi.org/10.1016/j.drugalcdep.2014.11.031 found that when cannabis is taken with prescription drugs, such as opioids, the treatment of both becomes more effective than either substance alone.
It’s clear that cannabis can help patients dying at home to end their lives more comfortably and with less pain. That alone should be celebrated, encouraged, and legal.
References [ + ]
|1.||↑||Gomes, B. (2013). Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliative Care. 2013 Feb 15;12:7. doi: 10.1186/1472-684X-12-7.|
|2.||↑||Croker, J. Alton, and Sanders, Sara. (2019). The Role of Cannabis in Improving Pain and Symptom Management in End-of-Life Care. Public Policy & Aging Report. Volume 29, Issue 3, 2019, Pages 95–100, https://doi.org/10.1093/ppar/prz014|
|3.||↑||Costantino, R.C. et al. (2019). A Survey of Hospice Professionals Regarding Medical Cannabis Practices. Journal of Palliative Medicine. 2019 Oct;22(10):1208-1212. doi: 10.1089/jpm.2018.0535.|
|4.||↑||Degenhardt, Louisa et al. (2015). Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study. Drug and Alcohol Dependence. Volume 147, 144-150: https://doi.org/10.1016/j.drugalcdep.2014.11.031|