Home Healthcare and Cannabis

RxLeaf August 1, 2020 0 comments

What is Home Healthcare?

The rise of home healthcare services means more freedom for medical cannabis patients. Ryan’s Law made cannabis available in Californian hospitals, but most federally funded institutions still do not allow cannabis on the premises. Moreover, this includes long term care facilities, hospitals, and hospice centers. Accordingly, medical cannabis consumers want better control over their care choices and personal well-being. Lack of access may contribute to the projected rise in demand for home healthcare

Without a doubt, in North America, the population growing most rapidly is older adults (seniors). And as the Baby Boomers age, the healthcare industry is shifting. The shift is away from an expensive, government-funded, institutional model, to one of healthcare in the patient’s home

Moreover, home healthcare changes depending on where you live. For example, in The U.S., home healthcare’s cost is generally lower than a hospital stay. But in Canada, the cost may be mostly out-of-pocket – rather than covered by their medical system. Canada’s medical system is tax-funded, and while some of this supports home care costs, there are other costs it does not cover. Regardless, whichever side of the border seniors live, they should expect additional home healthcare costs.

These may include:

  • Physiotherapy
  • Personal care
  • Cost of a home care nurse
  • Transportation
  • Retrofitting the home for mobility and safety.

home healthcare nurse talking to older adult patient

The Definition of Home Healthcare

Broadly, home healthcare refers to medical services received in a personal residence instead of a healthcare facility or community care center. This can entail anything from a few visits to long term palliative support. The government regulates home care service, although it does so differently from federally supported facilities, like hospitals

Home healthcare is often a bridge from hospital care to independent living. However, there are some long term care circumstances, such as the case of dementia. Finally, there are palliative care options that help patients die at home. 

What to Expect From Home Care Services

Patients will be able to access a wide range of medical services. These include a home care nurse who may correspondingly:

  • Dispense medicine.
  • Change wound dressings.
  • Counsel the patient about nutrition.
  • Provide personal care services, including bathing, changing, or transportation.
  • Help the patient use medical equipment and supplies (oxygen equipment, wheelchair, or a walker).

Accordingly, a doctor or other qualified healthcare professional will prescribe or recommend these services for the patient.

Professionals That Help with Home Healthcare

A number of individuals make up a home healthcare team. These are the people who are regularly involved:

The Home Care Nurse

Basically, nurses oversee the overall health plan for each patient. Accordingly, nurses assess and monitor the patient’s overall health by recording vital signs, dispensing medications, caring for wounds and ostomies, changing catheters, managing ventilators, or monitoring diabetic symptoms. 

The Physiotherapist

This person provides hands-on treatment to improve mobility, strength, and body functions. As a result, physiotherapy functions as both rehabilitation and preventative care. 

A Dietician

Educates patients on how to assemble a diet promoting overall wellbeing. Moreover, nutrition professionals understand the science of food and nutrition, and how it impacts health. 

Social Worker

A social worker can help families and individual patients access mental health services, financial assistance, and help manage complex situations. This individual can also connect the patient (and their family) to community resources. 

Personal Support Worker (PSW)

Provides assistance with everyday tasks. These people are very important in helping patients safely stay at home. Services include: lifting and transferring, toileting, bathing, escorting to events, light housekeeping, medication reminders, laundry, meal preparation, and feeding.

Older Adult woman having her hair combed by psw

Government Regulation of Home Healthcare

Canada

Canada saw the writing on the wall with its aging population. As a result, in 2017, it decided to make home care services more widely available. All in all, Canada created a ten-year federal, provincial, and territorial agreement to invest $11 billion of federal money toward improving home healthcare and mental health services. In exchange, the provinces and territories have agreed to fulfill a common set of objectives toward improving home healthcare and mental health services. 

The Canada Health Act does not insure home care services in the same way it does hospital stays and doctor’s office visits. Accordingly, there are transfer payments made to individual provinces to support home healthcare initiatives, but it is then largely regulated by provincial and municipal governments. This makes coverage inconsistent and can mean long wait times. Additionally, there are no uniform standards of care and no federal oversight. Accordingly, a mixture of provincial and private funding supports home support services.

The United States

Research published in the Journal of General Internal Medicine (2018)1)Levine, D.M., Ouchi, K., Blanchfield, B. et al. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. Journal of General Internal Medicine 33, 729–736 (2018). https://doi.org/10.1007/s11606-018-4307-z found that it would cost approximately fifty two per cent less to treat in-home compared to in-hospital. Further, in 2019 it was projected that the annual growth rate for spending on home care is almost seven percent. These easily surpass the growth in nursing home care and community care centers. 

In 2017, the American federal government created a set of rules under which home health agencies can participate in Medicare and Medicaid programs. These apply to every state, effectively creating a uniform standard of care for patients engaging in home care services

nurse hand over elder hand on walker

Can a Home Care Nurse Give Cannabis Medicine?

Medical cannabis has been federally legal in Canada since 2001. Subsequently, recreational cannabis was approved for adult use in 2018. As a result, Canadians have wide access to cannabis flower plus edibles and concentrates. Canadian adults are allowed to possess 150 grams of dried cannabis, but they are still prohibited from consuming in some areas. Designated areas must be used, and since many long term care facilities are privately owned, those companies are able to make their own rules and regulations around cannabis. As a result, older adults in Canada might not be able to access the medicine of choice in a nursing home

In America, similar restrictions and allowances exist, but these can be more difficult to navigate, as there are state-by-state differences. Alarmingly, many older adults looking into long term care options report that it is extremely difficult to find a nursing home or community care center that allows the consumption of cannabis, even in legal states.

Private Care Centers Have Their Own Rules

Similarly, in both countries, home care services are privately owned and home care nurses may be forbidden from dispensing medical cannabis in the home. While federal laws say nurse practitioners and home care nurses can dispense medical cannabis, there are restrictions in terms of where2)“Access to Cannabis for Medical Purposes: What Every Nurse Should Know”. Canadian Nurses Protective Society. 2018. Online: shorturl.at/ixzP2. and there may be additional restrictions depending on the policies of individual, privately owned companies.

Overall, however, home care patients have better control over how they medicate. They are allowed to consume cannabis in all forms within their own home (dependent on legalities in their region). This is particularly valuable for end-of-life care. During this transition, patients need good pain management. Another important concern for dying patients is to avoid getting locked into a drugged haze. Many people want to be aware and present with loved ones when the time comes to die. Cannabis is a good option and staying in a private residence with a home healthcare worker gives the patient and the family more control. 

Why Choose Home Healthcare?

The best healthcare for older adults needs many considerations. These are some of the advantages and disadvantages of choosing home healthcare.

Advantages to Home Care Services

Home Healthcare Cost is Lower

In America, the cost of home health services will depend on the patient’s provider. However, in general, home care is far more affordable than a lengthy hospital stay; Or than living in a long term care center. In fact, a 2018 study3)Levine, D.M., Ouchi, K., Blanchfield, B. et al. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. Journal of General Internal Medicine 33, 729–736 (2018). https://doi.org/10.1007/s11606-018-4307-z on palliative care indicated that home healthcare can cost an average of 52 percent less than a hospital stay.

For Canadians, many parts of home care are covered by the Healthcare Act. Things that are not covered are often filled by volunteer organizations or come at a reasonable cost. Personal care, for example, is $20 to $30 per hour. It is far cheaper to hire a personal care worker than to live in a long term care home. Additionally, Canadians do not have the option to stay in hospital for long term recovery when those needs can be met with other options.

home care nurse with arm around elder female

Home Hospital Care Means Lower Secondary Infection Rates and Shorter Recovery

Hospitals can be dangerous due to exposure to secondary infections, including those from antibiotic resistant bacteria. The World Health Organization estimates that seven out of one hundred hospital visits will result in a secondary infection. Patients who stay at home are not exposed to these dangers that can be life threatening to frail older adults.

A pilot study was recently published in the Annals of Internal Medicine (2018).4)Levine DM, Ouchi K, Blanchfield B, et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020;172(2):77-85. doi:10.7326/M19-0600 Dr. Levine and a team of investigators at Brigham and Women’s Hospital completed a home care and hospital comparison. They wanted to prove that patients could receive acute level hospital care in their own homes. The results say home care gives a twenty percent decrease in health care costs. Further, home hospital care reduces readmission rates and shortens recovery time.

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Greater Control Over Care

Family can be more involved in home care. This keeps the recovery setting intimate and familiar. Overall, family engagement boosts mental wellness for the patient. Additionally, home care medical cannabis patients do not need to worry about not being able to get their medicine

Home healthcare also allows patients to have increased access to physical activity. This can improve strength and reduce recovery time. It also gives more privacy in toileting and bathing, even while using the help of a personal service worker.

older woman using walker outside

Independence and Mental Wellness

When patients have independence of choice and setting, overall mental wellbeing is better. Healing in a place where one has no disruption in access to family, community, or routine is a key element to preventing depression and loneliness. These factors can have significant negative impact on health for older adults in a nursing home or hospital.

A study published in Social Psychological and Personality Science (2013), investigated levels of reported loneliness and the role cannabis may play in helping. The subjects were 5,031 Americans who reported on personal levels of loneliness. They also indicated cannabis consumption levels and feelings of self worth.5)Deckman, T., DeWall, C. N., Way, B., Gilman, R., & Richman, S. (2014). “Can Marijuana Reduce Social Pain?” Social Psychological and Personality Science, 5(2), 131–139. https://doi.org/10.1177/1948550613488949

Researchers found a correlation between increased loneliness and decreased feelings of low self-worth. They also found that cannabis consumption helped. In fact, the final report states cannabis, “buffered the lonely from both negative self-worth and poor mental health.”

Faster Recovery in Home Care

When one has to stay inside a single room or a hospital bed, there can be a decline in physical fitness that impacts healing and overall wellness. A pilot study,6)Levine DM, Ouchi K, Blanchfield B, et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020;172(2):77-85. doi:10.7326/M19-0600 published in the Annals of Internal Medicine (2020), demonstrated that those who stayed home have better outcomes. This includes a 70 percent lower rate of re-admission.

The patient and the home care nurse have a better read on recovery with their one-on-one relationship. There is a consistency of care because the patient only sees one care provider who oversees all aspects of healing. 

Disadvantages of Home Care Services

Cost to Retrofit the Home

Retrofitting the house to accommodate medical needs can be very expensive. Patients may need extra railings or a special walk-in bath, for example. Some patients may even need to rent or purchase a hospital-style bed that has the ability to elevate different parts of the body (and includes safety rails). 

Private insurance, Medicare, or Medicaid may cover some of the costs for these items, but patients generally have to pay some out-of-pocket. 

Patients Can Experience Loneliness at Home

The patient may experience loneliness if there is a lack of family and community connection. This can have significant negative impact on mental wellbeing.  As such, one of the benefits of long term care facilities are the organized activities that older adults can participate in. A lack of social activities can lead to mental and physical decline.

In a study published in Brain Research Bulletin (2017), researchers looked at the consequence of loneliness in the rodent model. Mice we subjected to social isolation stress (SIS) to induce loneliness. After only a short period, researchers found that the lonely mice struggled to complete even the most simple tasks. These were tasks that they were previously able to complete.7)Haj-Mirzaian A, Amini-Khoei H, Haj-Mirzaian A, et al. Activation of cannabinoid receptors elicits antidepressant-like effects in a mouse model of social isolation stress. Brain Res Bull. 2017;130:200-210. doi:10.1016/j.brainresbull.2017.01.018

As it is unethical to create loneliness in human subjects, patient reports are what is relied upon. These indicate the same, that loneliness quickly leads to depression. This then causes an inability to complete tasks and/or lack of interest in activities that were previously sought.

Absence of Emergency Resources

The patient has access to trained medical personnel while living in a long term care facility. These professionals will be quick to respond and assess the need for emergency services. That doesn’t happen in the home setting, and therefore it is an increased risk to frail patients. 

How to get Home Healthcare

There are different qualifications that must be met, largely dependent on which region you live within. In Canada, a recommendation from a physician will connect patients to a local home care coordinator. In the United States, one must also have a recommendation from a doctor. Providers will have a list of approved home healthcare options.

In America, there are specific qualifications that allow the patient to access home healthcare through Medicare or Medicaid. Additionally, Medicare will cover the full cost of home healthcare for sixty days.

For both countries, only certain cases (e.g. those under sixty-five years of age) and services will be fully covered. Private insurance will often cover the gaps. But, your home healthcare coordinator will be able to help with access and navigating the qualifying conditions.

What Happens After a Doctor Recommends Home Healthcare?

First, a home care coordinator will call and gather information about patient needs through an ‘intake interview’. The hospital will complete this connection if the patient is being discharged into home care. 

Following the call, a home visit will take place. Someone from the home care company will visit the home to assess additional service needs. These include retrofitting the home, and occupational therapy.

Then the home care coordinator will connect the patient with all of the required services. These may include a home care nurse, or a dietician, and even a personal service worker.

Finally, services will start and a schedule will be set that works for the patient and his or her family. If the patient is not happy with the care, every company has a reporting procedure. It is the responsibility of the home care coordinator to review that procedure with during the intake interview.

senior man opens door for home nurse arrival

Can Everyone Get Home Healthcare?

For many, the biggest factor in not getting home healthcare is simply the availability of service. In North America, there is more need for home care than availability.8)St. Michael’s Hospital. “Insufficient home care the biggest challenge to overcome after release from hospital.” ScienceDaily. ScienceDaily, 6 January 2020. <www.sciencedaily.com/releases/2020/01/200106103453.htm>. This forces people to either go without care or to use another service, such as a nursing home.

Unfortunately, a lack of home care nursing and personal service workers isn’t the only limiting factor. Lack of insurance and ineligibility are the next most-common barriers to home healthcare access. 

When people can’t access the care of choice, they experience worse outcomes. People who lack home healthcare, and need it, show an increased use of other services. This creates a trickle down effect of burden on the whole system. Alarmingly, this population shows an increased admission into emergency wards and nursing homes. As a result, they lose independence and experience a reduced emotional well being.

The Cost of Home Healthcare

Almost half of home healthcare patients are considered to be older adults (65+). For many, it is an alternative to a nursing home. A small portion of this population will engage for palliative care. 

Is Home Healthcare Covered in Canada?

Almost two-thirds of all Canadian residents have insurance, either privately purchased or through their workplace. For those that qualify, there is also funding through the provincial healthcare plan. 

In Canada, there is both public and private funding for home healthcare. Those relying on public access will be able to use an assigned government-contracted agency that is paid for by the government. Alternatively, the patient can engage a home care agency for which they will be given a monthly ‘stipend’ from the government. This is called ‘self-managed’ care and it should be noted that not all aspects will be fully covered in this case. Home healthcare is provincially regulated in Canada.

What Home Health Care does Medicare Pay For?

Older adults needing home healthcare service in America are covered under Medicare. Patients pay a portion of the costs through deductibles. Since this is a federal program, it is the same across the United States. Medicaid may fill in some gaps for lower income older adults. Qualifications vary from state to state. 

It is important to recognize that direct medical expenses (medication, equipment rental, nursing) are not the only costs for home healthcare. There are other in-home services needed when you are recovering from a health crisis or in palliative care. These include, but are not limited to, babysitting, transportation, meal preparation, and cleaning. 

calculator displaying the term tax help

Are Home Healthcare Expenses Tax Deductible?

In Canada, private home healthcare expenses may be tax deductible. A personal care worker hired to help with toileting, dressing, cleaning, transfer and lifting, transportation is considered a tax deductible medical expense under Canadian tax law.

In America, three criteria must be met for the expense to qualify as tax deductible: (1) patient is chronically ill; (2) care is prescribed by a health care professional, such as a doctor or nurse practitioner; (3) the type of care must be approved by the IRS as a tax deductible medical expense. 

The Burden of Sickness is More Than Money

Nearly every sickness has a ripple effect, causing a loss of time or money to the patient or their family. The ‘economic burden of illness’ is estimated to be in the billions of dollars. This includes direct medical expenses, as well as time off work and lost productivity.

A big portion of this burden is the cost that comes with a decline in mental health for caregivers. Many families that engage home care services optimistically believe that they can fill in many of the gaps of personal care. This can become quickly exhausting and sometimes dangerous. For example, dementia patients may need 24-hour care because they wander off in the night or endanger their lives by leaving on stove burners. Additionally, lifting and transferring an older adult in recovery from a health emergency puts them as risk of further harm. The physical and mental strain for family caregivers, plus the hours away from work, make this decision to help (and not hire) one that requires serious thought. 

Cannabis and Home Healthcare

More Older Adults Try Cannabis

The number of older adults trying medical cannabis has risen a lot in the last few years. Moreover, it may be the fastest growing population to embrace cannabis medicine. Additionally, expects predict that by 2060, those over sixty five years of age will make up 24% of the Canada’s population. And for the U.S,. 23% of the population. That’s a lot of potential cannabis consumers.

But, why are older adults trying cannabis? Most are encouraged by stories from peers or the results of pre-clinical and phase one human trials. Cannabis has helped many older adults reduce, not only the amount of medication they take, but also the number of prescriptions

Does Cannabis Help Older Adults Stay Healthy?

Early studies indicate that cannabis may be an important tool for healing in older adults. The evidence suggests that through multiple mechanisms, it may help make them less frail. Interestingly, a new study published in the Journal of the American Geriatric Society (2019), found that two significant risks for frailty are prescription drugs for pain or sleep. When these are combined, the risk is increased. Studies show cannabis can help manage both insomnia and pain. It is also a suitable medicine for many home healthcare needs.9)Cil, G., Park, J. and Bergen, A.W. (2019), Self‐Reported Prescription Drug Use for Pain and for Sleep and Incident Frailty. J Am Geriatr Soc, 67: 2474-2481. doi:10.1111/jgs.16214

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Further, replacing one or more prescription medications with a naturally occurring substance, such as cannabis, can have a positive effect on the health of older adults. Some of the most promising examples of how cannabis may help are as follows:

older male adult sleeping on a yellow couch

Cannabis for Sleep Disturbances

While it may be true that THC is best known for its intoxicating abilities, research suggests that THC can also lead to sleepiness. It may achieve this by interacting with CB1 and CB2 receptors. Accordingly, research suggests that CB1 receptors, in particular, have an impact on THC’s sleep-inducing potential. Moreover, one animal study, published in the International Journal of Molecular Medicine (2017), shows that light/dark cycles change the number of CB1 receptors in the body. This subsequently suggests that agonists like THC and the body-made cannabinoid anandamide could subsequently play a key role in sleep regulation.10)Bazwinsky-Wutschke, I., Zipprich, A., & Dehghani, F. (2017). Daytime-Dependent Changes of Cannabinoid Receptor Type 1 and Type 2 Expression in Rat Liver. International journal of molecular sciences, 18(9), 1844. https://doi.org/10.3390/ijms18091844

CBD May Improve Sleep Disorders

Additionally, a widely cited Current Psychiatry literature review indicates that CBD finally holds promise as a treatment for sleep disorders. Subsequently, REM Sleep Behavior Disorder patients, and Excessive Daytime Sleepiness patients may have some hope. But, there is an even greater body of evidence to suggest that CBD has potential to fight other disorders that negatively impact sleep routines. Namely, insomnia caused by anxiety. 11)Babson KA, Sottile J, Morabito D. Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr Psychiatry Rep. 2017;19(4):23. doi:10.1007/s11920-017-0775-9

One study, published in the Permanent Journal (2019), investigated the relationship of CBD and neuropsychiatric disorders. It was found that CBD was able to reduce the anxiety scores of seventy nine percent of patients. Sleep scores also improved in sixty six percent of patients. Finally, it suggested that CBD is able to activate the serotonin receptor, 5-HT1A. And studies suggest that increased serotonin expression improves sleep onset.12)Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. doi:10.7812/TPP/18-041

Chronic Wound Care at Home

Chronic wounds can be a source of embarrassment and physical pain for home healthcare patients. Caring for a wound can seem a very intimate act and this is difficult for some. Importantly, wound care makes up for a high percentage of home care protocols.

But, open wounds that refuse to heal can result in serious infection. These situations drastically increase hospitalization, overall healthcare costs, and can even increase chance of death. Chronic wound problems are more frequent as the population ages and as chronic health conditions, such as diabetes and obesity, become more common.

Research already indicates that cannabis holds potential as an analgesic, anti-inflammatory, and antibacterial medicine. All of these properties could help in the treatment and healing of chronic wounds. Cannabis also acts as an effective pain management tool. 

CBD and Treatment of Inflammation in Wounds

CBD has become a popular option for people who want to reduce pain caused by inflammation. But, what does the science say? Researchers believe that CBD primarily works through receptors called TPRV1 and GPR55 receptor (or CB3 receptor). Additionally, CBD may also play a role in stopping endogenous cannabinoids (anandamide, for instance) from breaking down. The build up of these endocannabinoids can reduce pain signalling.

Interestingly, some studies indicate that CBD is up to twenty times more effective at treating inflammatory pain than NSAIDS. These include this one, published in Therapeutics and Clinical Risk Management (2008). Further, CBD may be safer than NSAIDS. It does not increase the risk of stomach ulcers.13)Russo E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and clinical risk management, 4(1), 245–259. https://doi.org/10.2147/tcrm.s1928

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Post-op Pain and Infection Management

It is well known that post-surgical wounds can become easily infected. A 2001 study discovered that even after clean and sterile surgery, the rate of wound infection is eight percent.14)Noman TA, Raja’a YA, Assiraji HM, Assofi YA. Rate of wound infection after clean surgery. Saudi Med J. 2001;22(1):58-60. This risk increases substantially for elderly patients, with a 25 percent infection rate after sterile surgery (for patients above sixty years old). This risk must be carefully managed after being discharged to the home healthcare setting.

Wound Healing and Cannabis

A 2010 study, published in Forensic Sciences Research, looked at wound healing mice.15)Li, N., Du, Q., Bai, R., & Sun, J. (2018). Vitality and wound-age estimation in forensic pathology: review and future prospects. Forensic sciences research, 5(1), 15–24. https://doi.org/10.1080/20961790.2018.1445441 Rodents are the model for pre-clinical research as they have many metabolic and receptor similarities to humans.

It found that wounds held increased CB1 receptors and this excess peaked at day five following injury, with a return to baseline at fourteen days post-injury. Additionally, the endogenous cannabinoid, anandamide, was also present in high amounts. While it is not yet clear exactly what anandamide and CB1-receptors are doing to increase the rate of healing, it is clear these are involved. Extrapolating data, THC may work as an analogue for anandamide. This means that, in addition to helping patients deal with post op pain, cannabis may also help speed healing by targeting CB1 receptors at the wound site and backing up the healing work of anandamide. Faster healing means less risk of secondary infection or other complications.

Addiction and Opioid Use Post Surgery

As for pain management, a study, published in JAMA Surgery (2017), shows that generally, most opioid users become addicted after a minor surgical procedure. Unfortunately, opioids are generally the go-to prescription for post op pain management. But over and over, research suggests that their prescription may not be appropriate. Cannabis is able to effectively manage most types of pain, including that of minor surgical procedures.16)Brummett CM, Waljee JF, Goesling J, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504

Cannabis works with the endocannabinoid system to reduce inflammation, and therefore decrease pain. A study published in PLoS One in 2010, found that opioids may not work as well as we think in reducing pain.17)Alkaitis, M. S., Solorzano, C., Landry, R. P., Piomelli, D., DeLeo, J. A., & Romero-Sandoval, E. A. (2010). Evidence for a role of endocannabinoids, astrocytes and p38 phosphorylation in the resolution of postoperative pain. PloS one, 5(5), e10891. https://doi.org/10.1371/journal.pone.0010891 In fact, two to ten percent of those who have taken prescription opioids post-op go on to experience chronic pain conditions. Further, cannabis does not lead to overdose and it does not result in increased risk of pain sensitivity. 

The Role of Cannabis in Palliative Care

A study published in the European Journal of Internal Medicine (2018), looked at the general effectiveness of cannabis for palliative care. At the time of the conclusion of the study, 60 percent of participants were using cannabis to treat cancer symptoms.18)Bar-Lev Schleider L, Mechoulam R, Lederman V, et al. Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. Eur J Intern Med. 2018;49:37-43. doi:10.1016/j.ejim.2018.01.023

Most patients in the palliative category were using cannabis to alleviate pain. These cancer patients reported their pain to to be eight to ten on a scale that ends at ten (being the highest). After six months of cannabis treatment, less than five percent of patients continued to report high levels of pain.

Cannabis treatment for palliative care seems to be a safe, effective, and well-tolerated option for patients to cope with the malignancy related symptoms. Initially, less than twenty percent of the patients in this group reported they expected a good quality of life. Impressively, after six months of treatment, about seventy percent of patients indicated a significant improvement in quality of life.

Interestingly, 36 percent of patients taking the opioids stopped taking these altogether after the six months of treatment with the medical cannabis. It is very probable that the mechanism by which medical cannabis affects the common issues with cancer patients is very similar to the one by which opioids affect the same condition.

arm with wasted muscle

Can Cannabis Help Muscle Wasting?

Cachexia (muscle wasting) is a common problem for patients in long term care, whether that be in a home care situation or a facility. This condition is caused by increased inflammation along with a change in the energy and protein balance in the body.

Pharmaceutical medications that aim to increase weight mass and improve anabolism are the usual treatment for cachexia. Doctors may also prescribe physiotherapy to build muscle and dietary supplements, NSAIDs, beta-2 adrenergic agonists, and corticosteroids. Unfortunately, success rates are slim. When cachexia strikes, patients are often already approaching a terminal phase.

CBG May Help Build Muscle Mass

Science is just learning about how cannabinoid signaling is involved in developing muscle mass. Specifically, research is finding that the down-regulation of the CB1 receptor affects the growth of skeletal muscle. It’s possible that CBD can prevent binding to the CB1 receptor, which is how this cannabinoid may be used to treat muscle wasting in neurodegenerative disorders like MS.

But, there is also another cannabinoid that may impact muscle development even more, and that’s cannabigerol (CBG). We’re still learning about this little-known cannabinoid, but what is known so far is that it helps reduce inflammation and could potentially contribute to muscle growth by encouraging protein synthesis.

A study in the British Journal of Pharmacology (2010), found that CBG can activate α2-adrenoceptors, along with blocking CB1.19)Cascio, M. G., Gauson, L. A., Stevenson, L. A., Ross, R. A., & Pertwee, R. G. (2010). Evidence that the plant cannabinoid cannabigerol is a highly potent alpha2-adrenoceptor agonist and moderately potent 5HT1A receptor antagonist. British journal of pharmacology, 159(1), 129–141. https://doi.org/10.1111/j.1476-5381.2009.00515.x These qualities are what make CBG another candidate as a possible aid in muscle growth and recovery.

Home care nurse pro cannabis

How Much Do Home Care Nurses Know About Medical Cannabis?

A survey of Canadian nurses, published in Cannabis and Cannabinoid Research (2018), found that serious gaps in education and understanding were evident in the nursing profession.20)Balneaves, Lynda G. et al. (2018.) A National Needs Assessment of Canadian Nurse Practitioners Regarding Cannabis for Therapeutic Purposes.  Cannabis and Cannabinoid Research. Dec 2018. 66-73. http://doi.org/10.1089/can.2018.0002 In fact, nearly 50 percent said they felt uncomfortable authorizing a patient to consume medical cannabis through the ACMPR. 

This is troubling. Basically, nurses play a vital role in advancing the safe and effective consumption of cannabis, and especially cannabis for medicinal purposes. When dealing with an elderly population of home healthcare recipients, who may be less experienced with cannabis and have greater health risks overall, the pivotal role that nurses play can’t be over stated.  When nurses aren’t sure of the best dosage guidelines, how can they advise new patients or calm fears about taking too much?

Individual hospitals or healthcare facilities can get around the lack of nursing regulations by posting their own cannabis guidelines in regard to how, when, and why to use it as treatment. And, overall, there needs to be signifiant improvement in cannabis education for home care nurses in North America.

Some Final Notes on Home Healthcare  

Seniors want access to cannabis medicine, and they certainly want freedom of choice for healthcare. The two are inherently intwined and must grow together. The rise of cannabis nurses’ groups finally provides hope that many are planning adequately for the future, but it may not be enough. 

Basically, the best way to ensure the long-term viability of home healthcare is to make sure it meets patient needs. And this most definitely includes evidence-based cannabis education. 

References   [ + ]

1, 3. Levine, D.M., Ouchi, K., Blanchfield, B. et al. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. Journal of General Internal Medicine 33, 729–736 (2018). https://doi.org/10.1007/s11606-018-4307-z
2. “Access to Cannabis for Medical Purposes: What Every Nurse Should Know”. Canadian Nurses Protective Society. 2018. Online: shorturl.at/ixzP2.
4, 6. Levine DM, Ouchi K, Blanchfield B, et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020;172(2):77-85. doi:10.7326/M19-0600
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