By Dr Janelle Trees, BSC (HONS), MBBS (HONS), FRACGP
If someone you love or care for has needed palliative care, or you are facing the prospect of using palliative yourself, you’ll know that any medicine that improves quality of life is to be welcomed with open arms.
Palliative care is medical care for a client with a life-limiting disease who has exhausted realistic options for a cure of their disease; or was diagnosed with a disease or at a stage of disease where there is no option for a cure. It’s a branch of medicine which is unique for its commitment to the physical, emotional and spiritual comfort of the patient.
People who have no experience of palliative care tend to think that it is only for patients who are actively dying. This is not so. At that stage, opioid medications—made from the poppy—are the drugs of choice. It might take half a day or seven days for a person to die.
In the meantime—and that might be weeks or months or years—the goal is to live comfortably and as well as possible with the disease. Many people feel that cannabis pain management is helpful at this stage of life.
Cannabis has been shown by many small studies to be helpful for nausea, anxiety, pain relief (including some kinds of nerve pain), relaxing muscle spasm and insomnia. Anecdotal evidence—the stories our patients tell us—can also persuade some doctors that medicinal marijuana is worth a try for relief of symptoms associated with terminal illness. The effects of medical marijuana may be milder than those of pharmaceutical drugs, but there may also be less side effects. And you could be one of those people who has a great positive response to the medicine without adverse effects. Every person has an individual response to medicine and this is particularly true when working with marijuana and pain.
Let’s have a quick survey of some of the available evidence.
There was a gold-standard, medium sized study conducted over 28 European centres in 2010. Cancer patients whose pain was inadequately controlled using regular opiate-based medicines, compared placebo with cannabis-based pain relief and found that twice as many patients using a THC:CBD extract experienced significantly better (more than 30%) pain relief. Interestingly, that study found that THC-based medicine alone was not significantly effective.
In a different, US-based study, some patients needing to take opioid-type medication, like morphine, codeine, tramadol or oxycodone, found that they were able to reduce the amount of other medication they needed to take when using cannabis-based pain management.
Medicinal marijuana in Australia is not just for pain management. It has other benefits. Because it seems to regulate the bowel—there are receptors for cannabinoids in the bowel—medical marijuana may be particularly helpful for patients who suffer with constipation, the major problem palliative patients have with opiates.
In another small, preliminary study of ten patients with dementia, THC alone was safe and helpful for patients with dementia, reducing delusions, agitation, aggression and irritability. Not surprisingly, caregiver stress improved too.
The right dose of medical cannabis can make you feel better psychologically. The right formula can ease anxiety.
The end of life sometimes brings emotional issues or unresolved conflicts to a crescendo. In the context of supportive psychological counselling, medical cannabis might help. It has been used with benefit for some patients with Post-Traumatic Stress Disorder. Sometimes people are emotionally traumatised by years of living with their disease, having endured painful and difficult treatments and intense isolation.
If you or someone you care about is under palliative care, it is worth discussing the possibility of using medicinal marijuana with your GP.