Common challenges at the end of life include; pain (physical and emotional), nausea/vomiting, anorexia, cachexia, dyspnea, anxiety/agitation, depression, feelings of helplessness/hopelessness/despair, loss of functional ability, issues surrounding loss of dignity, anticipatory grief, fears, unresolved familial conflicts, and preparing patients as well as their family members for the dying process.

 

Cannabinoids have been shown to interact with the Endocannabinoid System (ECS), a system of physiology present in all vertebrates which promotes balance in the body at the cellular level. CB1 and CB2 cannabinoid receptors are plentifully dispersed throughout the body. When this physiological system is out of balance, supplementing with plant based cannabinoids have been shown to act on the brain, the organs and the all systems in the body, providing a safe and effective alternative in caring for dying patients.

 

Working as a hospice medical social worker, I came to discover that many of our dying people have not only had to become criminals themselves, but often had to rely on the criminal activity of family members – husbands, wives, mothers, fathers, sons, daughters, grandchildren – to obtain cannabis at one of the most vulnerable points in the life of a family, when someone is dying. This knowledge led me to the Florida legislature to advocate for safe and legal access to medical cannabis, removing the “criminal” element from the equation.

 

In 2016, the Florida legislature expanded the “Right to Try” law to include the use of full spectrum, whole plant cannabis by patients who have received a prognosis of 1 year or less to live. This new law also serves to decriminalize the use of cannabis by qualifying patients. Nobody should fear arrest or prosecution for using plant based preparations shown to have both a high level of safety and efficacy in relieving symptoms prevalent at the end of life, as well as promoting a sense of well-being.

 

Clearly, effectively caring for patients and families at the end of life life can be complex and requires a multi-faceted approach, this involves much more than medication management. With terminal illness being one of the qualifying conditions in Florida, it is essential that hospice and palliative care teams are trained in the ECS and cannabis as a therapeutic agent.

 

There is a great deal of misunderstanding related to cannabis as medicine, including the various routes of administrations. From my experience, when people hear cannabis, the most common image that comes to mind is that of a person smoking, an image regularly associated with illicit behavior, steeped in shame and guilt. It is my contention that shame and guilt have no place in the healing relationship or the healing environment.

 

What is not commonly understood is that there are a variety of methods to administer cannabinoid medicines, including but not limited to: vaporization, ingestion, sublingual oils/tinctures/sprays, capsules as well as topical preparations. Smoking cannabis for symptom control and/or treatment purposes, continues to be prohibited under Florida law.

 

As healthcare professionals we have a moral and ethical responsibility to seek out, research and understand new treatment modalities which will empower patients in making informed decisions and participate in the therapeutic relationship.