Herodotus, an ancient Greek Historian, wrote about using cannabis as a “grieving ritual” in preparation for purification preceding the funeral of a loved one. As described in ancient texts, cannabis was a botanical “medicine”, used to help individuals move past traumatic experiences and suffering, when a beloved member of the Community died. With these “ancient roots”, it should come as no surprise that in modern times, we’re rediscovering the benefits cannabis affords patients and families at the end of life.

Common challenges at the end of life include: Pain, both physical and emotional, nausea, vomiting, anorexia (lack or loss of appetite), depression, dyspnea (shortness of breath/difficulty breathing), cachexia (wasting of the body), anxiety, agitation, unresolved familial conflicts/issues, feelings of helplessness, hopelessness and despair, anticipatory grief, preparing for the dying process, and the biggest, from my perspective … fear – fear of pain, fear of loss of control, of the loss of autonomy, of mental and functional abilities, fear related to the loss of dignity, of leaving loved ones behind and the fear of death itself.
 
An Italian researcher by the name of Vincenzo DiMarzo tells us that cannabinoids serve 5 essential functions; they help us eat, sleep, relax, protect and forget … all of which are essential in increasing quality of life.
 
Cannabinoids have been shown to enhance fear extinction in humans, this alone can impact the dying experience immensely. People report their use of cannabis helps them accept things that were difficult to accept before, such as their impending death. Cannabis can also enhance adjunctive therapies commonly utilized at the end of life, such as progressive relaxation, guided imagery, music therapy, and art therapy, to name a few.
 
Hospice and palliative care teams develop a plan of care that meets each person’s individual needs for pain management and symptom control. They work together, focusing on all of a person’s needs; physical, emotional, and spiritual. The goal is to help keep a person as pain-free as possible, with loved ones nearby. Effective management requires that the team be thoroughly familiar with the recommended interventions and medications. Frequent re-evaluation of a patient is critical.
 
A variety of opioids and other drugs are commonly utilized to palliate symptoms in hospice and palliative care, oftentimes additional medications are needed to combat the side effects of the primary medication. It’s quite common for end of life patients to be on a dozen combination of drugs, all aimed at providing relief and increasing quality of life. Sadly, many times we see these drugs doing more harm than good. Additionally, some of these medications produce “side effects” that resemble symptoms hospice care teams work so hard to relieve. Symptoms such as; tremors, shakiness, nervousness, headaches, restlessness, irritability, muscle aches/pains, throat or nasal irritation, rapid heart rate (tachycardia), and feelings of fluttering or pounding heart (palpitations).
 
The most commonly reported side effects of cannabis include: dizziness (this can be mitigated through the use of cbd in combination with thc), sedation (which can be a welcomed side effect, especially in those who struggle to get a restful night’s sleep), dry mouth and euphoria. Merriam-Webster defines euphoria as a state of well being or elation and the Cambridge English dictionary defines it as a feeling of extreme happiness or confidence. As someone who’s worked with dying people and their families for many years, I see euphoria as a welcomed “side effect” as one approaches death.
 
The National Academy of Medicine reports that there is strong scientific evidence indicating cannabis is an incredibly effective treatment for chronic pain, something end of life patients regularly struggle with. We know that cannabis helps people get a more restful night’s sleep, and that disturbed sleeping patterns very often accompany chronic pain. The pleiotropic properties of cannabis make it a perfect option for the chronic pain/sleep disturbance challenge. One medication targeting multiple issues as opposed to multiple medications for each condition requiring symptom relief. This naturally leads to a reduction in the use of multiple medications.
 
Cannabinoids can be used safely in conjunction with opioids. Additionally, when they are used together, lower doses of opioids are needed to achieve the desired outcome than when opioids are used alone. Prescribing lower levels of opioids directly translates into a lower likelihood of accidental overdose and increased patient safety.
 
Cannabis holds amazing therapeutic properties making it a natural choice for people nearing the end of life. It can help with symptoms such as pain, weight loss, nausea, insomnia, neuropathy, depression, and even the fear of death itself.
 
To achieve excellence in hospice and palliative care, the goal needs to be to manage a person’s symptoms while still enhancing the quality of life each individual still has ahead of them, whether that is 1 year, 1 month, 1 day or 1 hour. When a person is able to eat, sleep, relax, protect and forget, this can make all the difference in their world.
 
As healthcare providers we need to be seeking out knowledge of new and emerging therapies, it is both our moral and ethical responsibility to the patients we serve. Cannabis can be another “tool” in the end of life “toolbox”. Opening these types of conversations is essential in providing excellent care to suffering people.