As more states legalize medical marijuana, hospice and palliative care professionals work to steer the complex regulatory structure around a substance that is still illegal at the federal level. While a hospice is unlikely to prescribe medical cannabis, many patients have access to the drug from other sources. Providers are looking for more education and awareness on how to manage their patients’ marijuana use.
According to data from the Medical Marijuana Policy Project, more than 5.4 million federally licensed patients use medical cannabis in the United States. Nearly 87% of Americans are in favor of using medical marijuana as a treatment option for terminally ill patients, and 58% said they were “strongly supportive” according to a survey by the MorseLife Health System Hospice and Palliative Care.
Federal lawmakers have pursued laws to legalize cannabis at the national level, so far without success. The House passed the Marijuana Opportunity Reinvestment and Expungement Act of 2020, or the MORE Act of 2020, in December late 2020, but died on committee. The legislature reintroduced the bill in May, and a Senate version is in the works. President Biden rejects the measure.
Some in the medical field have wondered if it could be a potential substitute for opioids from some patients. Barriers to wider use, according to Jennifer Moore Ballentine, executive director of the Shelly Institute for Palliative Care at California State University, include a lack of understanding of the substance’s risks and benefits and limited research into potential drug interactions.
“Since it is a controlled substance, there has been no opportunity to study it and really find out what it is good for. There’s really no hard evidence to hold on to, it’s mostly anecdotal research that shows it’s good for pain, appetite, and sleep, ”said Moore Ballentine.
The authors of a 2019 study by the Journal of Palliative Medicine postulated that hospice practitioners would benefit from more education about medical cannabis use and a better understanding of its effectiveness and guidelines for use. A case study published in SAGE Open showed that a Pennsylvania patient was withdrawn from opioids (on which she had become dependent) due to the use of medical marijuana. Although these results were positive, this case involved a single patient and lagged behind a large-scale study or clinical trial. The case study authors called for more research into the effects of medicinal cannabis.
Concerns about potential regulatory action by federal agencies are another barrier to the use of medical cannabis in hospice and palliative care, according to Moore Ballentine. The U.S. Centers for Medicare and Medicaid Services (CMS) have focused on curbing dollars spent on the hospice as occupancy rises nationwide and stepped up enforcement to control costs. Medicare hospice spending increases by about $ 1 billion annually.
“There is strong oversight of hospices by CMS and other federal regulators for all sorts of reasons. If [cannabis use] the reason there might be real ramifications for the hospice. There is some element of fear, and mostly just ignorance, because there is still no really robust clinical evidence of how best to use or prescribe cannabis or its derivatives in hospice care. “
A growing number of states are legalizing and taking steps to regulate medical cannabis. A recent report showed that according to the National Conference of State Legislatives, 36 states and four territories allow the use of medicinal cannabis products.
According to Moore Ballentine, state and federal guidelines need to align to standardize the use of medicinal cannabis with benefits for and against.
“[Marijuana] needs to be legalized nationwide and there needs to be standardization about the purity and dosage of the product, just like we have for everything else, ”Moore Ballentine told Hospice News. “All the risks are linked to the fact that it will no longer be the cheap and cheerful alternative to opioids. It’s another expensive, controlled, prescribed drug, so there are pros and cons. “