Many of us have had an encounter with hospice at some point in our life. Whether it be a loved one or a friend the philosophy of hospice is dignity at the end of life, education regarding the dying process, spiritual support and living the last days with as much quality as possible. Any medical therapies administered in hospice are focused on symptom management of advanced life-limiting illness and are not curative.
Medical cannabis has been legalized at the state level for the treatment of many of the same symptoms we traditionally see in hospice with fewer side effects. Additionally, cannabis can be administered in various ways eliminating the need to smoke or inhale the medication. The challenge is federally we are encouraged to continue the current practice and treat with an arsenal of medications versus adopting the use of medical cannabis to promote comfort and quality at the end of life.
Upon admission to hospice, it is common for a “hospice comfort kit” to be shipped to the patient’s home. The most basic of hospice comfort kits contain medications for pain, anxiety, nausea, insomnia, and breathing issues that arise during the last days of life. In addition, the side effects of these medications can exacerbate other symptoms, such as constipation, requiring additional medications. The medications typically found in a hospice comfort kit are as follows:
- Morphine liquid — used to treat pain and shortness of breath
- Ativan (Lorazepam) — can be used to treat anxiety, nausea or insomnia
- Haldol (Haloperidol) — can treat agitation and terminal restlessness
- Compazine (prochlorperazine) — in either pill or rectal suppository form, this medication is used to treat nausea and vomiting
- Phenergan (promethazine) — an anti-emetic like Compazine, Phenergan is used to treat nausea and vomiting
- Dulcolax suppositories (Bisacodyl) — rectal suppositories to treat constipation
- Senna — a plant-based laxative used to treat constipation
- Fleet Enema — used to treat constipation if other treatments are ineffective
- Atropine drops — used to treat wet respirations, also known as the death rattle
Other medications may be included depending on the hospice diagnosis. For example, a patient with a who is at risk for seizures may have valium suppositories included in the comfort kit. Hospice covers the cost of these medications during a patient’s time on service and it is a significant expense.
Practitioners are hesitant to accept cannabis as an addition or alternative to these treatments for fear of losing their federal funding or being targeted. If a family or patient chooses to utilize cannabis while in hospice it is an out of pocket cost and typically without guidance from the medical community. Medical professionals have an opportunity to utilize a more natural solution with less known side effects but federally their hands are tied.
The lack of research regarding medical cannabis is a real problem in the eyes of the medical community. Protocols around dosing and administration along with the consistency of components within the cannabis products being consumed is a concern. While this may be a viable argument, cannabis has been officially legalized for medicinal use at the state level and the medical community’s involvement is needed.
Cannabis research is being done in other countries and there are some medical professionals in the United States that are taking on the risk and working with cannabis in hospice and palliative care with success. However, most patients will continue to lack access to this guidance and oversight despite legalization.
Medical cannabis cards are being issued, which means it is here and will be utilized in hospice and other care settings. Healthcare’s slow adoption of cannabis as a treatment impacts the safety and efficacy of its use. As medical experts, our lack of knowledge and involvement in the use of medical cannabis ultimately puts our practice and patients at risk regardless of care setting.
Darcey Trescone, RN, BSN is a Healthcare Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms. To learn more visit www.TresconeConsulting.com. She can also be reached at darcey@tresconeconsulting.com.
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