Researchers: Educate Hospice Staff on Medical Cannabis

Hospice clinicians, particularly those who perform home visits, need more education about how to address medical cannabis, authors of a recent Journal of Palliative Medicine study told Hospice News. With a rising number of states legalizing medical cannabis, hospice clinicians are increasingly likely to encounter the substance in patient homes.

A team of pharmacist and nurse researchers from the University of Maryland, Enclara Pharmacia and Turn-Key Health surveyed 310 hospice clinicians and administrators in 40 states regarding their views on medical cannabis in hospice care, finding that more than 91% of respondents supported its use. About 60% of those respondents were nurses. 

Hospice physicians rarely recommend or certify patients for medical cannabis, the study found. When cannabis conversations do occur they are most frequently initiated by the patient. About 84% of the survey respondents said they believed health care professionals would benefit from standardized protocols for managing medical cannabis.

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“When it comes to medical cannabis, nurses often have as many questions as patients do,” said University of Maryland Pharmacist Ryan Costantino, co-author of the study. “They ask questions such as, ‘If I go into a room where a patient is smoking cannabis, will I get high?’ ‘Will I smell like cannabis when I arrive at the next patient’s home?’ Hospices should be developing policies and educating staff on what to do when they encounter cannabis in patient homes.” 

More than 2.6 million patients use legal medical cannabis in the United States, according to the Marijuana Policy Project, a Washington-based advocacy group. Cannabis remains illegal at the federal level and is not covered under the Medicare Hospice Benefit.

Hospices do not provide cannabis to patients even in states where it is legal, but they can be reasonably certain that at least some of their patients are using the substance, even in jurisdictions that haven’t legalized the drug.

“There are definitely hospice patients that use medical cannabis. People have used cannabis for many years even before it became legal in some areas. The question is whether their doctors know they are using it,” said Lynn McPherson, also a pharmacist with University of Maryland and a study co-author. “Legal or illegal, cannabis is a medication, and clinicians need to know what medications their patients are taking. Like any other medication, cannabis poses some risks, including potential adverse drug interactions.”

Though medical cannabis has shown some promise in ameliorating symptoms often experienced by hospice patients, including pain, nausea, anxiety, lack of appetite and others, according to the American Cancer Society, Costantino and McPherson said they agree that more research is needed regarding the drug’s safety, particularly in regards to long term use.