Research is growing around how certain substances such as psychedelics and cannabis can aid in treating pain, anxiety, depression, trauma, post-traumatic stress disorder (PTSD), grief, migraines and other medical conditions.
Medical cannabis can also be beneficial in symptom management for cancer patients, according to recent research. For instance, certain compounds in the cannabis plant hold potential therapeutic benefits for patients by increasing appetite when experiencing chemotherapy-induced nausea and vomiting, researchers found.
Researchers have identified a number of clinical benefits, including reduction of anxiety, depression and improved acceptance of mortality, according to a 2019 literature review in the journal Current Oncology.
The biggest challenge is understanding how cannabis laws in particular apply to pain and symptom management in end-of-life care, according to Jennifer Moore Ballentine, CEO of the Coalition for Compassionate Care of California. Providers toeing lines between local and national laws, she said.
“What hospices need to be aware of is that it’s not just the big picture, but also the little picture,” Ballentine told Hospice News. “It’s a challenge to navigate state rules with federal laws versus the hospice or palliative individual’s best interests and the end-of-life care plan.”
If restrictions eased around controlled substances, then hospice providers might be more open to their use, according to Dr. Karl Steinberg, medical director for Hospice by the Sea.
In other words, they would be in less fear of regulators taking disciplinary actions against clinicians for prescribing substances that might be beneficial for pain and symptom management as agreed upon by a physician and their patient’s goals of care, Steinberg said. He is also CEO of California-based Stone Mountain Medical Associates, Inc. and serves on the national advisory board for the California State University Shiley Institute for Palliative Care.
However, researchers should pay more attention to potential risks in ongoing research, according to Ladybird Morgan, a registered nurse and social worker for the palliative care company Mettle Health and co-founder of The Humane Prison Hospice Project.
“I don’t see a lot of focus on the possible harms. There are definitely just basic physiological cardiac risks. MDMA and some other psychedelics can really increase your blood pressure and heart rate,” Morgan told Hospice News. “That can potentially have a negative impact. It’s not the norm, but it’s certainly there. In terms of mental stability, you will require a lot of integration afterward, meaning that it’s not necessarily going to spiral you out into a crash, but the potential for increased depression is there, higher risks of suicidality.”
The key is to educate clinical staff on what is and is not permissible within their service regions, Dr. Michael D. Fratkin, California-based palliative care specialist, stated. This means paying attention to local rules and regulations tied to controlled substances, as well as understanding which of these drugs is permitted in hospice care, he added.
Ketamine is among the federally controlled substances legal for medical use in the United States, and one that is gaining momentum in a range of health uses – including in hospice and palliative medicine, according to Fratkin.
“There’s an enormous amount of activity of using ketamine for its antidepressant effects in palliative patients, but also for its adjuvant pain benefits,” he said. “Over the last five to seven years, ketamine has become more valuable and useful in transformative care for people seeking psychedelic and psychotherapeutic support. More centers are emerging that provide it in end-of-life care and as a catalyst in facing depression, anxiety, complex grief and physical and emotional pain in the world of hospice and palliative. It’s actually pretty cheap compared to some other drugs in the space.”