Page 5 - Top Ten Tips Palliative Care Clinicians Should Know About Medical Cannabis

PALLIATIVE CARE CLINICIANS AND MEDICAL CANNABIS 5

this study; however, many states declare that the presence of 4. Bergamaschi MM, Queiroz RHC, Chagas MHN, et al.:
either THC or a metabolite defines a driver as impaired, Cannabidiol reduces the anxiety induced by simulated
which will influence the recommendations clinicians make public speaking in treatment-naive social phobia patients.
regarding the medical use of THC-containing products. 58 Neuropsychopharmacology 2011;36:1219–1226.
5. Leweke FM, Piomelli D, Pahlisch F, et al.: Cannabidiol en-
Conclusion hances anandamide signaling and alleviates psychotic symp-
toms of schizophrenia. Transl Psychiatry 2012;2:e95–e97.
In a policy regarding medical cannabis, the American 6. National Academies of Sciences, Engineering, and Medi-
Medical Association stated that further trials are necessary to cine, Health and Medicine Division, Board on Population
assess the safety and efficacy of medical cannabis, that it not Health and Public Health Practice, Committee on the
only opposes the legalization of medical cannabis but also Health Effects of Marijuana: An Evidence Review and
supports legislation that provides immunity to physicians Research Agenda. The Health Effects of Cannabis and
who certify that a patient has an approved medical condition Cannabinoids: The Current State of Evidence and Re-
or recommend medical cannabis in accordance with their commendations for Research 2017. doi:10.17226/24625.
state’s laws. 59 Such policies provide neither guidance re- 7. VA and Marijuana—What Veterans Need to Know:
garding the application of current evidence around medical www.publichealth.va.gov/marijuana.asp (Last accessed
cannabis to clinical practice in states where it is legal nor is November 24, 2018).
Downloaded by Gothenburg University Library from www.liebertpub.com at 01/15/19. For personal use only.
there advice for those clinicians who are practicing in envi- 8. Gill LL: New hope for pain relief? Consumer Rep 2018;83:
ronments in which patients will take the substance illicitly, 44–49.
regardless of clinician recommendation. Other professional 9. Whiting PF, Wolff RF, Deshpande S, et al.: Cannabinoids
organizations such as National Hospice and Palliative Care for medical use: A systematic review and meta-analysis.
JAMA 2015;313:2456–2473.
Organization and the American Academy of Hospice and 10. Keyhani S, Steigerwald S, Ishida J, et al.: Risks and ben-
Palliative Care provide educational opportunities regarding
efits of marijuana use. Ann Intern Med 2018;169:282–290.
medical cannabis but take no official position on its legali-
doi:10.7326/M18-0810.
zation or use. Because the legalization, promotion, and use of
11. Nielsen S, Sabioni P, Trigo JM, et al.: Opioid-sparing effect
medical cannabis is far outpacing research, even those cli-
of cannabinoids: A systematic review and meta-analysis.
nicians who do not recommend medical cannabis must still Neuropsychopharmacology 2017;289:859.
remain informed regarding its purported and substantiated 12. Williamson EM, Evans FJ: Cannabinoids in clinical prac-
indications and its adverse effects. Even in areas where the tice. Drugs 2000;60:1303–1314.
evidence for medical cannabis is stronger, several barriers 13. Cerda ´ M, Wall M, Keyes KM, et al.: Medical marijuana
limit its use, including lack of insurance coverage and federal laws in 50 states: Investigating the relationship between
scheduling. Patients who want medical cannabis must pay for state legalization of medical marijuana and marijuana use,
it out of pocket, and these costs vary from state to state. 60 abuse and dependence. Drug Alcohol Depend 2012;120:
Future studies aim to investigate the role and efficacy of 22–27.
medical cannabis in PC and hospice patients, as well as the 14. Lev-Ran S, Roerecke M, Le Foll B, et al.: The association
general epidemiology of use of medical cannabis in different between cannabis use and depression: A systematic review
conditions. 61,62 This is particularly important as little is known and meta-analysis of longitudinal studies. Psychol Med
about cannabis use in hospice populations at least in part be- 2013;44:797–810.
cause many hospices do not inquire about substance use, even 15. Fergusson DM, Horwood LJ: Does cannabis use encour-
if patients are using cannabis therapeutically and not re- age other forms of illicit drug use? Addiction 2000;95:
creationally. 63 Federal scheduling and stigmatization of can- 505–520.
nabis continues to present a challenge to research, however. 16. Abrams DI, Couey P, Shade SB, et al.: Cannabinoid-opioid
Much is known regarding the use of medical cannabis, but interaction in chronic pain. Clin Pharmacol Ther 2011;90:
844–851.
there remains much to be discovered.
17. Wilsey B, Deutsch R, Samara E, et al.: A preliminary
evaluation of the relationship of cannabinoid blood con-
Author Disclosure Statement
centrations with the analgesic response to vaporized can-
No competing financial interests exist. nabis. J Pain Res 2016;9:587–598.
18. Wilsey B, Marcotte T, Deutsch R, et al.: Low-dose va-
porized cannabis significantly improves neuropathic pain.
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