Medicinal cannabis use in palliative care

Herbert, Anthony; Hardy, Janet

doi:10.31128/ajgp-02-21-5831

Cited by 8 publications

(10 citation statements)

References 28 publications

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“…The use of cannabis as a medicine can be traced as far back as 2000 BCE in Central Asia, where it has documented use in treating a significant array of health problems ( Crocq, 2020 ). The recent worldwide renaissance in the use of cannabis for medical purposes is supported by evidence of efficacy, albeit somewhat variable, across a range of conditions such as chronic pain ( Stella et al, 2021 ), muscle spasticity in multiple sclerosis ( Fragoso et al, 2020 ), chemotherapy-induced nausea and vomiting ( Grimison et al, 2020 ), palliative care ( Herbert and Hardy, 2021 ), and severe forms of childhood epilepsy ( Nabbout and Thiele, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

et al. 2022

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A regulatory framework allowing legal access to medicinal cannabis (MC) products has operated in Australia since November 2016. MC prescribing by healthcare practitioners (HCPs) is primarily conducted through the Special Access Scheme - Category B (SAS-B) pathway, through which prescribers apply to the Therapeutic Goods Administration (TGA–the federal regulator) for approval to prescribe a category of product to an individual patient suffering from a specific indication. The dataset collected by the TGA provides a unique opportunity to examine MC prescribing trends over time in the Australian population. Here we analysed this TGA SAS-B dataset since inception with respect to age, gender, product type (e.g., oil, flower, etc.), CBD content, indication treated, and prescriber location. Results are presented descriptively as well as being analysed using non-linear regression models. Relationship between variables were explored via correspondence analyses. Indications were classified with reference to the International Statistical Classification of Diseases and Related Health Problems (10th Revision). As of 31 August 2021, a total of 159,665 SAS-B approvals had been issued for MC products, 82.4% of were since January 2020. Leading indications for approvals were for pain, anxiety, and sleep disorders. Oil products were the most popular product type, while CBD-dominant products (≥98% CBD) accounted for 25.1% of total approvals. Approvals for flower products increased markedly during 2020–2021, as did approvals involving younger age groups (18–31 years old), male patients, and non-CBD dominant products. A disproportionate number of SAS-B MC applications (around 50%) came from HCPs in the state of Queensland. Associations between patient gender and age and/or indication with product type were found. For example, approvals for oil products were commonly associated with approvals for pain. While, overall prescribing increased dramatically over the last 2 years of analysis, stabilization of approval numbers is evident for some indications, such as pain. Current prescribing practices do not always reflect provided TGA guidance documents for MC prescribing. While acknowledging some limitations around the SAS-B dataset, it provides a unique and valuable resource with which to better understand current prescribing practices and utilisation of MC products within Australia.

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Section: Introductionmentioning

confidence: 99%

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

et al. 2022

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“…The endocannabinoid system has aroused increasing interest in research. Currently, its ability to modulate the immune, autonomic nervous, gastrointestinal, endocrine and cardiovascular systems is known [11]. Medicinal substances such as terpenes, flavonoids and cannabinoids, more than 140 different ones, the most studied being 9-tetrahydrocannabinol (THC) and cannabidiol (CBD) found in the flowers and bracts of cannabis spp [3] [6] [11] [12].…”

Section: Discussionmentioning

confidence: 99%

“…There are studies that argue that its adverse effects are minimal when compared to the improvement of the condition [3] and, especially, of the effects of opioids, and its administration is considered safer [4]. On the other hand, there are studies showing that its use can cause changes in liver function and a possible reduction in the effectiveness of chemotherapy [11], and its use should be restricted to only patients admitted to the hospice [24].…”

Section: Discussionmentioning

confidence: 99%

“…positive effect on its improvement has been demonstrated, especially of THC[2] [3][5] [6][11] [16][18]. Cannabinoids have been shown to be more effective than various antiemetics, such as prochlorperazine, metaclopramide, chlorpromazine, thiethylperazine, domperidone, and alizapride[2] [11].Not restricted to just these occurrences, CBD and THC present good results in cases of anorexia, fatigue and constipation[1] [2] [3] [5] [9] [11] [16] [18] [19],and weight gain was observed in patients who administered 3 mg of THC 1 hour after meals[2] [19]. In addition, its antitumor effect has been verified, mainly for astrocytomas and glioblastomas[2] [6] [16][18].…”

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confidence: 99%

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Use of Medicinal Cannabis for Palliative Care Patients: A Systematic Review

Costa¹,

Carvalho²

2022

JBM

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Background: Medical cannabis is a rapidly growing area of medicine. In this sense, due to the numerous benefits associated with its use, it has been increasingly proposed for patients in palliative care, in which the improvement of debilitating symptoms is directly associated with better quality of life. However, due to the complexity of treatments for these individuals, further studies are needed to determine the best possible prescription for them. Objective: Understand the endocannabinoid system and evaluate the feasibility of using medical cannabis in palliative care patients. Methods: Systematic literature review, addressing the following topics: "cancer, cannabis, and palliative care". The search was carried out using the Virtual Health Library: Lilacs, SciELO, Medline, PubMed, and Cochrane, with articles between 2013 and 2022. Results and discussion: A total of 116 articles were found with the descriptors. After reading the abstracts, 22 showed greater association with the theme and were chosen for the preparation of this review. Conclusion: It is concluded that medical cannabis is an excellent treatment option for most of the symptoms present in patients in palliative care. In this way, the adoption of this drug by the public becomes logical. However, it is the physician's role to seek to understand the particularities of these individuals and this new possibility of treatment, which, it seems, will significantly improve the end of life of these patients-this being the main role of the medical teams.

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“…There is an increasing interest in the use of medicinal cannabinoids for the relief of symptoms in palliative care by patients' clinicians and strong public pressure. 3 Cannabinoid-based medicines (CBMs) could potentially affect pain, sleep disorders, tiredness, anxiety, depression, anorexia, and nausea–vomiting induced by chemotherapy. Moreover, they could help relieve the end-of-life's emotional, existential, and spiritual suffering.…”

Section: Introductionmentioning

confidence: 99%

Patient-Related Barriers to the Prescription of Cannabinoid-Based Medicines in Palliative Care: A Qualitative Approach

Kalonji

Revol

Broers

et al. 2022

Palliative Medicine Reports

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Background: A minority of palliative care patients benefit from prescribed cannabinoid-based medicines (CBMs). Objective: The objective of this study was to explore the perceptions, expectations, and experiences of CBM usage among palliative care patients and to evaluate whether and how they may constitute an obstacle to prescription. Design: This is a qualitative study involving semistructured in-depth interviews with 10 patients hospitalized in a palliative care unit in Geneva, Switzerland. The data were analyzed using the interpretative phenomenological analysis method. Results: Semistructured interviews were conducted on 10 patients (average age of 73.3 years), mainly with advanced cancer. Most patients favored CBM use in palliative care and distinguished it from recreational use. Seven themes were identified from patients' perceptions, experiences, and expectations during the interviews: right time to begin CBMs, off-label use, information about side effects, lack of a safe medical framework, costs, relatives, and social acceptance of CBMs. Conclusion: The obstacles described by the patients seem to be surmountable with specific measures at the clinical level. We suggest training health professionals in a palliative care setting, especially in explaining the effects and side effects. CBMs will undoubtedly play a more significant role in palliative care medicine in the years to come.

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Medicinal cannabis use in palliative care

Cited by 8 publications

References 28 publications

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

Use of Medicinal Cannabis for Palliative Care Patients: A Systematic Review

Patient-Related Barriers to the Prescription of Cannabinoid-Based Medicines in Palliative Care: A Qualitative Approach

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