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Terminal Symptoms and Existential Trauma: The role of cannabis in end of life care

Dr Frankel was invited to discuss the role of dosed cannabis medicine in palliative care, in the control of terminal symptoms and keeping patients comfortable as they approach the end of life.

There is potential for cannabis to treat a wide range of the conditions associated with palliative care, particularly the major issues of pain, mood disorders and insomnia.

As with all medical treatment, the use of cannabis depends on the individual patient, their history of cannabis use and their sensitivity to THC. In Dr Frankel’s practice, elderly patients can start with whole plant CBD both safely and effectively. Whilst there is some benefit from isolates and hemp CBD products, the whole plant extract is much more effective medically.

Dr Frankel has applied whole plant cannabis medicines to end of life care to offer patients control of terminal symptoms. Indeed, some patients start using cannabis with the expectation that they are approaching death but experience such positive outcomes that their ‘end of life’ care turns out to be long-term management.

Those patients in hospices are generally admitted to control their symptoms, particularly pain, poor appetite and hydration. In Frankel’s experience, cannabis can help to alleviate these symptoms, at times to a degree that patients are discharged from hospices.

Cannabis also has an important role in minimizing the use of narcotics. Patients at the end of life and in hospices are often prescribed high doses of opioids, with myriad side effects. Cannabis as a treatment to wean patients off opioids can be transformative in terms of quality of life and patient comfort.

Frankel is currently collaborating with an oncologist and an orthopedic surgeon in observational trials to use cannabis in peri-operative care and alongside chemotherapy. These are care points where patients are at significant risk of addiction to narcotics. Whole plant CBD decreases the craving for narcotics (alcohol and cocaine), as well as offering alternative pain relief. Whole plant CBD can therefore be very useful in keeping patients safe and comfortable.

It is not easy to die - almost all patients will face some kind of fear at the prospect, and any holistic approach to end of life care needs to take account of this. Dr Frankel highlights that physicians have a role to play in supporting patients to face the existential trauma of death.

Cannabis is not the only plant medicine to play an important role in this arena. There is good evidence that psilocybin (the active ingredient in magic mushrooms) reduces the anxiety in patients with end stage cancer, with participants at one UCLA trial reporting a perspective-altering, life-affirming experience more effective than any talking therapy or anti depressant drug. In this context, mushrooms have been approved for medical use in Oregon, with similar liberalization anticipated in western states.

Dr Frankel discussed this topic with Paxton Quigley’s ‘Cannabis Healing’ show. If you prefer to listen, the full interview is available online on the station’s website, on 24 March



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