Dying to Know Day: Palliative Care and Medicinal Cannabis

Just like birth, death is a natural part of the human experience — yet it remains one of the most sensitive and least discussed topics in society. Dying to Know Day helps people start important discussions around end-of-life planning and ensures that people in the final stages of life can receive the compassionate care they deserve.

The annual event observed on the 8th of August each year in Australia, "Dying to Know Day" raises awareness about planning for death and encourages all adult Australians to be strong self-advocates for end-of-life and palliative care choices. 

When you’re thinking about palliative care planning for yourself or a loved one, it can be hard to know where to start or what medications could provide the most comfort. Medicinal cannabis has emerged as an effective complementary therapy in the field of palliative care for some patients, with ongoing scientific research showing that medicinal cannabis may help to alleviate pain, reduce discomfort, and address distressing symptoms experienced by terminally ill patients. 

So today, let’s learn more about the importance of Dying to Know Day, explore palliative care, and learn about how medicinal cannabis may help people naturally reduce their pain and improve their quality of life in their final days.

What is Dying to Know Day?

Dying to Know Day is an annual event observed on the 8th of August in Australia.

The event encourages people to start conversations about advance care planning, palliative care options, and — importantly— how to document your healthcare preferences before you think you’ll need to.

Avoiding the topic of death is fairly normal. It’s hard to imagine the end of our lives or imagine the people we love reaching the end of their lives. For many people, it’s easier to put off hard conversations and continue living in the moment. However, the fear of this natural transition can sometimes mean that our end-of-life wishes aren’t known or acted upon later.

In Australia, Death can be a very difficult subject. So much so that a recent study indicated that up to 70% of Australians don’t have a legally binding will and only 15% of the general adult community and 14% of older people have advanced care planning in place to document their healthcare decisions if they become seriously ill and unable to communicate their treatment preferences.

Through community events, workshops, and educational programs, Dying to Know Day seeks to empower individuals to make informed decisions about their healthcare, ensuring their wishes are respected. This day provides an opportunity for us to be brave and embrace the facts of death and dying, including cultural practices, spiritual beliefs, and the role of palliative care.

What is Palliative Care? 

Palliative care is a holistic approach to end-of-life healthcare that focuses on providing support, relief, and comfort to individuals with life-limiting illnesses. Unlike curative treatments that target the underlying disease, palliative care aims to improve the overall quality of life for patients and their families by addressing physical, emotional, psychosocial, and spiritual needs.

This specialised form of care is not always limited to end-of-life stages but can be provided alongside curative treatments to enhance the patient's well-being throughout the course of their illness.

Understanding what kind of palliative care you want, or want for your family is an important part of end-of-life planning. A multidisciplinary team of healthcare professionals, including doctors, nurses, social workers, counsellors, or our specialist Polln doctors to provide unique medicinal cannabis support, can collaborate to create personalised care plans that cater to each patient's unique needs. 

Common Palliative Care Medications

There is no one palliative care medication. Instead, a variety of medications may be prescribed to manage pain, control symptoms, and address specific medical needs. Some of the common palliative care medications that people may want to include in their end-of-life planning include:

Analgesics (Pain Medications):

• Non-Opioid Analgesics: Non-opioid pain medications like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be used for mild to moderate pain relief or in combination with opioids to enhance pain control.
  
  
• Medicinal Cannabis: Medicinal cannabis, containing cannabinoids like THC and CBD, has shown promise in managing pain effectively. Some palliative care patients may find relief from chronic pain through the use of medicinal cannabis as a complementary or alternative option to traditional analgesics.
  
  
• Opioids: Opioids are potent pain-relieving medications frequently used in palliative care to manage moderate to severe pain. Common opioids include morphine, fentanyl, oxycodone, and hydromorphone. They work by binding to specific receptors in the central nervous system to block pain signals.‍

Antiemetics (Anti-Nausea Medications):

• Ondansetron: Ondansetron is an antiemetic (anti-nausea) medication commonly used to prevent or alleviate nausea and vomiting, particularly associated with chemotherapy or opioid use. However, it’s important to note this can cause constipation with long-term use.
  
  
• Medicinal Cannabis: Medicinal cannabis has demonstrated antiemetic properties, making it a potential option for managing treatment-induced nausea and vomiting in palliative care patients.
  
  
• Metoclopramide: Metoclopramide is another antiemetic that can help manage nausea and improve gastric emptying. However, this can cause akathesia (an inability to remain still) which lasts a few hours. Unfortunately, doctors cannot predict which patients will experience this common side effect until they actually take this medication.
  

Anxiolytics (Anxiety Medications):

• Lorazepam: Lorazepam is a benzodiazepine used to manage anxiety, agitation, or restlessness in palliative care patients.
  
  
• Diazepam: Diazepam is another benzodiazepine with anxiolytic (anti-anxiety) properties, often used to promote relaxation and reduce anxiety.
  
  
• Midazolam: Midazolam is a benzodiazepine commonly used for symptom management in palliative care, such as relieving anxiety, managing seizures, or inducing sedation for comfort.
  
  
• Medicinal Cannabis: CBD-dominant strains of medicinal cannabis have shown potential as anxiolytics, providing a sense of calm and relaxation without the psychoactive effects of THC. These strains may be considered to relieve anxiety or emotional distress in end-of-life patients.
  

Antidepressants and Antipsychotics:

• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs such as sertraline and fluoxetine may be used to manage depression and anxiety in palliative care patients.
  
  
• Atypical Antipsychotics: Atypical (lower risk) antipsychotic medications like quetiapine can help manage agitation, delirium, or psychosis.
  
  
• Medicinal Cannabis: While not a primary treatment for psychiatric conditions, some patients may find relief from symptoms of anxiety and depression through the use of medicinal cannabis, particularly CBD-rich strains.
  

Corticosteroids and inflammation management:

• Dexamethasone: Dexamethasone, a corticosteroid, is often used in palliative care to reduce inflammation and control symptoms like pain or edema.
  
  
• Medicinal Cannabis: Some studies suggest that certain cannabinoids in medicinal cannabis have anti-inflammatory properties, which may be beneficial in managing symptoms associated with inflammation.
  

Laxatives and Stool Softeners:

• Senna: Senna is a natural laxative used to treat constipation in palliative care patients.
  
  
• Docusate Sodium: Docusate sodium is a stool softener that helps ease bowel movements and prevent constipation.
  

Antipyretics (Fever-Reducing Medications):

• Acetaminophen: Acetaminophen (Paracetamol, sold as Panadol) is commonly used to reduce fever and relieve mild to moderate pain in palliative care patients.‍

Anticholinergics (inhibits involuntary muscle movements):

• Scopolamine: Scopolamine patches may be used to help manage the presence of mucus in the respiratory tract (death rattle) or help with certain symptoms like nausea or delirium.
  

Sedatives and Hypnotics:

• Zolpidem: Zolpidem is a sedative medication that may be used for short-term management of insomnia in palliative care.
  
  
• Medicinal Cannabis: Certain strains of medicinal cannabis, particularly those higher in CBD content, may offer potential benefits in promoting relaxation and improving sleep quality for people experiencing insomnia.

Remember that medication choices during palliative care are different for every person and that your or a loved one’s patient needs may change over time. Regular assessment, communication, and adjustments to medication regimens are an important part of overall palliative care management.

How Can Medicinal Cannabis Help People in Palliative Care? 

In recent years, there has been growing interest in the potential of medicinal cannabis as a complementary therapy in palliative care. Medicinal cannabis contains various cannabinoids, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), which interact with the body's endocannabinoid system to produce a range of therapeutic effects.

One benefit of medicinal cannabis for end-of-life care is that it is able to manage several common palliative care areas at once, these include:

• Pain Management: Chronic pain is a common and distressing symptom experienced by people with advanced illnesses. By acting on the body's endocannabinoid receptors, medicinal cannabis can modulate pain perception and offer an alternative or complementary option for pain relief.

• Nausea and Vomiting Relief: Nausea and vomiting, often caused by treatments such as chemotherapy, can be managed by medicinal cannabis. It has shown promise in stimulating appetite, which can be helpful for patients experiencing reduced food intake due to their illness.
  

• Anxiety and Emotional Support: Understandably, facing a life-limiting illness can trigger intense emotional distress and anxiety in both patients and their families. Incorporating medicinal cannabis into the palliative care regimen may provide emotional support to some patients during their end-of-life journey.
  
  It’s important to note that there is a potential for cannabis to cause or increase anxiety in some patients so it’s always important to work with an experienced doctor when exploring new treatments

• Improved Sleep: Insomnia and disrupted sleep patterns are common challenges faced by palliative care patients. Medicinal cannabis has shown potential in improving sleep quality and addressing sleep disturbances.
  

• Reduced Dependence on Opioids: In cases where palliative care patients rely on opioids for pain management, medicinal cannabis can provide increased pain relief with lower opioid doses, minimising the risk of opioid-related side effects, including nausea, vomiting, constipation, itchy skin, dizziness, dry mouth and sedation.

If you’re thinking about including medicinal cannabis into your or a loved one’s end-of-life care plans, then it’s a good idea to reach out to a knowledgeable doctor, like a member of our caring Polln team, about your options and learn more about how medicinal cannabis can potentially support comfort care for the dying.

It’s also important to remember that while medicinal cannabis holds promise as a complementary therapy in palliative care, the effectiveness of medicinal cannabis may vary depending on individual factors such as the patient's specific medical condition, medical history, and tolerance levels.

Commonly Used Cannabinoids in Palliative Medicine 

Cannabinoids, the active compounds found in medicinal cannabis, interact with the body's endocannabinoid system in different ways to regulate various bodily functions. In palliative medicine, certain cannabinoids provide different kinds of potential therapeutic benefits for patients facing life-limiting illnesses. Some cannabinoids that could provide therapeutic benefits  in palliative care include:

Tetrahydrocannabinol (THC): ‍

THC is one of the primary compounds in cannabis, commonly known for its euphoric effects (aka the ‘high’). In palliative care, THC-rich medications are often prescribed to address pain and discomfort experienced by patients.

Cannabidiol (CBD):‍

CBD is a non-psychoactive cannabinoid found in medicinal cannabis. It can provide therapeutic effects without causing the "high" associated with THC. In palliative medicine, CBD-dominant treatments are often prescribed to address symptoms like anxiety, nausea, and inflammation.

Cannabinol (CBN):‍

CBN is a minor cannabinoid that’s found in aged or oxidised medicinal cannabis. While CBN is not as extensively studied as THC or CBD, some research suggests potential sedative effects that may aid in sleep and relaxation for patients experiencing insomnia or restlessness.

Delta-8-Tetrahydrocannabinol (Delta-8-THC):‍

Delta-8-THC is a less potent isomer of Delta-9-THC, the primary psychoactive compound in medicinal cannabis. It exhibits milder psychoactive effects and may be considered as an option for patients who are sensitive to Delta-9-THC.

Cannabigerol (CBG):‍

CBG is another non-psychoactive minor cannabinoid found in medicinal cannabis. While research on CBG is still in its early stages, it has shown potential anti-inflammatory and neuroprotective properties, which might be relevant to palliative care patients managing various symptoms.

Healthcare providers, like our experienced cannabis-friendly Polln doctors, can work closely with patients and their families to find the most appropriate and effective cannabinoids to offer symptom relief and improve the overall well-being of those facing end-of-life challenges.

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How to Include Medicinal Cannabis in a Palliative Care Plan

If this Dying to Know Day, you’re thinking about incorporating medicinal cannabis into your or someone you love’s palliative care plan it is essential to seek guidance from your healthcare team. Here are some steps to include medicinal cannabis in your palliative care plan:

Step 1: Talk to Your Palliative Care Team and/or Healthcare Professionals

Whether you’re looking to include medicinal cannabis into a current or future palliative care plan, talking to a knowledgeable healthcare team is the first step. Share your interest in exploring this treatment option and ask for their guidance.

Your healthcare team can help you understand the potential benefits and risks of using medicinal cannabis for your specific symptoms and medical condition. If you’re working with a specialised medicinal cannabis doctor, like a Polln Medicinal Cannabis practitioner, then they can integrate their care with your, or a loved one’s, pre-existing healthcare team to ensure better patient outcomes.  

Step 2: Discuss Your Medical History and Current Symptoms‍

Your healthcare team will discuss your medical history and the symptoms you are experiencing. Be open about any pain, nausea, anxiety, or other issues you are facing. If you’re planning for future care, then highlight current conditions that might need further management later on (i.e., anxiety disorders).

Step 3: Consider the Best Form of Medicinal Cannabis for You

Discuss which form of medicinal cannabis (capsules, flower, oils etc.) might be the most appropriate for you based on your preferences and medical needs. Your medical team will consider factors like ease of administration and how quickly you need relief from your symptoms. Learn more about the different medicinal cannabis formats available here.

Step 4: Work Together to Find the Right Dosage

If you decide to start a course of medicinal cannabis, your specialist doctor will start you on a low dose and adjust it based on how you respond. It's important to share any changes in your symptoms or side effects so your dose can be adjusted as necessary.

The Bottom Line

Dying to Know Day serves as an annual reminder of how death is a natural and inevitable part of life — and that rather than ignore it or hide from it, there is a lot to be gained from having open discussions about the end of life and how we can plan for a comfortable departure.

Dying to Know Day empowers people to make informed decisions about their healthcare and encourages discussions about advance care planning and palliative care options for themselves or their loved ones. Palliative care is an important part of end-of-life planning. It provides a holistic approach to end-of-life healthcare and can help support a patient's physical, emotional, and spiritual needs.

For people considering medicinal cannabis to support a palliative care plan for themselves or a loved one to potentially help alleviate pain, manage symptoms like nausea and anxiety, and improve sleep quality. It’s important to involve healthcare professionals, like our Polln doctors, in the decision-making process so as to best support each person’s unique end-of-life needs.

FAQs:

Can cannabis cause nausea in palliative care? ‍

Medicinal cannabis can cause nausea in some palliative care patients, but it can also relieve it. The effects of cannabis on nausea depend on the individual, the type and dose of cannabis used, and the underlying medical condition.

Some studies have found that cannabis can reduce nausea and vomiting in cancer patients who are undergoing chemotherapy, as such, medicinal cannabis is sometimes prescribed to alleviate these symptoms in palliative care. However, medicinal cannabis, like any medication, can have side effects, and some people may experience nausea from its use. Some people may also experience nausea when they consume high doses or specific strains of cannabis.

Is cannabis an effective and safe treatment option in the management of palliative care pain?

The use of medicinal cannabis in managing palliative care pain is an area of ongoing research with evidence showing its potential benefits in end-of-life pain management for some patients.

However, it's important to note that individual responses to cannabis treatments can vary so it’s best to consult with a qualified medicinal cannabis doctor for a full assessment of your health history and goals. An experienced practitioner who is also experienced with geriatrics and palliative can also address any safety concerns you might have related to THC's side effects and potential interactions with other medications.