Medical Marijuana Evidence-Based Practice

Cannabis

The Efficacy of Medical Marijuana Use in Palliative Care

Clinical Question

Because marijuana has been legalized for medical use in twenty states, its use has received much media attention and scrutiny. Nurses need to be aware of their roles, rights, and responsibilities regarding working with patients who have been prescribed medical marijuana. Likewise, nurse practitioners need to be aware of the specific circumstances in which medical marijuana might be indicated as a treatment intervention. The focus of this research is on the efficacy of medical marijuana in a specific patient population: persons in palliative care. Approximately 1.5 million patients per year in the United States are in hospice or palliative care. If it is possible that medical marijuana will help patients in palliative care, nurses need to be aware of this fact.

The specific clinical question for this topic would be as follows: Among hospice or palliative care patients (P), what is the effect of medical marijuana (I) on pain relief, anxiety reduction, and sleep aid (O) compared with a control group (C) over a six-month period (T)? The PICOT question as it is phrased reveals the emphasis on therapeutic intervention:

Population: Palliative care patients

Intervention: Medical marijuana

Control: Palliative care patients not taking medical marijuana

Outcome: Pain relief, anxiety reduction, sleep aid.

Time: Duration of stay in hospice.

This paper will describe existing literature on the use of medical marijuana within the patient population.

Levels of Evidence

The newness of medical marijuana means that few experimental research designs in palliative care settings exist. However, the evidence used to investigate the PICOT question derives from a variety of nursing sources. Much existing research comes in the form of literature reviews. Many describe the history of cannabis use, the nature of cannabis as a medical intervention, how it works, and targeted treatment interventions that have been indicated in experimental research designs. Ideally, the research would emphasis experimental designs. Qualitative research, especially related to nurse, patient, and caregiver attitudes, would also be relevant. Medical research on specific interventions may also be helpful, even if such research does not directly impact nursing care. Research on patient attitudes, if available, could illuminate some issues related to comprehensive family nursing care. Moreover, position statements like those issued by the Oregon Nurses Association (n.d.) or that of the Hospice and Palliative Nursing Association (HPNA, 2014) can be fruitful in illuminating the contexts of medication marijuana use and nurse roles and responsibilities. Nursing literature on medical marijuana tends to focus on patient advocacy and the responsibility of nurses to learn more about medical marijuana.

Search Strategy/CINAHL Search

Databases used include library databases like CINAHL, PubMED and Ebsco as well as Google scholar. The search terms used include "medical marijuana," (161,000 results), "medical cannabis," (122,000 results) "medical marijuana nursing," (24,500 results), "medical marijuana outcomes," (60,900 results), "medical marijuana palliative care," (7280 results), and "medical marijuana hospice," (3360 results). Narrowing the articles to a reasonable number was not difficult, given the dearth of existing literature specifically related to the PICOT question and the patient population. The term "therapeutic cannabis" was added after realizing several authors preferred that term to "medical marijuana." Additionally, a search was conducted using only the term "hospice and palliative care statistics" in order to retrieve the actual patient population numbers that are a part of the PICOT question.

Relevant Articles

de Vries K, Green AJ (2012) Therapeutic use of cannabis. Nursing Times; 108: 9, 12-15.

This article provides a thorough overview of prior literature, but more importantly, discusses the role of the nurse and the nurse's responsibility to be well-informed about therapeutic cannabis. Moreover, this research emphasizes patient advocacy and the responsibility of the nurse to inform patients about not only their rights within state law but also the therapeutic benefits and side effects from using cannabis. Issues related to symptoms, and how to supplement cannabis with other interventions is discussed, as well as the need for nurses to recognize that patients may benefit from cannabis use specifically in palliative care situations. The patients' family can also be considered as valuable sources of input when discussing matters related to any intervention.