Medical marijuana efficacy in palliative care pain management

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.

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.

Green, A.J. & deVries, K. (2010). Cannabis use in palliative care. Joural of Clinical Nursing 19. Retrieved online: http://www.advancedholistichealth.org/PDF_Files/Palliative%20care.pdf

This article is one of the few that addresses the PICOT question in its entirety, although not within an experimental research design framework. After a review of literature, the authors show how therapeutic cannabis can be administered within a nursing context not only for specific medical interventions such as pain relief, but also as a means to improve patient quality of life when in hospice or palliative care. Ethical questions related to obtaining medical marijuana on the black market are discussed in an honest and reasonable manner. This research is important because in contemplating these dilemmas, nurses can become better informed and able to help their patients and their patients' families make the best possible decisions.