CBD and Palliative Care: How can CBD help Patients in Hospice?

As we age, we face a full breadth of health problems, which will cause feelings of hopelessness and angst. Especially in end-of-life care, depression and anxiety are common problems and are often missed or overlooked. It's a painful and emotional time for the patient, relatives, and caregivers. Fortunately, some resources will provide comfort and support for everybody involved. If you or a beloved are handling a terminal illness, you will probably look into every available option. In this article, we'll be discussing the role of hospice care and how cannabis can help hospice patients. Recent cannabis research focuses on the CBD compound and its medicinal effects in order to assess its utility in treating stress and anxiety. So far, the scientific results look promising.



What is CBD?

Cannabidiol (CBD) may be a present compound found within the resinous flower of cannabis, a plant with an upscale history as a drug going back thousands of years. Today the therapeutic properties of CBD are being tested and confirmed by scientists and doctors around the world. A safe, non-addictive substance, CBD, is one of the hundreds of "phytocannabinoids," unique to cannabis plants and endow the plant with its robust therapeutic profile.


What is Palliative Care?

Palliative care aims to supply comfort for a terminally ill person. The care can start anytime, but it is best to start at the diagnosis stage.


Anyone living with an acute terminal illness can investigate palliative care. These illnesses can include cancer, coronary failure, Parkinson's disease, dementia, chronic obstructive pulmonary disease, and far more.


Palliative care provides patients with the options and choices in their treatment plans. It's also helpful to an older person who is experiencing discomfort and disability towards the end of their life. The palliative care team is responsible for many aspects and struggles that the family and patient deal with such as providing emotional and practical support. When starting palliative care, the patient can do so within a hospital, house, palliative clinic, or other functional units. If the specialist believes the patient will die within six months, they qualify for hospice transition. The palliative team also intensifies comfort care.


According to the Planet Health Organization, palliative care is "an approach that improves the standard of lifetime of patients and their families facing the issues related to life-threatening illness, through the prevention and cure of suffering by means of early identification, excellent evaluation, therapy of pain, and other problems i.e. physical, psychosocial and spiritual."[1]


Palliative care surrounds end-of-life care, but a patient undergoing palliative care isn't necessarily nearing death.


Nevertheless, when a patient approaches the end-of-life stage within a hospice setting, the stress on life quality rules often get bent to fulfill a dying patient's wishes and beliefs. Dogs and family pets are welcome guests in a patient's living quarters, and a glass of wine isn't muffled if that's what the patient desires. So why not allow medical cannabis if it reduces the suffering of a dying patient?


In some states within the U.S. palliative and end-of-life care are considered a qualifying condition for medical cannabis prescriptions.



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What is Hospice Care?

Hospice is medical aid focused on helping those with a terminal illness. It helps to enhance the quality of life and help address any problems they or their family face, on top of fighting the disease itself. For most, hospice is typically started when the patient has a predicted life of fewer than a year, or their health is rapidly degenerating.


In most cases, hospice care starts from a patient's home, be it their own or at a caring facility. Hospice care involves duties such as; diet counseling, medication to assist symptoms, physiotherapy, and even counseling for loved ones. It doesn't include treatment intended to cure the illness. Since hospice care started, its usage has deviated from its original primary purpose: to help those with cancer, to help look after heart conditions, dementia, stroke, and other conditions. As of 2018, half of all patients in hospice care are being treated for cancer.

Hospice and palliative care are becoming more critical due to an aging population where chronic or progressive conditions cause most deaths. For several people undergoing end-of-life care, mental disorders like depression and anxiety also are common.


Hospice care is the assistance given to patients who are nearing the end of life. Hospice is more of a conception of care rather than a therapy. It addresses the entire person instead of just the disease and improving the life quality of the patient. It supports patients and their families with a team of specialists who address things like pain, physical distress, emotional and spiritual issues.


Hospice care also supports families and caregivers during the sickness and anxiety support after the patient passes. Patients approach hospice care when their prognosis is less than six months, and other medical treatments have been attempted.


If hospice care is suggested, it doesn't mean that the patient will die in six months. It means their condition makes dying a genuine possibility. Hospice care supports a patient feel as comfortable as possible to concentrate on their primary objectives of life.


At this stage, doctors give prescriptions for everything, which leads to the side-effects of those prescriptions. To counter the side-effects, doctors again provide a prescription. For example, Ex joint pain medication results in sleeping disorder so, the doctors give you another pill for that, which leads to another side-effect which they treat with another prescription, and it goes on.


To elude this, patients can add CBD to their regimen. This will help them to reduce some of the other medications, providing them a more definite and luminous end of life experience that they can enjoy with their loved ones, rather than being in an overmedicated haze.


How Does CBD Helps Patients in Hospice Care?

Properties of CBD are believed to incorporate anticonvulsant, relaxant, anxiolytic, antioxidant, and anti-inflammatory effects. Thus, it provides benefits in treating pain, anxiety, depression, insomnia, neurological disorders, epilepsy, inflammation, and cancer and is believed to supply an overall calming effect on the central nervous system.


CBD features a vast range of uses, which will help increase the lifetime of those in hospice. Before we get into those, though, it's essential to acknowledge the recent increase in CBD support in hospice care. Both patients and physicians call for its use, with a recent survey showing overwhelming support no matter their state's legal status [2]. This pair with a previous study of patients in Washington state found high rates of cannabis use and requests by patients [3].


One of the explanations for this support is marijuana's use in cancer treatment. There are already various marijuana-based drugs to battle a number of the side effects of both the condition itself and its treatment. Studies have shown that THC, one of the most cannabinoids found in marijuana, may lower nausea in some users [4]. On top of this, CBD has also been found to be a potent antiemetic, itself coming with several other beneficial effects.


Chronic pain is another frequent problem many patients face while in hospice care, and one that's notoriously hard to assist with traditional pharmaceuticals. This type of pain is particularly common in those with degenerative conditions like Parkinson's, Alzheimer's, and fibromyalgia. During this area, both CBD and THC are found useful. Other studies have suggested adding medical marijuana to an already established analgesic drug routine. Instead of outright substitution, it's recommended that addition generate the most effective results for some people. It's been further hypothesized that adding marijuana to the patient's opioid intake may decrease tolerance and withdrawal rates [5]. Once-ineffective dosages may become useful, particularly useful in hospice care, where patients are more likely to possess a longtime drug regimen.


CBD can also be used to help with other common problems related to hospice care. A 2018 survey found improvements in fatigue, sleep problems, anxiety, and depression [6]. An equivalent survey found over a one-half increase in patients reporting their quality of life as "good" after using CBD. Therefore, some users' additional advantage ending their use of opioids shows that CBD utilization might not be limited to pain reduction. With the wide variety of CBD products available within the U.S., it's helpful for hospice nurses to possess a general understanding of the variations between products, their expected adverse effects, and whether patients are using products appropriately. Understanding these products can provide hospice staff with a more comprehensive understanding of the essential differences among the CBD products on the market and advise patients for the appropriate use.


Nevertheless, those that have used CBD have reported reductions in stress and anxiety, and therefore the cannabis industry is confident within the effects their CBD products have for medicinal purposes. It all boils right down to personal choice. CBD doesn't have mind-altering effects and thus doesn't act sort of a drug. Though, patients who are substantially against the utilization of cannabis, generally, may choose not to use cannabinoids. Hospice patients who think CBD will help relieve their stress and anxiety can try to use the CBD. If it helps, the better. Therefore, to use CBD is an entirely personal decision.


Importance of Sleep, Nutrition, and Social Activity for Patients:

Sleep is a critical, often overlooked, part of the overall health and well-being of any person. Sleep is essential as it helps the body to be recovered and ready for another day. Getting adequate rest can also help reduce unnecessary weight gain, heart failure, and prolonged-time of sickness.


There are many benefits of sleep, such as:

  • Better productivity and concentration

  • Lower weight gain risk

  • Better calorie regulation

  • Greater athletic performance

  • Lower risk of heart disease

  • More social and emotional intelligence

  • Preventing depression

  • Lower inflammation

  • Stronger immune system

Nutrition and hydration are basic human needs that, when handling a patient, should be the primary priority. A lack of a healthy diet will contribute to malnutrition, which in the elderly is considered a significant cause of morbidity and mortality. Clinical medical treatments will be ineffective if the patient's nutritional status is deficient or unbalanced. Hence, diet is as critical as medicine in recovering from chronic illnesses, wounds, infections, and surgical operations.


Analysis has demonstrated that social contact provides multiple opportunities for older adults. Staying socially involved and improving interpersonal relationships may help promote good physical and mental health and cognitive performance.


Patients who continue to establish close friendships and explore other means of social communication live longer than those who become alienated. Relationships and social experiences also help guard against sickness by improving your immune system.


CBD’s Impact on Sleeping and Eating:


Studies on Sleep and CBD:

Seventy-two people with anxiety and poor sleep were included in another study released in The Permanente Journal. At the onset of the research and the first-month follow-up, the researchers completed anxiety and sleep tests. 25 mg of CBD in capsule form was given to study participants. The dosage was taken at night by people who mainly had sleep complaints. The morning CBD was taken by participants who had anxiety as their primary complaint.


In 79 percent of individuals, anxiety rates decreased after the first month, and in 66 percent of the subjects, sleep ratings increased, which showed less difficulty sleeping. The findings indicate that in many of the patients, CBD reduced sleep problems. But although the decline in anxiety symptoms held constant for the remainder of the study, the sleep scores fluctuated over time [7].


Studies on CBD and Appetite:

CBD has been shown to suppress appetite on its own, causing it to stay away from CBD isolates (CBD-ONLY containing products).


However, CBD has also been shown to improve THC's effects, including its impact on appetite, rendering a combination containing both of these cannabinoids much greater at increasing overall appetite levels.


The cannabinoids, primarily THC, kickstart hunger cravings by essentially "flipping the hunger switch" in the brain [8]. It also increases ghrelin production — the hormone responsible for making us feel hungry [9].


It is why full-spectrum cannabis oils are considered to be the best. Even if the THC content is shallow, these are more effective than CBD oils without any THC at all for treating anorexia.


Is CBD the Right Choice for Hospice Patients?

Hospice care is a growing category of drugs centered on extending the lifetime of those with chronic and terminal conditions. Patients may enter hospice care because of several reasons, many of which CBD may help relieve. Chronic pain, insomnia, depression, and anxiety are common problems of those living in hospice care that CBD has found to be a better treatment. CBD can also fit into an already established drug regimen for a few users, increasing its usefulness. It's been found that patients who use CBD during hospice report better quality of life and lessened dependence on other medicines. If the patient is susceptible to heart problems, uses certain medications, or features a case history of mental disturbance, special care must be taken when administering CBD.



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References:

[1] https://www.who.int/cancer/palliative/definition/en/

[2] https://www.ncbi.nlm.nih.gov/pubmed/31094609

[3] https://www.ncbi.nlm.nih.gov/pubmed/28944449

[4] https://www.ncbi.nlm.nih.gov/pubmed/11606489/

[5] https://www.tandfonline.com/doi/abs/10.1080/02791072.2012.684624

[6] http://apm.amegroups.com/article/view/20097/21242#B4

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/

[8]https://www.medicinalgenomics.com/wp-content/uploads/2011/12/Cellular-basis-for-the-Munchies.pdf

[9] http://www.jbc.org/content/280/26/25196.full.pdf

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