What ethical considerations should be taken into account when prescribing medical cannabis to terminally ill patients? Can professionals justify such prescriptions?
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Medical cannabis – an introduction
It’s no secret that the introduction of medical cannabis into the realm of modern medicine has brought with it a minefield of controversy. What can be said of cannabis in the role of palliative care? Does the same code of ethics apply when prescribing for patients who are living out their final days? Studies indicate that medical cannabis can improve quality of life for the terminally ill. Should doctors be prescribing medical cannabis to these patients? CTV news reported on this question. Here’s what they found:
Dr. David Juurlink is the head of pharmacology and toxicology at the prestigious Sunnybrook Health and Sciences Centre. Dr. Juurlink is an esteemed professional and is widely regarded as a drug-safety expert.
According to Dr. Juurlink, one of the primary goals of modern medicine is to relieve suffering. Juurlink is of the opinion that when traditional medicines do not provide adequate relief, the onus is on doctors to at least consider a patient’s requests for medical cannabis. In fact, Juurlink is on record as having said:
“From a safety perspective, medical cannabis is miles ahead of many of the other drugs that sit on our pharmacy shelves.”
Dr. Juurlink is not the only medical professional to publicly air such sentiments. His views are echoed by Dr. Vincent Maida, an Associate Professor from the University of Toronto.
Dr. Maida, a consultant in palliative medicine at the William Osler Health Centre in Toronto, has been treating terminally ill patients for more than two decades. He has pointed out that no-one has ever died as a direct result of a marijuana overdose. However, opioid based painkillers, which are standard pain killers across many countries, are responsible for thousands of deaths each year.
Fewer unpleasant side effects
Although opioid-based painkillers do provide much relief from pain, these medicines are subject to three main drawbacks. Firstly, conventional drugs are known to produce an array of unpleasant side effects. Symptoms include constipation, nausea and abnormal blood pressure. These side effects are not so apparent in patients receiving medical cannabis treatments.
Patients who rely on opioids also tend to develop a tolerance to these drugs. Larger doses are required to produce the same effects. In many cases, doses become so large that patients unintentionally overdose, with consequences ranging from serious to fatal. This is not the case with medical cannabis and CBD-based medications.
Drug dependence is the third aspect which is associated with opioids. Prolonged use results in sufferers being unable to cope without such drugs. Stopping or reducing their intake of opioid-based painkillers triggers withdrawal symptoms which include diarrhoea, stomach cramps and/or abdominal pain.
Medical cannabis versus recreational pot
It is important that one distinguishes between medical cannabis and recreational pot. Medical cannabis is produced under license. Strict controls are in place to determine the ratios between THC and CBD.
Medical marijuana needs to be certified to be free from pesticides, heavy metals and other contaminants which may affect patient treatment. These controls do not apply to recreational pot where virtually anyone can grow marijuana with the least amount of know-how and zero access to third party laboratory testing.
Once the aforementioned arguments are taken into account, and provided no laws are being broken, it becomes apparent that medical cannabis can indeed be administered to palliative patients under the care and supervision of a registered medical practitioner.
Perhaps the question should not be “Can medical cannabis play a role in the final days of palliative care?”but rather “Why is medical cannabis not being more readily prescribed to those who are suffering from terminal illnesses?”