Cannabinoids for Palliative Care Symptoms

Palliative care is a resource for anyone living with a serious illness and can be helpful at any stage of illness. In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. Of late, some patients are opting for complimentary or alternative treatments to manage multiple symptoms. Indeed, in a recent study palliative care patients reported using cannabis for pain, anorexia, insomnia, nausea, anxiety, and depression. 

Previously, there was limited information guiding clinicians and patients to choose an efficacious formulation. However, a new study from Duke University investigated different ratios of tetrahydrocannabinol (THC) versus cannabidiol (CBD) on common palliative care symptoms, including neuropathic pain, anorexia, anxiety symptoms, depressive symptoms, insomnia, and post-traumatic flashbacks. Of the six symptoms, patients self-reported symptom improvement with increased THC:CBD ratio for neuropathic pain, insomnia, and depressive symptoms. Increased THC:CBD ratio was not associated with an improved response of post-traumatic flashbacks or anorexia. For anxiety symptoms, increases above a ratio of 1:1 were associated with reduced effectiveness. However, this may not be surprising given that anxiety is a well-known side effect of THC. 

These findings highlight the importance of considering THC:CBD ratio in treatment decisions. Future research should focus on clinical efficacy, safety, and tolerability. 

Citations:  

Casarett DJ, Beliveau JN, Arbus MS. Benefit of tetrahydrocannabinol versus cannabidiol for common palliative care symptoms. J Palliat Med. 2019 Aug 6. 

Wilson MM, Masterson E, Broglio K. Cannabis use among patients in a rural academic palliative care clinic. J Palliat Med. 2019 Apr 17. 

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