MARIJUANA AT THE END OF LIFE:

ONE FOR THE ROAD?

Mary Lynn McPherson, Pharm.D., BCPS, CPE

Professor and Vice ChairUniversity of Maryland School of

Pharmacy

Medical Marijuana at End of Life

Medical Utility of Marijuana

Over 17,000 published articles on cannabinoids Evidence for symptom relief includes:

Nausea, vomiting, cachexia Pain, muscle spams AIDS, multiple sclerosis, neuropathic pain

Significant potential role in hospice and palliative care

Public Support for Medicinal MJ 70-80% Americans support a policy for

physicians to prescribe marijuana ABC News/Washington Post poll report

81% support legalization for marijuana for medical use (vs. 69% in 1997)

To date no research assessing the knowledge, experience and views of hospice professionals regarding the use of marijuana in terminal illness

Haney et al. J Acquir Immune Defic Syndro 2007;45:545-554Kalata J. AARP the Magazine December 2004Abcnews.com/pollingunit, May 31, 2010

Survey Instrument

16 item questionnaire Two open-ended questions regarding

participant’s knowledge of potential medical uses and adverse effects of marijuana

MCQ to determine participant’s experience and views regarding use of marijuana to palliate symptoms Strongly agree, somewhat agree, somewhat

disagree, strongly disagree, no opinion/don’t know

Demographic information collected

Survey Methods

Approved by UMMS IRB Focus group of nine hospice professionals

separate from the survey provided feedback on the clarity and readability of the questionnaire

Survey launched on surveymonkey.com Email invitation sent to 400 hospice healthcare

professionals on the “all clinical” listserv of a hospice providing care in 11 states (in 2010)

Survey open for 10 days

Data analyses

Most frequently mentioned symptoms and side effects were grouped into categories

Descriptive statistics including mean, median or frequencies were computed

Age, gender, discipline, # years in practice, # years in hospice, % time in palliative care, state legal status of marijuana Evaluated with respect to participant’s

responses using the ×2 and Fisher’s exact test

Data analyses

For statistical analysis, response options combined: Strongly agree + somewhat agree = agree Somewhat disagree + strongly disagree =

disagree Physicians + nurses; social workers + other Age > 50 and < 49 years Years of practice < 5 or > 5 years % time in palliative care < 50% and > 50% Marijuana considered legal in Michigan and

California

Results

Response rate was 52% (209 of 400) Demographics

83% female Mean age 46.5 years MD 6.8%, RN 68.6%, SW 17.8%, other 9.4% > 10 years in practice – 69.9% 1-4 years in palliative care 39.8%; > 10 years

26.7% % time in palliative care 100% for 64.6% Certified in palliative med/hospice – 62.1% no

Knowledge of Marijuana

Results

Question %

MJ should be legalized for medicinal use 90%

See MJ being used in practice, or get questions from patients/family

47.8%

Would you “turn a blind eye” to patient smoking MJ with good effect

75%

Marijuana has medical benefits 86.1%

Nonphysicians “strongly agreed” with this statement

Physicians more likely to “somewhat agree” with this statement

Acquisition of marijuana

“Obtain” small amounts for a loved one 70%

Get from a pharmacy 88.7%

Grow their own supply 51.2%

Is marijuana addictive?

Disagree (> 50 years of age/< 50 years of age) 64%/47%

Who should legalize marijuana?

Discussion

Majority of respondents felt MJ should be legalized for palliation of symptoms

When recommended by a prescriber, adults should be allowed to obtain MJ

About half of hospice HCP have had experiences with patients asking about or using MJ

Discussion

Hospice HCP were familiar with the uses and adverse effects of MJ

Older HCP disagreed more often that MJ was addictive (more experience in EOL so less concerned?)

HCP in states where MJ is not legal were more agreeable with medical benefit, legalization and acquisition of MJ for palliative purposes

Legal status of MJ influences opinions

HCP living in states where MJ is legal may be more likely to have personal views on recreational MJ that affect their professional views

Discussion

Physician respondents generally more often “somewhat agreed” vs. “strongly agree” for legal matters

2001 survey on physician views toward prescribing MJ revealed only 1/3 would prescribe MJ if legal

In this study (prescribe MJ if legal): 69% MDs somewhat agreed 15% MDs strongly agreed

Is this a reflection of the practice, or 9 years passing?

Limitations / Conclusions

One hospice program (although in 11 states) Did not query personal use of MJ

First study to evaluate the knowledge, experience and views of hospice HCP on MJ for medical purposes.

Like the general public, hospice HCPs are generally in favor of legalization of MJ, and if legalized, would support its use in symptom management for terminally ill patients.

MARIJUANA AT THE END OF

LIFE:ONE FOR THE

ROAD?

Mary Lynn McPherson, Pharm.D., BCPS, CPE

Professor and Vice ChairUniversity of Maryland School of

Pharmacy