END OF LIFE AND PALLIATIVE CARE
By Dr Anthony Ordman, Senior Clinical Adviser and Hon. Medical Director, Integro Clinics
Living with a life-limiting diagnosis must be one of the most difficult experiences that anyone has to go through. So many doors must seem to close when a doctor tells you that there is little more that can be done to your life-limiting condition. And for those who care for patients in such situations, or live alongside them, feeling helpless in being able helping to alleviate their pain and suffering, must be also be a difficult to bear.
So often, the response has been to treat the patient’s physical pain, with increasing doses of medications such as opioids, perhaps with antidepressants, or sleeping medicines, alongside all the other medications that must also be taken, adding the side effects of these medicines to the significant side effects of their oncology medicines.
Carers will know well the impact that all these medications can have on their loved ones. Many patients report experiencing ‘brain fog’, extreme fatigue or nausea. They will sometimes talk about how they feel unable to interact with their families in a meaningful way, or feel unable to engage still with activities that bring them joy.
The goal of treatment towards the end of life must be to enable the best quality of life for the patient and their family, while promoting as much independence as possible for as long as possible. While this may be the intention, it can be a difficult thing to get right.
Over my many years working in pain medicine, mainly in a large London teaching hospital, I’ve worked with, and alongside, some of the very best palliative care services in the country. These were services who brought a deep understanding of what the person and their family were going through towards the end of life. They used these understandings, and all the available medicines, in the most skilful ways. But still, these services have been to a considerable extent reliant on conventional medicines, including the opioids, and still the last days could pass in a haze of sedation and sleep, isolating the person from their loved ones. Other palliative care services up and down the country may rely more heavily on strong painkillers, which can take away the persons aspects of a person’s personality and energy, making emotional close- ness more difficult at this important time, and making meaningful and loving goodbyes more difficult for all.
THE ENDO-CANNABINOID SYSTEM AND CANNABIS MEDICINES
Over the years, aware of the limitations of many of the pain medicines that have been available to us, I have always been keen to find innovative treatments for patients. And so I always attended medical scientific lectures on the Endo-Cannabinoid System (ECS) found in all animals, with great interested. This naturally occurring system, which is part of all our nervous and other body systems, uses natural chemical messengers that are similar to the cannabinoids found in cannabis plants to regulate homeostasis, or ‘balance’, within the body. When it’s working well, the ECS can regulate and normalise such bodily functions as sensation, pain and anxiety and sleep. It may also reduce inflammation. Knowledge of this system always promised great things for pain management, except for one thing; cannabis medicines were not legal.
Then, in November 2018, the UK regulations were changed, making cannabis medicines legal on prescription by a specialist. For those patients who had been advocating for this change for many years, this was a significant moment. But it was a quiet change, and most patients and doctors alike, were unaware that this had even happened, and the NHS was not able to respond in any noticeable way to the new regulations.
Over the last year, in my private clinic, along with a few chosen colleagues, I have been using cannabis medicines to help people with long-term pain, including some with life-limiting conditions. I’ve been surprised and impressed by how cannabis medicines can reduce pain and morphine requirements, and can lift mood and anxiety, and improve sleep, without ever making someone high, or even overly sleepy during the day. Even constipation has been improved. People at the end of their lives have felt that their days have been enhanced, making the very best of the days left, allowing enjoyable activities, and closeness and then meaningful farewells to happen.
My colleagues and I are keen to meet other people and their relatives, who find themselves faced with a life limiting illness, and who wish to discuss and find out about what cannabis medicines could do to help them to enhance the quality of life that remains to them.
If you think this might be for you, please do contact me, and I would be pleased to arrange an appointment, perhaps by video link, and discuss matters with you.