By Dr. Mary Raven, Palliative Care Physician &
Michelle Leerkes, RN, Palliative Care Nurse Navigator
When patients undergo treatment for cancer, they often experience nausea, pain, anxiety, fatigue and a variety of other symptoms. In recent years, therapeutic marijuana has become a more common way of helping patients manage some of their symptoms.
Woman’s Hospital began offering therapeutic marijuana (TM) for qualifying patients along with a recommendation from their physician in 2019 at the Breast & GYN Cancer Pavilion, a partnership with Mary Bird Perkins-Our Lady of the Lake Cancer Center. So far we’ve had more than 270 patients utilize TM with overwhelmingly positive response. Most patients who use TM report a decrease in symptoms and overall improved daily function.
Unfortunately, there is often still a stigma surrounding the use of TM. Part of our role is to educate patients about TM so they can make their own informed decision if it is right for them. We also hope to educate the community about TM and to address the misconceptions:
What is Therapeutic Marijuana (TM)?
Therapeutic marijuana refers to consumable marijuana products derived directly from the Cannabis plant. The Cannabis (aka marijuana) plant produces 400+ compounds, the most commonly used at present are CBD (cannabidiol) and THC (tetrahydrocannabinol). There are perceived medicinal uses for both compounds as well as combination products that contain both THC and CBD.
THC is thought to be helpful for chemotherapy induced nausea and vomiting, appetite stimulation, help with relaxation, and insomnia. It is also the compound in the marijuana plant that makes a person feel “high.” CBD is generally thought to be helpful for a variety of ailments including mild to moderate pain, anxiety, seizure disorders, and can potentially help combat side effects of THC as well. CBD does not cause intoxication or feeling “high.”
Is it legal?
Medical marijuana is legal to recommend by healthcare providers in Louisiana without violating federal law. This is because legislation has been passed that allows for certain patients with debilitating conditions to receive it. Outside of medical usage, marijuana remains a Schedule I controlled substance by the DEA.
Who can receive TM?
Patients with debilitating medical conditions, such as cancer, can receive TM for management of the symptoms associated with cancer and/or side effects of the treatments they are receiving. Symptoms and/or side effects that TM may help to relieve include pain, anxiety, nausea, insomnia, decreased appetite, and neuropathic pain.
How do I receive TM?
If you feel that you may benefit from using TM to manage your symptoms, please discuss this with your doctor. In order to receive TM, you must have a recommendation for TM from a physician who has a schedule I privileges through the state board of pharmacy. This physician could be your oncologist, or your oncologist may refer you to a different medical specialty. Once you receive a recommendation you can purchase your product at a licensed dispensary in your area. Please note, TM is recommended for patients who have tried and failed alternative means of managing symptoms.
What products are available?
Therapeutic marijuana currently available in Louisiana comes in an oil-based concentrated extract form, consisting of the following three varieties: THC only, CBD only, and a THC/CBD combination formula. The pharmacist can help you with which product is best for you.
Other formulations currently available include a metered dose inhaler, gelatin chews, distillate syringe (highly concentrated oil), and topical creams.
Will my insurance cover TM?
Because TM is a recommended product and not a prescribed medication, insurance will not cover the cost of TM. You will be expected to pay out of pocket. Prices range from $60-$140 depending on product.
Do I have to smoke my TM tincture?
No, TM tinctures are designed to be absorbed by placing the tincture under the tongue, holding for 30 seconds, then swallowing. You may also place the dose in your mouth and swallow; however, under the tongue is the preferred method.
Can I use TM with other medications?
As always, safety is important. Opioids, benzodiazepines and marijuana can all be mind-altering and can cause addiction in certain individuals. Effort should be taken to reduce the use of these medications if using therapeutic marijuana, particularly opioids and benzodiazepines. If you have questions or concerns, please discuss with your doctor.
Palliative care is given throughout a patient’s experience with cancer. It should begin at diagnosis and continue through treatment, follow-up care, and the end of life, if needed. The goal of palliative care is to help patients attain the highest quality of life, focusing on pain relief, and treating the symptoms and stresses of cancer or other serious illness. It also supports the emotional, physical and spiritual needs of patients and their families with life-limiting or life-altering illnesses. Learn more.