Navigating the Highs and Lows: Marijuana Use in Hospice Care

Navigating the Highs and Lows: Marijuana Use in Hospice Care

In recent years, there has been a growing interest in exploring alternative therapies for patients in hospice care, and one such option that has gained attention is the use of marijuana. This controversial topic raises important questions about the potential risks and benefits associated with integrating marijuana into end-of-life care. In this blog, we will delve into the complexities surrounding marijuana use in hospice settings, considering both the potential advantages and drawbacks.

Benefits of Marijuana in Hospice Care

  1. Pain Management: One of the primary reasons marijuana is considered in hospice care is its potential to alleviate pain. The cannabinoids in marijuana, particularly THC and CBD, have been shown to have analgesic properties, providing relief for patients grappling with chronic pain associated with terminal illnesses.
  2. Appetite Stimulation: Patients in hospice care often face challenges such as loss of appetite and weight loss. Marijuana has been known to stimulate appetite, commonly referred to as the “munchies.” This effect can be particularly beneficial for patients who struggle with maintaining a healthy weight during their final stages of life.
  3. Nausea and Vomiting Control: Cancer treatments and certain illnesses can induce severe nausea and vomiting. Marijuana, especially strains rich in CBD, has demonstrated antiemetic properties that can help alleviate these distressing symptoms, improving the overall quality of life for patients.
  4. Anxiety and Depression Relief: Facing the end of life can be emotionally challenging for both patients and their families. Marijuana has shown promise in reducing symptoms of anxiety and depression, offering a sense of calm and tranquility during a difficult time.

Risks of Marijuana in Hospice Care

  1. Cognitive Impairment: One of the well-known side effects of marijuana use is cognitive impairment. In hospice care, where maintaining clarity of thought and communication is crucial, the potential for marijuana to cause confusion and memory issues may be a concern.
  2. Respiratory Issues: Smoking marijuana can have adverse effects on the respiratory system, which is especially problematic for patients with pre-existing respiratory conditions. Alternative methods of consumption, such as edibles or tinctures, may be considered to mitigate this risk.
  3. Drug Interactions: Marijuana can interact with other medications, potentially altering their effectiveness or intensifying side effects. Hospice patients often take multiple medications, and the introduction of marijuana should be carefully monitored to prevent any adverse interactions.
  4. Legal and Ethical Considerations: The legal status of marijuana varies globally and even within certain regions. Hospice care providers must navigate complex legal and ethical landscapes when considering marijuana as part of a patient’s treatment plan.


The integration of marijuana into hospice care remains a nuanced and controversial topic, with both potential benefits and risks. While it has shown promise in addressing pain, appetite loss, and emotional distress, concerns about cognitive impairment, respiratory issues, drug interactions, and legal considerations must be carefully weighed.

Open communication between healthcare providers, patients, and their families is paramount to ensure that any decision aligns with the patient’s overall well-being and end-of-life goals. As the landscape of medical marijuana evolves, ongoing research and a compassionate approach to care will help guide its appropriate use in hospice settings.

Could hospice be a hopeful word

Could hospice be a hopeful word

Outside my office door right now, a group is meeting and discussing what they miss about their loved ones. There is a reality that everyone dies and that everyone who has ever loved will grieve. So if that is the inevitable, how is hospice shifting the way we treat the dying days?  The mere mention of the word “hospice” can evoke fear and discomfort in many individuals. Often misunderstood, hospice care is a critical and compassionate approach to end-of-life care that prioritizes the physical, emotional, and spiritual well-being of patients and their families. In this blog, we aim to dispel common misconceptions and shed light on the true essence of hospice care. 

Hospice does not hasten death:

Hospice care does not aim to hasten or postpone death. Instead, it provides comprehensive support to enhance the quality of life during the natural progression of a terminal illness. The focus on comfort and symptom management helps patients experience a peaceful and dignified end-of-life journey.

Hospice is about living fully until the end:

What if you knew you only had days to live? Would you treasure that time? Contrary to the belief that hospice care is a place where people go to die, it is fundamentally about helping individuals live their remaining days to the fullest extent possible. Hospice professionals work collaboratively with patients and their families to manage symptoms, control pain, and promote emotional well-being, enabling patients to cherish meaningful moments with loved ones.

Individualized care plans:

Hospice care is highly individualized, tailored to meet the unique needs and preferences of each patient. It is not a one-size-fits-all approach but rather a comprehensive plan that addresses the physical, emotional, and spiritual aspects of end-of-life care. This personalized approach ensures that patients receive the support and comfort that aligns with their values and goals.

Family-centered support:

Hospice care extends beyond the patient to embrace their family members. The focus is on creating a supportive environment that helps families navigate the complexities of terminal illness, providing counseling, education, and practical assistance. The goal is to empower families to cope with the emotional challenges they may face during this difficult time.

Dignity and comfort are priorities:

Maintaining a patient’s dignity and ensuring their comfort are at the core of hospice care. The interdisciplinary team, which may include physicians, nurses, social workers, chaplains, and volunteers, collaborates to address the physical, emotional, and spiritual needs of the patient. This holistic approach fosters an atmosphere of respect and compassion.

In dispelling the fear surrounding the word “hospice,” it is crucial to recognize the compassionate and person-centered nature of hospice care. By understanding that hospice is about celebrating life, providing comfort, and supporting families, we can shift the narrative and encourage open conversations about end-of-life care. Choosing hospice is not a surrender but a decision to embrace a holistic and dignified approach to the final chapter of life’s journey.

Anticipatory Grief: Coping with Loss Before It Happens

Anticipatory Grief: Coping with Loss Before It Happens

Anticipatory grief, also referred to as anticipatory loss or preparatory loss, is a unique form of mourning that occurs before the actual loss takes place. It is the feeling of loss that is felt before the loss happens. While traditional grief typically follows a loss, anticipatory grief begins before the loss and can be triggered by the anticipation of impending death or significant life changes. In our minds it is the “beginning of the end.” Typically, in grief, one is focused on a loss in the past. But in anticipatory grief one is focused on the loss ahead.

What is anticipatory grief?

Anticipatory grief is the emotional response to an anticipated loss. It involves mourning the impending death of a loved one or preparing for other significant life changes, such as the end of a relationship, a terminal diagnosis, or a major life transition. Anticipatory grief allows individuals to begin processing their emotions before the loss occurs, which can help facilitate the grieving process later on.

What is the difference between conventional grief and anticipatory grief?

Conventional grief involves mourning a loss that has already occurred. Anticipatory grief is forward looking. It is grieving a loss that has not yet occurred but that one believes will occur. Anticipation of loss still leaves room for hope that the loss will not happen. This hope, however unrealistic it may be, often leaves anticipatory grievers “hanging on to possibilities” in unrealistic and non-helpful ways.

Who experiences anticipatory grief?

Anticipatory grief can be experienced by anyone who is facing an impending loss or significant life change. This may include family members and friends of terminally ill individuals, individuals facing their own terminal illness, caregivers, and those experiencing major life transitions such as divorce or retirement. Anticipatory grief is not limited by age, gender, or background, and can affect people from all walks of life.  Younger caregivers and patients often experience more severe anticipatory grief.

When is anticipatory grief experienced?

Anticipatory grief can occur at any time when an individual is faced with the prospect of impending loss or significant life changes. It may begin as soon as a terminal diagnosis is received or when a major life transition is anticipated. The duration of anticipatory grief can vary widely, lasting anywhere from weeks to months or even years depending on the circumstances. Anticipatory grief may also continue after the loss has occurred, as individuals navigate the ongoing impact of their loss.

What are signs of anticipatory grief?

People experiencing anticipatory grief may show some of the following signs:

  • Feelings of sadness, anxiety, or depression
  • Preoccupation with thoughts of loss
  • Changes in appetite or sleep patterns
  • Withdrawal from social activities or relationships
  • Difficulty concentrating or making decisions
  • Increased irritability or anger
  • Physical symptoms such as fatigue, headaches, or stomach problems

What are the stages of anticipatory grief?

There are four phases that one may feel while experiencing anticipatory grief. These may come in any order or simultaneously.

  • Accepting that death is inevitable. This phase often brings sadness and depression
  • Feelings of concern for the dying person. For family and friends, this phase often brings feelings of regret – regret over past actions, prior unresolved arguments, and the like. For the dying person this may be regret over missed opportunities or fear of dying.
  • Rehearsing the death. A person may become focused on planning for death including funeral arrangements, saying goodbyes, and what needs to be done in preparation for death.
  • Imagining the future. Family and friends may envision the future without the loved one. This may include imagining holidays and other special occasions with the loved one missing. The patient may imagine how the family and friends will experience life without him. The patient may also begin to imagine the afterlife.

How can anticipatory grief be treated?

While anticipatory grief can be challenging, there are strategies that can help individuals cope with their emotions and navigate the grieving process:

1. Seek support: Reach out to friends, family members, or a therapist for emotional support and guidance.

2. Practice self-care: Take care of your physical and emotional well-being by eating well, exercising regularly, and engaging in activities that bring joy and relaxation.

3. Communicate openly: Share your feelings and concerns with loved ones and healthcare providers. Talking about your emotions can help validate your experiences and provide comfort.

4. Create meaningful moments: Make time to create lasting memories with your loved one and engage in activities that bring you closer together.

5. Seek professional help: If you’re struggling to cope with anticipatory grief, consider seeking help from a mental health professional. Therapy or counseling can provide valuable support and coping strategies.

Is anticipatory grief beneficial?

Anticipatory grief is a natural response to impending loss or significant life changes. By understanding what anticipatory grief is, who experiences it, when it occurs, signs of anticipatory grief, and strategies for coping, individuals can better navigate this challenging emotional journey.  The research is contradictory as to whether anticipatory grief is beneficial in helping cope after the loss has occurred. Some research suggests that anticipatory grief may help with coping with the loss.  Other research suggests that it has no effect on post-death bereavement.

Seeking support from loved ones and mental health professionals, practicing self-care, and communicating openly about feelings are essential steps in coping with anticipatory grief.

What is grief?

What is grief?

Grief is the emotional, psychological, and physical response to loss. It is a natural process that helps individuals come to terms with the reality of their loss and adjust to life without the person or thing they’ve lost. Whether it’s the death of a loved one, the end of a relationship, or a major life change, grief can affect individuals of all ages and backgrounds. Grief can manifest in various ways, including sadness, anger, guilt, confusion, and physical symptoms such as fatigue or changes in appetite.

Who experiences grief?

Anyone can experience grief, regardless of age, gender, or background. Grief is a universal human experience that affects people of all cultures and walks of life. Common triggers for grief include the death of a loved one, divorce or separation, the loss of a job, a serious illness or injury, or a significant life transition such as moving to a new city or retiring.

When is grief experienced?

Grief can be experienced at any time following a loss, and there is no set timeline for the grieving process. While some individuals may begin to experience grief immediately after a loss, others may not fully process their emotions until weeks, months, or even years later. Grief can also be triggered by anniversaries, holidays, or other significant reminders of the loss.

What are signs of grief?

Signs of grief can vary widely from person to person, but common symptoms may include:

  • Intense sadness or depression
  • Feelings of numbness or disbelief
  • Anger or irritability
  • Guilt or self-blame
  • Difficulty concentrating or making decisions
  • Changes in appetite or sleep patterns
  • Physical symptoms such as fatigue, headaches, or stomach problems

How can grief be treated?

While grief is a natural and unavoidable part of life, there are strategies that can help individuals cope with their loss and navigate the grieving process:

1. Allow yourself to feel:  It’s important to acknowledge and express emotions, even if they are painful or difficult to bear. A person who is grieving should give himself permission to grieve in his own way and at his own pace.

2. Seek support: : It is important that people who are grieving reach out to friends, family members, or a therapist for support. Talking about feelings with others who understand can provide comfort and validation. 

3. Take care of yourself:  Practicing self-care by eating well, exercising regularly, getting plenty of rest, and engaging in activities that bring joy and relaxation are important aspects to treating grief.

4. Honor the loved one:  Find ways to remember and honor the person who was lost. This could involve creating a memorial, participating in rituals or traditions, or finding meaningful ways to keep their memory alive. 

5.  Seek professional help:  A grieving person who is struggling to cope with the grief or who is experiencing prolonged or severe symptoms should consider seeking help from a mental health professional. Therapy or counseling can provide valuable support and guidance during the grieving process.

Grief is a natural and universal response to loss that affects individuals in different ways. By understanding what grief is, who experiences it, when it occurs, signs of grief, and strategies for coping, individuals can navigate the grieving process with greater resilience and self-compassion. Seeking support is often beneficial to many who are grieving – whether through bereavement groups, friends, or professional help. And it is important to remember that patience is required during the grieving process as it may take time to heal and find peace after loss.

End-of-Life Pain Management

End-of-Life Pain Management

People with terminal illness experience pain at the end of life and for many, this pain goes untreated. One of the key elements of hospice care is effectively managing the patient’s pain. Untreated or undertreated pain results in needless suffering – due to physical pain and mental distress. However, family caregivers often have a difficult time assessing their loved one’s pain.  Further, they are often concerned with side effects of pain medications, including concerns of addiction to or tolerance of pain medications. Further, both patients and family caregivers often have trouble communication with the hospice team the degree and nature of pain that the patient is experiencing. This often leads to ineffective pain management and needless suffering in end-of-life.

What are some considerations when giving pain medication?


Respect the patient’s wishes regarding pain management. Understanding a patient’s goals and values guides the care team in providing personalized and compassionate care.


Pain medication decisions are made in consultation with the patient, considering their preferences, values, and goals for care.


The hospice team includes the primary physician, medical director, nurse, social worker, chaplain, hospice aide, caregivers, and patient. Everyone works together to create the right plan.

How should pain medication be administered and monitored?

Individualized and Regular Assessment

Pain medicine is administered based on individualized assessments of the patient’s pain levels. Regular assessments of pain are important for managing pain and ensuring the plan remains effective.

Address pain early

Addressing pain before it becomes too severe can contribute to more effective pain control and improved quality of life.


Encourage patients to communicate openly about their pain levels. This information is crucial for healthcare providers to make informed decisions about medication adjustments. Regular communication between caregivers and healthcare providers ensures an accurate understanding about the patient’s pain.

Low dose pain medicine

It is preferable to initiate low-dose medication to maintain alertness and minimize potential side effects.


Titrate pain medication up as needed, to achieve optimal pain relief. Regular assessments guide the titration process ensuring the right balance between pain control and functionality. Often a long-acting pain medication is given coupled with a breakthrough pain medication, if needed, to keep pain at or below goal level.

Timely administration

Administer pain medicine in a timely manner, adhering to the prescribed schedule. Consistent dosing helps maintain a baseline level of comfort.

Pain log

Use a pain log to track pain levels, related factors, what medicine was given, dosage of medication, and time medication was given.


The hospice team should educate the patient and caregivers on the use of pain medication, including dosage, timing, and potential side effects.


Monitor for potential side effects of pain medication and collaborate with the healthcare team to address any concerns. This includes a careful assessment of the patient’s overall well being.

Consider a holistic approach to pain management

Many hospice agencies advocate for a holistic approach to pain management, including physical, emotional, and spiritual care.  Alongside pain medications, this involves exploring and integrating non-pharmacological interventions such as massage, music therapy, aromatherapy, and relaxation techniques for a more comprehensive approach to pain relief.

Where can you find out more?