Palliative care cancer patients interested in medical cannabis had very low risk of drug dependence | Research

The takeaway

Among 182 palliative care patients with advanced cancer who were screened for a medicinal cannabis trial, none met criteria for high risk of drug dependence, with the vast majority being low risk.

Palliative care clinicians, oncologists, and medical cannabis program administrators

Zero patients met high-risk drug dependence criteria

What the researchers found

Of 182 palliative care patients screened, 92% reported lifetime alcohol use and 73% lifetime tobacco use. No participant reached threshold criteria for high risk of drug dependence on the ASSIST screening tool, with the majority being low risk. There was no correlation between ASSIST scores, symptom distress (ESAS), or opioid use.

Why it matters

Concerns about drug dependence sometimes discourage prescribing medicinal cannabis in palliative care. These data suggest dependence risk may be very low in this population.

The numbers in context

182 participants; 92% lifetime alcohol use; 73% lifetime tobacco use; 0% high risk for drug dependence; majority low risk; no correlation between ASSIST, ESAS, and morphine equivalent dose

How the study worked

Analysis of screening data from palliative care patients with advanced cancer who expressed interest in a medicinal cannabis trial. All completed the ASSIST drug dependence screening, Edmonton Symptom Assessment Scale (ESAS), and concomitant medication records.

What this study cannot tell us

Self-selected patients interested in a cannabis trial; questionnaire bias acknowledged by authors; ASSIST may not be sensitive to dependence patterns in palliative populations; cross-sectional screening data; small sample

How to read the evidence

Screening data from trial-interested patients, inherently self-selected with potential questionnaire bias acknowledged by authors.

When this study was published

2024 study

The bigger picture

The finding that no palliative care patient met high-risk dependence criteria challenges the reflexive application of substance use screening barriers to end-of-life cannabis access.

Questions still open

Should routine drug dependence screening be a prerequisite for medicinal cannabis in palliative care? Does the concept of "dependence risk" apply the same way in end-of-life contexts?

Common questions

Are palliative care patients at risk for cannabis dependence?

In this study of 182 patients with advanced cancer, none scored at high risk for drug dependence. The vast majority were low risk. This suggests that concerns about dependence may be overstated for this population.

Should cancer patients be screened for substance risk before getting medical cannabis?

The authors suggest routine drug screening may not be justified for palliative care patients, given the universal low-risk findings. However, they acknowledge the possibility of questionnaire bias, as patients interested in a cannabis trial may underreport substance use concerns.

Read the original research

Drug dependence epidemiology in palliative care medicinal cannabis trials.

BMJ supportive & palliative care, 14(3), 295-298

View on PubMed ↗Publisher’s paper ↗

Citation

Lee, Chee Yen; Good, Phillip; Huggett, Georgie; Greer, Ristan; Hardy, Janet. (2024). Drug dependence epidemiology in palliative care medicinal cannabis trials.. BMJ supportive & palliative care, 14(3), 295-298. https://doi.org/10.1136/spcare-2023-004583