1. MARIJUANA AT THE END OF LIFE: ONE FOR THE ROAD? Mary Lynn McPherson, Pharm.D., BCPS, CPE Professor and Vice Chair University of Maryland School of Pharmacy

2. Medical Marijuana at End of Life

3. 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

4. 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;45:545-554 Kalata J. AARP the Magazine December 2004 Abcnews.com/pollingunit, May 31, 2010

5. 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

6. 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

7. 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

8. 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 years  % time in palliative care 50%  Marijuana considered legal in Michigan and California

9. 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

10. Knowledge of Marijuana

12. Results Question% MJ should be legalized for medicinal use90% See MJ being used in practice, or get questions from patients/family47.8% Would you “turn a blind eye” to patient smoking MJ with good effect75% Marijuana has medical benefits86.1% Nonphysicians “strongly agreed” with this statement Physicians more likely to “somewhat agree” with this statement Acquisition of marijuana “Obtain” small amounts for a loved one70% Get from a pharmacy88.7% Grow their own supply51.2% Is marijuana addictive? Disagree (> 50 years of age/< 50 years of age)64%/47%

13. Who should legalize marijuana?

14. 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

15. 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

16. 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

17. 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?

18. 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.

19. MARIJUANA AT THE END OF LIFE: ONE FOR THE ROAD? Mary Lynn McPherson, Pharm.D., BCPS, CPE Professor and Vice Chair University of Maryland School of Pharmacy