How to Die Well - Part 2: Palliative Treatment with Cannabis


This is the second part of the blogcast series, ‘How to Die Well’. The first part of this series dealt with the squirrelly but nonetheless necessary foundational discussion to delineate the medical treatment of death, from the philosophical understanding of it. It might serve as a good primer for subsequent articles in this series and you can read or listen to it here. We will shortly be interviewing some experts in the fields of Cannibinoid research as it pertains to cancer treatment, so the touchstone for end of life discussion will be around how Cannabis can help with terminally ill cancer patients, but as you will see, the scope goes way beyond cancer - or palliative care for that matter.

Psychedelics touch every aspect of the discussion around death. The more classical psychedelics (such as LSD, Ayahuasca and Psilocybin) are the headline grabbers. Their ability to create paradigm shifting pyrotechnics inside the minds of terminally ill patients is showing great promise in helping otherwise terrified people approach their end of life with grace, peace and equipoise. This is no small feat and studies continue. The real step-wise changes in how well we die, however, might not come from this field but rather from the world of Cannabis.

A different type of evangelism surrounds all things ‘green’ - If you can imagine the insufferable prospect of a Williamsburg Barista called Atticus giving you a CBD infused honey-drip-macadamia-chai-latte whilst talking at (not to) you about how it will reduce anxiety and boost your creativity at “like, a cellular level”, then you have some sensibility for why the signal-to-noise ratio is as skewed as it is. However, buried underneath this hype is an international field of research which is positing legitimate improvements in palliative care for terminally ill patients, and the strong foundations of a body of oncological research that is venturing into the rarified territory of tumour suppression. Put that in your pipe and smoke it, Atticus.


So let’s zoom out and take a plant’s eye view. Everyone and their Gran has heard the word Cannabis. Cannabis is a genus of plant in the family of Cannabacae (in botanical terms, a family is at the top, then comes genus and then comes species). There are great number of different species within this genus of cannabis, but the one of most interest is Cannabis Sativa, because it produces cannabinoids. Cannabinoids are relevant to humans because they act on the endocannabinoid system - a biological system involved in regulating many physiological and cognitive processes. It takes two to tango - so cannabinoids are only of interest to humans because of this antecedent and endogenous system.

There is a plethora of different cannabinoids, (well over 100 at last count), but the belle of the ball is perhaps Tetrahydrocannabinol (THC) because it is the principal psychoactive constituent of cannabis.

So now you know what Cannabis is (a genus of the family of plants cannabacae), what Cannabis Sativa is (a species of the genus). You know why it is of particular interest (because it contains, amongst other things psychoactive components) and you know what cannabinoids do (mediate the release of neurotransmitters by interacting with the endocannainoid system in the body). You know what THC stands for (Tetrahydrocannabinoid) and you know why it is important (because it is the principle psychoactive component of cannabis). There is so, so much more to all of this, and it sometimes feels like you need a PhD in biochemistry to fully understand what is going on at a constituent level. I certainly do not understand.

However, don’t be intimidated by people who seem to know more than you, because I suspect that a lot of them are suffering the effects of dunning kruger syndrome. Admitting how ignorant you are is the only pre-requisite that gives you any sort hope of knowing anything worth knowing. I’m talking to you Atticus.



THC is usually the most abundant, and most biologically potent cannabinoid. If the cannabinoids were an orchestra, this is the first string in terms of its phenomenological impact.

The second string is perhaps Cannabidiol (more commonly known as CBD). It is not psychoactive, but actually tempers the effects of THC. CBD is the sweetheart of a wife who smooths the ragged edges of her much louder THC husband at the dinner party. Preparations with higher ratios of CBD are therefore generally better tolerated physiologically as a result. There are horses for courses, and as such neither of these major components is either ‘good’ or ‘bad’ - both show respective promise in the treatment of various types of cancers, for example.

CBD products are everywhere - a pre-existing and (somewhat) underground network/industry of suppliers, producers and consumers has popped up through the concrete cracks of ambiguous regulatory frameworks and burst onto the pavement of mainstream culture at an astounding rate.

But what can cannabis products actually do in the face of death?


You are out on much more an empirical limb if you posit that cannabis products can have a positive impact on mortality than if you posit their positive impact on morbidity. The latter is what we will focus on now.


Chronic pain is absolutely no joke. When the pain extends beyond the period of healing, you are in the foothills of having to reclassify the pain as a disease rather than a symptom, and that is often the case for terminally ill patients. Peripheral neuropathy is a common complication of chemotherapy, characterised by pain, weakness, numbness, and/or a tingling or burning sensation in the hands and feet. I am reminded of the fable of Androcles - a Greek slave who was chased down through the forest by soldiers after an escape attempt. He was brought before his master and was thrown to a lion. The lion fawned over him like a large dog, and it transpired that during his sojourn in the woods he had removed a thorn from the beast’s paw. The lion was so grateful that instead of eating him it brought him fresh kills of deer with which sustained Androcles prior to his recapture. This story resonates because we know we are not ourselves when we are in chronic pain. Ask any pain specialist - many people successfully treated at pain clinics enter like lions and leave like lambs, and pain management is therefore of paramount importance in palliative care.

The scientific jury is still out on the absolute utility of Cannabis products from a pain perspective, but there is so much ground left to cover. The treatment of pain is a hugely complex area, with multiple overlapping aetiologies, so the real benefit may be when cannabis products are extensively researched as synergistic elements which can help reduce minimum effective dose of opioid medication, and thus mitigate the unpleasant second and third order impacts of these powerful pain medications. In such a situation, decision trees are in play, which allow physicians to make systematic choices.

If you fail to see how multivariate the aetiology of pain is and why its chronic presence often unhelpfully colours every aspect of a dying person’s life, think about this - if you get a call and then moments later stub your toe how sore will it be? It is reasonable to assume that if the call was relaying news that your house had just burned down it would be a lot sorer than if the call informed you that you had won the lottery.


“We talked the modern world to arm’s length -

Fireside agrarians; not even cancer

Could usurp the house’s form. You shrank

From our courtesy to closet with the stranger

Whose passion banked your eyes of their gutted fire.”

These are the last lines of Richard Tillinghurst’s poem, ‘For a teacher’s wife, dying of cancer’.

They capture the affront that is felt by those around the dying person, as cancer (or any sort of physiological entropy for that matter) takes the life right out of people. If poorly managed, wastage - either of the flesh as in cancer or the mind as in Alzheimer’s - echoes in the generations, leaving people with imprinted memories of gaunt and unrecognisable faces. Such wastage as characterised by conditions like anorexia, early satiety, weight loss and cachexia (which is a ‘catch all’ term including the aforementioned but also muscle atrophy and fatigue) are unfortunately prevalent in late stage cancer, but there are few effective treatments. My work as a psychotherapist has given me cause to help people unpack psychological trauma relating to the experience of such things, which haunted them decades after the fact. I now understand that a good death is required as much for those who remain as for those who will depart.

  • Cannabis can function as an anti-emetic - The National Comprehensive Cancer Network guidelines cautiously mention cannabinoids as a breakthrough treatment for chemotherapy-induced nausea and vomiting not responsive to other antiemetics

  • Cannabis can also function as an appetite stimulant, but the urban legend of the munchies might be overstated. A large randomized placebo controlled trial of over 200 patients did not find that cannabis extract or dronabidol (which is the licensed pharmaceutical preparation of THC) fared any better than placebo in controlling for cancer cachexia symptoms. An even larger study showed that dronabidol was outcompeted by the progestational agent megestrol in terms of improving weight gain and appetite in cancer patients, and combined therapy was no better. One smaller study of dronabinol in cancer patients did however demonstrate ‘enhanced chemosensory perception’ in the treatment group - which is a fancy way of saying their food tasted better - and that is worth noting, because enjoying your food can be really huge - palates are precious.

    If anyone therefore tells you that cannabis products are the last word in weight gain and appetite stimulation in palliative care you now know that it’s a bit more nuanced than that, and a lot more research needs to be done into combining cannabis with other more established treatments. Method of ingestion is also something which needs to be further investigated. Does your gran need a big fat vape or a wee pill? When you’re dealing with things as multifactorial and subjective as appetite and nausea, that is neither a facetious nor a rhetorical question.



Perhaps the most popularised effect of cannabis in lay terms is its ability to alleviate anxiety and let people relax. One thing is known from a very robust meta-analytic literature, and that is, cannabis use (including cannabis use disorder) is very strongly and positively associated with anxiety disorders. We can pretty much say that for sure. What we cannot say is whether this correlation is causal. Does this data indicate that cannabis use promotes anxiety disorders? Alternatively, does it indicate that people are self-medicating with cannabis as an alternative to mainstream psychiatric medications? (The literature on this topic is actually quite scant). The National Cancer institute note that small scale studies of patients who inhaled cannabis reported improved well-being and mood and reduced anxiety,. A full discussion of the complex relationship between cannabis and anxiety is beyond our scope for today, suffice to say that there are plenty of other things that could be tried to deal with anxiety as it relates to end of life. I believe, that if it is possible, and of course appropriate, the roots of the anxiety should be investigated - even in the last epoch of life. I am of course not advocating that a terminally ill patient embark on a 2 year course of twice weekly psychodynamic therapy to find out why their mummy didn’t love them enough. I am rather suggesting the first pass of scientific attention looking at psychedelic treatment of end of life anxiety be focussed on the classical psychedelics. Psychotherapy augmented with psilocybin has shown promise in radically reducing anxiety, where a course of cannabis might only mask or mitigate. We should not perhaps be so keen to palliate where there is a chance to ameliorate, or to put it another way - just because you are going to take the tumour to the grave with you does not mean you also have to take the anxiety all the way to that terminus as well.


All of this information is helpful but not exactly earth shattering. If cannabinoids can help people enjoy their food more, be in less pain, sleep and eat better and experience more day to day well-being on their way out, then that is a wondrous thing. If further research shows they actually tesselate rather nicely with existing pharmacological mainstays, then everyone will be happy about that. The truth is that the current waves of rescheduling and decriminalisation will hopefully create more of a cultural shift away from the taboo of cannabis as a dirty, ‘hippy’ substance that does more harm than good and is not worth using taxpayers’ money to research. However, in researching this article myself, I had to swim over the crest of massive wave of highly ranked and partisan bullshit proselytising cannabis as a natural panacea. This, I think (albeit in a different way), could prove to be just as inhibiting to research as draconian regulation. Yes Atticus, you might be as bad as ‘The man’.

Mainstream acceptance is required to really ratchet up quality research into the true potential of these substances because, according to Manuel Guzman, Professor of Biochemistry and Molecular Biology at Complutense University in Madrid,

‘…these compounds have been shown to inhibit the growth of tumour cells in culture and animal models by modulating key cell-signalling pathways. Cannabinoids are usually well tolerated, and do not produce the generalised toxic effects of conventional chemotherapies. So, could cannabinoids be used to develop new anticancer therapies?’

In the next edition we will be deep diving into this anticancer potential, and we will pose the following question…

…Is the best way to die well perhaps not to die at all?

Niall Campbell