Marinol/marijuana use

  1. Patient is asking about marijuana use for his cancer/brain mets pain. His asked me for dronabinol/Marinol and how many he can smoke in a day? How would you persue this if it was you pt?
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  2. 22 Comments

  3. by   caroladybelle
    You ask him what legally that he has used for pain thus far.

    In most places, MJ is still illegal for all. And marinol comes as a prescription with directions for its use that he should be following.

    And while there is anectodotal information that MJ is useful as an appetite stimulant, and an antiemetic, there is no plausible evidence that it can be used for pain other than in glaucoma. And marinol is indicated as an appetite stimulant/antiemetic but not as a pain med.

    In addition, in areas in which MJ is prescribed (despite legal issues), it too comes with a prescription. It is also preferred that it comes in a liquid distillation, NOT SMOKED.

    First, the question needs to be directed to the MD. Given the question that is asked, it is obvious that the patient is misinformed about MJ and getting from a random source (which may "cut" the drug with dangerous substances - drug dealers are not terribly ethical) which can seriously damage his health. Second, proper, legal pain control measures need to be tried aggressively before going to unsubstantiated illegal substance, that isn't even indicated by anectdotal evidence).

    For the vast majority of patients, pain/nausea/anxiety control can be managed perfectly well in a hospice patient with aggressive use of legally obtainable proven meds, and no need to compromise pulmonary status by smoking. But some people are mentally resist to that concept.

    Unless he is getting the drug from semi/legit sources, there can be no estimation of the THC and no way to estimate dosage. And if he is getting "legit" or "semilegit" meds, they should be giving some dosage instructions with the "script".
  4. by   Balder_LPN
    Quote from caroladybelle
    that the patient is misinformed about MJ and getting from a random source (which may "cut" the drug with dangerous substances - drug dealers are not terribly ethical)

    You gave alot of good info in your post, but this section is a bit off. MJ is not "cut with dangerous substances", what substance would look like pot and be able to be smoked?

    I think you where on the money with most of this, but if you say to a pot smoker that his stuff may be "cut", anything else that comes out of your mouth may as well just be air, cause he wont hear the it.
  5. by   caroladybelle
    Quote from Balder
    You gave alot of good info in your post, but this section is a bit off. MJ is not "cut with dangerous substances", what substance would look like pot and be able to be smoked?

    I think you where on the money with most of this, but if you say to a pot smoker that his stuff may be "cut", anything else that comes out of your mouth may as well just be air, cause he wont hear the it.
    Sorry, sir, but you are highly incorrect.

    I have been in the CS labs long enough to see more MJ that was not MJ mixed in MJ, than MJ that was the pure unadulterated stuff. Not to mention grown using toxic chemicals, impregnated with highly dangerous substances, etc.

    People have bought an amazing amount of garbage being sold as MJ.

    I have also witnessed incidents where patients have had deterimental reactions at the infusion center, traced to having smoked a joint of uncertain origin prior to coming in for chemo.

    The MDs that I have worked have no problem with their patients smoking MJ, though in most places they cannot legally prescribe it. They do prefer that they obtain the drug from "trusted" sources. In my home area of GA, many people grow it themselves or provide for their friends.
    Last edit by caroladybelle on Dec 14, '05
  6. by   LoriAlabamaRN
    I've seen cases where the patient bought pot, it was mostly oregano (not the spice powder kind, but whole chunks) and the patient was allergic to oregano.
  7. by   doodlemom
    Quote from Mazzi
    Patient is asking about marijuana use for his cancer/brain mets pain. His asked me for dronabinol/Marinol and how many he can smoke in a day? How would you persue this if it was you pt?
    I work in a state where pot is not legal for medicinal use. I can tell you that my patients' experience over the years with marijuana has mostly been a positive one - using it for nausea, appetite increase, overall "yuck" feeling, and yes, even with pain. I think that it helps the patient to relax so maybe the pain is better. I know that I'll get a lot of flack for that one, but I am a firm believer in medical marijuana. I have seen it work well with my patients. Every one of my patients that have tried both marinol and marijuana say that marijuana works better. There is not a "maximum" dose of marijuana. People smoke it until they get the desired effect. Some pot is very strong and some is not, so it all depends on that. I would not worry too much about the added substances in their dope unless they're buying it off the street corner. Most every one of us knows someone that knows someone (you may not realize it now) that has a connection to high quality pot.
  8. by   doodlemom
    Quote from caroladybelle
    Sorry, sir, but you are highly incorrect.

    I have been in the CS labs long enough to see more MJ that was not MJ mixed in MJ, than MJ that was the pure unadulterated stuff. Not to mention grown using toxic chemicals, impregnated with highly dangerous substances, etc.

    People have bought an amazing amount of garbage being sold as MJ.

    I have also witnessed incidents where patients have had deterimental reactions at the infusion center, traced to having smoked a joint of uncertain origin prior to coming in for chemo.

    The MDs that I have worked have no problem with their patients smoking MJ, though in most places they cannot legally prescribe it. They do prefer that they obtain the drug from "trusted" sources. In my home area of GA, many people grow it themselves or provide for their friends.
    What does CS stand for?
  9. by   aimeee
    I'm guessing Controlled Substances.
  10. by   Spidey's mom
    Pot here is laced with methamphetamine.

    Carol is right.

    steph
  11. by   doodlemom
    Quote from stevielynn
    Pot here is laced with methamphetamine.

    Carol is right.

    steph
    And you know this because...?? Honestly, I think this is a scare tactic used by the DEA:uhoh21:
  12. by   sjrn85
    My feeling is, whatever makes the pt. comfortable. For heaven's sake, the pts. we're talking about here are terminal...what does it matter in the end how they get comfortable?

    Not everyone responds to the usual hospice drugs used for pain and nausea. Even if what's happening is only a placebo effect...so what?

    Just because meth may be mixed with pot in one area does not mean that it is rampant everywhere.
  13. by   Tweety
    Regardless of my gut feeling and opinion about pot, it's illegal here in Florida. If a patient asked me about it, I'm not putting my license on the line and giving advice, or promoting it's use. My genetle response would be "I'm sorry, I can't offer any opinion on an illegal substance."

    Marinol p.o. can be given with a perscription and I would advice accordingly. (It's also widely abused here sadly.) But I have to keep my personal opinion about medical use of marijuana to myself. I would never advise a patient to do something illegal. But I wouldn't judge if he/she choose to do so on their own.
  14. by   ray2512
    First of all I hope this client is on a good dose of Decadron, at least 16 mg daily. Secondly, there is no doubt in my mind that marajuana would help in several ways. MJ is also an anti-inflamatory which may help with the inner cranial pressure. It will help with nausea and vomiting and anxiety, not to mention depression. I would guess this client in terminal since you mentioned brain mets. I don't think MJ will hurt him in anyway and smoking it is the best delivery system.

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