Rolling It Out: Operationalizing Inpatient Use of Medical Cannabis for Symptom Management in Advanced Cancer

Key Message : Inpatient use of medical cannabis requires proactive interdisciplinary collaboration to bridge policy and practice. For patients with advanced cancer and refractory symptoms, palliative care teams can play a key role in advocating for continuity of symptom management and safely integrating nontraditional therapies into hospital workflows.

Abstract:

Background:
Because medical cannabis remains federally prohibited, there are no national or state-wide policies guiding its inpatient use (1-4). In New York State (NYS), the Medical Cannabis Program allows certified patients to obtain cannabis from registered dispensaries as outpatients. For patients with advanced cancer and refractory symptoms, continuity of nontraditional symptom-relieving therapies across care settings can be critical, and interdisciplinary collaboration is often required to navigate regulatory and institutional barriers surrounding inpatient use.

Case:
A 38-year-old woman with metastatic gastric adenocarcinoma and severe malnutrition on total parenteral nutrition was admitted for refractory pain, nausea, vomiting, insomnia, and anxiety. During this prolonged hospitalization, she required over 1,000 oral morphine equivalents of intravenous hydromorphone daily along with scheduled anti-emetics and adjunctive analgesics. She had been certified for medical cannabis (MC) as an outpatient, which she reported as one of few effective treatments for symptom relief. Although our hospital had an existing policy on inpatient MC use (issued 2016, revised in 2018, reviewed in 2024), it had never been implemented before, and staff expressed discomfort due to unfamiliarity.

The inpatient palliative care team consulted with hospital leadership, legal, nursing, pharmacy, security, and the NYS Department of Health to establish workflows. Steps included verifying registered caregiver status, ensuring registry identification was acquired, and identifying approved MC formulations. Nursing administration developed processes for bedside documentation; the pharmacy director integrated the product into the electronic medication administration record. With these coordinated efforts, the patient successfully self-administered MC with marked improvement in nausea, appetite, and insomnia. Within days, she transitioned to an oral regimen and was discharged home.

Conclusion:
This case highlights the importance of interdisciplinary advocacy to operationalize institutional policies for inpatient medical cannabis use. Collaboration among clinical, nursing, pharmacy, and leadership teams can enable safe, patient-centered integration of nontraditional therapies in inpatient settings.

References: 1. Perlman A, McLeod HM, Ventresca EC et al. Medical Cannabis State and Federal Regulations. Mayo Clinic Proceedings 2021;96:2671-2681.
2. Kane M, Vellky R, Burn S, Frank DM. Institutional policy consideration for medical cannabis. Journal of the American Pharmacists Association 2023;63:1026-1029.
3. Hong G, Sideris A, Waldman S, Stauffer J, Wu CL. Legal and Regulatory Aspects of Medical Cannabis in the United States. Anesthesia & Analgesia 2024;138:31-41.
4. Carver AE, Jorgensen J, Barberio MW, Lomuscio CE, Brumbaugh D. A Pediatric Hospital Policy for Medical Marijuana Use. Pediatrics 2020;146:e20194079.