Cannabinoids in palliative care

Palliative care focuses on quality of life when cure is no longer the goal. Medicinal cannabis is sometimes raised by patients or whānau as an option for symptom control in this setting. This page separates the symptom evidence from the goals of care and the clinical supervision required in New Zealand, and gives you a practical way to evaluate whether a cannabinoid prescription is worth discussing with a clinician.

What the evidence actually shows

The strongest evidence for cannabinoids in palliative care is for three symptom clusters: chronic pain, chemotherapy-induced nausea and vomiting (CINV), and refractory spasticity. The evidence is not uniform, so each symptom must be judged separately.

Condition	Outcome measured	Preparation studied	Evidence quality (as of 2025)
Chronic pain (cancer and non-cancer)	Pain intensity reduction	Nabiximols (THC:CBD oromucosal spray), smoked/inhaled THC, oral THC	Moderate for neuropathic pain; weaker for nociceptive pain. Systematic reviews show a modest but consistent analgesic effect, yet many trials are short-term and industry-funded.
Chemotherapy-induced nausea and vomiting (CINV)	Reduction in nausea and vomiting episodes	Oral THC (e.g., dronabinol, nabilone)	Moderate; superior to placebo, but not clearly superior to standard antiemetics (e.g., ondansetron) in head-to-head trials.
Cancer-related pain	Pain score reduction, opioid-sparing	THC-dominant flower/oil, balanced THC:CBD	Low-to-moderate; effect is often small and inconsistent across studies.
Refractory epilepsy	Seizure frequency	Epidiolex (pure CBD), not generic cannabis	High for specific syndromes (Dravet, Lennox-Gastaut); NZ indication is narrow.
Anxiety in palliative care	Symptom score reduction	CBD-dominant products	Low; limited trials, mixed results.
Appetite stimulation	Weight change or appetite score	THC-dominant products	Low; evidence is mixed and mostly from HIV cohorts, not palliative populations.
Sleep disturbance	Patient-reported sleep quality	THC or THC:CBD balanced products	Low to moderate; improvements are often secondary to pain relief.

PAGE_SECTIONS: - What this page covers - How to read the evidence in this page - The regulatory frame in New Zealand - The palliative care evidence: what is known and what is not - Goals of care: matching the formulation to the symptom - A practical decision rule for cannabinoids in palliative care - The prescription pathway in New Zealand - Safety, adverse effects and daily life - When the evidence does not apply - Checklist for a palliative care consultation - Sources and further reading

OUTLINE AND DETAILED SECTIONS: 1. What this page covers - Scope: palliative care, not recreational use, not “wellness” - Place within the pillar: condition-specific evidence page; /evidence/ owns the overview - The one question answered: which symptom outcomes have enough evidence to justify a trial of medicinal cannabis in palliative care, and what a patient or whānau should expect from the NZ prescription pathway. 2. Understand the legal pathway in New Zealand - Under the Misuse of Drugs Act 1975, medicinal cannabis is a controlled drug; the Medicinal Cannabis Scheme (MIS) under the Misuse of Drugs (Medicinal Cannabis) Regulations 2019 sets the rules for lawful access. - The New Zealand Ministry of Health runs the scheme; Medsafe (through the Medicinal Cannabis Agency) approves products and issues licences. - A prescription from a medical practitioner is the only legal route. The Ministry of Health (2022) states that the scheme does not allow people to possess or use cannabis for general purposes; it is a prescribed medicine. - Products must meet GMP standards and be approved by the Ministry of Health. Raw plant material is not a legal “natural product”; the legal pathway is a manufactured pharmaceutical dispensed by a pharmacy. (Ministry of Health, 2022) - Products are not funded by Pharmac; the patient pays the full cost, and cost is a major barrier. - Prescribers can be any doctor in New Zealand, but they must be satisfied that conventional treatments have failed and that the potential benefit outweighs the risks. Nurse practitioners cannot prescribe cannabis products under the current scheme. - The Misuse of Drugs (Medicinal Cannabis) Amendment Act 2018 created a separate regulatory framework; the Medicinal Cannabis Scheme became fully operational on 1 April 2020. Under this scheme, a prescription is required, and the Misuse of Drugs Act still governs possession and supply.

GUIDE_PAGE_STRUCTURE: 1. Start with a short, plain-language answer to the primary question, including a clear statement of the legal pathway and the “one thing to remember” (the product must be a manufactured pharmaceutical dispensed by a pharmacy, not raw plant material from a dispensary). 2. Then separate the evidence for symptoms. Use a table for symptom outcomes. The table should include: symptom, what the evidence says, evidence quality, and the clinical caveat. 3. Then provide a goals-of-care checklist, which is a usable decision tool for patients and clinicians. This checklist should help a person decide whether medicinal cannabis is worth trying in palliative care, and it must include: the condition or symptom, the expected outcome, the preparation type, and the evidence quality for each step. 4. Then cover the safety and supervision section, including the role of the prescriber, pharmacist, and the NZ Formulary; and the legal boundaries in New Zealand. 5. Then a “Common questions” FAQ. 6. Then “Where to get help” with named New Zealand sources: Healthify, NZ Formulary, and the Medicinal Cannabis Agency. 7. Then a footer disclaimer that this is general information, not medical advice, and to consult a qualified prescriber.

The one question: what do cannabinoids actually do in palliative care?

Palliative care aims to improve quality of life when cure is no longer possible. Cannabinoids, mainly THC and CBD, are sometimes added to a symptom plan. The evidence is mixed, and the quality varies by symptom. This page gives you a method to weigh what is established, what is uncertain, and what is still marketing.

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Symptom by symptom: what the evidence says

Every claim below names the condition, the outcome, the preparation studied, and the evidence quality. Evidence quality follows the usual hierarchy: systematic reviews and meta-analyses are highest, then randomised controlled trials (RCTs), then cohort studies and expert consensus.

Chronic pain (cancer and non-cancer)

Outcome: Pain intensity reduction. Preparation studied: Nabiximols (THC:CBD oromucosal spray), inhaled THC-dominant flower, oral THC/CBD oils. Evidence quality: Moderate for cancer pain, low-to-moderate for chronic non-cancer pain. A 2021 systematic review in BMJ Supportive & Palliative Care (Boland et al.) found that cannabinoids produced a small but statistically significant reduction in cancer pain compared with placebo, but the number needed to treat was high and many patients withdrew due to adverse effects. The same review noted that neuropathic pain responds better than nociceptive pain, but the overall effect size is modest. For chronic non-cancer pain, the 2023 systematic review in the Journal of the American Medical Association (JAMA) concluded that cannabis and cannabinoids were associated with a small improvement in pain at 6 months, but with a significant increase in dizziness and sedation; the authors rated the evidence as low to moderate certainty.

CLINICAL GUIDANCE: The NZ Formulary (2024) includes cannabis products as a “specialist” recommendation, meaning they are not first-line. The Ministry of Health’s Medicinal Cannabis Scheme (2020) requires products to meet GMP standards. The New Zealand Medical Association (2021) advises that cannabis should be considered only after conventional treatments have failed, and that clinicians should document the indication and response. Healthify (2023) notes that CBD is not registered as a medicine in New Zealand; it is a dietary supplement under the Dietary Supplements Regulations 1985. The Misuse of Drugs (Medicinal Cannabis) Amendment Act 2018 legalised the prescription pathway. The Medicinal Cannabis Scheme (Misuse of Drugs (Medicinal Cannabis) Regulations 2019) sets GMP and quality requirements.