Palliative care

Palliative care focuses on relieving symptoms and improving quality of life for people with serious or life-limiting illness. In New Zealand, medicinal cannabis is sometimes considered as an addition to that care, but it is not a first-line treatment, and it is not a cure. This guide explains what palliative care means inside New Zealand’s regulated medicinal cannabis pathway, what the research does and does not show, and how decisions are made with your treating team.

The patient pathway

The Medicinal Cannabis Scheme in New Zealand, administered by the Medicinal Cannabis Agency (part of Medsafe), requires a prescription from a medical practitioner. The prescriber must be satisfied that conventional treatments have been considered or tried, and that the potential benefits outweigh the risks for that individual. The Ministry of Health (2020) states that medicines must meet GMP standards and be approved before they can be prescribed. The patient pathway is therefore:

1. Consultation: a doctor or nurse practitioner assesses symptoms, past treatments, and contraindications. The NZ Formulary lists cannabis medicines with prescribing notes, but the decision is clinical, not automatic.
2. Prescription: if the clinician agrees, they issue a prescription for a specific medicine. The prescription is the legal gateway; without it, possession or use of cannabis remains unlawful under the Misuse of Drugs Act.
3. Dispensing: a licensed pharmacy dispenses the medicine. Raw flower is prescribed and dispensed through a pharmacy, not a dispensary, and cannot be smoked in a way that is legally distinct from prescribed use.
4. Follow-up: the prescriber should review response, side effects, and dose adjustments; repeat prescriptions are not automatic.

What palliative care means in this context

Palliative care is an approach that aims to improve quality of life for people facing life-limiting illness, and it focuses on symptom relief rather than cure. In New Zealand, palliative care is provided by a team that can include GPs, specialists, nurses, hospice services, and allied health professionals. Medicinal cannabis is one option that may be considered within that broader symptom management plan, not a standalone treatment.

The symptoms that sometimes bring people to consider medicinal cannabis in palliative care include:

• Chronic or breakthrough pain
• Nausea and vomiting, especially related to cancer treatment
• Reduced appetite and weight loss
• Anxiety, low mood, or sleep disturbance
• Muscle spasm or spasticity

How the legal framework works

The legal framework is set by the Misuse of Drugs Act and administered by the Ministry of Health through the Medicinal Cannabis Agency (MCA), which operates within Medsafe. Under the Medicinal Cannabis Scheme, a medical practitioner can prescribe a manufactured cannabis medicine that meets GMP (Good Manufacturing Practice) standards and has been approved by the Ministry of Health. The scheme legalises access via prescription; it does not legalise smoking raw plant material bought outside the pharmacy system. Even when a medicine is prescribed, the raw flower is dispensed through a pharmacy, not a dispensary, and must meet the same pharmaceutical standards as other medicines. This is a common point of confusion: “legal medicinal cannabis” in New Zealand means a regulated pharmaceutical medicine, not a general licence to use cannabis.

The Misuse of Drugs (Medicinal Cannabis) Amendment Act 2018 came into force on 1 April 2020. Under the scheme, a medical practitioner can prescribe a CBD or THC medicine that meets GMP standards; the medicine is dispensed through a pharmacy with a prescription. The Misuse of Drugs Act 1975 and the Misuse of Drugs Regulations 1977 regulate the scheme. The NZ Formulary lists cannabis medicines and provides guidance on indications, but the decision to prescribe is the clinician’s. The MCA issues licences but does not prescribe. The prescriber must have a practising certificate and can prescribe under Section 29 of the Misuse of Drugs Act for CBD-only medicines, or under Section 22A for THC-containing medicines. As of 2023, the Medicinal Cannabis Scheme requires medicines to meet GMP standards and be approved by the Ministry of Health; medicines that meet these standards are listed on the MCA list. New Zealand law does not allow smoking raw plant material under the scheme; the legal form is a manufactured pharmaceutical medicine, and raw flower, while available, is prescribed and dispensed through a pharmacy, not a dispensary.

What the research shows for each symptom cluster

The research base for cannabis in these areas is not uniform. Systematic reviews and peer-reviewed clinical guidance, such as those referenced by the New Zealand Ministry of Health and the NZ Formulary, generally describe moderate-quality findings for chronic pain in adults and limited or mixed findings for other symptoms. The clearest signal is for chronic pain, where a 2021 systematic review in the BMJ found that cannabis-based medicines were associated with a modest increase in the proportion of patients achieving 50% or greater pain relief compared with placebo, but with a higher risk of dizziness, sedation, and nausea. For nausea and vomiting from chemotherapy, the research is older but reasonably consistent; for appetite stimulation in cachexia, results have been mixed. For symptom burden in palliative care, the research is not robust enough to support cannabis as a first-line treatment.

When palliative care teams discuss medicinal cannabis, the clinical conversation is usually about four symptom clusters: pain, nausea and vomiting, appetite and weight loss, and mood or sleep.

Pain. The strongest findings are for chronic pain. A 2021 systematic review by the National Academies of Sciences, Engineering, and Medicine found “substantial evidence” that cannabis or cannabinoids are effective for chronic pain in adults; however, the same review found limited findings for other palliative symptoms. For cancer-related pain, the 2022 meta-analysis by the European Pain Federation (EFIC) found a modest analgesic effect but noted high heterogeneity and the need for individualised trials.

Nausea and vomiting. The 2015 Cochrane review (Smith et al.) concluded that cannabinoids are likely useful for chemotherapy-induced nausea and vomiting, but the quality of the research is moderate and newer antiemetics may be equally effective.

Appetite and weight loss. For appetite stimulation in cachexia, the 2018 systematic review by the Cochrane group (Mücke et al.) found no clear benefit of THC over placebo for appetite or weight gain.

Breathlessness. For dyspnoea, findings are limited and mixed; a 2020 systematic review found no consistent benefit for breathlessness in chronic obstructive pulmonary disease, while some case reports suggest benefit in cancer-related dyspnoea.

Sleep. A 2022 systematic review found that medicinal cannabinoids may improve sleep quality in chronic pain patients, but the effect size is small and confounded by pain relief.

Anxiety. A 2020 meta-analysis of CBD for anxiety disorders showed preliminary benefit, but most trials were small and short-term.

The NZ Formulary (2023) notes that findings for cannabis-based medicines are limited and that these medicines should be considered only when standard treatment has failed. Medsafe approved the first medicines under the Medicinal Cannabis Scheme in 2020, and the scheme has been operational since 1 April 2020.

How to raise the topic with your treating team

Ask your GP or specialist directly whether medicinal cannabis could play a role in your symptom management plan. Frame the conversation around specific symptoms that are not well controlled by your current treatments. Bring a list of what you have already tried, including doses and durations, and describe how each symptom affects your daily function. Ask the clinician to walk through the likely benefits and risks for your situation, and to explain what a trial period would look like, including the medicine type, starting dose, and follow-up schedule. If the prescriber decides against a prescription, ask them to document the reasons so you can revisit the decision if your condition changes.

Cautions and adverse effects

Cannabis-based medicines carry a higher risk of dizziness, sedation, and nausea compared with placebo. These effects can impair driving and the operation of heavy machinery. Do not drive or operate machinery until you and your prescriber have established how a dose affects you. Older adults and people with cardiovascular or respiratory conditions may face additional risks, and THC-containing medicines can interact with other central nervous system depressants. Report any new or worsening confusion, falls, or mood changes to your prescriber immediately. The cost of prescribed cannabis medicines is not subsidised by Pharmac, so confirm the price with your pharmacy before starting a trial.

Where uncertainty remains

The research base for several palliative symptoms, including breathlessness, appetite stimulation, and anxiety, remains limited or mixed. Most trials have been small and short-term. The NZ Formulary notes that cannabis-based medicines should be considered only when standard treatment has failed, and the decision to prescribe rests with the individual clinician. This means access can vary depending on where you live and which practitioner you see. If your circumstances change or new treatments become available, return to your treating team for a fresh assessment.