There is an increased interest in the use of cannabinoids in the treatment of symptoms in cancer and palliative care patients. Their multimodal action, in spite of limited efficacy, may make them an attractive alternative, particularly in patients with multiple concomitant symptoms of mild and moderate intensity. There is evidence to indicate cannabis in the treatment of pain, spasticity, seizures, sleep disorders, nausea and vomiting, and Tourette syndrome. Although the effectiveness of cannabinoids is limited, it was confirmed in neuropathic pain management and combination with opioids. A relatively favorable adverse effects profile, including no depressive effect on the respiratory system, may make cannabis complement a rather narrow armamentarium that is in the disposition of a palliative care professional.

1. Introduction
Marijuana and hashish are frequently used psychoactive substances. However, they have also been used for medical purposes for thousands of years. There is an increased interest to use cannabinoids in the treatment of symptoms in patients with cancer or HIV, in Tourette syndrome, epilepsy, spasticity, and in digestive disorders [1,2]. Controversies around the legalization of cannabis for recreational use impede the approval of its medical preparations. They recall those of the ’80s that impeded implementation of cancer pain treatment with opioids and tend to express political, rather than medical positions. There are two contradictory positions regarding the medical use of cannabis. One is affirmative and even irrespective of the clinical evidence. The second one is conservative with prejudices and fears. The right approach should be evidence-based. In this light, there are critical questions regarding the medical use of cannabis. Is it an effective and safe symptom controlling medicine in palliative care patients? Does it have anti-cancer life-prolonging properties?
In which indications has cannabis appeared useful? How much can we expect from cannabis in the
management of pain and other symptoms? What should a palliative care physician and an oncologist
know about cannabis and cannabinoids? This paper aims to summarize the theoretical and clinical
rationale for the use of cannabinoids in the treatment of palliative care patients.