Curiosity About Medical Cannabis: Special Considerations for Older patients

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First it won over millennials. Then came the Baby Boomers. Now medical cannabis is piquing the interest of patients over the age of 65. Despite initial hesitations during the first wave of legalization, seniors are slowly coming around to the value of medical cannabis. 

 

This rapid shift is thanks to the unique combination of legalization, changing social norms, and the potential that cannabinoid therapy holds for age-related conditions. Cannabis is already approved as medicine (at the state level) for several age-related diseases like arthritis, chronic pain, Parkinson’s, and oncologic co-treatment. With this in mind, the increased (and for some renewed) interest in cannabis’s power is perhaps not so surprising.  

 

The sudden uptick in cannabis consumers over the age of 65 has also caught the attention of marketers. Seniors represent a large and mostly untapped demographic. As per some assessments, seniors, on average, have between five to seven ongoing prescriptions. If seniors choose to replace one or more of these prescriptions with medical cannabis, it could lead to exponential market growth. 

 

It’s worth taking a closer look at these changing perspectives among people over the age of 65 and the age-related illnesses medical cannabis may treat.

 

Increased Curiosity Among Patients 65 Years and Up

 

In 2019, the Journal of International Medicine published a research letter entitled “Trends in Cannabis Use Among Older Adults in the United States, 2015-2018.” The authors sought to determine if cannabis use among people over the age of 65 continues to rise based on national trends. As they detail, between 2004 and 2016, rates of cannabis use among this demographic “increased sharply” from 0.4 percent to 2.9 percent. Would the pro-cannabis trend continue?

 

Based on more than 14,000 respondents, the researchers determined, yet again, much more interest in cannabis among an older demographic. Between 2016 and the end of 2018, “the prevalence of past-year cannabis use among adults 65 years and older increased significantly from 2.4% to 4.2%.” This increase equals a more than 75 percent relative increase.

 

Many physicians are reporting similar trends in their discussions with older patients. In one poignant example, Peter Grinspoon, MD, a contributor to Harvard Health, detailed his experience seeing many more older patients asking questions about cannabis use. When his older patients bring the topic up, “some of them — typically ‘children of the 60s’ — are quite comfortable with the idea of using medical marijuana; others bring it up quietly, as if they are asking permission to break the law.” 

 

National trends and physicians are all reporting that the stigma about medical cannabis is crumbling—which is perhaps surprising for the generation who lived through the War on Drugs, and one which is often assumed to have more conservative views on the subject. It’s time for a more thoughtful approach to medical cannabis for seniors.

 

Age-Related Conditions Already a Target for Cannabinoid Therapies

 

In “Medical Cannabis for Older Patients—Treatment Protocol and Initial Results” published in 2019 in the Journal of Clinical Medicine, the authors explored medical cannabis use among seniors and its efficacy. They included participants over the age of 65 with the following cannabis treatment indications in descending order of prevalence: chronic pain, Parkinson’s disease, orthopedic pain, oncologic treatment, dementia, arthritis, restlessness, fibromyalgia, and palliative care. After six months, nearly 60 percent of respondents were still using medical cannabis, and at the one-year follow-up, more than 84 percent reported some benefit to their condition. 

 

For each of the conditions included in the above study, there is growing preliminary evidence about the effectiveness of cannabis. Rheumatic diseases (fibromyalgia, chronic pain, osteoarthritis, and rheumatoid arthritis) are perhaps among the most prominent examples of relevant medical cannabis research. Several preclinical studies within this realm have already been completed, including a survey of Israeli patients prescribed medical cannabis for the treatment of fibromyalgia. The results published in the Journal of Clinical Rheumatology concluded, “All the patients reported a significant improvement in every parameter,” with some patients reducing or eliminating other medications in favor of cannabis.

 

In a much earlier phase, another study reported positive results of cannabidiol (CBD) for the treatment of a rat model of rheumatoid arthritis. This study, combined with benefits reported by patients themselves, is leading to cautious optimism about the future of cannabis for age-related illness, especially rheumatic disease.

 

Special Considerations for an Aging Demographic

 

Yet, despite this excitement, caution is required. The researchers behind the study in the 2019 Journal of Clinical Medicine clarified, “The potential risks of cannabis should not be disregarded.” An older demographic poses a set of unique challenges. Physicians and regulations need to take special care when working with patients over the age of 65.

 

One of the primary issues when working with seniors is the risk of adverse effects. Medical cannabis continues to defy the traditional understanding of pharmaceuticals. There are significant, and often confounding, differences among patients in terms of efficacy, dose size, and THC sensitivity. With guidelines on the proper dose a long way off, keeping patients safe is a difficult task.

 

Most evidence suggests that adults generally become more sensitive to THC the older they get, which often leads to an increase in adverse events during treatment. An intense adverse event can lead to problems with adherence. In the 2019 study above, at the six-month follow-up, more than 30 percent of elderly participants reported an adverse event. The adverse events included sleepiness, dizziness, and fatigue. 

 

How does this stack up against the side effects of other common pharmaceuticals? In contrast with one of the most prevalent prescriptions among seniors, opiates for chronic pain, cannabis-related issues are frustrating, but mild in comparison. 

 

As only one example of this stark contrast, the study “Opiates and elderly: Use and Side Effects” explores several of the most common opiate-related side effects. As per the review, “constipation is the most common side effect of morphine in hospice patients with a prevalence of 48% and it impacted negatively on quality of life significant side effects.” Other serious side effects include respiratory depression, sedation, cognitive impairment, and nausea. These are all much more serious than fatigue, sleepiness, and dizziness. 

 

The high rate of cannabis-related adverse events among the 2019 study participants likely comes down to a lack of supervision on dose protocols. Dose is everything with THC-rich medical cannabis, and without adequate guidelines on size and frequency, patients are at higher risk for adverse events. This is especially true for THC-naive patients. Should patients receive personalized instruction and a careful self-titration schedule, theoretically, the risk of side effects could be substantially reduced.

 

Finally, the risk for cannabis-related side effects must also consider potential interactions between cannabis and additional prescription —and, the increased rates of heart disease, respiratory disease, nervous system impairment, and other pharmacokinetic risks that increase with age. Medical cannabis use amongst this demographic is naturally more challenging than other age groups.

 

Have We Reached the Last Frontier of Medical Cannabis?

 

Are people over the age of 65 the last frontier of medical cannabis? A lot is riding on the rollout of medical cannabis amongst an older demographic, and not just a new profitable market. Physicians, researchers, and regulators must take a cautious approach that balances the potential medicinal value with the risk of side effects. 

 

With that in mind, an 84 percent success rate for symptom improvement among the 2019 study participants is remarkable. Furthermore, it’s worth comparing the relatively mild side effects of cannabis-related treatment with those of other commonly prescribed pharmaceuticals, like opiates. 

 

Medical cannabis has colossal potential for helping seniors relieve the symptoms of age-related disease. Now it’s time for more research to help create improved and senior-septic dosing options.