An Introduction to Cannabis Use in the Elderly Patient
Good morning TRUCE readers, cannabis warriors and patients. In today’s Medical Minute I am going to introduce some issues regarding cannabis use in the elderly population. This group of patients is the largest age demographic in my chronic pain practice, and easily the largest growing group of cannabis users that I see regularly. Today’s cannabis isn’t the same stuff from the 1960’s and 70’s. As such, regardless of past use it requires a whole new approach to ensure success and benefit in these patients, and especially to avoid unwanted side effects that may discourage the elderly user to abandon this medicine after a brief failed trial.
Before I get started, please don’t be offended by any age discussion or suggestions about experience. Elderly, geriatric, aging, seniors are all terms I will use to describe patients that are getting older. This could range from patients in their 50’s on up to centenarians. All patients are different. Some aged patients are expert cannabis users with decades of else and knowledge. Some are absolute neophytes. This info is generally intended to inform those older patients who are new to this medicine.
Often times I see an aging patient, brought in to clinic by their adult children who have encouraged their parent to try cannabis to treat a variety of conditions, usually pain. They bring mom or dad in after having them try an edible, or some other product that they brought to them from out-of-state. It’s no surprise that without careful counseling and titration the patient got so stoned that they’ve frequently had an unpleasant experience. Unfortunately some are extremely hesitant to try it again. This doesn’t have to be the case.
There are unique issues facing the elderly patient. Growing evidence supports that there is a gradual decline in the functioning of our Endocannabinoid Systems with aging. Supplementation of cannabinoids can help treat symptoms related to this. Elderly patients have more chronic pain, more sleep issues, more cognitive decline, increase risk of anhedonia….the potential symptoms go on and on. Cannabis can be effective for all of these things.
Seniors are more likely to take multiple medications (poly-pharmacy) and it is a serious issue. Studies show that more than half of seniors take one or more unnecessary medication. There is a strong relationship between poly-pharmacy and negative clinical outcomes. Cannabis can replace multiple medications. This reduces the risks of drug-drug interactions. Of course cannabis can have its own interactions, please download the wonderful free primer on cannabis drug interactions linked at the bottom of the page (and thank you to ProjectCBD.org and Martin Lee for that).
More on poly-pharmacy here:
What are some other benefits of MC for seniors, you ask? We should all know by now the incredible safety profile of this medication. It is literally impossible to overdose by respiratory arrest, as there are ZERO documented overdose deaths by this means in recorded history of humans. We can possibly eliminate (or at least decrease) opioid use in this population by adding cannabis.
Elderly patients may find a significant increase in their quality of life. Enjoyment in activities usually considered routine is seen. Time distortion and savoring are present. Socializing is improved, relaxation is better.
The past couple TMM posts have covered psychoactivity of cannabis. Please read these if interested. I don’t want to be redundant but there is a great deal of pertinent info there, as seniors may have amplified psychoactive effects (both positive and negative).
Psychoactivity of Cannabis, Part 1 (“the good”):
Psychoactivity of Cannabis, Part 2 (“the bad”):
COST of treatment is a controversial topic. Seniors spend an average of $3000 annually (out of pocket) for their prescriptions. With appropriate dosing, the national average for patients’ medical cannabis is only $650-800 yearly. I believe this figure is likely going to be higher in Utah, but there still is a tremendous possibility to cut costs. If insurance plans would cover medical cannabis then this cost savings would of course be far greater. I am not blind to the possibility that cannabis adds cost to healthcare though.
Furthermore ACCESS to cannabis is a problem that can be amplified for seniors, as transportation and medical issues can make trips to dispensaries more problematic. This is indeed a moving target here in Utah. Assuming that the kinks are worked out, having local access to affordable, safe medicine is critical for Utah’s elderly patients.
Here are a few clinical pearls for starting cannabis in the elderly patient:
-Dosing: Start low, go slow, stay low (but don’t be afraid to go high if needed)
-Decrease the ratio of CBD to THC (try to stay under 3:1) for daytime use to avoid AEs
-Consider tinctures for titratable dosing
-Discuss clear goals of treatment ahead of time (I like to work on improving their sleep quality as a first step)
-Frequent follow up, have patients bring their medicine to clinic to interpret and educate
-Warn patients about potential for dizziness and risk of falls
This is obviously a brief primer, there is so much more information to understand about cannabis in the aging population that doctors, nurses and patients need to know. I am sure there are many topics we will expand upon in future blog posts.
Next week there will be no TRUCE Medical Minute post. Happy Thanksgiving!
Andrew Talbott, MD
TRUCE Medical Advisor
Board Certified in Anesthesiology and Pain Medicine
Cannabis/drug interactions info:
Top image is from a Leafly article, https://www.leafly.ca/…/seniors-are-erasing-the-lines-betwe…