Sleep and Other Benefits
Older adults use marijuana for a variety of reasons beyond pain, including insomnia and anxiety.12
“I have a lifelong insomnia problem, due to early childhood trauma,” said Paige E, LCSW, a 75-year-old therapist who asked that her name not be used for this article. “I have tried the full array of psychotropic medications as well as sleeping medications, all of which were either ineffective or which gave me terrible side effects. Once my psychiatrist prescribed medical marijuana, my sleep improved and I’m less anxious. We were both surprised at how effective it turned out to be.”
Additional reasons seniors turn to cannabis include glaucoma and chemotherapy side effects such as nausea (when relevant).12
Challenges of Cannabis Use in Older Adults
Two out of three older Americans have multiple chronic health conditions that generally require multiple prescription medications, increasing the risk of adverse drug effects, which can further endanger their health.13
“There’s a variety of competing medical issues in older individuals, as they start to have more physical problems and take an ever-increasing number of medications to manage those,” Dr Prozialeck observed. “Unfortunately, little is known about how various medications — both OTC and prescription drugs — interact with marijuana.”
Some research suggests that marijuana may interact with several agents that are commonly prescribed to older adults via alteration of the liver’s cytochrome P450 enzyme system. Additionally, marijuana used together with other CNS depressants might have an additive sedative effect.14
Older people are more sensitive to many medications, as a result of age-related changes in body chemistry and brain function and cannabis is no exception, Dr Prozialeck noted. “There are no guidelines, no prescribing recommendations, virtually no research to guide practitioners or pharmacists in safe prescribing and drug-drug interactions in older adults.”
However, certain potential adverse effects of cannabis are known and should be on the radar of clinicians. “We know that prolonged use of cannabis can impair cognition,15 and cognitive impairment is already a concern in the elderly in many domains, including driving,” he warned. “Although some research16,17 suggests that cannabis can be helpful with symptoms of dementia such as agitation, cannabis has also been associated with psychotic disorders15 which is another concern in the elderly, particularly those with dementia.”
Know Your Cannabinoids
Cannabis combines Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in an approximately 1:1 ratio. The THC is the agent with psychoactive properties, while CBD affects anxiety and pain.1 “Cannabidiol is the more active pain reliever and doesn’t produce a ‘high,’ and there are many strains of medical marijuana that are bred to produce high cannabidiol and low THC,” said Dr Prozialeck.
With regard to obtaining the product, most states have a required procedure. “In Illinois where I live, the physician must submit a form to the Illinois Department of Public Health certifying that a patient has one of about 40 conditions that qualify them for the use of medical marijuana. When the department has reviewed the form and completed a background check, the patient receives a card allowing the use of medical marijuana, which can then be taken to a dispensary,” he explained.
Dr Rudroff noted that in Iowa, there are only 5 dispensaries that offer medical marijuana. The cardholder receives the name of these dispensaries. “I prefer this because the product can be dispensed in a more controlled way—in contrast to other states such as Colorado, where it has gotten out of hand, is less controlled, and there are dispensaries everywhere,” he said, adding that “a good dispensary should be able to let the patient know the ratio of THC to CBD.”