Marijuana Usage
These patients range from people in their 60s with renal failure who can no longer take certain pain medications but still need to manage chronic pain to patients in their 90s who are trying to find a good night’s sleep and are leery of the side effects of traditional sleep medications.
Some of them, typically “children of the 60s,” are quite comfortable using medical marijuana; others bring it up quietly as if asking permission to break the law.
According to a recent study in the Journal of the American Medical Association, cannabis use among older adults within the US has been steadily increasing.
During this study, the prevalence of past-year use increased from 2.4% to 4.2% from 2015 to 2018. This study is according to other research, as with reports from physicians who recommend cannabis in their daily practices.
What could be behind this trend?
A confluence of things seems to be responsible, including the decrease in stigma related to cannabis use and the increased interest in the use of medical marijuana by older patients.
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Stigma may be a complicated issue, but most would agree that the stigma related to cannabis use is lessening, especially for medical cannabis. During a recent poll, 94% of USA citizens voiced support for legal access to medical marijuana, and most states have approved some sort of legal access.
One marker for the decrease in stigma is the recent statement by the 38 million-member AARP, during which they declared their support for the medical use of marijuana for older adults in states that have legalized it, in close consultation with their medical providers, where they will discuss the most up-to-date clinical evidence, weighing the balance of advantages and harms.
Conditions older adults using cannabis have
Studies show that older adults commonly use medical cannabis for the identical conditions younger patients do: pain, insomnia, neuropathy, and anxiety.
Risks for older people using medical cannabis
This is new territory, as there haven’t been large numbers of older adults who report using medical cannabis, or if they need been using it, they have kept it quiet, thanks to its illegality and stigma.
Medical cannabis is usually well tolerated among older adults; however, like all medications, there’s no such thing as a free lunch, meaning there are always side effects and drawbacks.
Cardiac health and cannabis use
Cannabis is understood to increase heart rate and can increase blood pressure. However, there doesn’t seem to be much if any quality evidence directly linking cannabis use with coronary events, consistent with a recent review by the Journal of the American College of Cardiology.
Still, the authors of this review recommend screening people with coronary disease for cannabis use. The scenario is an older patient with underlying coronary disease taking a high dosage of cannabis and then having an anxiety attack, which could trigger a coronary syndrome or arrhythmia.
Medication interactions
Older people tend to possess comorbid health conditions and may take multiple medications. Cannabis has about 600 chemicals in it.
In theory, the two main active ingredients in cannabis, THC, and CBD, could either increase or decrease the blood levels of other drugs you’re taking by affecting the enzymes in your liver that help metabolize your medications.
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CBD is in danger of increasing the other drugs in your system by “competitively inhibiting” the molecules you need to break down and clear these medications from your body.
People should be particularly cautious using cannabis with anti-seizure medications and blood thinners, as these medications tend to have serious side effects and not as much room for error.
Disclosing marijuana use is especially important if you plan to have surgery because the drugs used for anesthesia and post-surgical pain management may need to be adjusted.
Both Pro and Con
The psychoactivity, or the high that cannabis causes, is another potential concern for older adults, especially those in danger of confusion and dementia.
Nowadays, with the power to buy cannabis in medical dispensaries, there’s more control over the types or strains of cannabis that one can buy and consume, and it’s easier to avoid the high by controlling the dose and keeping the THC content low.
Strains that are low in THC and better in CBD, which is non-intoxicating, could also be preferable to avoid the psychoactive experience of marijuana.
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Still, if an older person has experienced delirium or psychiatric conditions, they and their doctors should proceed cautiously.
Interestingly, there’s some research that cognitive functioning can improve when patients use medical cannabis due to, among other things, improved sleep and pain control.
It seems plausible that older patients could be using lower doses of pain and sleep medications, which may affect thinking, and that they combat the negative effects of chronic pain and insomnia, which even affect cognitive functioning. However, like most cannabis-related things, this too needs further study to verify and clarify.
Cannabis use among the elderly is growing with more public acceptance and reduced stigma. Medical cannabis is increasingly considered an efficient treatment for insomnia and chronic pain.
It’s key to possess an informed discussion with your doctor to weigh the safety risks, especially if you’ve got cardiac issues, are taking multiple medications, or have cognitive changes thanks to aging.
Educate yourself as much as possible about cannabis before starting to use it. Most of the adverse effects of cannabis usage are dose-related, so it’s important to know the strength of the marijuana you are taking and to “start low and go slow.”
Start with the lowest effective dose and work your way up to a dose that alleviates your symptoms with minimal side effects.
