Medical Cannabis for Seniors

By Flor Ortiz. Veterinary Zootechnician (FMVZ-UNAM), medical researcher of the medicinal use of cannabis in veterinary and human medicine.

Did you know that several of the properties of medical marijuana or cannabis can help treat diseases of the elderly? As we age we lose some functions, and cannabis can help counteract some of these effects. Learn more in this text.

This article was written to inform the general public about medical cannabis, so we have tried to keep the language simple.

Cannabis or medical marijuana has shown promise in treating many conditions that concern older adults, so here we will talk a little about this population group in Mexico and how they can benefit from this plant.

Older adult population in Mexico

Based on the ENADID 2018, 15.4 million people aged 60 and over reside in the country. Almost half of them live in single family households, and 1.7 million live alone. Seven out of ten older adults living alone present some type of disability or limitation.

In the country, 85.4% of elderly people living alone are affiliated with a health care institution, and most of them seek medical attention when they have a health problem. In fact, 9 out of every 100 are seen in a pharmacy office.

Aging causes a natural deterioration of the body's functions, which results in difficulty in performing activities of daily living, and in turn this deterioration may cause some disability or limitation, so that these patients may need some kind of assistance, from canes to nurses. The greater the age, the greater the probability of suffering limitations or disabilities. [7]

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The elderly population constitutes a growing segment of medical cannabis users, ranging from approximately 7% to 33% depending on the country. [1] A recent study in Israel found that among 279 cancer patients receiving medical cannabis, 50% were 60 years of age or older, which hints at the potential of medical marijuana's properties to treat older adults. [8]

Cannabis has fewer side effects than other drugs

Conventional medications used in elderly patients may cause side effects that worsen the quality of life or cause other symptoms.

Some examples:

opioids may increase the risk of constipation, confusion, falls and fractures;
benzodiazepines also increase the risk of fractures and soft tissue injuries;
dopamine antagonists may increase the risk of death in older adults with dementia.

Because of this, the properties of medical marijuana or cannabis may offer an alternative to help older adults. [4]

How does cannabis work in older adults?

Cannabis contains numerous cannabinoids, including tetrahydrocannabinol or THC and cannabidiol or CBD. These compounds act on the Endocannabinoid System (ECS). [12]

Apparently, the activity of the endocannabinoid system (ECS) decreases with aging, and cannabis may help to "rejuvenate" the ECS.

These properties are derived from the cannabinoids in marijuana, and may be useful in treating age-related deficiencies. [3]

Medical cannabis can help by improving sleep quality and mood, decreasing pain, and reducing tremors, spasticity, or agitation. [11]

The main symptoms or diseases for which cannabis has been used are: [1,5,8,11,12].

Joint diseases.
Parkinson's disease.
Chronic pain.
Dementia and Alzheimer's disease.
Neurological and psychiatric diseases.
Sleep disturbances.
Nausea and vomiting (associated with chemotherapy).
Respiratory diseases.
Mood disorders and agitation.

The most common forms of use in this age group are: topical application, spraying or spraying under the tongue, followed by ingestion of capsules, vaping and finally edibles. [6]

Don't forget: Consult your doctor!

Although medical cannabis is considered natural and possibly less harmful than common medications, it should not be used without the advice of a physician.

Whenever cannabinoid medication is started, it should be dosed according to the rule "start at low doses and increase slowly", until a dose is reached that has an effect on the symptoms. This avoids adverse effects, including falls and hypotension (lowering of blood pressure). [9]

The most common adverse effects are dizziness, euphoria, drowsiness, confusion and disorientation. These events are very important in the elderly population, as they may suffer from conditions such as dementia, frequent falls, mobility problems, hearing or visual impairment. [1]

Acute toxicity and overdose are also possible, especially in first-time users who self-medicate or do not consult their physician. Products that are drunk or eaten may take several hours before they take effect, which may lead users to ingest a larger amount out of impatience, increasing the potential for accidental overdose. [10]

With too high doses, respiratory depression, cardiovascular and neurological toxicity have been reported. In addition, consumption of large single doses of THC can trigger an episode of acute psychosis. For all these reasons, always consult your doctor before using medical cannabis.

Precautions

Marijuana abuse has not historically been a major concern in older adults; however, it is possible that it may be related to increased substance abuse in these individuals. [4]

It is important to warn people not to drive for at least 6 hours after vaporizing or smoking and 9 hours after consuming edibles.

Conclusions

The medicinal properties of marijuana or cannabis are a reality. Patients are seeking cannabinoid medicine because of its perceived benefits on chronic diseases. More research is still lacking on the applications of medical cannabis and how it helps older adults, but the evidence of its benefits in multiple conditions already exists.

References

[1] Abuhasira, R., Schleider, L. B.-L., Mechoulam, R., & Novack, V. (2018). Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. European Journal of Internal Medicine, 49, 44-50. doi:10.1016/j.ejim.2018.01.019.

[2] Beauchet, O. (2018). Medical Cannabis use in older patients: update on medical knowledge. Maturitas.doi:10.1016/j.maturitas.2018.10.010

[3] Bilkei-Gorzo, A., Albayram, O., Draffehn, A., Michel, K., Piyanova, A., Oppenheimer, H. Zimmer, A. (2017). A chronic low dose of Δ9-tetrahydrocannabinol (THC) restores cognitive function in old mice. Nature Medicine, 23(6), 782-787.doi:10.1038/nm.4311.

[4] Briscoe, J., & Casarett, D. (2018). Medical Marijuana Use in Older Adults. Journal of the American Geriatrics Society, 66(5), 859-863. doi:10.1111/jgs.15346.

[5] Häuser, W., Fitzcharles, M. A., Radbruch, L., and Petzke, F. (2017). Cannabinoids in Pain Management and Palliative Medicine. Deutsches Arzteblatt international, 114(38), 627-634. https://doi.org/10.3238/arztebl.2017.0627

[6] Highet, B. H., Lesser, E. R., Johnson, P. W., & Kaur, J. S. (2020). Tetrahydrocannabinol and Cannabidiol Use in an Outpatient Palliative Medicine Population. American Journal of Hospice and Palliative Medicine®. https://doi.org/10.1177/1049909119900378.

[7] Instituto Nacional de Estadística y Geografía. (2019, septiembre 30). ESTADÍSTICAS A PROPÓSITO DEL DÍA INTERNACIONAL DE LAS PERSONAS DE EDAD (1º DE OCTUBRE). DATOS NACIONALES [Comunicado de prensa]. Recuperado de <PDF>, última consulta 20 julio de 2020.

[8] Katz, I., Katz, D., Shoenfeld, Y., & Porat-Katz, B. S. (2017). Clinical Evidence for Utilizing Cannabinoids in the Elderly. The Israel Medical Association journal: IMAJ, 19(2), 71-75.

[9] MacCallum, C. A., Russo, E. B. (2018). Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine, 49, 12-19. doi:10.1016/j.ejim.2018.01.004.

[10] Mahvan, T., Hilaire, M., Mann, A., Brown, A., Linn, B., Gardner, T., & Lai, B. (2017). Marijuana Use in the Elderly: Implications and Considerations. The Consultant Pharmacist, 32(6), 341-351.doi:10.4140/tcp.n.2017.341.

[11] Minerbi, A., Häuser, W., and Fitzcharles, M.-A. (2018). Medical Cannabis for Older Patients. Drugs & Aging.doi:10.1007/s40266-018-0616-5.

[12] Van den Elsen, G. A. A. H., Ahmed, A. I. A., Lammers, M., Kramers, C., Verkes, R. J., van der Marck, M. A., and Rikkert, M. G. M. O. (2014). Efficacy and safety of medical cannabinoids in older subjects: A systematic review. Ageing Research Reviews, 14, 56-64.doi:10.1016/j.arr.2014.01.007.

Medical cannabis for the elderly