“I’m interested. But I don’t want to get high!”
Nine years into my career as a registered cannabis practitioner in New York State, this is the most common first remark made to me by many potential patients, especially seniors. Their conventional medications aren’t helping, their children or friends are recommending they try cannabis, and they reach out to me to learn more. It is ironic because, remarkably since 2002, the use of cannabis has decreased among 12- to 17-year-olds, while it has markedly increased in the senior population—that is, those over 55 years.1
As The Hill put it last year, “Seniors, and not the high-school kind, are the fastest-growing population of cannabis users, a trend that illustrates what a long, strange trip the legalization movement has been.” The share of over-65 Americans who have used marijuana nearly tripled in a decade, from 11 percent in 2009 to 32 percent in 2019, according to a respected federal survey on drug use. More than half of the 60–64 demographic reported cannabis use, another sharp increase.2
As we all age, the panoply of medical issues that begin to plague most of us starts to add up. They inevitably chip away at who we are. And more and more of us wind up on increasing numbers of prescription drugs to deal with it all. Many of these drugs, while addressing the serious issues we may have developed, also carry major risks and side effects. Not surprisingly, seniors are taking advantage of the many benefits and often lower dangers of cannabis to treat many of those issues.
And, while the stigma of “Reefer Madness” continues to resonate most with the elderly demographic (fortunately, that film and the misinformation surrounding it was thrown into the dustbin of history many years ago), it’s not surprising that this is the same group that is turning to cannabis with the greatest frequency.
If we look at many of the common conditions that occur with aging—chronic pain, cancer, depression, anxiety, dementia, neuropathies, arthritis, sleep disorders, decreased appetite, and decreased libido—we can begin to understand why the elderly would prefer to try cannabis instead of, or to supplement, their existing drug regimens.
Studies going back over 30 years, not just in the United States but abroad as well, have suggested medical cannabis can provide benefits when conventional treatment does not for conditions that include neuropathic pain, chemotherapy-induced nausea, and vomiting, spasticity (from multiple sclerosis and spinal cord injury), and palliative and end-of-life pain.
In addition, I have seen in my patients that cannabis can also provide its users with increased energy and, as importantly, joy and a contemplative state of mind in dealing with the issues we all face as we age.
Barriers to Research, Funding, and Accessibility
With the widespread availability of various cannabis-based products, there is an urgent need to understand their safety and effectiveness for medical indications. Three primary barriers contribute to the difficulty in initiating research geared toward answering the most pressing public health questions: the US regulatory status of cannabis and cannabinoids, reliable and consistent sources for cannabis and cannabinoid study medications, and limited funding and resources to support studies.
In addition, many people who provide care for older adults don’t feel confident discussing cannabis use with their patients or clients. This research and the subsequent dissemination of legitimate information it would provide can educate them so they can feel comfortable discussing it with those they care for.
Along with their increasing ailments and the drugs they need to take comes the added risk of drug interactions. Cannabis certainly can cause them, and that is why I applaud New York State for requiring medical dispensaries to have a pharmacist on site. These trained practitioners are there not only to help choose the most appropriate products for patients but also to be a final gatekeeper to catch any potential drug interactions, just as they do in retail pharmacies.
Unfortunately, few senior living facilities are taking advantage of the benefits of cannabis for their communities. Because it’s still categorized as a Schedule I narcotic federally, there is an understandable concern for facilities getting Medicare funding that this money could be withheld. Even in states like New York, where it is no longer classified as a narcotic requiring special handling in licensed facilities, there is still reluctance to provide it to the community that resides there.
I’ve been working with organizations like CaringKind, Presbyterian Senior Living, Aging Life Care Association (ALCA), and Empire State Association of Adult Living Facilities (ESAAL) for the last several years, discussing these issues. Because of their openness to learning about cannabis, we’ve been working together to educate not just the leadership of their organizations but the members and their families as well. By bringing this information to them, we hope to remove the negative associations cannabis has had since the 1930s (when it was removed from the US Pharmacopeia after being categorized as a legitimate medicine for more than 80 years ) and help them make it available to those who live there.
If cannabis were descheduled, it would remove those barriers to research, funding, and accessibility.
I recently attended an online conference run by the University of California at San Diego. The strides that are being made, looking at minor cannabinoids, like CBN and THCV, at helping patients with cancer and other ailments of the elderly, were striking and exciting. The plant has many hidden benefits just waiting to be discovered. It was gratifying to learn that, even with the restrictions in place, agencies like the National Institute of Drug Abuse and the National Center for Complementary and Integrative Health are pursuing projects assessing those benefits. They are now doing research and making their data available so that we can reach out to all deserving populations, especially the elderly. In that way, we can give them the most benign and beneficial treatment options available as they live out the rest of their lives as comfortably and joyfully as possible.
