Cannabis and Seniors: Part 1

Seniors are the fastest growing demographic of cannabis users.

Radicle Health provides access to medical and educational cannabis resources. We help our patients, most of whom are seniors, use cannabis to help treat age-related and chronic illness. Our board-certified Adult Geriatric Nurse Practitioner, Eloise Theisen, has treated over 4000 patients with cannabis.

The average age of our patients is 76 years, and about 90% of the patients that we see have previously never used cannabis. About half of these patients want to use cannabis to treat pain, and about half want to use cannabis to treat sleep issues.

Cannabis can be a safe and effective choice for seniors looking to treat age-related and chronic illness, or wanting to wean themselves from pharmaceuticals with severe side effects. However, many of the patients that we see at Radicle Health are initially skeptical of using cannabis as a treatment modality.

And yet, seniors are the fastest growing demographic of cannabis users.   Cannabis use among adults 65 and older is up 250%, and up nearly 60% in adults aged 50-65. Despite these trends, the cannabis industry has a lot of barriers of access for seniors. The product choices can be confusing—sometimes bewildering—the information and advice dubious, and—without the proper guidance and information—the success rates can be low.

Because of misinformation and misguided laws, we work in an industry where, historically, the burden of health care was shifted away from licensed professionals to mostly young retail workers. It’s not uncommon that a patient will confess that their budtenders know more about using cannabis to treat their illness than the patient’s primary care physician. These budtenders have been on the front lines of cannabis activism, providing help and guidance to patients who could find no help elsewhere. These men and women should be applauded for their work.

That said, evaluating a patient and creating a treatment plan, especially for an older adult, is complex. We can’t expect a person with a non-medical degree to adequately assess a patient’s needs, especially senior patients.

Senior patients are unique, because—as we age—things slow down. We begin to see evidence of declining bioavailability, meaning that our bodies are able to use less of the things that we ingest. Our kidneys and liver work less efficiently, meaning that our bodies cannot as quickly clean toxins from the blood and metabolize the things that we consume. We struggle with other age-related biological changes, such as problems with balance, vision, and hearing. And, many of us struggle with the consequences of life-long habits, such as poor diets, too much alcohol, or smoking.

Because senior patients experience a higher prevalence of chronic illness, they are more likely to be prescribed medication by their doctors. In fact, people aged 65 years and older comprise only 13 percent of the population, yet account for more than one-third of total outpatient spending on prescription medications in the United States.

Additionally, older patients are more likely to be prescribed long-term and multiple prescriptions, and health issues related to poly-pharmacy increase with age. Poly-pharmacy is defined as 5 or more medications, not including supplements or vitamins. According to the Centers for Disease Control and Prevention, nearly 40% of seniors age 60 years and older take at least five medications. Patients living in assisted living and skilled nursing facilities are frequently prescribed as many as 20 medications daily.

And while this group comprises approximately 14% of the U.S. population, the same demographic account for nearly 25% of all emergency room visits. About half of these hospitalizations are a result of adverse drug events, or ADR.

The risk of ADR is 10% with one medication and increases with each additional medication. The risk of ADR is 100% when 10 or more medications are prescribed.

With each additional prescription, medication compliance decreases and the risks of interactions and adverse effects increase. Those experiencing cognitive decline may fail to understand or remember the proper dosing for each medication. And, poly-pharmacy increases risk of death for patients taking prescriptions with black box warnings, especially for patients using anti-psychotics to treat Alzheimer's or dementia.

The Cytochrome P450 is a family of enzymes that are primarily expressed in the liver and which are responsible for metabolizing many of our medications. These enzymes work less efficiently by as much as 30% in seniors. Consequently, older patients are at risk for increased side effects, especially those who are suffering with hepatic disease.

Seniors taking cannabis medications to help treat common ailments can encounter a set of challenges unrelated to the products themselves. New state regulations require that all cannabis be packaged in childproof containers. Senior patients can struggle to open these containers, especially if they suffer from arthritis in the fingers and hands. Seniors may lack the dexterity to manipulate small droppers, syringes, and bottles, it’s easy to spill liquid medicines, and seniors may lack the strength to depress pumps or open vacuum-sealed packaging.

Senior patients may struggle to understand new technologies or devices, or they may simply lack the equipment necessary to charge or use new devices. Label instructions may be printed in fonts too small to read, and labels often lack information necessary for patients to use medications safely. Patients may encounter discrepancies between the information they received from their doctor and the information that they received at the dispensary.

Finally, seniors living on fixed incomes may not be able to afford medications or may not be physically able to pick up medications from pharmacies or dispensaries.

Despite these considerations and challenges, we know that cannabis can improve the quality of life and the health of seniors, and cannabis treatment can be a good alternative to the over-medication and subsequent side effects to which many seniors are exposed and from which many senior patients suffer serious harm.

Determining where to start and which products to buy can be overwhelming, especially for new cannabis users. So, senior patients: what can you do to maximize the safety and efficacy of your treatment plan and to minimize the risks of using cannabis as a treatment modality?

See part 2 of this series to find out!