Medical Marijuana For Older Adults

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Back when baby boomers were in high school or college, marijuana was mostly about youthful experimentation. Now, medical marijuana gives cannabis new meaning for some older adults. In a growing number of states, people can use marijuana products to treat conditions such as chemotherapy side effects or certain types of pain.

Fibromyalgia has been a source of pain and disruption for Teri Robnett, 59, of Colorado. For 30 years, she’s coped with fatigue, anxiety, insomnia and irritable bowel issues. Over the years, she’s tried almost every treatment that traditional medicine has to offer, from ibuprofen to prescribed antidepressants and opioid painkillers like OxyContin. None really helped. Instead, alternative measures such as massage, acupuncture and herbal medicines provided some relief.

In 2009, Robnett began working in a marijuana dispensary. Although she had tried marijuana while much younger, she could take it or leave it for recreational use. Now, as she saw others turning to medical marijuana for conditions like hers, she received authorization to try it herself. “I feel so much better,” was her almost immediate reaction.

Pain Relief and Appetite Boost

As early as the 1970s, marijuana was considered as a possible therapy for glaucoma, a common eye disease related to aging. However, it’s not practical as a glaucoma treatment, according to the American Academy of Ophthalmology.

Pain treatment is the most promising medical use for marijuana supported by data so far, says Margaret Haney, a professor of neurobiology in psychiatry at Columbia University Medical Center in New York City who conducts cannabis research.

“There really is evidence that cannabis and cannabinoids, including synthetic cannabinoids, reduce pain,” Haney says. “What’s very exciting is there’s some suggestion that cannabinoids can be useful for a type of pain that isn’t well-treated by other drugs – neuropathic pain.”

Neuropathic pain is caused by nerve damage, also known as neuropathy. Neuropathy can occur with diabetes, HIV infection or medications, and cancer chemotherapy.

Marinol capsules and Syndros oral solution, which contain synthetic cannabis, or dronabinol, are approved by the Food and Drug Administration for treating anorexia associated with weight loss in patients with AIDS, and nausea and vomiting associated with cancer chemotherapy. Cesamet, also approved, contains nabilone, another synthetic form.

Marijuana could also be helpful for other older adults with poor appetite and nausea who are at risk for unwanted weight loss and malnutrition.

“If [marijuana] is legal in your state, it’s certainly reasonable to try it for appetite,” Haney says. “Just be cautious, and particularly cautious with edibles, because they really are hard to titrate to the effect you want.”

Medical Marijuana Uncertainties

Epidiolex, a cannabidiol-based prescription drug, is under review for FDA approval. Studies suggest the drug reduces seizures in two forms of epilepsy.

Anxiety relief is one reason people turn to marijuana, although that can backfire. While marijuana is relaxing and enjoyable for a subset of users, Haney says, “Many others find it enhances anxiety tremendously.”

Cannabinoid oil, or CBD oil, is generating a lot of buzz for its potential therapeutic properties. CBD oil does not cause intoxication. Instead, early evidence suggests CBD might help people cope with social anxiety or post-traumatic stress disorder symptoms, among other problems. However, many questions exist about quality and effectiveness of consumer CBD products and there’s still a legal gray area around its use.

Marijuana remains a Schedule 1 restricted drug under federal law, classifying it on a par with heroin and above other dangerous and addictive opioid drugs like OxyContin. That makes it much more difficult for researchers like Haney to conduct larger, more conclusive studies.

“We just published a lab study showing that a low dose of opioids in combination with marijuana produces a nice [pain-relieving] effect,” Haney notes. “The dose of opioids alone was low enough that it didn’t do anything. But when you combined it with cannabis, it did.”

Pot Precautions

If you’re considering medical marijuana, there’s a lot to think about. Marijuana comes in a much wider assortment of smoking, vaping, topical, oral, spray and edible products than it used to.

Meanwhile, your body has evolved with age. Your health status, balance and drug tolerance have probably changed. Prescription drugs you currently take may interact with marijuana in a variety of ways.

Driving under the influence of marijuana is unsafe at any age. “People often make the comparison to alcohol, and it’s definitely less risky than alcohol in terms of driving,” Haney says. “But it still doubles the risk of accidents.”

Just as with any FDA-approved prescription drugs, you should discuss possible marijuana side effects and drug interactions with your pharmacist or health provider.

“As people get older, the way their body processes medication, including marijuana, is different than it was in their 20s,” says Laura Borgelt, an associate dean and professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, in Aurora. “Not only is the drug more potent, or the dose stronger, but their body is metabolizing the drug differently.”

With conditions such as diabetes or chronic obstructive pulmonary disease, the impact of marijuana isn’t yet known, Borgelt says. However, fall risk is an obvious concern for older adults. “We know that marijuana can create cognitive impairment and slow cognitive processes,” she says. “It has also shown some [short-term] memory impairment.”

In a 2016 Colorado report evaluating state health trends since marijuana legalizations, the findings include an increase in marijuana-related ER visits and hospitalizations.

Edible marijuana products pose the most risk for interactions with prescription medications, Borgelt says, because both may be broken down, or metabolized, in the liver.

With sedating drugs, including benzodiazepines like Valium or certain sleep medications, there could be an additive effect with marijuana, Borgelt says. The same holds true if combining alcohol and marijuana.

Drug reactions could potentially occur with blood-thinner or anti-clotting medications, oral or injectable diabetes drugs, blood pressure medications and other drugs frequently prescribed to older patients for common medical conditions.

“Using FDA-approved therapies as a first-, second- or third-line [treatment] is the most appropriate way to medicate a condition at this point,” Borgelt emphasizes. However, she sees potential for new marijuana-treatment targets and discoveries as researchers learn more about the body’s endocannabinoid system.

Obtaining Legal Marijuana

Depending on your medical condition and where you live, you can obtain marijuana in official dispensaries with authorization from your doctor.

Medical marijuana and cannabis programs are legal in 29 states, the District of Columbia, Guam and Puerto Rico as of early 2018, according to the National Conference of State Legislatures. (Recreational marijuana is legal in eight states.)

Borgelt recommends seeking out a cannabis health care professional for people who live in states with medical marijuana laws. These physicians make recommendations for cannabis based on a qualifying condition, which varies from state to state.

The cannabis physician verifies that the condition exists and marijuana is a viable option. The patient can then get paperwork to send to the state for a medical marijuana card. State health department websites provide specific instructions.

As Robnett continues using medical marijuana, she’s learned to combine different strains and forms of cannabis and tailor them to her needs. She might smoke or vape small amounts throughout the day, and then use edibles at night for longer-lasting results. On days when she feels most fatigued, CDB products help her feel more clear and present. No longer needing prescription drugs such as antidepressants or opioid pills is another plus.

Robnett is now a medical marijuana advocate and policy adviser as the executive director of the nonprofit Cannabis Patients Alliance. She is a co-owner of The Good Lab in Denver and Colorado Springs, which provides quality-testing services of medical marijuana products for patients, caregivers, consumers and others. “When traditional medicine gives up, cannabis gives people hope,” she says.