Roll it Up, Gramps!: Introducing cannabis to older folks

Of the 2.1 million Americans using medical marijuana, those age 65 and older are among the fastest-growing group of cannabis users. From 2007 to 2017, cannabis use in adults over the age of 65 increased tenfold. Although they make up less than 15% of the population, seniors are prescribed more than one-third of all prescription drugs in America, and it’s no surprise, considering that 80% of the elderly population are diagnosed with at least one chronic condition

It’s not news that older people experience pain and other ailments that can affect their quality of life. About 53% of Americans age 65 and older reported bothersome pain in the past month, according to a government survey, and among people older than 65 who signed up for the Colorado medical marijuana program, nearly 90% listed pain as a problem. Furthermore, the number of people aged 60 years and over is expected to double by 2025 worldwide and by 2050 in the United States, so we should expect to see the numbers of elderly cannabis users continue to grow — despite existing barriers like stigma, cost of medicine and doctor approval  (American Academy of Neurology, European Journal of Internal Medicine).

Now that I’ve hit you with the statistics, here are a few tips for the older folks looking to try cannabis, or the younger people who just want to help their elderly friends and relatives feel better.

Why Try Cannabis?

Why not? If you have an ailment that cannabis could help with, the cost/benefit analysis is in your favor. All drugs have side effects, but cannabis is one of the safest medicines on earth, and the adverse effects associated with it are minimal — mainly dry mouth, drowsiness or dizziness, according to studies. For most older people, there is much more to gain than to lose when experimenting with cannabis, and it could even turn out to be a more cost-effective treatment than some of your existing prescription drugs. A study published in the European Journal of Internal Medicine found that the therapeutic use of cannabis is safe and efficacious in the elderly population, and that cannabis use may even decrease the use of other prescription medicines, including opioids — a welcome supplement or alternative to the dangerous and addictive drugs typically prescribed for chronic pain.

How To Use Cannabis

If you want to try cannabis, there are a few things you should know beforehand. There are many different methods of using marijuana as medicine, and if you live in Rhode Island or any of the 33 states that have legalized cannabis for medical use, you may have more options than you realize. Cannabis can be smoked, vaporized, applied topically or ingested orally via edibles or sublingual tinctures. In the aforementioned study of elderly cannabis use, the most common route of administration was oil/sublingual (37.3%), followed by smoking (24.4%) and vaporization (6.4%). If you are able to go to a medical marijuana dispensary, they should have most of these products available to you, and the staff should be able to help you navigate the options based on your needs. As a medical marijuana patient, you can also utilize the help of a caregiver to grow/make medicine for you, or even experiment with crafting your own cannabis products at home, if you are so inclined.

CBD or THC? You’ve probably heard a lot about these two compounds, and I won’t go into too much detail here, but the answer is most likely both – besides the well-known “entourage effect,” in which cannabis compounds work synergistically to have greater medicinal benefits, research has shown that a 1:1 ratio of CBD/THC is most effective, while limiting side effects (American Academy of Neurology). That being said, if someone is unable or chooses not to participate in a state-sanctioned medical marijuana program, CBD products are much more easily accessible than THC, thanks to the 2018 Farm Bill that legalized the production of industrial hemp nationwide. According to a recent study, 42% of baby boomers use CBD to help alleviate their joint pain, while THC is known to have all sorts of medical benefits, including as a potential therapeutic treatment option for Alzheimer’s disease (National Council for Aging Care).

Know the laws. Understand that medical marijuana is not covered by insurance, which increases the cost of medicine to patients. If you live in a state that has legalized cannabis for adult-use, congratulations — you can just walk into a store and buy it. If you live in a medical marijuana state, you’ll need to get a patient card in order to grow at home, utilize a caregiver, or shop at a dispensary. If your state doesn’t have a medical marijuana program and you wish it did, contact your legislators! I am equally saddened and enraged to think of all of the people suffering needlessly around the country because their state refuses to get with the times and the science. Wherever you obtain your cannabis medicine, be sure it’s coming from a trusted source. Whether you choose to consume medical marijuana or hemp-derived CBD, ask the producer for lab test results that can prove the potency and safety of the medicine.

Dose Appropriately. I’ve said it before and I’ll say it again — the key to experimenting with any new drug is “start low, go slow” when it comes to dosing. When it comes to cannabis medicine, it’s crucial to find the right dosage and consumption method to fit your needs. Keep a journal to make notes on the time and method of ingestion, strength of dose and any positive or negative effects. And don’t be afraid to increase your dose — as I mentioned, cannabis is extremely safe, and the side effects are mild compared to other prescription drugs that Americans take every day. Nonetheless, it should be noted that the adverse effects of cannabis can be more detrimental to older individuals who already suffer from decreased balance or dry mouth, or who may be a fall risk. In addition, there may be increased contraindications for cannabis use in older folks — for example, decreased kidney/liver functions could impede an individual’s ability to metabolize cannabis, or it could interfere with the efficacy of existing medications in the body, such as the blood thinner Coumadin. As a general rule, only high doses of cannabinoids (over 60 mg/day) present a risk for adverse drug interactions, but it’s a good idea to cut back or refrain from using opioids, sleeping pills, benzodiazepines (Valium, Xanax, etc.) and alcohol while taking cannabis, and of course to never drive or make important decisions while impaired.

Talk to your health care provider(s)

Any and/or all of them — don’t be ashamed to express your interest in using cannabis, and don’t be afraid to ask questions! If it makes you more comfortable, bring a younger person (or someone well-versed in cannabis medicine) to help talk through things with your practitioner. If you have been experimenting with cannabis already, show them the notes you’ve taken on the dosage/effects. Stigma is one of the biggest barriers to older folks using cannabis, but chances are, your doctor won’t be as disapproving as you might imagine. A 2013 study from the New England Journal of Medicine found that four of five doctors approve of medical marijuana and that more than 90% of medical marijuana patients (of around 7,500 surveyed) say that medical marijuana has helped treat their conditions – and that was seven years ago! 

The exchange of information between patients and medical professionals is so important in terms of driving the dialogue around medical cannabis forward. Even the many doctors who already support medical marijuana have a lot to learn, but you can be part of the conversation — if the result is a better quality of life for you or your loved ones, then it’s well worth it!