Cannabinoids: Chemicals that influence cell receptors in the brain and body and can change how those cells behave.
Dispensary: A store that can legally sell cannabis products, either medical, recreational or both.
Endocannabinoid system: A group of receptors that make up a complex regulatory system throughout the brain, body, and central and peripheral nervous systems. The ECS creates and maintains the body’s internal stability (homeostasis) by adjusting the flow of neurotransmitters and regulating bodily functions, including appetite, sleep, emotion and movement.
Despite major changes in state laws, the U.S. medical cannabis landscape remains the Wild West.
“Those who want to use medical cannabis safely need to be their own sheriff.”
Dr. Peter Grinspoon, MD, is a primary care physician and medical cannabis specialist in Boston, and said that while cannabis use in older adults is on the rise, so much of the information online is still contradictory and confusing. Even if you’ve decided it might be a viable treatment option for your loved one, there’s still the challenge of finding a qualified medical professional.
After being officially outlawed for any use in 1970 with the passage of the Controlled Substances Act (CSA), multiple efforts to reschedule cannabis under the CSA have failed, despite a vast majority of Americans supporting full legalization. Individual states and other jurisdictions, however, have continued to implement policies that conflict with federal law. And by 2022, 37 states have legalized cannabis for medical use, and 19 states, two territories and the District of Columbia have regulated cannabis for nonmedical use.
The resulting patchwork of state laws have created a confusing treatment landscape for patients. To complicate matters, most practicing primary care doctors and specialists have almost no cannabis training, as most medical schools don’t teach the endocannabinoid system. (Only one school in the U.S. offers a master’s program in medical cannabis science and therapeutics.)
With the majority of U.S. states legalizing cannabis for medical use and Baby Boomers swelling the ranks of an aging population, many who experimented recreationally when young, are now returning to the plant to treat the aches and pains of older age. And recent studies have shown the perceived risk of regular cannabis use is decreasing among older people.
The fear tactics from the days of “Reefer Madness” have long disappeared, and cannabis use continues to increase among older adults. In fact, the rapid legalization of medical cannabis has increased interest in the plant, with 49% of U.S. adults reporting that they’ve tried it.
The most common use of medical cannabis for older adults is for pain—a complaint of 74% of seniors. Generally considered safer than opiates, cannabis has a much lower risk of addiction and can also take the place of NSAIDs such as Advil or Aleve.
“Chronic pain is the chief reason I recommend medical cannabis,” said Dr. Leigh Vinocur, MD, chief medical officer at Ananda Medical Practice and Consulting, in Baltimore, Maryland. “It has analgesic and anti-inflammatory properties, helps patients with sleep, and elevates mood.”
As it turns out, the plant’s specific compounds are uniquely designed to fit receptors in the human endocannabinoid system, which regulates a range of functions and processes, including sleep, mood, appetite, memory, reproduction and fertility.
There are far fewer cannabis clinical trials compared to pharmaceutical studies, but medical cannabis is being used to treat many of the most common conditions affecting older adults:
Alzheimer’s and dementia
Older adults with Alzheimer’s often use cannabis to assist with depression and loss of appetite that can accompany degenerative brain disease.
Almost all older adults experience pain from various causes. Topicals like creams and lotions infused with THC are applied to local areas and can help with arthritis and nerve damage, migraines and fibromyalgia. There’s also a growing body of evidence that cannabis can help with inflammation.
Anxiety and mental health disorders
Studies show that cannabinol (CBD), one of the two main chemicals in cannabis, can be effective for obsessive-compulsive disorder, post-traumatic stress disorder, panic attacks, depression and anxiety.
If you live in a state where medical cannabis is legal, many primary care physicians lack proper cannabis training and knowledge, which is why it’s important to identify a physician or other licensed professional with specific cannabis education.
A good place to start is your state’s medical cannabis commission, but remember that many of these members may only be required to screen for that particular state’s established qualifying conditions. But most providers can help with procuring a medical cannabis card.
“My first question would be, ‘Does the doctor send most patients out with a written plan on what to do?’” he said. “What kind of dosage to start with, how to adjust that dosage over time, and what to look for—it should really be a written plan because it’s such a complex treatment.”
He also said a good indicator is a doctor’s willingness to follow up, as it shows interest in patients’ well-being. Sulak also advised searching for cannabis physicians with a background in integrative or holistic medicine.
“The cannabis paradigm is really different from conventional medicine,” he said. “Doctors who have a background in integrative medicine or functional medicine are going to understand cannabis better. We’re used to complex patients who don’t respond to conventional treatment and who need a holistic perspective, and cannabis fits well in there.”
Finally, look for cannabis physicians who hold themselves to practice standards, which can be useful guidelines that allow patients to decide if a cannabis doctor is providing a higher level of care.
“It’s a very personalized therapy,” said Vinocur. “Unlike conventional medicine where it’s a ‘one-size-fits-all’ pill, with medical cannabis it’s important to find the correct dosing. A good medical cannabis clinician should spend more than an hour with patients discussing basic medical cannabis science, specific medical conditions, what ratio of cannabinoids are best, exact dosing and formulations. And they should offer a detailed written plan and track a patient’s progress.”
As you investigate cannabis treatment for your loved one, remember that insurance does not cover the cost of most office visits or cannabis products purchased through dispensaries.
Concerns for caregivers
Keep in mind that cannabis is not a cure-all and not the best treatment for everyone.
“Caregivers should make sure that the patient discusses cannabis therapy with current treating physicians or specialists,” said Vinocur. “Any adverse effects such as anxiety, dizziness or falls should be shared with their doctors.”
In addition, more than 70% of older adults have two or more chronic illnesses with 24% percent of seniors taking five or more prescriptions. Drug interactions can still occur with medical cannabis—and are seen more in oral use as opposed to inhaled cannabis due to how oral medications are metabolized.
“All oral medications, including cannabis preparations, are broken down in the liver by enzymes,” Vinocur said. “Competition for these enzymes can lead to possible increased blood levels of other medications, which can be toxic. I advise patients to use their oral cannabis two hours before or after taking other prescribed medication.”
Intoxication from cannabis is another concern, as it can lead to falls, a leading cause of injury-related death in people over 65.
“I always tell patients to ‘start low and go slow,’ and start them on the lowest possible dose and increase dosages slowly over several days,” she said, “and recommend patients begin a regimen on weekends or when caregivers are at home.”