These days, CBD lotions, edibles and vapes are springing up everywhere, from grocery stores and gas stations to local boutiques and online superstores. And if you know an older adult who experiences anxiety, sleep issues or chronic aches, you might be tempted to suggest a cannabis-based supplement.
What could it hurt? Because the products are so widely available, they must be safe—right?
In a new study published in the Journal of the American Geriatrics Society, researchers in California found a significant increase – 1,804% – in cannabis-related emergency room visits among adults over age 65 between 2005 and 2019. (Interestingly, the number of visits peaked between 2013 and 2017 and leveled off after the implementation of California’s Proposition 64 [The Adult Use of Marijuana Act]).
So, if the mere availability of medical and recreational marijuana doesn’t appear to correlate with a higher rate of cannabis-related emergency department visits, what’s behind the spike?
Research indicates an upward trend in the number of adults over 65 who report recent cannabis use over the last five years. With the decriminalization and documented therapeutic benefits, even individuals who didn’t experiment with cannabis in their younger years may be trying CBD products and/or medical or recreational marijuana in their 60s and beyond.
However, access and increased usage may not be fueling the spike in ER visits. The study did not include specific data about reason for the hospital visit. Instead, the study emphasizes cannabis use among older adults can lead to unintended consequences. For example, cannabis can slow reaction time and impair attention, which may lead to injuries and falls; increase the risk for psychosis, delirium and paranoia; exacerbate cardiovascular and pulmonary diseases; and interact with other prescription medications.
“Many patients assume they aren’t going to have adverse side effects from cannabis because they often don’t view it as seriously as they would a prescription drug,” said study author Benjamin Han, MD, MPH, an associate adjunct professor at UC San Diego School of Medicine.
Some ER visits, he writes, result from older adults’ overconfidence in their abilities to manage their use.
“As they have gotten older,” he reports, “their bodies are more sensitive, and the concentrations are very different from what they may have tried when they were younger.”
An older adult may also consume a cannabis edible to relieve sleeplessness or chronic pain and feel no effects after a few minutes.
“They don’t know much about the doses, so [they take] a lot more,” Han said in an interview with KPBS. “Two hours later, [their] heart is racing, [they’re] anxious, and they end up in the emergency department.”
Guidelines for safe usage of cannabis for older adults
The safest way to use any cannabis is under physician supervision—a conversation that, fortunately, is no longer taboo. And, because it can contain up to 15% THC and its manufacture is tightly controlled and regulated, medical marijuana may be the form most likely to provide the best relief of symptoms.
In addition, physicians can taper the dosage according to clinical protocols and closely monitor the patient for the early warning signs of adverse effects.
If your loved one wants to try an over-the-counter CBD product, it’s best to bring that product to the physician’s office for evaluation and a discussion of the benefits and risks, as well as a review for drug interactions.
Special considerations for older adults and cannabis use
Outside of a prescription for medical marijuana, the use of CBD products and recreational marijuana pose a significant risk to older adults for various reasons:
1. The legality of cannabis products varies by state.
While states have increasingly legalized marijuana for medical and/or recreational use, it remains illegal at the federal level. So, before providing any cannabis product to an older individual, it’s important to understand its legal status in your state.
2. Over-the-counter cannabis products are unregulated and lack FDA approval.
While CBD products legally appear in lotions, edibles and vape cartridges nationwide, the Food and Drug Administration has yet to evaluate whether any CBD product works, its proper dosage, its potential to interact with other drugs or possibility of dangerous side effects or other safety concerns. And several studies found major discrepancies between information on the labels of cannabis products and their actual contents.
“Many products that claim only to have CBD actually have varying degrees of THC present,” Marc Agronin, MD, writes in Psychiatric Times. “This lack of consistency often accounts for both inconsistent clinical effects as well as adverse effect issues, and these factors lead many older adults to discontinue use of cannabis products.”
3. Diabetes, hypertension or other preexisting conditions increase the likelihood of harmful side effects and potential drug interactions.
According to the Centers for Disease Control, 70% of older adults have two or more chronic illnesses with 24% percent of seniors taking five or more prescriptions. The Canadian Centre on Substance Use and Addiction’s Guide to Cannabis for Older Adults cautions cannabis may interact with:
- Pain medications
- Heart medications and blood thinners
- Sleeping pills
- Antidepressants and antianxiety medications
- Antibiotic and antifungal medications
- Allergy, cold and flu medications
- Heartburn medications
- Antiseizure medications
- Drugs to treat HIV/AIDS
- ADHD medications
Clinical signs an older adult needs to go to the ER
After an older adult uses cannabis, a caregiver may notice these changes in vital signs and upon physical exam, which are likely to warrant an emergency room visit:
- High blood pressure
- Abnormally low body temperature
- Abnormally fast breathing, wheezing
- Fast heart rate and/or palpitations
- Confusion, slurred speech, slow reaction time, inattention, decreased concentration, motor delay, poor muscle control, weakness, heightened sensation, drowsiness, hallucinations and delusions, anxiety and panic