Medical Cannabis for Older Patients—Treatment Protocol and Initial Results

Abstract

Older adults may benefit from cannabis treatment for various symptoms such as chronic pain, sleep difficulties, and others, that are not adequately controlled with evidence-based therapies. However, currently, there is a dearth of evidence about the efficacy and safety of cannabis treatment for these patients. This article aims to present a pragmatic treatment protocol for medical cannabis in older adults. We followed consecutive patients above 65 years of age prospectively who were treated with medical cannabis from April 2017 to October 2018. The outcomes included treatment adherence, global assessment of efficacy and adverse events after six months of treatment. During the study period, 184 patients began cannabis treatment, 63.6% were female, and the mean age was 81.2 ± 7.5 years (median age-82). After six months of treatment, 58.1% were still using cannabis. Of these patients, 33.6% reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Of the respondents, 84.8% reported some degree of improvement in their general condition. Special caution is warranted in older adults due to polypharmacy, pharmacokinetic changes, nervous system impairment, and increased cardiovascular risk. Medical cannabis should still be considered carefully and individually for each patient after a risk-benefit analysis and followed by frequent monitoring for efficacy and adverse events.

Safety and tolerability of natural and synthetic cannabinoids in adults aged over 50 years: A systematic review and meta-analysis

“…These results are also consistent with a prospective observational study of 901 people above 65 years of age (74.5 ± 7.5 years), who received medical cannabis from January 2015 to October 2017 in a specialized medical cannabis clinic, 31.7% reported at least 1 AE due to the treatment after 6 months, with dizziness (9.7%) and dry mouth (7.1%) as the commonest AEs [ 21 ]. Another similar study of 184 people (81.2 ± 7.5 years of age) from April 2017 to October 2018 showed 33.6% with AEs and dizziness (12.1%) and sleepiness and fatigue (11.2%) as the commonest AEs [ 90 ]. A previous systematic review of the efficacy and safety of medicinal cannabinoids which focused only on older people considered 5 controlled trials with THC ( n = 3) and oral THC:CBD ( n = 2) [ 12 ].…”

Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study

“…Despite the significant rise in use, the current evidence on the cardiovascular safety of medical cannabis in older adults is scarce [13,14]. Recently, the American Heart Association (AHA) issued a position statement urging caution in use of medical cannabis in older adults due to the possible detrimental cardiovascular effects [15].…”

Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state

“…The use of edibles, drinks, and other oral forms of cannabis administration was most prevalent among older ages, and though not significant in bivariate trend models, both oral administration and vaping increased significantly over time among those aged 50–64 in multivariable models. The increase in oral forms might be of concern as a recent study of treatment protocols for medical cannabis noted that oral preparations are not recommended for older adults because of the delayed onset in effects and difficulties in achieving stable effects (Abuhasira et al 2019 ). Focus groups in Washington and Colorado similarly report that the effects of edibles and other forms of orally ingestible cannabis can be unpredictable and inconsistent (Giombi et al 2018 ), and that advice regarding consumption is often unclear from the packaging (Kosa et al 2017 ).…”