Cannabis: An Emerging Treatment for Common Symptoms in Older Adults

Kevin H. Yang, BS; Christopher N. Kaufmann, PhD, MHS; Reva Nafsu, LVN; Ella T. Lifset; Khai Nguyen, MD, MHS; Michelle Sexton, ND; Benjamin H. Han, MD, MPH; Arum Kim, MD; Alison A. Moore, MD, MPH

Disclosures

J Am Geriatr Soc. 2021;69(1):91-97. 

In This Article

Abstract and Introduction

Abstract

Background/Objectives: Use of cannabis is increasing in a variety of populations in the United States; however, few investigations about how and for what reasons cannabis is used in older populations exist.

Design: Anonymous survey.

Setting: Geriatrics clinic.

Participants: A total of 568 adults 65 years and older.

Intervention: Not applicable.

Measurements: Survey assessing characteristics of cannabis use.

Results: Approximately 15% (N = 83) of survey responders reported using cannabis within the past 3 years. Half (53%) reported using cannabis regularly on a daily or weekly basis, and reported using cannabidiol-only products (46%). The majority (78%) used cannabis for medical purposes only, with the most common targeted conditions/symptoms being pain/arthritis (73%), sleep disturbance (29%), anxiety (24%), and depression (17%). Just over three-quarters reported cannabis "somewhat" or "extremely" helpful in managing one of these conditions, with few adverse effects. Just over half obtained cannabis via a dispensary, and lotions (35%), tinctures (35%), and smoking (30%) were the most common administration forms. Most indicated family members (94%) knew about their cannabis use, about half reported their friends knew, and 41% reported their healthcare provider knowing. Sixty-one percent used cannabis for the first time as older adults (aged ≥61 years), and these users overall engaged in less risky use patterns (e.g., more likely to use for medical purposes, less likely to consume via smoking).

Conclusion: Most older adults in the sample initiated cannabis use after the age of 60 years and used it primarily for medical purposes to treat pain, sleep disturbance, anxiety, and/or depression. Cannabis use by older adults is likely to increase due to medical need, favorable legalization, and attitudes.

Introduction

There is unprecedented interest in the United States in the potential health benefits of cannabis. As of 2020, 33 states have enacted recreational or medical cannabis legislation, which mirrors changing perspectives about cannabis use. For example, support for cannabis legalization has increased from 12% of Americans in 1969 to 67% in 2019.[1] With the enactment of the Farm Bill in 2019,[2] hemp-derived cannabidiol (CBD) products, which contain less than 3% of the psychoactive component tetrahydrocannabinol (THC), have become more available throughout the country, providing greater access to cannabis for patients.

There is also some evidence that cannabis is useful in addressing chronic medical conditions.[3–6] The National Academies of the Sciences, Engineering, and Medicine published an extensive review in 2017 of the health effects of cannabis, finding empirical evidence for cannabis reducing symptoms ranging from pain, spasticity, tremor, nausea, and, to some extent, sleep.[7] For example, in a placebo-controlled trial that evaluated aerosolized cannabis, there was a decline in pain ratings among patients with diabetic peripheral neuropathy,[8] and another study examining Sativex®, an extract of 1:1 THC/CBD ratio, found cannabis to be associated with an improvement in self-reported sleep quality among chronic pain patients.[9] Additionally, studies show cannabis may serve a palliative role in cancer treatment by ameliorating many of the adverse effects of chemotherapy.[10] Although it is clear more research is needed to prove the potential benefits as well as harms of cannabis in general and especially in older adults,[11–15] it is possible cannabis may serve as an effective treatment or palliative aid for addressing difficult to treat conditions, such as pain and insomnia, in older adults.[16,17]

Indeed, epidemiological studies have shown an increase in cannabis use among older adults. A study by Han and Palamar documented an increase in cannabis use from 2.4% in 2015 to 4.2% in 2018 among adults 65 years and older in the United States.[18] There is also evidence for increased use of cannabis in earlier years.[19,20]

Despite the increasing use of cannabis in older adults, few studies have examined the ways in which cannabis is used. Reynolds et al completed a survey among 345 patients in a geriatrics clinic at the University of Colorado in 2016 to 2017 and found 32% of patients used cannabis at least once in their lifetimes, and the common reasons for cannabis use were for pain and sleep disorders.[21] Lum et al conducted a survey among community-dwelling adults aged 60 years and older in Colorado, and found that older adults were likely to report using cannabis for both recreational and medical purposes and generally thought cannabis had a positive impact on their lives.[22] Brown et al studied data in the Florida Medical Marijuana Use Registry and found that over half of those registered were older adults, and the most common reason for cannabis use was for chronic pain.[23] There have been some studies including older adults that examine how cannabis is used in California,[24–26] a state where medical use has been legalized since 1996 and recreational use since 2016. For example, one survey among patients in a San Francisco dispensary found that older adults were less likely to report problematic cannabis consumption practices compared with younger patients.[24] However, most of these studies were sampled from the community or local dispensaries, and to the best of our knowledge, none has examined this in a geriatrics clinic setting.

More research is needed to delineate administration forms (e.g., smoking, tinctures, topicals), the health conditions and/or symptoms cannabis is being used to treat, the cannabinoid composition (e.g., CBD and THC), and potency and potential adverse effects experienced in this population. Additionally, more research is needed to examine this in a clinic population of older adults specifically within California. To address these gaps in the literature, we conducted a survey at a geriatrics clinic at the University of California, San Diego (UCSD), in La Jolla, CA, to obtain a more detailed picture of cannabis use in these patients.

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