OK, let’s get past all the jokes about aging Baby Boomers revisiting their youth and getting stoned. As the medical and recreational use of marijuana grows across the country, older adults are increasingly either smoking cannabis or taking it in the form of cannabidiol (CBD). Yet we know remarkably little about how CBD or its close relative tetrahydrocannabinol (THC) affects seniors.
Now, medical researchers are starting to take a hard look at both the clinical and policy implications of marijuana use by older adults. And it isn’t just weed. Johns Hopkins Medicine is beginning a new research initiative into the therapeutic use of psychedelics such as psilocybin (the active ingredient in magic mushrooms) for treating a wide range of medical issues, including dementia.
There is no doubt that interest in marijuana by seniors is growing. One study found use by people over 65 increased by 250 percent from 2001-2013.
We don’t know enough
Last month, the Gerentological Society of America—the professional organization for scientists, researchers, and physicians who specialize in aging—dedicated an entire issue of its Public Policy and Aging Report (paywall) to cannabis use among older adults. The articles looked at the state of the research, potential harms and benefits, and regulatory and clinical issues raised by marijuana use.
The articles generally reached two conclusions:
· We don’t know nearly enough about either the risks or benefits of marijuana.
· Conflicting regulatory and practice guidelines combined with the absence of clear research results and growing demand for the drug create extreme challenges for both physicians and their patients.
A big part of the problem is that while 38 states and US territories have legalized either medical or recreational marijuana, the federal government still considers it a Schedule I narcotic with no accepted medical use. That creates enormous confusion.
What about nursing homes?
For example, can someone who lives in federally-subsidized housing be evicted for using the drug, even if it is legal in their state?
Can residents of nursing homes where care is funded by Medicare or Medicaid be prescribed the drug even if it is legal in their state? Probably not. The Hebrew Home at Riverdale New York may have solved that problem by setting up a system for residents to purchase and securely store marijuana on their own (legal in NY) but where the facility plays no role in prescribing, purchasing, or administering the drug (which is illegal under federal law).
That creates yet another problem. Neither private insurance nor Medicare will pay for marijuana. Thus, those who use the drug must pay for it out of pocket, even when medical guidelines allow its use.
The American Medical Association has not endorsed the use of medical marijuana. The National Cancer Institute finds the research too inconclusive to make recommendations. But the American College of Physicians recognizes it as a treatment for glaucoma, the American College of Neurology supports its use to treat symptoms of multiple sclerosis, and the Academy of Medicine says it may be helpful in treatment of some cancer symptoms such as nausea and pain.