Older adults don’t have to smoke medical cannabis to get relief from chronic pain, sleep difficulties, nausea, tremor, spasticity, agitation, vomiting reduced appetite, post-traumatic stress disorder and other ailments that are not adequately controlled with current medically approved therapies, according to Israeli researchers.
Giving tetrahydrocannabinol (THC) oil and cannabidiol (CBD) oil to octogenarian patients in a controlled, regulated way, doctors from Ben-Gurion University of the Negev (BGU) and the Cannabis Clinical Research Unit at Soroka University Medical Center in Beersheba have improved the quality of life of their patients.
CBD oil is a collective term for oils made from fiber hemp and does not contain THC, the active substance that can produce a “high.” THC and CBD are the two best-known cannabinoids that recently received a lot of attention as a medical application.
In the new study, “Medical Cannabis for Older Patients – Treatment Protocol and Initial Results” that was published in the Journal of Clinical Medicine, the researchers present a new pragmatic treatment protocol, developed in collaboration with NiaMedic Healthcare & Research Services Ltd.
“Since well-established and evaluated protocols for treatment of older adults with medical cannabis do not exist, we developed our own approach based on close follow-up of effects, adverse events and the slow introduction of THC oil, CBD oil or a combination,” explained Dr. Ran Abuhasira of BGU’s Faculty of Health Sciences.
The potential risks of cannabis should not be disregarded, they wrote. “After individual consideration and personal risk-benefit analysis for each patient, medical cannabis treatment should be initiated slowly and gradually. Following treatment initiation, patients must be monitored frequently for adverse events and efficacy.”
In the paper, the researchers present a roadmap for the evaluation of symptoms and the possible potential of cannabis to alleviate these symptoms. During the study period, 184 patients with a median age of 82 began cannabis treatment at a specialized geriatric clinic. After six months of treatment, 58.1% of the patients were still using cannabis. Of these, 84.8% reported moderate to significant degrees of improvement in their general condition.
About a third reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Such side effects are particularly worrisome among the elderly, who may suffer from dementia, frequent falls, mobility problems, hearing, or vision impairments. The long-term effect of adult cannabis use on cognition is unclear. Two systematic reviews showed evidence that long-term use of cannabis is associated with negative effects on some cognitive functions, the team wrote.
The treatment protocols urge special caution in older adults in case of multiple drug interactions, pharmacokinetic changes, nervous system impairment, and increased cardiovascular risk, as patients of such ages usually are taking numerous medications on a regular basis. “Once treatment is initiated and the therapeutic dose is achieved, we recommend at least monthly follow-up at first to assess adverse events and treatment efficacy,” he added.
“If treatment is effective and well-tolerated, consideration can then be given to revising the current concomitant drug regimen, especially with respect to the use and dosage of opioids, benzodiazepines and other psychotropic or analgesic medications,” he continued. “Our experience shows that cannabis has the potential to lead to a reduction in the use of these medications. Therefore, we call for the implementation of our protocol in clinical practice to evaluate the benefit of cannabis treatment,” said Abuhasira.
“The recent interest and use of medical cannabis are growing substantially in many countries,” the team wrote. “The regulations on its use vary among countries, affecting medical practice and experience. Current public opinion is that cannabis has the therapeutic potential to treat and cure a long list of diseases, but there is a large gap between that opinion and the current evidence in the medical literature. Another common opinion is that medical cannabis is mainly used by young adults. However, the use of medical cannabis by older adults is increasing, and studies show variable prevalence, ranging from approximately 7% to more than one-third, depending on the country. Recreational use of cannabis by older adults is also increasing substantially, especially in the US.”
Regardless of the type and amount of medical cannabis given, “we act by the simple aphorism: ‘Start low, go slow, and stay as low as possible.’ We preferred to choose a combination of THC-predominant chemovars and CBD-predominant chemovars.”
The common therapeutic doses for most indications are five to 30 mg of THC and CBD per day divided to two-three doses, depending on the indication, the symptoms, and the current medication regimen.
“In some instances, the stigma associated with the use of the ‘drug’ can prevent our patients from accepting the use of medical cannabis—a relatively safe and potentially efficacious medication. Therefore, cannabis differs from other drugs in terms of public relations and the strong opinions held by many patients. Some patients dread it, while others may view it as the ultimate solution for most of their symptoms. Therefore, the explanation of the potential benefits and risks before the initiation of cannabis treatment takes on heightened importance for patients and their caregivers. This explanation should be performed by a nurse or a physician that are proficient in cannabis treatment,” Abuhasira said.
The research was partially funded by NiaMedic, an Israeli medical data company offering healthcare, research and consultation services, and specializing in integrating medical cannabis treatment with conventional care in older adults. NiaMedic had no influence on the data collection, analysis or manuscript preparation. NiaMedic provides advanced integration of proprietary Medical Cannabis treatments with conventional medical care.