BY DR. LASZLO MECHTLER
For many individuals, including the elderly, the use of cannabis, even as a part of one’s treatment regimen is relatively taboo. Over the last 100 years, this medicine has been vilified and subjected to a great deal of misinformation and stereotyping, a great deal of which can be largely attributed to a smear campaign, headed by some of the most prominent business leaders of the industrial revolution.
Culminating decades later, with President Richard Nixon’s declaration “marijuana is public enemy number one in the United States”. Shortly after this declaration cannabis was formally rescheduled as a schedule I drug, rendering it illegal.
As a nation, it was not until the early 2000’s that we began to see substantial legislative action, albeit at the state level, toward decriminalization and legalization of both medical and adult-use cannabis. New York State went on to legalize medical cannabis in 2014, launching its program formally in 2016.
When the program went live, 9 out of the 10 qualifying conditions were purely neurological in nature.
Being the medical director of the nation’s largest freestanding neurologic center, you could imagine the level of interest our patients expressed in this newly obtainable treatment option. As an organization, we were receiving upwards of 500 calls per day, many of which were from patients that would “not fit the usual stereotypes”. What do I mean by that, you may be asking?
Well for starters, these patients weren’t patients in their 20’s looking to get high, but rather patients ages 50+ with limited to no history of cannabis use, with multiple underlying conditions. Time and time again I would hear “I was talking with my friend who is using cannabis to treat this ailment or that ailment and they swear by cannabis. I am interested in using it to treat condition X, Y, or Z as well but I do not want to smoke it and I do not want to get high.”
As the treating physician I would go on to explain that cannabis does not need to be smoked and the goal of cannabis therapy is not to get high but rather to elicit the therapeutic benefits of the plant while avoiding the euphoria or “high”. This is done by using different delivery vehicles, tinctures, capsules, creams, vaporizers, powders, vaporizers, etc. as well as by adjusting the ratios of the two main cannabinoids found in the cannabis plant THC and CBD. There is a fair amount of patient education that must be done surrounding this treatment given the misinformation out there, as well as the number of variables that need to be taken into consideration.
In an effort to gain further insight into the treatment outcomes of the aging population, we conducted a large-scale retrospective study, leveraging our database of clinical outcomes for more than 17,000 patients undergoing cannabis therapy, with an average age of 54.5 and a range of (0.5-103 years).
The assessment of treatment methods in elderly populations is essential since it is a rapidly growing population and accounts for more than half of all healthcare spending in the US. Particularly, since ageing populations are more likely to use multiple medications, are subject to changes in pharmacokinetics; such as changes in drug distribution for example, and suffer from comorbid, chronic and cognitive medical conditions. Thus, an understanding of treatment outcomes and drug-drug interactions in those undergoing cannabis therapies is crucial.
The results of a large-scale retrospective study conducted by our team here at the Dent Neurologic Institute’s Cannabis Research Center lend credibility to the use of cannabis in the treatment of elderly patients.
In the study we evaluated clinical outcomes of 204 patients who were; at least 75 years old and were certified to use medical cannabis products as part of New York State’s Medical Marijuana Program. In total, 141 (69%) subjects reported symptomatic benefit in at least one domain, with subjective improvements noted in chronic pain (49.5%), sleep (17.6%), neuropathy (14.7%), mobility (9.3%), anxiety (9.3%), and other (10.8%).
With regard to polypharmacy, 32% of patients utilizing opioid medications reported the ability to decrease consumption or discontinue these medications entirely. Self-reported side effect profiles were also recorded, with 47% of the study population reporting at least one side effect within the following domains; physical (72%), cognitive (17%), and affective (11%).
Interestingly, of the 96 patients initially reporting side effects, 58 patients reported that their side effects resolved after dose adjustments to their cannabis regimen were made. Additionally, no patients with pre-existing cognitive conditions (ie dementia) noted a significant deterioration of their condition upon initiation of cannabis therapy.
These results were most commonly achieved utilizing a type I chemovar product (1:1 ratio THC:CBD), and product delivery via oral tincture. The success of this ratio and modality is likely attributed to the following factors: 1. Utilization of a balanced ratio affords patients the ability to enjoy the therapeutic benefits of THC while its negative psychoactive effects are countered by CBD. 2. The half-life of the oral tincture is 6-8 hours, meaning on average, patients utilizing this method of consumption experience 6-8 hours of therapeutic benefit. Though I would be remiss if I did not state this product ratio, consumption and modality may not be optimal for every patient.
Cannabis therapy is highly individualized, each patient’s response to product ratios and or delivery method may vary. The results of this study support the use of cannabis therapy in a comprehensive treatment plan of elderly patients when used under the guidance of a properly trained physician and care team; however, further research including placebo-controlled randomized trials are needed to further legitimize this option in this growing population.
MD, FAAN, FEAN, FASN, FAHS
Medical Director, DENT Neurologic Institute Chief, Neuro-Oncology Roswell Park Cancer Institute Medical Director, Jushi Dr. Laszlo Mechtler is Professor of Neurology and Oncology at the State University of New York at Buffalo. He is UCNS certified in Neuroimaging, Neuro-Oncology and Headache Medicine. Dr. Mechtler is the Medical Director of the DENT Neurologic Institute.
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