By Vanessa Orr
Now that cannabinoids, both psychoactive (THC) and non-psychoactive (CBD, CBG,THCA,CBN, etc.), have been made available to seniors with certain medical conditions, studies have shown that it can help to manage issues related to aging including chronic arthritic pain, anxiety and insomnia. And while the hope is that it can someday be used to help those diagnosed with Alzheimer’s disease and other dementia, not enough research has been done in the United States to verify its use for dementia treatment.
“There have been studies that underscore the way that cannabinoids can help with agitation, anxiety and insomnia, all of which can accompany dementia, and there is also observational data showing that cannabinoids help, but randomized prospective controlled trials have not been done,” explained Melanie K. Bone, MD, FACOG, director, Medical Cannabinoid Therapies, MorseLife Health System and clinical affiliate assistant professor, Charles E. Schmidt College of Medicine, Florida Atlantic University. “For some scientists, this is the gold standard to prove that it might work, and the rest is considered anecdotal.”
While there has been one US-based preclinical study in mice demonstrating that THC can reverse some of the decline related to dementia, it has not yet been proven in humans, according to Dr. Bone, who notes that in Israel, research about using cannabis for dementia is ongoing.
She adds that until 2021, all cannabis used for studies in the U.S. had to be obtained from one source, the University of Mississippi, and though the DEA now permits approved private growers to supply products to facilitate studies, institutional review boards (IRBs) have to approve all human studies looking at safety parameters.
“I had such a study, but the IRB raised legitimate concerns about dizziness and falls since the study was going to be on a locked memory care unit where falls already happen with more frequency than elsewhere, and it would be difficult with a small study to determine if the intervention caused more falls,” said Dr. Bone. “Additionally, the patients were unable to provide informed consent so it was up to the families who may or may not have wanted their loved ones to participate.”
Though Dr. Bone’s study was finally approved, the number of patients available to take part in the study has decreased during the interim, making the number of patients she was going to study too few to make any substantive conclusions.
As the director of medical cannabinoid therapies at MorseLife Health System, Dr. Bone continues her research into the use of cannabis for residents and those using the health system for palliative and hospice care and affiliated therapies. MorseLife is the only senior care provider authorized by the state of Florida to offer cannabis-based therapies in a variety of care settings as part of a pilot program.
Those using THC-containing products at MorseLife must have a medical marijuana card, order and pay for it themselves and self-administer the product. Those who use CBD only can have it administered with their regular medications, provided that Dr. Bone writes the orders and follows their progress.
“At MorseLife, we have had the same success that is typical for cannabis use by patients in my private practice and elsewhere—it seems to help people about 70 percent of the time,” said Dr. Bone. “The rest stop for a few reasons: either it is not working well enough, it is too hard to navigate the system or the expense is too much.
“We could make it better if we figured out a way to mainstream cannabis and get it covered by insurance,” she added. At this time, no federal funds will cover resources associated with cannabis-based therapies including those for medical marijuana patients.
Dr. Bone notes that after doing this type of work since 2016, while not all patients with dementia have an overwhelmingly positive change with cannabinoids, there is little to no downside to trying it.
“There may be rare gastrointestinal upset, and in some cases, patients have had difficulty with swallowing or chewing the products which has led to the need to stop, but the underlying ailment did not get worse,” she said.
Dr. Bone adds that senior patients do need a lot of guidance to get to efficacy without side effects, and sometimes become frustrated when the first recommendation is not the perfect one.
“Because their metabolism is changing and they are often on many other medications, it is imperative to take the time to try to determine possible drug-drug interactions and risk of dizziness, falling, and impaired perception, especially if they are dosing themselves,” she said.
“Usually, the older the patient, the more challenging it can be to initiate a new intervention, including cannabis. In addition, if there is age-related cognitive impairment, it can add to the challenge,” she continued. “But many seniors are still sharp and do very well with cannabis.”
