Seniors are increasingly turning to cannabis to find relief from the suffering and medical indignities of aging. I see this every day in my primary care clinic. Whether it is the grinding discomfort of chronic pain, the anxiety associated with losing friends and abilities, or the soul-crushing misery of insomnia, older adults are discovering that medical marijuana can often do what many of our standard prescriptions cannot. They are finding that cannabis often provides genuine relief without a laundry list of debilitating side effects. Many of our elders are finding cannabis to be an exit ramp from the polypharmacy that almost inevitably comes with aging.
The demographic shift is nothing short of a sea change. Older patients are currently the most rapidly growing group of cannabis users in the country. Roughly 25.8 percent of medical cannabis patients are 65 or older, and a staggering 34.5 percent fall into the 50 to 65 range. This shift is occurring despite fifty years of misinformation and one-sided science courtesy of our War on Drugs, all of which has needlessly stigmatized this plant-based medicine.
The contradictory and inconsistent messaging that seems to accompany most cannabis education has left the medical establishment ill-equipped to educate patients, or to even sensibly discuss treatment options with them. Doctors are often caught flat-footed when patients broach the subject of medical cannabis. Because of a persistent lack of practical, clinical knowledge, many physicians find themselves unable to answer basic questions or to advise patients, leaving patients to navigate these waters on their own. For lack of better options, patients seek medical advice from well-intentioned bud-tenders who work at the medical cannabis dispensaries and who have no medical training. We can do much better than this.
The solution is to provide physicians with high-quality, balanced, and scientifically informed education about cannabis. After decades of insisting that cannabis does not have any medical value, and of ignoring the lived experience of tens of millions of Americans who have been benefiting from medical cannabis, JAMA has finally started calling for doctors to be educated on this issue. This will be a win for physicians and patients alike.
A legacy of healing
This issue is not just an academic or professional interest for me. When I was just eight years old, my brother Danny succumbed to childhood leukemia. My parents were desperate to lessen his suffering, and I watched them cross legal lines in the early 1970s to procure medical cannabis for him to use. It was the only thing that alleviated the brutal nausea, vomiting, and wasting associated with his chemotherapy. It was extraordinarily effective. It gave Danny the ability to eat, to maintain his weight, and, most importantly to me, to play with his little brother. Witnessing that transformation fixed in my mind a truth that no amount of prohibitionist or DARE-era rhetoric could erase: Cannabis can be a powerful medicine.
That journey came full circle with my father, Dr. Lester Grinspoon, a legendary psychiatrist, cannabis expert, and scholar at Harvard Medical School, who used cannabis himself as he aged to manage chronic pain and cancer-related symptoms. With the use of cannabis, he was able to maintain a quality of life that would have been impossible otherwise. For his end-of-life care, he was mostly able to use cannabis instead of morphine, and was much less sedated and more able to say goodbye to his family than he would have been if heavily sedated on opioids. He had spent his career fighting to educate physicians and the public alike about the medicinal benefits of cannabis and, in the end, demonstrated these same benefits in his personal life.
For the last twenty-five years, I have carried that mission forward in my own practice, helping thousands of patients integrate medical cannabis into their lives safely and effectively.
Clinical pragmatism and navigating risk
It is important to be upfront with patients about the clinical nuances and potential harms of treatment with medical cannabis. Cannabis is not a panacea, and it is not a cure-all for every ailment. It certainly does not work for everyone. Like any medication, it has its legitimate indications and potential side effects. Like other medications, it can be used in a more or less safe manner.
Some patients, particularly those who are cannabis-naive, simply cannot tolerate the impairment or the high that comes with higher doses of THC. Like most other medications used for pain or for sleep, cannabis can cause dizziness, affect a patient’s balance, and temporarily impact short-term memory. We cannot ignore the fact that for a modest percentage of users, cannabis can be addictive. Heavy users can suffer from cannabis hyperemesis syndrome, which is miserable, dangerous, and difficult to control. Cannabis can potentially destabilize people with psychosis or coronary syndromes.
These challenges must be viewed in their proper context. When I look at the entirety of the available scientific literature and the thousands of patients I have treated over the last quarter-century, a clear picture emerges. When used with skill, caution, and proper guidance, cannabis often presents fewer harms than the traditional pharmaceuticals we so readily prescribe to our seniors. Unlike many of those drugs, cannabis does not destroy the liver or kidneys, it does not cause gastric ulcers or chronic constipation, and it does not contribute to the development of dementia.
If used correctly, cannabis can be surprisingly safe for older patients. The most important consideration is the dosage. Patients must be urged to start low and go slow when getting started. As with all medications, we strive to use the lowest effective dose. The doses used by medical cannabis patients can tend to be much lower than those used by recreational users. Patients also need to be educated about the relative advantages and disadvantages of different delivery methods. For example, doctors do not typically recommend smoking cannabis because cannabis smoke contains toxic combustion products.
The various consumption methods differ in important ways. I am a big fan of under-the-tongue tinctures, as they make it very easy to carefully titrate the dose of the psychoactive component THC. Tinctures are also easily combined with other medicinal cannabinoids such as CBD.
ADVERTISEMENT
Our job as care providers is to meet patients where they are, armed with evidence and empathy. In the case of the four or so million seniors who are currently using medical cannabis, as well as the millions more who wish to have a sensible discussion with their doctor about potentially using medical cannabis, we have an obligation to educate ourselves on this issue. With proper instruction and guidance, we can help our seniors safely use medical cannabis to improve their health-related quality of life. The ultimate goal of medicine is not just to add years to a person’s life, but to add quality and vitality to those final years. Medical cannabis can be a profoundly helpful tool in this journey.
Peter Grinspoon is an internal medicine physician.
