Older adults and cannabis use Flashcards
Cannabis
- The Cannabis Act (C-45) became law on October 17, 2018
- There are legal sources of cannabis include authorized retailers and inline licensed producers
- Strict oversight by federal government on suppliers
- Federal government exerts heavy control over the production and distribution of cannabis
- Stats Canada National Cannabis stats is updated every 3 months since 2018 to monitor cannabis consumption before and after the legislative change (self-repost, online survey)
- More than 5 million Canadians report having used cannabis in the last 3 months
Usage of cannabis increased
- Especially in OAs
Cannabis used by OAs in Canada (Stats Can, 2019)
- Cannabis consumption among seniors has been accelerating at a much faster pace than it has among other age groups
- 52% of OAs aged 65+ use cannabis exclusively for medical reasons
- While the remaining seniors were evenly split between non-medical only (24%) and both medical and non-medical reasons (24%)
- Nearly 60% of youth (15-24yo) reported using cannabis exclusively for non-medical purposes
- Majority obtain cannabis exclusive from a legal source
Mirrors US trends
- Recreational cannabis use was legalized in 2012 in Colorado and Washington states
- Ages 65+ relative increased form 2006-2013 (250%) than adults aged 50-64 (57.8%)
- Boomers are also the “biggest spenders”; dropping more than $95/month on cannabis, which is 53% more than those 21-24 years old
Why are more OAs turning to cannabis?
Numerous medical ailments include
- Anxiety
- Sleep
- Agitation
- Nausea
- Pain; arthritis
- Weight loss
- Depression
- ADHA
- PTSD
- Cataracts
Among baby boomers, marijuana users perceived marijuana as:
- A safer alternative with less adverse effects compared to substances and drugs such as alcohol, other illicit drugs, and prescription drugs
- Having a lower risk for addiction
- Better effectiveness for treating symptoms of medical conditions
- Rise in weed use among OAs is driven by the aging of the baby-boomer generation, who dabbled extensively with pot in their youth and may be returning to it in old age for a variety of reasons
- It has even been suggested that marijuana use may reduce the use of opioids
THC and CBD
- 100s of cannabinoids in cannabis but tow are considered to have the move therapeutic value
- THC (the psychoactive “high” feeling)
- CBD (non-psychoactive)
- CBD can have some anti-aging and other behavioural effects
- Could reduce pain and anxiety, shown in animal models
- Activates the endocannabinoid system by binding to CB1 or/and CB2 receptors
Forms
Dried flowers
- sativa, indica, hybrid streams
Pre-rolled joints
- sativa, indica, and hybrid streams
Oils/tinctures/topical ointments
- bottled, sprays, and capsules containing all or isolated components of various strains; salves
Edibles
- contain components, mostly CBD and/or THC, that is infused with any food that contains a fat-soluble components (brownies, cookies, gummies, etc)
Endocannabinoiod system (ECS)
Cerebral cortex
- altered consciousness, perceptual distortions, memory impairment, delusions and hallucinations
Hypothalamus
- increase in appetite
Brain stem
- antinausea, increase HR, decrease BP, drowiness, decrease pain
Hippocampus
- memory impairment
Cerebellum
- decreased spasticity, impaired coordination
Amygdala
- anxiety (increase or decrease), decreased hostility
Medical cannabis
- 2015 the government introduced new ‘marijuana for medical purposes regulations’, which allow physicians to ‘authorize’ medical marijuana use for virtually any health condition for which this is considered beneficial; supply facilitated by licensed commercial producers
- “weed doctors”
- Getting a prescription from FMDs is a challenge and seen as a barrier for OAs
- Physicians lack strong evidence and are reluctant to prescribe
- OAs desire to communicate with the HCP but fear stigma
- OAs who used cannabis for medical purposes reported positive outcomes but highlighted difficulties in accessing medical cannabis
- Chemically, there are no differences between medical cannabis and recreational product from ‘legal’ and authorized source
- Difference: OHIP coverage/price to patient
Rise of CBD
- CBD users/sales doubled
- Baby boomers and females driving increase in sales
- Potency of CBD product varies based on source
- Could reduce immune system response
- Can treat children with severe epilepsy
Are cannabinoids effective to reduce behaviours in OAs with dementia?
- Some studies suggest cannabinoids could help to manage a few behavioural symptoms of dementia, such as agitation and aggression
- Synthetic THC (Nabilone) reduced agitation in a study
- Two studies showed that THC might be useful in treatment of anorexia and behavioural symptoms in dementia
- Most studies done on nursing hoe residents (highly dependent and frail)
- Measures were based on periodic staff observation
CBD oil and OAs with dementia: future research
- Profs on pulg
- Exploring the physiological, functional, and behavioural effects of CBD oil in OA with dementia living in their home
Why hasn’t more research been done?
- The US DEA considers marijuana a Schedule I drug, the same as heroin, LSD, and ecstacy , and “likely to be abused and lacking in medical value”
- Because of that, researchers need a special license to study it
- Despite legalization in Canada, Health Canada requires a scientist to apply for a blanket research license
- “Onerous regulations and insufficient funding are holding back cannabis research in Canada”
- Process takes 9-11 months at least; backlog stalling research
Are nurses permitted to administer medical cannabis to a patient?
- YES
- the new Canadian Regulations provide nurses with the legal authority to possess and distribute cannabis for medical purposes
- Allowed in both hospital and home care settings
- The RN has a role to facilitate a patient’s choice, which may include providing assistance to patient who cannot take their own medical cannabis independently
- RNs must ensure that they are able to administer the medication safely, competently and manage the potential outcomes of administering it
- Dependant on hospital policy and if they allow it
When will a physician prescribe medical marijuana
- Very limited, for medical conditions which evidence is there that it helps
1) neuropathic pain
2) end of life pain
3) chemotherapy-induces nausea and vomiting
4) spasticity due to MS or SCI
