That’s when it clicked: His nightly marijuana habit could be causing problems.
“I said, ‘I thought you said you don’t use drugs,’ and he said, ‘I don’t. That’s my medicine,’” said Libby Stuyt, the Colorado psychiatrist who treated the patient three years ago.
Seniors are increasingly embracing cannabis, often for relief from aches and insomnia that come with age. According to a 2022 federal survey, 8 percent of people 65 and older reported having used marijuana in the past year. The rate has roughly doubled in seven years, according to estimates.
While many experts agree that marijuana has therapeutic value, they also caution that older adults should consider potential downsides, such as marijuana interfering with other medication or exacerbating chronic conditions. High-potency products that are far stronger than what older people smoked in their youth can cause nasty surprises with unknown long-term effects.
The dementia patient’s ailments reflected side effects of daily marijuana use, Stuyt said. When acclimated to marijuana, users can feel anxious when not high. Regular use can lead to cannabinoid hyperemesis syndrome, a rare side effect causing vomiting bouts.
Stuyt, who has publicly criticized cannabis commercialization, said the patient reported feeling better as he reduced use, though she doesn’t know his condition today because she lost touch with him during the coronavirus pandemic. The lesson she took from treating him was that doctors should ask patients, especially older ones, about marijuana use and be prepared to talk about side effects and drug interactions.
As marijuana undergoes rapid legalization and cultural acceptance, calls for abstinence are counterproductive, especially for seniors wary of the prescription pills shoveled their way, experts say. Decades of stigma and exaggerated warnings about marijuana’s ills have eroded the credibility of medical experts when they raise concerns. Physicians say they can help patients weigh the benefits and the risks through candid, judgment-free conversations.
But such conversations are complicated by the dearth of clinical trials studying the effects of cannabis, available in an increasingly broad range of potency and forms including gummies, oils, vapes and classic joints. The available body of research has raised red flags for older adults and their providers to consider.
Studies on the health effects of cannabis on older adults suggest its use is associated with greater frequencies of mental health issues, cognitive impairment and accidents, according to a sweeping review of literature led by Dianna Wolfe, a senior clinical research associate at Ottawa Hospital Research Institute in Canada. The therapeutic effects were inconsistent. The authors cautioned that the review should be interpreted not as definitively concluding that cannabis causes those negative health effects or provides no medical benefits, but rather as underscoring the need for more research.
A study presented at an American Heart Association conference in November found that adults older than 65 with “cannabis use disorder,” which is essentially addiction, and cardiovascular risk factors such as high blood pressure are at higher risk for heart attacks and strokes while hospitalized. The data could be skewed by hospitals having different standards for cannabis use disorder.
Loren Wold, a cardiac specialist at Ohio State University’s College of Medicine, said the research should give pause to older adults who are prone to irregular heartbeats or have high blood pressure and want to use marijuana.
“It really needs to be a cost-benefit analysis,” Wold said. “Based on your health history, is cannabis likely going to be beneficial or potentially deleterious?”
His family confronted the issue when a doctor suggested that his 80-year-old father, Ronald, try cannabis gummies to manage lupus, an autoimmune disorder that had inflicted pain in his joints for decades. Ronald initially thought it was strange to recommend a long-outlawed drug, but medical marijuana is now legal in North Dakota, where he lives. His son, who consulted his father’s doctor to help weigh health risks, concluded that Ronald was not at high risk because he does not have high blood pressure or other chronic conditions.
“I tried all kind of pain relievers and everything for over 50 some years, and so far, this is the only one that the first time I tried it, it worked right away,” Ronald Wold said. “I’m one person, though. It’s not going to affect every person the same way.”
The experience is not always pleasant.
A study published in January 2023 in the Journal of the American Geriatrics Society found that cannabis-related emergency department visits for adults 65 and older in California soared from 366 in 2005 to 12,167 in 2019.
The study does not distinguish between life-threatening and benign cases, such as someone panicking at an unfamiliar sensation but recovering without issue after several hours. Some visits could be spurred by patients unwittingly eating a marijuana-laced edible and not realizing they’re high, or older people learning they can’t handle the high-potency products flourishing on the market today.
Seemingly mundane cases of older people becoming dizzy and disoriented should not be dismissed, according to Benjamin Han, the study’s lead author.
“We can’t always dismiss these symptoms, especially if they have underlying cardiovascular disease or have a history of an abnormal heart rhythm,” Han, a geriatrician at the University of California at San Diego School of Medicine, wrote in an email. “Cannabis may trigger exacerbation of existing chronic diseases that could potentially be a danger to their health.”
He added that seniors should be mindful of the risk of developing cannabis use disorder, despite perceptions that people do not get addicted to marijuana.
A 68-year-old Washington state resident, who spoke on the condition of anonymity to discuss his addiction, said he recently decided to stop using cannabis, which he had been using regularly for eight years as a replacement for alcohol. He was spending hundreds of dollars a month on infused cannabis flower, vape cartridges and laced beverages as his tolerance grew and he struggled to stop. He developed a persistent cough and chest pains. No one asked about marijuana during his annual physical.
He said his chest pains and cough ended after he quit using marijuana in November.
Polarized discourse around marijuana frustrates him, he said, leaving him perplexed by one side casting marijuana as a gateway drug that cannot be used responsibly and the other touting it as a natural gift without serious downsides.
“I’m not going to stand up on a soapbox and lecture everyone about what to do with their body,” he said. “But don’t go into this blindly thinking it has no consequences and marijuana is God’s gift.”
Experts say seniors should be mindful that the effects of cannabis can vary widely based on the person and the form the product takes. They often advise to start with low doses.
Peter Ilchuk, a 76-year-old retiree in Tampa, said that a few puffs of a vape pen containing a cartridge with more than 50 percent THC — the main active ingredient of cannabis — helps him fall asleep every night, but that he wishes he had lower-potency options. His memory is not as good as it used to be, and he wonders if it’s just age or the higher-potency product playing a role.
Gummies don’t give him the instant effect he’s looking for, and he’s leery of Florida’s medical marijuana program, which requires paying for what he described as superficial medical consultations that don’t address his health questions.
“I’m hoping they can do more research on the beneficial and negative effects of marijuana,” Ilchuk said. “If there is a chance it has some effect on my overall health, I would want to reduce it.”
Older adults have also embraced products containing CBD, a nonintoxicating component of marijuana, instead of THC, the compound that gets people high. A 2020 review of CBD research found that it is well-tolerated with few serious adverse effects but that interactions with other medications should be monitored closely.
Ken Finn, a pain medicine physician in Colorado, said older patients often ask about CBD products, which are more readily available at stores besides the dispensaries that sell intoxicating weed. He responds by going on Drugs.com while they are in the examination room to look at how the compound can negatively interact with medications commonly used among older patients, such as blood thinners, antidepressants and seizure medication. The enzyme that metabolizes CBD is the same one that metabolizes other drugs, influencing the effectiveness of prescription medication when taken with cannabis.
“I tell them [to] proceed with caution but if they want to do it, that’s okay,” Finn said.
Finn also recalled treating a younger patient with a heart transplant who was getting free CBD products from a friend’s dispensary. He warned the patient about research suggesting that CBD could reduce the amount of immunosuppressing drugs in his bloodstream, medicine necessary to prevent his body from rejecting the donated organ. The patient ended up needing a second transplant, but it’s unclear whether that might have happened regardless of his CBD use.
Because the CBD market is loosely regulated and beset with legal loopholes, some products labeled as pure CBD actually contain THC.
In Atlanta, a 94-year-old woman showed up at an emergency room disoriented, lethargic and anxious. A chest X-ray and CT scan of her head came back normal, but her urine tested positive for THC, according to a report on her case. Five days into her stay, a relative admitted to giving her brownies laced with what was marketed as pure CBD oil to help her back pain and poor appetite.
Joyce Akwe, a physician and associate professor of medicine at Emory University School of Medicine who was involved in the woman’s care and co-authored the case report, said the episode illustrates the perils of giving elderly relatives cannabis without consulting a medical professional.
While immediate highs are usually short-lived, Akwe said it’s possible for elderly patients to be confused for days. She said the takeaway isn’t to steer clear of cannabis, but to be mindful of risk factors.
People on opioids for chronic pain may need to reduce their dosage if they turn to cannabis for additional relief.
Memory impairment caused by cannabis can be especially detrimental for people with cognitive disorders such as Alzheimer’s disease.
“A lot of people think, ‘Well, cannabis is a plant, so it’s not going to be harmful,’” Akwe said. “We have poisons that come from plants. So people should never ignore the fact that cannabis is something that can be harmful.”