The Age of Cannabis Has Arrived: Issues for Older Adults.

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Author: Marc Agronin
Date: Mar. 2021
From: Psychiatric Times(Vol. 38, Issue 3)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 2,213 words
Lexile Measure: 1900L

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A new question must be added to the list that mental health clinicians ask their older patients while taking a history, regardless of age: "Have you used any cannabis products recently?"

I learned this lesson during a follow-up appointment with an 82-year-old man with Alzheimer disease. He reported some rather abrupt cognitive decline, and I asked him and his wife about recent medical changes without finding any clear precipitant. Finally, his wife sheepishly confessed that their son had sent them a grab bag of cannabis-derived products that the patient was taking. The family was desperate for anything to help his cognitive decline and they had heard that cannabis was a miracle cure for Alzheimer disease and many other conditions. Unfortunately, the patient received no benefit but did experience some mild, noticeable adverse effects. Without my probing, I never would have known. The next patient I asked explicitly about using cannabis products responded in an equally explicit manner: "No I haven't," he said, "but can you get me some?" It was clear that the age of cannabis had arrived.

Older individuals with psychiatric disorders are increasingly using cannabis, largely in the form of prescribed medical marijuana and cannabidiol (CBD). This trend has been driven by several factors: reduced stigma, lifted restrictions on possession and sale by most states, and the enormous proliferation of articles and ads that tout supposed benefits of cannabis for many conditions that afflict the elderly, including chronic pain, peripheral neuropathy, stress, anxiety, depression, insomnia, headaches, and the adverse effects of chemotherapy. (1,2) As a result, medical marijuana use by individuals 65 or older has increased more than 8-fold in recent years, from less than 0.5% in 2006 to 4.2% in 2018 (3) (Figure). In a survey of 345 adults in Colorado, 16% had used medical marijuana since legalization, with half the users being 75 or older. (4) CBD has seen a particularly enormous surge in interest and availability after it was exempted from federal regulations in the 2018 US Farm Bill. Since then, it is estimated that 6.4% of adults aged 45 to 55 and 3.7% of those 55 or older have used CBD at least once. (5)

Cannabis, Cognition, and Quality of Life

Although the cannabis sativa plant contains hundreds of chemicals known as cannabinoids, the 2 main active chemicals are [DELTA]-9-tetrahydrocannabinol (THC) and CBD. THC has both psychotropic and euphoric properties and confers the high associated with marijuana, while CBD is noneuphoric because it does not activate the cannabinoid 1 receptor like THC does. The same plants that produce THC also produce CBD. Both THC and CBD come in a variety of forms; they can be smoked, vaped, eaten, ingested as liquids, used as oils, and applied via creams and cosmetics.

The psychotropic effects of both THC and CBD are mainly because of their interaction with endogenous cannabinoid receptors in the brain, as well as activation of a variety of other cannabinoid and noncannabinoid receptors (ie, serotonergic, glutaminergic, [micro]-opioid, and [[alpha].sub.1]-adrenergic) in the central nervous...

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Gale Document Number: GALE|A676445534