Seniors and marijuana

In Canada, access to medical marijuana has been legal since around 2001, and access to recreational marijuana will become legal in July 2018. This is good news for seniors. I’ll tell you why, but first we need a little detour into the past.

Marijuana (also called cannabis) packs a double punch: it has medicinal properties, and it produces a high. For centuries, cultures around the world have woven it into their healing practices, customs and religious rites. But in the West, especially in the United States, the legal history of marijuana has taken a sinister turn. It has been repeatedly vilified by powerful individuals and groups in the service of political, racist and business agendas. The history of marijuana in America is sordid but fascinating. If you want to get your toes wet you can start here or here. The upshot is that the research evidence is sparse and uneven, and patients are missing out.

Here is the best evidence available to date. This is a nerdy list, but I want to be unbiased and thorough. First, here are the conditions that marijuana can treat.

Conclusive or substantial evidence:

• Treatment of chronic pain in adults
• Treatment of chemotherapy-induced nausea and vomiting
• Improving multiple sclerosis spasticity symptoms

Moderate evidence:

• Sleep disturbance associated with certain disorders

Limited evidence:

• Increasing appetite and reducing weight loss associated with HIV / AIDS
• Improving symptoms of Tourette syndrome
• Improving anxiety symptoms
• Improving symptoms of post-traumatic stress disorder

Here are the possible adverse effects.

Substantial evidence:

• Statistical association between cannabis smoking and worse respiratory symptoms in respiratory disease with long-term cannabis smoking
• Increased risk of motor vehicle crashes
• Development of schizophrenia or other psychoses, with the highest risk among the most frequent users
• Statistical association between increases in cannabis use frequency and progression to developing problem cannabis use

Moderate evidence:

• No statistical association between smoking cannabis and incidence of lung cancer
• Impairment in cognitive domains of learning, memory and attention (acute cannabis use)
• Small increased risk for development of depressive disorders
• Increased risk of suicide ideation and suicide attempts with a higher incidence among heavier users
• Increased incidence of social anxiety disorder with regular cannabis use
• Being male and smoking cigarettes are risk factors for the progression of cannabis use to developing problem cannabis use
• Major depressive disorder is a risk factor for the development of problem cannabis use

Limited or no evidence:

• Increased risk of acute myocardial infarction
• Statistical association between cannabis smoking and developing chronic obstructive pulmonary disease
• Statistical association between cannabis use and death due to cannabis overdose

Obviously there are plenty of research gaps, but with increasing public acceptance and more and more jurisdictions legalizing marijuana, hopefully the research will soon follow. Meanwhile, what stands out for me is the evidence for chronic pain, an issue of pressing concern for many seniors. It’s an obvious and very welcome alternative to opioids. So if you have chronic pain or any of the other conditions listed above as having evidence support, and you’re not satisfied with your current treatment, consider discussing marijuana with your doctor. Remember that medical marijuana comes without the kick. Just take the lowest possible dose, use in moderation, and eat it instead of smoking it.

Some doctors are uncomfortable prescribing marijuana, given the spotty knowledge base, lack of evidence for dosing levels, lack of standardized medication, and tentative, limited guidance from the College of Family Physicians of Canada. All in good time. If your doctor won’t prescribe it, then just wait until next July, have a candy and see what happens. Peace, man.