CANNABIS USE IN THE AGE OF LEGALIZATION: IMPLICATIONS FOR THE GERIATRIC POPULATION

The prevalence of cannabis use among older adults has significantly increased in recent years. This trend likely captures the attitudes of the aging Baby Boomer generation as well as the spread of laws legalizing cannabis across the United States. As cannabis usage becomes more common in older adults, physicians must remain up to date regarding how cannabis is accessed and consumed, the types of strains and products sold in dispensaries, the indications and efficacy of FDA approved forms, as well as the different effects of tetrahydrocannabinol (THC) and cannabidiol (CBD). Despite the significant increase in cannabis use, there remains a paucity of evidence on the efficacy and safety in older adults. From a harm reduction standpoint, data regarding the safety profile of cannabis is essential since aging is typically associated with changes in pharmacokinetics and pharmacodynamics, multimorbidity, increase in prescription medication utilization and declines in function. Of particular importance in the geriatric population are the associations between cannabis and cognition, falls and injury, drug interactions, pain modulation and treatment of dementia related agitation. In terms of cognition and memory, heavy cannabis use has been traditionally associated with negative neurocognitive consequences. Interestingly, new animal models have found that low dose THC may actually improve memory and cognition in old animals, although how this data will translate to humans remains unclear. Next, commonly experienced side effects of cannabis in the elderly include dizziness, hypotension, drowsiness and confusion, all of which may impact fall risk. The risk of side effects may be compounded when considering interactions with other prescribed medications. In terms of pain modulation, although physicians may seek non-opioid pain regimens for geriatric patients, there is low-strength evidence that cannabis alleviates neuropathic pain and insufficient evidence for other types of pain. Finally, data does not yet support the usage of cannabis to improve neuropsychiatric symptoms in dementia patients. While physician knowledge of legalities, usage trends, indications and adverse effects of cannabis is necessary to manage medically and socially complex aging patients, this remains challenging in the setting of a very limited evidence-base.