Johny Marice
As cannabis use continues its upward trajectory across the United States, particularly among the aging demographic, medical professionals at Stanford Medicine are sounding a critical alarm. Today’s marijuana products, significantly more potent than those available in past decades, carry a heightened risk profile for older adults, demanding increased awareness and cautious consideration from both consumers and healthcare providers. This evolving landscape necessitates a closer examination of the science, the risks, and the crucial need for informed decision-making.
The Shifting Landscape of Cannabis Use Among Seniors
The demographic once considered less likely to engage with cannabis is now increasingly exploring its use. This trend is fueled by a complex interplay of factors, including the growing availability of legal cannabis products, a shifting societal perception of marijuana, and the persistent search for relief from chronic health conditions common in later life. Eloise Theisen, a geriatric nurse practitioner specializing in cannabis therapy at Stanford Medicine, observed this firsthand. Her personal journey with cannabis for chronic pain following a severe car accident provided an intimate understanding of its potential benefits, but her subsequent work in oncology revealed a critical gap in patient education and professional guidance.
"I found that our patients were going to use it whether their providers approved of it or not," Theisen stated. "Many of our patients were older, and they had risks that needed to be evaluated and addressed before they started using cannabis." This realization underscored the urgent need for evidence-based information tailored to the unique physiological characteristics and health considerations of older adults.
Escalating Potency: A New Era of Cannabis
A fundamental concern highlighted by Stanford experts is the dramatic increase in the potency of cannabis products. What was once a substance with tetrahydrocannabinol (THC) levels typically ranging from 1% to 4% in the 1970s has transformed into a market where legal cannabis flower commonly averages 20% THC, with some strains reaching as high as 35%. This escalation is even more pronounced in concentrated forms such as oils, edibles, and extracts, which can contain THC levels approaching 90%.
"We’re trying to catch up in our understanding of how that drastic of an increase in the psychoactive ingredient is impacting the brain and the body," explained Claudia Padula, PhD, assistant professor of psychiatry and behavioral sciences at Stanford Medicine. This exponential rise in THC content presents a significant challenge, as many older adults may be unaware of this potency shift, potentially leading to accidental overconsumption. A Canadian study examining emergency room visits before and after nationwide cannabis legalization revealed a nearly threefold increase in cannabis poisoning cases among adults over 65, a statistic that experts believe is directly linked to the heightened strength of modern products.
"There are so many different formulations and so many different strengths," noted Smita Das, MD, PhD, clinical associate professor of psychiatry and behavioral sciences at Stanford Medicine. "This is really not the cannabis of the ’70s."
Emerging Health Risks for Older Adults
The increased potency of cannabis is not the only concern. Stanford Medicine specialists have identified several specific health risks that are particularly relevant to older adults who engage in regular cannabis use.
Cardiovascular Concerns
While research into cannabis and its long-term effects is ongoing, a growing body of evidence suggests a link between regular cannabis use and cardiovascular disease. Joseph Wu, MD, PhD, director of the Stanford Cardiovascular Institute, highlighted the particular concern for older adults, given that heart disease remains the leading cause of death in the United States.
Dr. Wu’s research team has observed in animal studies that THC can trigger inflammation in blood vessels. Epidemiological research has further corroborated these findings, associating regular cannabis use in humans with a 29% increase in heart attack risk and a 20% increase in stroke risk. It is crucial to note that these risks can be exacerbated by co-occurring substance use. Many cannabis users also smoke cigarettes or consume alcohol, and the combination of these substances can amplify cardiovascular dangers. Furthermore, smoking cannabis has been linked to an increased risk of lung cancer and cancers of the head and neck.
"There is no safe amount of cannabis. Low doses and occasional use are still associated with vascular inflammation," Dr. Wu emphasized. "Abstinence is the safest option for heart health." He also pointed out that smoking and vaping cannabis appear to induce more inflammation than edible products, though edibles are not without their own risks.
Cognitive and Neurological Implications
Beyond cardiovascular health, cannabis use can pose risks to cognitive function and neurological well-being in older adults. Theisen noted that her patients have experienced dizziness, confusion, an increased risk of falls, and a worsening of pre-existing cognitive issues, including dementia.
A key factor contributing to these risks is the slower metabolism of cannabis in older adults. This means that the drug can remain in the system for longer durations, potentially prolonging its effects and increasing the likelihood of adverse reactions. This slower metabolic process also heightens the risk of dangerous interactions with prescription medications. For instance, cannabidiol (CBD), a non-intoxicating cannabis compound, can interfere with enzymes crucial for metabolizing medications such as blood thinners. This interference can lead to elevated drug levels in the body, significantly increasing the danger of bleeding following an injury or fall. In some cases, cannabis use can also diminish the effectiveness of essential medications.
Addiction Potential
Contrary to a persistent societal belief that cannabis is not addictive, research indicates otherwise. Dr. Das stated that approximately 30% of regular cannabis users may develop cannabis use disorder. This condition is diagnosed based on the extent to which cannabis use negatively impacts an individual’s daily life, encompassing aspects like withdrawal symptoms, the need for escalating doses to achieve the same effect, and interference with personal relationships and responsibilities.
While the addiction rates for cannabis are lower than those for alcohol, Dr. Das observed that many healthcare providers do not routinely inquire about cannabis use among older adults. "I’m noticing that older adults may not necessarily be disclosing cannabis use to their providers unless specifically asked. This isn’t a population we traditionally think about in terms of using cannabis," she explained. "If someone comes to me for another reason such as depression or alcohol use disorder, I might be the first person who has asked them about their cannabis use."
For individuals seeking to reduce or cease their cannabis use, open communication with a doctor or addiction specialist is paramount. Treatments such as cognitive behavioral therapy have demonstrated efficacy in managing substance use disorders. Dr. Padula’s research, employing functional MRI scans, is exploring how the brain responds to environmental cues in individuals with cannabis use disorder, revealing heightened sensitivity to drug-related signals in those who relapse after treatment.
The Nuance of Medical Efficacy: Promises and Limitations
While the risks associated with potent cannabis products are a primary concern, the potential for therapeutic benefits, particularly for specific conditions, cannot be entirely dismissed. However, experts emphasize that research in this area remains limited and often yields mixed results.
The U.S. Food and Drug Administration (FDA) has not approved cannabis itself for widespread medical treatment. However, it has approved two cannabis-derived compounds: CBD for specific forms of childhood epilepsy and dronabinol (a synthetic cannabinoid) for managing nausea and appetite loss in patients undergoing cancer treatment or living with HIV/AIDS. Additionally, cannabis compounds have shown promise in alleviating muscle spasms associated with multiple sclerosis, though this application is not currently approved in the United States.
CBD products are widely marketed for a range of ailments, including pain, sleep disturbances, anxiety, and substance use disorders. Yet, robust scientific evidence to support many of these claims is still lacking. Research into cannabis for chronic pain has yielded inconsistent findings, with some studies reporting pain relief while others point to significant placebo effects. The American Psychiatric Association has issued a statement opposing cannabis as a psychiatric treatment due to the absence of evidence demonstrating its efficacy for such disorders.
Eloise Theisen offers a more nuanced perspective from her work in palliative care. She notes that many patients facing life-limiting illnesses turn to cannabis as an alternative to opioid medications, seeking relief from cancer-related symptoms like pain. Research has indicated that chronic pain patients using cannabis sometimes reduce their opioid consumption, a significant development given the serious side effects and addiction potential of opioids. Theisen also highlights the value of the sense of well-being that cannabis can provide, particularly for patients with a limited prognosis. "THC has gotten a bad rap over the years, but in very small doses it can be therapeutic," she remarked. "There’s also a lot of stigma around its effects of euphoria. In our patients who may have months to a few years to live, still being able to experience joy is really important."
The Imperative of Open Dialogue
Despite the ongoing debates surrounding the medical utility of cannabis, Stanford experts universally agree on one critical point: older adults must engage in honest and open conversations with their healthcare providers before using cannabis. Theisen strongly advocates for patients to seek guidance from medical professionals rather than relying on advice from dispensary staff or experimenting independently.
In the early years of cannabis legalization, Theisen frequently encountered instances of patients experiencing accidental overconsumption of high-dose edibles due to inadequate instructions. "Patients would sometimes end up in the emergency department, or they would not want to take it again because they thought, ‘This isn’t going to work for me,’" she recalled.
Reliable and accessible information about cannabis remains a challenge for many. Healthcare providers are uniquely positioned to help patients assess the appropriateness of cannabis for their individual needs, explore alternative treatments, and identify potential risks associated with their existing medical conditions and medications.
"Your primary care physician will know the constellation of your medical conditions and other medications you might be on," Dr. Padula advised. "Talking to your doctor and letting them know not only what you’re prescribed, but what you’re using recreationally, will help formulate a way to do it in as safe a manner as possible." This collaborative approach is essential for navigating the complex landscape of cannabis use among older Americans, ensuring that decisions are informed by medical expertise and tailored to individual health profiles.
