In what has become an annual autumn networking ritual, the International Association for Cannabinoid Medicines (IACM) hosted a three-day conference (October 31 - November 2) in Berlin. Cannabis geriatrics and age-related pathologies were major topics at this year’s gathering of preeminent scientists, physicians, educators, and business representatives.
IS CANNABIS SAFE FOR SENIORS?
Seniors are currently the fastest-growing demographic of cannabis users worldwide, but is cannabis safe for the elderly? What might be the benefits?
These questions were addressed by Israeli researchers who examined clinically supervised cannabis use among the elderly. Dr. Ilya Reznik discussed the findings of a prospective observational study, which involved 184 elderly patients at a geriatric clinic in Israel. Eighty-three percent of the patients were 75 years or older.
The study entailed a comprehensive examination of each patient at the outset of cannabis therapy, plus a follow-up evaluation six months later. None of the participants enrolled in the study had any previous experience with cannabis. Most suffered from chronic pain (77%) and other age-related conditions, such as sleep disturbances, cancer-related symptoms, mood disorders, and Parkinson’s Disease.
The majority of the subjects (66%) utilized cannabis oil sublingually as the sole method of administration, and half of them took three doses daily.
The investigators sought to assess the efficacy of cannabis and the frequency and risk of adverse cognitive and cardiovascular effects, as well as postural instability and other problems. For the most part, side effects were relatively mild, affecting one third of the seniors enrolled in the study; these included dizziness (12%), sleepiness (11%), and dryness of the mouth.
Most significantly, the six-month follow-up appraisal revealed that one-third of the cannabis patients were able to discontinue opioids, as well as other pharmaceutical painkillers and anti-inflammatory drugs.
MEDICAL CANNABIS PROTOCOL FOR SENIORS
In his presentation, Dr. Addie Ron, an Israeli geriatric specialist and colleague of Dr. Resnick, shared details of the medical cannabis protocol that their team successfully designed and implemented at the Soroka University Research Institute and Clinic, which sponsored the prospective observational study of elderly patients.
The first step prior to commencing cannabis-based therapy involved a case-by-case, risk-benefit analysis of older adult participants. A cautious approach was recommended due to polypharmacy, nervous system impairment, potential cardiovascular risk, and pharmacokinetic variables.
In keeping with the principle “Primum non nŏcēre” or “do no harm,” the typical protocol required a start-low, go-slow approach to dosing cannabis – with a 5mg increase every 7 days until reaching the desired effects. Specifically, this is how patients were told to titrate their cannabis medicine:
- Day 1-3: 5mg THC + 5mg CBD
- Day 4-6: 10mg THC + 10mg CBD
- Day 7-14: 15mg THC + 15mg CBD
Each patient’s progress was closely monitored for side effects and efficacy; when the desired effect was achieved, the dosage stabilized with no need for further increase.
Most patients chose to consume cannabis oil via sublingual administration – with positive results for all involved. With respect to THC (with CBD), the prospective observational study found that a low, nonintoxicating dose, comprising between 0.75 mg and 1.5 mg of THC twice daily, was well tolerated and resulted in better functioning, increased body weight, improvement in cognition, decreased constipation, and improved mobility.
CANNABIS AND ALZHEIMER’S
With 35 million people diagnosed with Alzheimer’s worldwide, there is an urgent, unmet need for innovative approaches to treating this degenerative neurological illness. Can cannabis help someone suffering from dementia?
Dr. Javier Fernandez-Ruiz and a group of researchers at Complutense University in Madrid, Spain, are probing the role of the endocannabinoid system in Alzheimer’s Disease (AD). At IACM, Fernandez-Ruiz presented research showing that cannabinoid receptors – which are instrumental in the preservation, rescue, and/or replacement of neural cells in a healthy brain – become dysregulated during AD neurodegeneration.
Certain prescription meds, such as Donepezil, work by inhibiting an enzyme known as acetylcholinesterase, which breaks down acetylcholine, a key neurotransmitter involved in memory and cognition. Scientists have learned that cannabinoids – in particular, THC – act in a similar way as they also inhibit acetylcholinesterase. Moreover, cannabinoids can confer other possible benefits, as well, such as increased appetite, weight gain, and decreased anxiety and aggression.
Another team of Israeli scientists, in collaboration with Tikkun Olam, a medical cannabis producer, conducted a phase II randomized, double-blind, placebo controlled study to determine the safety and efficacy of whole plant CBD-rich oil for treating Alzheimer’s-related agitation, one of the most common symptoms in patients with severe dementia.
64 patients, average age 79, were enrolled in this clinical trial, which lasted 16 weeks (6 weeks titration and 10 weeks of assessments during stable dosage). Weekly medical examinations focused on the following:
- Vital signs
- Physical examination
- Blood pressure
- Behavioral disorders (based on the Cohen-Mansfield Agitation Inventory)
- Neuropsychiatric inventory
- Clinical Global Impression Severity /agitation-aggression
- Mini-Mental State Examination
- Mood (based on GDS questionnaire)
- Safety tests
- Concomitant medications
- Adverse events
By the end of this study, which found no significant adverse effects, 72% of patients treated with CBD-rich oil (compared to 30% of the placebo group) achieved relief from dementia-induced agitation. The authors concluded that CBD-rich oil is a safe treatment that can reduce agitation and other adverse behavioral symptoms in patients with dementia.
The research and clinical experiences reported at IACM 2019 confirm the strong safety profile of cannabis-based medication for the senior population, especially when THC levels are balanced by high levels of CBD and the remedies are administered sublingually. Scientists and doctors have also observed promising results with cannabis therapy that may help to improve the quality of life of older adults by mitigating normal as well as pathological age-related decline. For senior citizens that means improvement in cognition and mobility, increased body weight, decreased constipation, and better overall functioning.
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