As the cannabis, CBD, and hemp industry continues to expand and evolve in the United States, the population of those who use cannabis both medicinally and recreationally does too. A study published in the Annals of Internal Medicine appears to reflect the changing attitudes toward cannabis across the country and across generations.
In states with a medical marijuana program, many of the qualifying conditions for residents affect people of any age, and symptoms could be worse in older adults. As trust in the traditional pharmaceutical market has faltered due to the pandemic and opioid crisis, it makes sense that many people would turn to alternatives to relieve their pain and other symptoms.
Let’s look at the rise of this shadow market and the risks and benefits of marijuana use for the aging population of the United States.
The Rise of Cannabis Use Among Older Adults
Put simply, the percentage of older adults in America using medicinal and recreational cannabis is getting higher. According to a study published in the Journal of the American Medical Association in 2020, the use of cannabis by adults 65 years of age and older increased sharply from 2.4% to 4.2%, a 75% relative increase over a three-year period, with women over 65 representing a 93% increase. When looking at adults over 65 with diabetes, there was a 180% relative increase from 2015 to 2018 and for those who seek mental health treatment, a 157.1% relative increase in use was shown.
There are a few reasons we may be seeing these sharp increases–shifts in public perception and legalization leading to better access are probably the most common.
As older adults hear more about legal cannabis and its benefits, the assumption is that cannabis purchased in legal dispensaries is safer than purchasing illegally. While this may be true, without visibility and transparency into the cannabis supply chain, it is next to impossible to know if the product you are purchasing is accurately labeled, high quality, and professionally tested.
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Benefits of Cannabis Use for Older Adults
Chronic pain is one of the top reasons older adults seek out legalized medical marijuana. In states that have a medicinal use program, chronic pain, nausea from chemotherapy, and stiffness from multiple sclerosis are the three main reasons adults seek out cannabis.
The limited amount of research done on the effects of marijuana on these conditions in older adults seems to support the anecdotal evidence that older adults suffering from these symptoms find relief from cannabis use. In older adults, relief of pain and suffering and increase in functional status and quality of life are major goals of medication. Many of the medicines used, however, have adverse effects. NSAIDs can cause bleeding in the gastrointestinal tract or cardiac events, sedatives can impair motor skills and cause dizziness and confusion, and opioid usage can lead to addiction, nausea, vomiting, falls, and decreases in respiration.
These side effects can greatly decrease quality of life and many people are searching for a better alternative. This doesn’t mean, though, that cannabis has no adverse effects.
Challenges and Risks
One of the main challenges doctors find in prescribing cannabis to older adults is the lack of research on their population. There are several potential adverse effects of cannabis use, including those we see in younger populations. Mild functional and structural brain impairments affecting attention, motor skills, memory, and executive function are seen with regular marijuana use, and without more research, it is difficult to know how older adults might tolerate the same effects.
If adults over 65 are new to the feeling of cannabis use, it could lead them to panic and have other adverse reactions. A study published earlier this year showed a 1,808% relative increase in cannabis-related trips to the emergency room for adults over 65 in California. Cannabis can slow reaction times, leading to falls and injuries. The risk of psychosis and paranoia is increased, as well as the exacerbation of existing cardiovascular and pulmonary symptoms, all of which could lead to the need for emergency services. Lastly, much is unknown about how cannabis interacts with other prescription medications.
According to Psychiatric Times, CBD is an inhibitor of several enzymes found in common medications for older patients, including blood thinners, antibiotics, and antidepressants. It is important for people taking prescription medications to be honest about their cannabis use so their doctors can make sure there are no negative interactions with their meds.
The Shadow Market: What It Entails
A shadow market is an unregulated, or less regulated, market where goods and services are exchanged with little or no oversight. It doesn’t necessarily mean the trade is explicitly illegal, just that it is an alternative to a public market.
The dangers of the cannabis shadow market cannot be overstated for older adults. Both obtaining and consuming cannabis with no regulation can be difficult for anyone, especially older adults who may not be as well versed in researching safety practices.
Additionally, there is no way to know if the products you are ingesting contain the proper dosage, have been properly tested, or contain any ingredients you aren’t aware of.
Policy and Healthcare Considerations
Policy reform is a great way to tackle the shadow market. Federal legalization is the end goal, but revisiting current cannabis policies to address the needs of all adults, including the older generations, would ensure consumer safety and increase access for everyone. Some ideas for increasing access for older adults could be specialized dispensaries with experts in geriatric treatment on staff and home delivery for those who are less mobile.
Policy reform in the United States should also tackle awareness for healthcare providers and emphasize the importance of cannabis education to better assist older patient populations.
Safe Use of Cannabis Among Older Populations
To make cannabis, CBD, and hemp usage safe for people of all ages, and especially for our vulnerable older population, the United States needs further research, federal policy reform, and widespread healthcare initiatives. It is important that everyone who needs access to safe and reliable cannabis is educated for effective use and is able to find trustworthy products.
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