According to the Canadian Institute for Health Information, nearly a quarter of Canadians 65 and up take 10 or more prescription drugs. Taking multiple prescription drugs — or polypharmacy, as it’s called — can be challenging for patients and healthcare providers alike. For patients, it can be difficult to remember to take their medications at the right time each day. For healthcare providers, it’s a struggle to manage drug interactions, side-effects, and adherence.
“Seniors who were prescribed 10+ drugs were more likely to be hospitalized for an adverse drug reaction — over 5 times more likely than seniors who were prescribed fewer drugs,” the Canadian Institute for Health Information page states.
As interest in cannabis medicine grows, research is revealing more and more conditions where the herb helps. Many of these conditions are relevant in the older adult population, for example, chronic pain, arthritis, insomnia, digestive disorders, and inflammation, all of which are common problems among older adults.
Some people are wondering if cannabis treatment could reduce the prescription load on seniors. If a senior is suffering from multiple conditions that cannabis can help with, treating two or more conditions with one drug is ideal. Evidence is stacking up in favour of this idea.
In a 2017 survey, 46 per cent of cannabis users reported using cannabis products in place of prescription drugs. The most common drugs cited for replacement were opioids (such as OxyContin and Vicodin), benzodiazepines (such as Xanax, Valium and Ativan) and antidepressants (such as Zoloft and Paxil). Many of the respondents reported using cannabis to replace more than one prescription medication.
A 2016 study found that cannabis was effective for chronic pain, and that those treated with cannabis used less opiate medication than before the study. The study was uncontrolled, which means researchers can’t determine whether cannabis played a causal role in their findings. Nonetheless, it is a promising start for future research. A 2016 survey published in the Journal of Pain reported similar findings.
Natural Care nurse practitioner Lynn Haslam is enthusiastic about cannabis’s potential to reduce overall prescription load.
“I recently treated a patient in long-term care with cannabis for management of his agitation and pain stemming from dementia. It was extremely effective and reduced the need for opioid treatment and other medications,” she recounts.
Haslam also laments the fact that medications can cause side-effects, which must then be treated with more medications.
“When a patient suffers from chronic pain, it’s common for us to treat them with opioids. However, opioids can then cause constipation, which increases the number of medications the patient is taking. It can become a self-perpetuating cycle.”
Cannabis, on the other hand, tends to cause relatively few side-effects. A 2018 survey of nearly 3,000 elderly patients treated with cannabis reported that dizziness and dry mouth were the most common adverse effects, each affecting between 5-10 per cent of those surveyed. The authors concluded that cannabis is safe and effective in the older adult population.
Haslam’s experience agrees with the survey. “Opioids can cause a number of adverse effects and place older adults at risk. For example, they may experience drowsiness, dizziness, sedation and constipation,” she explains. “Cannabis therapies tend to have a safer profile than opioids, especially in the older adult population.”
Healthcare providers who are knowledgeable about cannabis can recommend strains and formulations that are safe and effective for a patient’s situation. For example, some patients may not be able to vaporize cannabis flowers. These patients would be prescribed an oil or capsule formula.
Haslam recommends CBD-dominant formulas as a good starting place. CBD, also known as cannabidiol, is a non-intoxicating cannabinoid found in the cannabis plant. It offers many of the same benefits as THC, but does not cause a “high” or carry the risks of confusion and psychosis.
“Although a CBD formulation has a very high safety profile, there is a small risk of dizziness, especially with the first day or two of dosing,” says Haslam. This is why Haslam always recommends starting low and going slow. “[Caregivers should] titrate the dose as needed to find the lowest dose that manages the patient’s symptoms.”
Overall, Haslam is optimistic about the future of cannabis medicine in the older adult population. Research is mounting to support the idea that cannabis can safely and effectively treat health problems in older adult populations, and that it can reduce the use of prescription medications.