New research out of California finds seniors are being treated in emergency rooms in significantly higher numbers for adverse side effects from cannabis consumption.
Researchers from the University of California, San Diego (UCSD) said they studied the issue because they noticed more primary care patients ending up in the ER after using marijuana products.
"While we did expect to see an increase, just given the increase in the use of cannabis by older adults, the sharp increase, especially from 2013 to 2016, did surprise us," said first study author Dr. Benjamin Han, a geriatrician in the Division of Geriatrics, Gerontology and Palliative Care at UCSD's School of Medicine.
While people 65 and up were involved in only 366 cannabis-related ER visits in 2005, that number skyrocketed to 12,167 in 2019. The relative increase was 1,808%.
Older patients taking marijuana or related products may have dizziness and falls, heart palpitations, panic attacks, confusion, anxiety or worsening of underlying lung diseases, such as asthma or COPD, Han said.
One relatively rare condition is cannabinoid hyperemesis syndrome, where the drug is associated with cyclic vomiting.
Older adults are at higher risk for adverse cannabis reactions, likely due to a combination of greater sensitivity and being unfamiliar with newer forms of the drug, Han said.
"Certainly, as we age there are physiological changes that do make us more sensitive to any psychoactive substance, including cannabis or alcohol. But we do also see older people who are not familiar with cannabis and may unintentionally take more than they wanted to," Han explained.
More older Americans are using cannabis since it has been legalized for medical or recreational use in many states. California has had legal medical marijuana since 1996 and legal recreational cannabis since 2016.
Just last week, a study published in the journal JAMA Network Open showed that 3 out of 10 people said they had tried cannabis to treat their pain, and most of those patients reported that they wound up substituting weed in place of other painkillers.
Older adults typically use cannabis to treat pain or arthritis, sleep problems, anxiety and depression, Han said.
It can be challenging to determine whether a person's symptoms are from the cannabis or if they happened to use cannabis and had these unrelated symptoms, he said.
“Cannabis can cause a range of potential adverse effects, but this is often difficult to determine 'too much' given the range of cannabinoids, dosing, ratios and routes of ingestion," Han said. "We also are still learning about potential harms of cannabis, including its potential negative impact on existing chronic diseases. Cannabis use disorder -- or problematic use -- is also a concern for people who use cannabis regularly."
Researchers said that past work on alcohol use has shown that older adults are more likely to make behavior changes if the behavior is linked to a medical symptom or outcome they don't want. Linking cannabis to these risks may also help change behavior.
It is possible older adults will answer more frankly if asked specific questions, researchers suggested. Providers could then follow up with questions about frequency of use, what a person is using it for and if they know how much of the drug is contained in what they're using.
Providers can then offer patients some guidance.
“It is very important that clinicians ask and talk about cannabis use with their patients in a non-judgmental manner, especially among older populations who are increasingly trying cannabis to treat a range of chronic symptoms,” Han said. “That being said, weighing the benefits versus the risks of cannabis for older adults can be challenging for clinicians, given the lack of clinical studies.”
The new findings were published Jan. 9 in the Journal of the American Geriatrics Society. The U.S. National Institute on Drug Abuse provided some of the funding.
Dr. Leigh Vinocur is a spokesperson for the American College of Emergency Physicians, and also has a cannabis consulting practice for both patients and the industry. She said one issue is lack of education about how to use cannabis safely, both for patients and for the physicians treating them, as well as lack of standardization.
The reason for an increase in seniors in California emergency rooms could be that as they age and are experiencing pain and other health issues, they also remember cannabis from the 1960s, but it's not the same, said Vinocur, who was not part of the new study.
Cannabis ingested orally may also counteract with other medications a patient is taking, something that those working at dispensaries may not have the expertise to offer advice, she noted.
"Anything you take orally goes through your liver and we have only so many enzymes at a time to break down what comes into the liver," Vinocur said.
Vinocur offers advice to her patients on how and when to take cannabis in terms of other medications and health issues. She said she has seen it make a significant difference for patients under palliative care when undergoing cancer treatments.
"If patients are under the guidance of a knowledgeable health care clinician, medical cannabis can be absolutely safe for patients," Vinocur said.
The U.S. National Center for Complementary and Integrative Health has more on cannabis and cannabinoids.
SOURCES: Benjamin Han, MD, MPH, geriatrician, Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, School of Medicine; Leigh Vinocur, MD, MS, spokesperson, American College of Emergency Physicians and cannabis consultant, Ananda Medical Practice and Cannabis Consulting, Baltimore, Md.; Journal of the American Geriatrics Society, Jan. 9, 2023