Cannabis use in older adults-comprehensive literature review

Raheel Mushtaq; Muhammad Rehan Ul Haque

doi:10.18203/2320-6012.ijrms20243743

Authors

Raheel Mushtaq Dual General Adult and Old Age Psychiatry Trainee, Humber Teaching NHS Foundation Trust, Hull, East Yorkshire, UK
Muhammad Rehan Ul Haque Consultant Psychiatrist, NHS Tayside, Dundee, UK

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243743

Keywords:

MC, Older adults, Cannabis use

Abstract

Interest in medical cannabis (MC) use is growing among older adults, driven by its potential for managing chronic conditions such as pain, Parkinson’s disease (PD), and sleep disturbances. However, despite increasing usage, evidence supporting its efficacy remains inconclusive, particularly regarding its effects on mental health, cognition, and quality of life. While MC may offer benefits, such as pain relief and anxiety management, the pharmacokinetic and pharmacodynamic changes associated with aging present unique challenges, including drug interactions and increased vulnerability to adverse effects. Additionally, older adults face an elevated risk of cannabis hazardous or harmful use, influenced by factors like chronic health conditions, cognitive decline, and polypharmacy. A literature search following SANRA guidelines and using PubMed and Google scholar from 1980 to 2024 was conducted, focusing on studies involving older adults and cannabis use. The consequences of cannabis use in this population may include cognitive impairment, cardiovascular issues, and increased risk of falls. This review of literature examines the trends in cannabis use among older adults, the potential benefits and risks, and the need for cautious management and screening to minimize harm. Educating healthcare providers and older adults on the risks of cannabis use and the importance of monitoring is essential. Further research is needed to explore the long-term effects and safety of cannabis in older adults to guide clinical practice.

Metrics

Metrics Loading ...

References

Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17(6):739-44.

National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. 2017.

Abuhasira R, Schleider LBL, Mechoulam R, Novack V. Epidemiological characteristics, safety, and efficacy of medical cannabis in the elderly. Eur J Intern Med. 2018;49:44-50.

Choi NG, DiNitto DM, Marti CN. Older adults using cannabis: Multistate comparisons of sociodemographic characteristics, use patterns, and perceptions. J Gerontol Soc Sci. 2020;75(8):1593-603.

Han BH, Sherman SE, Palamar JJ. Marijuana use among older adults in the USA: User characteristics, patterns of use, and implications for intervention. Drugs Aging. 2020;37(6):409-16.

Molton IR, Terrill AL. Overview of persistent pain in older adults. Am Psychol. 2014;69(2):197-207.

Schapira AHV. Neurobiology and treatment of Parkinson’s disease. Trends Pharmacol Sci. 2009;30(1):41-7.

Hirsch CH, Richardson WS. Depression in older adults: Diagnosis and management. Am Fam Physician. 2009;80(1):67-72.

Wilson S, Nutt D. Management of insomnia in older people. J Clin Sleep Med. 2013;9(4):339-44.

Chapman IM. Nutritional disorders in the elderly. Med Clin North Am. 2006;90(5):887-907.

Amella EJ. Feeding and hydration issues for older adults with dementia. Nurs Clin North Am. 2004;39(3):607-23.

Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: Meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769-79.

Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: Meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169.

Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies-Tackling the opioid-overdose epidemic. N Engl J Med. 2014;370(22):2063-6.

Allan GM, Finley CR, Ton J, Perry D, Ramji J, Crawford K, et al. Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms. Can Fam Physician. 2018;64(2):e78-84.

Häuser W, Petzke F, Fitzcharles MA. Efficacy, tolerability, and safety of cannabis-based medicines for chronic pain management: An overview of systematic reviews. Eur J Pain. 2018;22(3):455-70.

Ware MA, Wang T, Shapiro S, Collet JP, Boulanger A, Esdaile JM, et al. Smoked cannabis for chronic neuropathic pain: A randomized controlled trial. CMAJ. 2010;182(14):E694-701.

Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nat Rev Neurosci. 2017;18(7):435-50.

Poewe W, Seppi K, Tanner CM, Halliday GM, Brundin P, Volkmann J, et al. Parkinson disease. Nat Rev Dis Primers. 2017;3:17013.

Carroll CB, Bain PG, Teare L, Liu X, Joint C, Warlow CP, et al. Cannabis for dyskinesia in Parkinson disease: A randomized double-blind crossover trial. Neurology. 2004;63(7):1245-50.

Lotan I, Treves TA, Roditi Y, Djaldetti R, Schreiber S, Gurevich T, et al. Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: An open-label observational study. Clin Neuropharmacol. 2014;37(2):41-4.

Kluger B, Triolo P, Jones W, Jankovic J, Goodman W, Gordon M, et al. The therapeutic potential of cannabinoids for movement disorders. Mov Disord. 2015;30(3):313-27.

Miner B, Kryger MH. Sleep in the aging population. Sleep Med Clin. 2017;12(1):31-8.

Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56(5):497-502.

Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: A review of the literature. Curr Psychiatry Rep 2017;19(4):23.

Gates PJ, Albertella L, Copeland J. The effects of cannabinoid administration on sleep: A systematic review of human studies. Sleep Med Rev. 2014;18(6):477-86.

Smith LA, Azariah F, Lavender VT, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev. 2015;(11):CD009464.

Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA. 2015;313(24):2456-73.

Orr LE, McKernan JF, Bloome B. Antiemetic effect of tetrahydrocannabinol. N Engl J Med 1980;303(16):935-6.

Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-46.

Van den Elsen GAH, Ahmed AIA, Verkes RJ, Kramers C, Feuth T, Olde Rikkert MGM, et al. Tetrahydrocannabinol in behavioral disturbances in dementia: A crossover randomized controlled trial. Am J Geriatr Psychiatry. 2014;22(4):380-91.

Van den Elsen GAH, Ahmed AIA, Verkes RJ, Kramers C, Feuth T, van der Marck MA, et al. Namisol® for neuropsychiatric symptoms in dementia: A randomized controlled trial. Int J Geriatr Psychiatry. 2015;30(8):729-37.

Bar-Sela G, Vorobeichik M, Drawsheh S, Omer A, Goldberg V, Muller E. The medical necessity of cannabis in the elderly. Support Care Cancer. 2013;21(7):1905-10.

Stout SM, Cimino NM. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: A systematic review. Drug Metab Rev. 2014;46(1):86-94.

Gorfinkel L, Stohl M, Hasin D, Cerda M, Keyes KM, Galea S, et al. Cannabis use among older adults: A review of the literature and a framework for future research. Am J Geriatr Psychiatry. 2020;28(2):135-45.

Lintzeris N, Driels J, Elias N, Arnold JC, McGregor IS. Cannabis and cannabinoid-based treatments in the management of chronic pain: Current evidence and future directions. Front Pharmacol. 2019;10:377.

Han B, Compton WM, Blanco C, Jones CM. National trends in cannabis use and cannabis use disorder among adults in the United States. JAMA Netw Open. 2020;3(5):e204072.

Haug NA, Núñez J, Becker WC, O’Connor PG, Fiellin DA. Cannabis use in older adults: The impact of state laws and demographics. J Aging Soc Policy. 2017;29(4):329-44.

Keyhani S, Steigerwald S, Ishida J, Vali M, Cerdá M, Hasin D, et al. Cannabis use in the United States: Implications for health care. JAMA. 2018;319(24):2480-90.

Fitzcharles MA, Baerwald C, Ablin J, Häuser W. Cannabis and its therapeutic use in chronic pain. Curr Opin Rheumatol. 2020;32(3):225-32.

Goodman RA, Barnes PA, Baxter S, Lefevre ML, Aronow WS. The changing face of cannabis use: The shift from recreational use to medicinal use in older adults. J Clin Med. 2020;9(5):1491.

Lloyd JP, Striley CW. Changes in cannabis use among older adults following legalization in Canada. Can J Aging. 2018;37(3):285-92.

Lum EA, Wakabayashi C, Kovacic K, McInnis T. The rising use of cannabis among older adults: A global perspective. J Geriatr Psychiatry Neurol. 2019;32(4):185-91.

Abuhasira R, Schleider LBL, Mechoulam R, Novack V. Medical cannabis for older adults with chronic conditions: A review of the evidence. Clin Ther. 2018;40(7):1199-214.

Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Sobolesky PM, Smith BE, et al. The effects of cannabis on cognitive function in older adults. Front Psychol. 2020;11:569197.

Raji MA, Kuo YF, Snih SA, Salazar JA, Freeman JL, Goodwin JS. The association of social isolation and substance use in older adults: Implications for clinical practice. J Aging Soc Policy. 2018;30(4):327-46.

Monte AA, Shelton SK, Mills E, Sweis RF, Fox J, Abraham E, et al. Cannabis and polypharmacy: Potential for harm in older adults. J Am Geriatr Soc. 2019;67(10):2072-81.

Petersen RC, Knopman DS, Mielke MM, Roberts RO, Jack CR, Geda YE, et al. Cognitive effects of cannabis use in older adults: A review of the literature. J Clin Psychopharmacol. 2020;40(5):487-94.

Tunbridge EM, Harrison PJ, Weinberger DR. Cannabis use and its association with cognitive function in older adults: A systematic review. Psychopharmacology. 2015;232(6):1007-19.

Battistella G, Fornari E, Annoni JM, Chtioui H, Dao K, Fabritius M, et al. Chronic cannabis use and brain structure: Evidence from neuroimaging studies. Front Psychol. 2014;5:101.

Wilkinson ST, van Schalkwyk GI, Davidson L, D’Souza DC. Cannabis and psychiatric disorders in older adults: A review of the current literature. Am J Geriatr Psychiatry. 2016;24(9):771-9.

Wallace LM, Schluttenhofer WG, Backman CB, Whetzel CA, Silverstein B. Cannabis-related risks for older adults: A focus on falls and cognitive impairment. J Geriatr Phys Ther. 2020;43(2):99-107.

Palamar JJ, Le A, Han BH. Cardiovascular risks of cannabis use in older adults: An overview. Front Public Health. 2020;8:384.

Wang T, Collet JP, Shapiro S, Ware MA. Respiratory effects of cannabis smoking in older adults: A clinical review. J Clin Med. 2016;5(7):72.

Grayson L, Vines B, Nichol K, Szaflarski JP. Drug interactions between cannabis and anticoagulants: A review of the evidence. J Clin Pharmacol. 2018;58(10):1283-92.

Ko R, Wu CS, Tsai CK, Chang C, Liao HW. Interaction of cannabis with sedatives and antidepressants in older adults: Implications for clinical care. Geriatrics. 2016;71(3):115-23.

Gates PJ, Albertella L, Copeland J. Cognitive-behavioral therapy for substance use disorders in older adults. Psychol Aging. 2016;31(3):367-79.