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Chronic pain associated with osteoarthritis and osteoarthrosis and neurodegenerative disorders such as Parkinson’s disease and dementia from Alzheimer’s are examples of conditions frequently found in the elderly. There is a close relationship between advancing age and imbalance in Endocannabinoid System, which can facilitate the onset and progression of said diseases. Therefore, we highlight in this content, the therapeutic potential of Cannabis-based medicines in the elderly.
However, we all know that there are important clinical particularities in the follow-up and therapeutic management of the elderly, and regarding medical cannabis there is no difference. It takes expertise and experience to make safe and assertive prescriptions of cannabis-based medicines in this specific population.
If you want to incorporate this vast therapeutic arsenal into your prescriptive practice, read and keep this guide. We will explain the main uses of medical cannabis in the elderly and how to make an effective prescription. Check it out!
The Endocannabinoid System in the Elderly
A relatively recent scientific discovery, the Endocannabinoid System (ECS) is a set of receptors, ligands and enzymes that act as signals between cells, modulating different pathophysiological processes.
These endocannabinoid receptors and substances are present in all body organs and systems, performing different tasks in order to keep body’s homeostasis.
The balance of body systems is essential for health, as any imbalance in physiological functions can be decisive for the development and progression of diseases. The elderly are more susceptible to this imbalance precisely because, the older we get, the less endocannabinoid substances our body produces. In addition, the amount of endocannabinoid receptors that would be activated by these ligands is also lower, directly interfering with the homeostatic process.
This research published in 2016 in the scientific journal Cannabis and Cannabinoid Research. supports this relationship between deficiency of endocannabinoid substances and the development and/or progression of diseases.
According to this study, people with low levels of the endocannabinoids anandamide and 2-arachidonoylglycerol are more likely to develop inflammatory and central nervous system diseases such as migraine, fibromyalgia and irritable bowel syndrome.
>> You can read the full study here: Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.
Advantages for the treatment of the elderly with Medical Cannabis
Among the physiological activities modulated by the Endocannabinoid System, we highlight inflammatory processes, appetite and gastrointestinal transit, the sleep-wake cycle, neuronal plasticity and processes related to memory. The impairment of some of these functions tends to worsen in the elderly, due to the change in ECS tone in elderly patients.
From this perspective, the plant’s phytocannabinoids emerge as an effective alternative in the treatment and control of several disorders, filling the performance gap of the Endocannabinoid System and bringing more quality of life to the elderly in various clinical conditions. Below, we list the benefits of Medical Cannabis in these contexts.
Alzheimer’s disease and other dementias
Dementia from Alzheimer’s is the most common neurodegenerative disease in the world and the main cause of functional dependence, institutionalization and death among the elderly in Brazil.
Scientific studies suggest that medical Cannabis is a promising therapy to assist in this treatment, as it has few side effects and acts on the main pathophysiological mechanisms of the disease, such as reducing neuroinflammation and regulating neurotransmitters.
In addition, phytocannabinoids also have potential results in fighting symptoms resulting from Alzheimer’s and other dementias. The adjuvant use of cannabinoid derivatives improves the well-being and quality of life of patients and their caregivers in cases of psychomotor agitation, reduced appetite and sleep disorders.
Regarding the reduction in neuroinflammation, this pre-clinical study, published in 2014 in the Journal of Alzheimer’s Disease reviewed the therapeutic effects of THC on the disease. The results showed that this phytocannabinoid helped to delay the deposition of beta-amyloid plaques – aggregated proteins that build up in the brain indicating the onset and progression of Alzheimer’s disease.
>> You can read the full study here: The potential therapeutic effects of THC on Alzheimer’s disease.
>> Access this post and learn about other scientific evidence on the use of medical Cannabis in Alzheimer’s disease!
Parkinson’s Disease
The Parkinson’s disease is another disease related to neuroinflammation and oxidative stress, which induces the death of specific neuronal networks. This is the second most common neurodegenerative disease in the world. Cannabinoid derivatives, through different neuroprotective actions, are able to promote the reduction of the disease’s motor and non-motor symptoms.
This is shown in this German survey published in 2021, conducted by means of a questionnaire to 1.348 participants. Of these, 8,4% were users of Medical Cannabis. Results in the user group include reduced pain and muscle cramps (40%) and improvement in stiffness, tremors, depression and anxiety (20%).
Interestingly, regarding the comparative use of CBD and THC, the latter was more effective: 68% of THC-rich products users reported improvements in parkinsonian symptoms. Among CBD-rich products, 54% reported improvement.
>> You can read the full study here: Cannabis in Parkinson’s Disease: The Patients’ View.
>> Access this post and learn more scientific evidence on the use of medical Cannabis in Parkinson’s disease!
Chronic pain
Elderly people are the population that consumes the most drugs in the country, according to the Associação Brasileira de Distribuição e Logística de Produtos Farmacêuticos (Abradilan). One of the main reasons is chronic pain. According to the Sociedade Brasileira de Geriatria e Gerontologia, about 50% of the elderly in outpatient care have this complaint, and the incidence can reach 80% in long-stay institutions patients.
In addition to the already existing conclusive and substantial scientific evidence that cannabinoid derivatives are effective in fighting chronic pain, medical cannabis can be a valuable tool in rationalizing the use of medicines in the elderly population, avoiding the complications arising from polypharmacy.
In this context, it is noteworthy the potential for dose reduction and weaning of opioid derivatives and benzodiazepines, often used to treat chronic pain, anxiety and insomnia in elderly patients. Cannabinoids have properties that help fight common adverse effects of these medicines, such as irritability, nausea, inappetence, constipation, lethargy and fatigue. In addition, there is a synergistic effect from combining opioid derivatives and cannabinoids, preventing the development of tolerance to opioids and, consequently, avoiding the need to increase the dose of said medicines.
The phytocannabinoids CBD and THC help to modulate the emotional and cognitive components related to pain perception in several clinical contexts, as evidenced in this Canadian research published in 2021. The study showed that, after starting treatment with medical cannabis, a group of patients managed to reduce by about 5-fold the average daily dose of morphine to control chronic pain.
>> You can read the full study here: Cannabis Significantly Reduces the Use of Prescription Opioids and Improves Quality of Life in Authorized Patients: Results of a Large Prospective Study.
>> To learn more about medical cannabis and opioid weaning, visit this post and learn about the analgesic properties of phytocannabinoids!
Anxiety and depression
Anxiety and depression disorders commonly affect the elderly. Chronic health problems, loss of loved ones and social isolation are some of the factors that can boost these conditions. In this context, medical Cannabis is a promising alternative because it has anxiolytic properties capable of reducing anxiety and depression crisis by stimulating serotonergic receptors, among other mechanisms of action.
Other psychiatric disorders such as Post-traumatic stress disorder (PTSD), panic syndrome and various phobias can also be alleviated by phytocannabinoids. This is what suggests this bibliographic review published in 2019 in the scientific journal Current Psychiatry Reports..
>> You can read the full study here: Cannabinoid Regulation of Fear and Anxiety: an Update.
Sleep disorders
Insomnia and parasomnias are common sleep disorders in the elderly. Often, these conditions are associated with other diseases, and may result from anxiety, depression, dementia and other clinical diseases.
In these situations, the medical use of THC proves to be an effective alternative with fewer side effects when compared to the chronic use of benzodiazepines.
It is worth remembering that THC has a differentiated therapeutic profile, even compared to CBD. This cannabinoid has important therapeutic potential not only in sleep disorders, but also in stimulating appetite and improving mood. These factors greatly contribute to the quality of life of the elderly, especially when they are in palliative care resulting from serious and disabling diseases such as cancer, Parkinson’s and Alzheimer’s.
>> Want to learn more about the medical attributes of THC? access this post to deconstruct the myths surrounding the medical use of this substance!
Cancer
After the age of 65, our chances of getting cancer gradually increase. According to the National Cancer Institute (Inca), elderly people are 11-fold more likely to develop the disease than younger people.
Many studies that suggest the antineoplastic potential of cannabinoid derivatives are under development, but the use of medical cannabis as an adjuvant in cancer patient is already extensively explored – whether to fight symptoms resulting from cancer therapy, or to fight symptoms of the disease itself.
Chronic pain, fatigue, anxiety, depression and insomnia, common symptoms resulting from the disease, and nausea, vomiting and inappetence resulting from radio and chemotherapy can be alleviated with cannabinoid therapy, as showed in this bibliographic review published in 2019.
>> You can read the full review here: Opportunities for cannabis in supportive care in cancer.
Although scientific research points to the various benefits of cannabinoid therapy, prescriptions need to be thoughtful and assertive to achieve good results. Especially in case of elderly patients, where there is a higher risk for the occurrence of adverse effects and drug interactions.
Patients with severe and unstable cardiovascular diseases and patients with untreated psychiatric diseases are examples of patients who demand an even more careful prescriptive practice In these situations, doses are titrated more slowly to optimal dosage, i.e., the one that optimizes therapeutic results, while modulating potential adverse effects..
Only a technically adequate training in the field is able to provide this disruptive knowledge to physicians who wish to safely and effectively prescribe cannabinoid derivatives. The WeCann Academy is committed to this journey of learning and the International Certification in Endocannabinoid Medicine.
We connect experts from around the world in a global community of studies and research in the Endocannabinoid System to interconnect highly qualified, scientific knowledge and practical experience in the medical use of Cannabis.
Would you like to join us? Contact us and get ready for this new frontier of Medicine!
References
Cao C, Li Y, Liu H, Bai G, Mayl J, Lin X, Sutherland K, Nabar N, Cai J. The potential therapeutic effects of THC on Alzheimer’s disease. J Alzheimers Dis. 2014.
Kleckner AS, Kleckner IR, Kamen CS, Tejani MA, Janelsins MC, Morrow GR, Peppone LJ. Opportunities for cannabis in supportive care in cancer. Ther Adv Med Oncol. 2019.
Lucas P, Boyd S, Milloy MJ, Walsh Z. Cannabis Significantly Reduces the Use of Prescription Opioids and Improves Quality of Life in Authorized Patients: Results of a Large Prospective Study. Pain Med. 2021.
Papagianni EP, Stevenson CW. Cannabinoid Regulation of Fear and Anxiety: an Update. Curr Psychiatry Rep. 2019.
Russo EB. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis Cannabinoid Res. 2016.
Yenilmez F, Fründt O, Hidding U, Buhmann C. Cannabis in Parkinson’s Disease: The Patients’ View. J Parkinsons Dis. 2021.
