Pharmacists’ advice to boomers on medical cannabis use
One To One
Although marijuana use has traditionally been associated with young people, there is an emerging trend of renewed interest in cannabis among the baby boomer generation. According to recent media reports, seniors are taking marijuana laws into consideration when evaluating retirement locations. With the growing number of retirees, coupled with the increasing number of states that have legalized medical marijuana use and the health conditions that medical marijuana could potentially help treat, pharmacists’ expertise is needed more than ever before.
“I believe baby boomers might seek out cannabis for the same reasons they seek out other medications. They have symptoms they would like to gain relief from, and they hope that cannabis can provide that relief,” said William Chris Charles, PharmD, BCPS, AE-C, transitions of care coordinator at Sinai Hospital of Baltimore.
Currently, 23 states plus Washington, DC, have laws that legalize medical marijuana use. Colorado, Oregon, Washington, Alaska, and the District of Columbia allow recreational use. According to Charles, these laws “lessen the stigma that surrounds using cannabis.” He told Pharmacy Today that “as these chips fall into place, more baby boomers may start actually using cannabis to relieve their symptoms.”
Weeding through the data
Although there are no FDA-approved indications for cannabis, a large body of data suggest that it may help provide relief for chronic pain and spasticity.
“Other supported indications include improvements in chemotherapy-induced nausea and vomiting, weight gain in HIV infection, sleep disorders, and Tourette syndrome,” said Charles, who is a member of the Maryland Medical Cannabis Commission. The commission is working on the implementation of Maryland’s medical marijuana program, which is expected to be operational in the second half of 2016.
Charles stressed that more research about the benefits of cannabis needs to be done. “Most of the data [consist] of case reports, small open-label trials, and animal studies,” he said. “A lot of the information may be biased, but the sheer volume definitely warrants well-designed, randomized, controlled trials.”
There is no standard dosing for cannabis, so pharmacists should advise patients to start with a low dose of about 2–5 mg of tetrahydrocannabinol (THC) and titrate it to both effect and a tolerable level of adverse effects, noted Charles.
He suggested the following counseling points:
- Cannabis should never be smoked because it carries lung disease risks.
- Cannabinoids are very sensitive to light and heat, so patients should store their cannabis in the refrigerator or freezer.
- Patients of all ages should not drive for 6 hours after taking 35 mg of THC or less, and longer if they take more.
- Patients with heart disease should strongly consider not using cannabis, as there may be a link between cannabis use and the risk of heart attack and stroke.
- Warn older patients not to share any of their cannabis, especially with pregnant mothers and persons younger than 25 years. Not only is sharing cannabis illegal, but cannabis also has been linked to birth and developmental defects, schizophrenia, and acute and possibly permanent cognitive impairment.
A ‘joint’ effort
Charles pointed out that in addition to counseling patients, pharmacists play a vital role in keeping patients safe, because physicians are barred from writing prescriptions for cannabis with any of the specific instructions that would normally be found on a prescription. Pharmacists need to work with the patient and the physician to help avoid harmful interactions.
Charles also believes pharmacists need to get in on the cannabis discussion to make sure patients receive optimal care. “Medical cannabis is not going away, so I hope that each pharmacist considers this issue, educates themselves, and decides how to be involved,” said Charles.