Many Seniors Are In Pain, and the Cannabis Stigma Prevents Them from Getting Relief
Now more than ever, this population and their caregivers need to know the truth about plant-based solutions.
An estimated 50 percent of Americans over the age of 65 suffer from chronic pain. And for seniors in assisted living, the number is as high as 80 percent.
A recent study published in Progress in Neuro-Psychopharmacology and Biological Psychiatry dubbed the problem "the silent epidemic of chronic pain in older adults." Yes, some degree of aches and pains are an inherent part of aging, but these statistics should disturb us. Doctors link chronic pain in seniors to insomnia, social isolation, disability, depression, dementia, and increased mortality.
Our elders deserve better.
A complex problem
Treating chronic pain in seniors is complex. Many older adults are unable to tolerate non-steroidal anti-inflammatory pain medications like acetaminophen, ibuprofen, and naproxen. Opioids haven't solved the problem, either. In a 2019 study on chronic studying seniors, researchers reported that "pharmaceutical treatment of chronic pain in older adults is usually only partially effective and is often limited by side effects." Opioids pose particular risks for seniors, from a higher risk of falls and fractures to increasing rates of addiction.
Now more than ever, this population and their caregivers need to know about plant-based pain solutions. Compounds such as THC, CBD, or one of the many emerging trace cannabinoids, are non-addictive, evidence-based options for pain management. While Americans over 65 face significant barriers to accessing cannabinoids, the promising new research around their efficacy for treating pain should incentivize us to bring those barriers down.
Obstacles to plant-based medicine
Prohibition, propaganda, and stigmatization around cannabis remain obstacles, even in 2021. (It is a sad irony that American seniors—the population most in need of low-risk pain management tools—were subjected to the most propaganda and fear-mongering around the cannabis plant.)
While most Americans now say cannabis should be legal in some form, that percentage decreases with age. Older people are much more likely to believe that cannabis consumption is inherently harmful, a "gateway" to drug abuse, and a threat to public safety. After decades of misinformation, fear-mongering, and drug war rhetoric, it's no wonder so many seniors are warier of plants than of pills.
Many older Americans are still often ashamed or fearful when asking about cannabis, even with their doctors. "In a recent survey, 30 percent of older adults didn't even answer the question about whether or not they used medical marijuana," notes Hillary Lum, a geriatrician and associate professor at the University of Colorado School of Medicine. "If people feel uncomfortable with it on an anonymous survey, they may also feel uncomfortable telling their doctor."
CBD has fewer negative connotations, partly because of its quasi-legality, partly because it's non-intoxicating—but partly because it doesn't share the criminal undertones of cannabis. But even if older Americans are open to the idea of trying CBD for pain relief, they still have to overcome the hurdles of informed medical counsel, safety assurance, and access.
Every reputable health expert urges seniors to consult with their doctor before adding CBD or THC to their medication regimen, and with good reason: Nearly nine in ten (89 percent) of Americans 65 and older take prescription medication, and 54 percent take four or more prescription drugs. The potential for drug interactions with cannabinoids is real—but when older patients seek advice from their doctors regarding cannabis or CBD, it's difficult for them to get definitive answers.
Because federal restrictions have made it extremely difficult to study cannabis, medical professionals lack the research they need to recommend a treatment. Even Eloise Theisen, president of the American Cannabis Nurses Association and a geriatric nurse-practitioner, acknowledges that health care professionals knowledgeable about cannabis are hard to find.
Many doctors are not prescribing medical cannabis
In states where medical cannabis is legal to treat serious medical conditions, doctors are too often uninformed about the risk and benefit profiles of cannabinoids. In Texas, for example, patients with cancer, epilepsy, ALS, Alzheimer's, and cancer can get a medical marijuana card, but only if they receive a recommendation from one of the 150 doctors in the state who are registered members of the program (that's 150 out of 43,000 doctors in the entire state).
Many doctors don't feel adequately educated around cannabis and don't register to become prescribers, perpetuating the access/education problem. Half of the Mayo Clinic's primary care doctors said in a 2019 survey that they weren't prepared to answer patients' questions about medical marijuana—even though 58 percent considered it a legitimate medical therapy for terminal illnesses, untreatable pain, and cancer symptoms.
Nathaniel Morris, MD, a Stanford resident in psychiatry, made waves when he argued that physicians need concrete, ongoing education on cannabinoids: "Marijuana has become an inescapable part of my medical training, and most of my learning has come from patients."
Imagine you're a senior with chronic pain who's suspicious of opioids and has overcome decades of Reefer Madness propaganda. You somehow miraculously connect with a physician who is open to cannabinoids for pain management and educated about how they might interact with other prescriptions you're taking. But even after your doctor gives you the green light, your search isn't over. Now you have to go find that CBD tincture or that THC gummy. Which one should you get? Is the CBD at the grocery store any good? What is a low dosage? How do you read a COA? Are there dispensaries in my county? It's all so overwhelming that I don't blame anyone who gives up and simply gets another prescription drug that can be delivered to their doorstep.
Encouraging new research
Many argue that we cannot halt the opioid epidemic unless we address the underlying pain epidemic. While I understand clinicians' hesitancy to recommend a compound that's federally illegal to vulnerable seniors, I would also point them towards exciting new research. A peer-reviewed 2020 study in Israel of nearly 3,000 patients concluded that "The therapeutic use of cannabis is safe and efficacious in the elderly population" and that "Cannabis use may decrease the use of other prescription medicines, including opioids." Almost 94 percent of patients in the study reported improvement in their condition, with their pain level reduced by half.
Federal legalization would go a long way toward removing many of the barriers between older patients and cannabinoids as medicine—but until then, let's encourage healthcare professionals to consider cannabis for seniors in pain and support educating physicians in cannabis science. Let's use the promising results of the Israeli study to fund other research on cannabinoid efficacy for pain in elder populations. And let's do all we can to destigmatize the cannabis plants and their compounds so that older Americans know it's a viable option for pain management. Cannabis alleviates suffering (the FDA may not permit me to say that, but I'm saying it anyway). Cannabis normalization can help ensure that older Americans' golden years (and ours, when we become seniors) aren't lost to pain.
I'm asking health care providers, journalists, family members, and seniors themselves to speak up in support of cannabinoids as a valid pain relief option for seniors.