Seniors increasingly are using cannabidiol, or CBD, to help manage a variety of chronic disease symptoms. A new paper from the Gerontological Society of America tackles key questions about safety and side effects. Cannabidiol or CBD oil has become increasingly popular in the United States as a remedy for a variety of ailments. Many older adults have also embraced CBD to treat everything from depression to chronic pain.
‘Not necessarily benign’: Geriatricians address safety as seniors turn to CBD for chronic conditions
Seniors increasingly are using cannabidiol, or CBD, to help manage a variety of chronic disease symptoms — despite a lack of high-quality clinical research on the drug, according to the Gerontological Society of America. A new paper presents key questions about CBD safety and side effects in older adults, and what information clinicians will need to answer patients’ questions about the drug.
The GSA paper, “Medical Use of Cannabidiol (CBD) in Older Adults: A Focused Discussion on Safety,” summarizes a 2020 meeting of experts in pharmacy, clinical medicine and research, law and policy.
CBD is an active ingredient of cannabis, or marijuana, and an essential component of medical marijuana. There is a perception that the growing variety of health products containing CBD are low-risk for side effects, and a need exists for more clinical guidance, panelists said.
“Despite the scarcity of evidence, older adults are interested in using, or are already using, CBD products to alleviate symptoms from numerous diseases, undeterred by the risks. Thus, it is urgent to address current gaps in knowledge about the safety of CBD products in older adults through scientifically rigorous research,” the authors wrote.
Clinicians now face questions such as what ingredients are contained in CBD products, what effects can be expected, and whether CBD products interact with prescription or over-the-counter medications.
“It remains unclear what evidence supports their use for common chronic conditions such as pain, insomnia, loss of appetite, depression, anxiety, and weight loss,” the authors wrote. There is also the overarching question of what role healthcare providers should play in counseling patients who may perceive CBD to be outside of the clinician’s realm.
Those concerns become more pronounced in the context of the human aging process, they added.
One sign of possible safety concerns related to non-Food and Drug Administration-approved CBD products has been a sharp rise in calls to poison control centers between 2014 and 2020, according to William J. Lynch Jr., BPharm, RPh, of Jefferson Health and Rowan University School of Osteopathic Medicine, in New Jersey.
Seniors not immune to adverse effects
It is known that CBD consumed as an ingredient in a non-FDA-approved medical product can produce acute impairment of attention, memory, verbal learning, executive function and psychomotor function, the GSA said. But exactly how aging-related changes in physiology affect the responses of older adults is yet unknown, it added.
Adverse reactions seniors may face when using non-FDA-approved CBD products include insomnia, diarrhea, fatigue, malaise, rash, vomiting, elevations in the liver enzymes, and infections, Lynch said.
“It’s important to know these effects because as pharmacists and physicians, we might modify a person’s medications if we found elevated liver function tests, for example — especially for older adults,” he said. “There also are many drug interactions with CBD that could cause increased clotting or bleeding, hepatotoxicity, or changes in metabolism that would require doses of other medications to be changed. CBD is not necessarily benign.”
Experts are concerned about a lack of oversight by the FDA and a lack of documentation on potential drug interactions. Inert or nonactive ingredients in non-FDA-approved CBD products (such as sesame seed oil and alcohol) also have the potential to trigger side effects, the GSA authors wrote.
The clinicians’ role
Clinicians have limited data to share with patients about the safety and efficacy of unapproved CBD products for difficult-to-manage conditions, including anxiety or agitation, depression, as well as behavioral symptoms of Alzheimer’s disease, said Brent Forester, M.D., MSc, chief of the Division of Geriatric Psychiatry at McLean Hospital in Massachusetts and co-president of the American Association for Geriatric Psychiatry.
The current regulatory environment, in which cannabis and most derivative products are treated as Schedule I controlled substances, is a barrier to needed research in these areas, Forester said.
The FDA is seeking to address several topics of interest to the public, according to April Inyard Alexandrow, Ph.D., lead for the agency’s Cannabidiol Policy Working Group. These include:
- What happens if people use CBD daily for sustained periods of time?
- What level of intake triggers the known risks associated with CBD?
- How do different methods of exposure affect intake (for example, oral consumption, topical use, smoking, vaping)?
Most of the GSA meeting participants agreed that CBD science trails well behind policy and product marketing. More data should be collected on the clinical reasons older patients are motivated to use CBD and impediments to proper research should be lifted, they agreed.
“Participants felt that there was a need to build out evidence about the safety profile and efficacy of CBD as it relates to pain, anxiety, insomnia, Parkinson’s disease, dementia, and other conditions for which CBD is considered a potential therapeutic for unmet needs,” they wrote.
Despite limited clinical training on CBD, it is important to support care teams in counseling older patients through the development of new educational opportunities and clinical tools for delivering reliable information, the authors concluded.
10 Potential Health Benefits of CBD for Older Adults
Cannabidiol or CBD oil has become increasingly popular in the United States as a remedy for a variety of ailments. Many older adults have also embraced CBD to treat everything from depression to chronic pain.
Cannabidiol, otherwise known as CBD, is derived from the Cannabis sativa plant, also known as marijuana or hemp. More than 80 chemicals called cannabinoids have been identified in the Cannabis sativa plant. THC, the chemical that causes a “high,” is the active ingredient in marijuana. However, cannabidiol is most often obtained from hemp, and contains just trace amounts
There have been few side effects noted in CBD use studies, but they do occur and can include dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. CBD can also interact with other medications, such as blood thinners.
The benefits of CBD are increasingly being researched and documented. Here are 10 areas in which CBD use has potential benefits for seniors.
CBD may have the potential to help manage anxiety. Researchers think that it might change the way that the brain’s receptors respond to serotonin, which is closely associated with mental health outcomes. In one study, social anxiety sufferers were able to give a speech more easily with the help of CBD. Additionally, research done with animals has shown decreased expression of anxiety with CBD. CBD can help promote stress reduction and lead to fewer physiological effects from anxiety, like increased heart rate.
2. Neurodegenerative Disorders
CBD might be a promising product in the fight against neurodegenerative diseases. A loss of neurons in different parts of the nervous system leads to a corresponding decline in cognitive and motor functions; these conditions, such as Parkinson’s, dementia and stroke, cause the brain and nerves to deteriorate over time. Researchers are actively studying brain receptors to uncover the ways that CBD could help.
We discussed how CBD can lower inflammation. Because inflammation can actually make neurodegenerative symptoms worse, CBD can promote good brain health through this mechanism, too. Keep an eye out for more studies to come on this subject. CBD could evolve to become a useful tool to turn to in the fight against neurodegenerative diseases.
3. Mental Health & Mood-related Disorders
As people age, they experience major changes as a result of getting older. Health usually declines and people are more likely to deal with loss and grief. Additionally, social isolation, depression and loneliness may all play a factor in decreased mental health. CBD has been shown to help with these and other related conditions. CBD may interact with brain receptors that are involved in mood regulation. CBD can promote stress reduction, mindfulness and improvement in cognitive function. This powerful combination can strongly contribute to how the mind perceives its situation while enhancing mood.
4. Sleep Quality
Sleep issues and insomnia challenge many individuals, and older adults are no exception. This may be caused by changes in sleep patterns as individuals age. Additionally, medical conditions and prescribed medications further complicate things.
Prescription sleep medications can be effective. However, their use comes with long-term concerns. They may lead to dependence, addiction and even worse sleep quality over time.
CBD can help promote calmness and relaxation. Higher quality sleep can be the end result. This can be a natural way to lead to more regular and helpful sleep for older adults. Plus, it can reduce the need to take prescription sleep medications.
5. Pain Management
Around half of the older adult population lives with arthritis. Compared to traditional pain medications, CBD can be a compelling alternative as a natural and potentially safer remedy. Studies have indicated that CBD can reduce inflammation while alleviating pain. Conditions improved include joint pain, arthritis and multiple sclerosis.
6. Bone Health
Keeping bones healthy can be a challenge, especially for seniors living with osteoporosis. Bones become more fragile and vulnerable over time, making them more prone to breaking. For these reasons, seniors often experience significant pain and a propensity for fractures when falls occur. In addition to reducing inflammation and promoting cell repair, research shows that CBD may aid in strengthening bones. It can also promote the body’s ability to heal. While more research is needed, results in this area so far are promising.
7. Addiction & Dependence
When older adults are confronted with an illness, prescribed medication will usually follow. Tolerance may build for many medications that are taken over time. In some cases, addiction or dependence can be the end result. This can cause permanent damage to the body.
CBD has been shown to alleviate some conditions that involve opioids, generally without significant side effects. On top of that, CBD can aid in combating developed dependencies that grew out of the use of prescribed medications. It appears that CBD has the potential to help fight relapses and assist in overcoming withdrawals that develop during this time.
8. Heart Health
Heart disease is the leading cause of death for older adults. A top contributor to heart disease is high blood pressure. CBD has shown to be very promising as an alternative and natural treatment for high blood pressure. One recent study determined that it lowered the resting blood pressure of the study’s participants.Additionally, researchers administered stress tests and found a positive stress response in individuals evaluated in the study. Another study suggests that antioxidant properties of CBD can aid in lowering cardiac inflammation and deter the death of related cells that results from oxidative stress.
9. Cancer Treatment
CBD may help alleviate the symptoms of cancer along with the side effects stemming from treatment. In fact, CBD has shown a reduction in tumor growth in animals. It may even help the body absorb medications better or increase their potency.
Here, CBD may positively manage inflammation and change how cells can reproduce. CBD could also have the capacity to inhibit the growth of some types of tumor cells and stem their ability to reproduce efficiently.
10. Appetite Stimulation
A major health concern for seniors is malnutrition due to loss of appetite, whether due to medicaiton or age. This can lead to unnecessary and unwanted weight loss, muscle and tissue weakness, and other health issues. Marijuana has been studied extensively in this area, and is proven to enhance appetite in its users. CBD can stimulate appetite as well, according to some studies. In this way, it can be beneficial for seniors combating malnutrition and appetite loss.
Scientific research takes time and effort. With a broad range of CBD brands exploding on the market and the potential health benefits of the product coming to light, researchers have only just begun to scratch the surface on the ways that cannabinoids can promote wellness in seniors. In early studies, CBD has been shown to be very promising in improving a variety of ailments and conditions.
CBD is readily available over the counter in many forms. Older adults should talk to their doctor, pharmacist or home health provider before starting a CBD regimen. It’s important to determine if CBD treatment is the right option and make sure that no drug interactions or concerns exist. Also the stigma of marijuana and CBD use can be powerful; family members or the physician may harbor some negative associations to CBD and related products. Home health providers can step in to advocate for their patients who wish to use CBD to manage pain or anxiety. Providing educational materials and promising research on CBD to family members and skeptics should be a goal if you are offering CBD as an option in a home health regimen.
Brett Shay is the CEO of CareBridge Academy, a certified nurse aide and home health aide training school located in Philadelphia. He also leads Chosen Family Home Care, which is one of the nation’s only agencies dedicated to addressing the needs and challenges of the LGBTQ community and provides culturally competent care to the diverse local population.