Therapeutic Cannabis Use in Seniors: Risks, Benefits, and Guidelines
Every year, the International Association for Cannabinoid Medicines (IACM) holds conferences focused on the development of cannabinoid-based medicine and the use of cannabinoid drugs, inviting leading scientific and medical experts. The 2019 conference, held from October 31 to November 2 in Berlin, was dedicated to the effective and safe use of cannabis in treating age-related diseases, from arthritis to dementia and other neurodegenerative disorders. This article summarizes the event’s conclusions regarding the use of cannabinoids in geriatric medicine, highlighting both the benefits and the risks associated with these treatment methods.
Is Therapeutic Cannabis Use in Seniors Worth the Risk?
The topic was chosen for a reason: Data from legalized regions in the US and other countries show that the fastest-growing group of cannabis users is middle-aged and elderly people. Each year, more seniors are interested in the healing properties of cannabis, especially its ability to modulate pain and inflammation associated with age-related diseases, as well as its neuroprotective and neurogenic effects, which may help protect the brain from neurodegenerative diseases previously considered incurable.
Given this interest, the international cannabinoid medicine community decided to thoroughly discuss the use of cannabinoids in older adults, aiming to clarify their therapeutic effects, discuss the safest and most effective methods of use, and identify possible risks and side effects.
Answers to these questions were provided by a delegation of scientists from Israel, led by Dr. Ilya Reznik. His team presented results from over a year of observation of 184 patients at the Soroka Geriatric Clinic who regularly used various cannabinoid medicines to treat a wide range of age-related diseases. Of these, 83% were aged 75 and older, making them an ideal sample for studying cannabis use in elderly therapy.
In addition to monitoring the patients’ physiological and psychological states during treatment, Dr. Reznik’s study also tracked changes for six months after the prescribed course to detect any long-term effects or side effects. Notably, none of the participants had prior experience with cannabis or its extracts, either therapeutically or recreationally. The most common reason for using cannabis was chronic pain (77% of participants). Other diagnoses included sleep disorders, various forms of cancer, chronic behavioral disorders (such as persistent anxiety and depression), and neurodegenerative diseases like Alzheimer’s and Parkinson’s.
According to the study, 66% of participants regularly used standardized cannabis extract in the form of sublingual drops. About half of these patients took CBD drops three times a day after meals. The research team monitored for negative side effects such as heart issues, mood changes, and problems with coordination or posture. Ultimately, no serious side effects were found with regular extract use, though about a third of patients experienced mild, non-threatening side effects. Around 12% reported dizziness and mild nausea, 11% felt lethargic or sleepy, and the rest noted only dry mouth shortly after taking the extract.
After completing the therapy, about a third of participants were able to completely stop using opioid painkillers and pharmaceutical anti-inflammatories. Another third reduced their monthly intake of such medications by more than half, indicating a long-term positive effect of cannabis extract on pain and inflammation.
Safe and Effective Cannabis Extract Use Protocols for Seniors
Following Dr. Reznik, geriatric specialist Dr. Adi Ron presented a protocol for safe cannabinoid extract dosing in elderly patients, based on the study’s findings. Dr. Ron emphasized that dosing was calculated considering the reactions of the oldest participants, possible interactions with other medications, and the overall health and responsiveness of various biological systems (especially nervous, musculoskeletal, and cardiovascular systems).
The protocol follows the principle of “Do no harm,” recommending starting with the lowest effective dose of cannabinoids. The minimum dose was set at 5 mg of purified, natural CBD extract without other cannabinoid impurities. For safety, the dose should be increased by 5 mg per week (for both CBD and THC), based on the patient’s physiological and subjective response. The optimal therapeutic effect is reached when there are no noticeable negative side effects on the body or the patient’s well-being.
Specifically, the following concentrations and ratios were used during the experiment:
- Days 1–3: 5 mg CBD + 5 mg CBD and 5 mg THC
- Days 4–6: 10 mg CBD and 5 mg THC + 5 mg CBD and 5 mg THC
- Days 7–14: 15 mg CBD and 10 mg THC + 5 mg CBD and 5 mg THC
In this ratio, the dose can be increased up to 25–30 mg CBD per serving, with THC kept about 5–10 mg lower to minimize the risk of side effects, especially intoxication. Dr. Ron also noted that, on average, taking 4–5 mg of THC (split into two doses) mixed with about twice as much CBD (8–10 mg) is a comfortable daily therapeutic ratio. In this combination, CBD suppresses the psychoactive effects of THC while enhancing its therapeutic properties. Overall, this mixture had more noticeable positive effects on patients’ psychological well-being and bodily functions (including digestion, muscle tone, reaction speed, cognitive abilities, memory, and mobility) than pure CBD extracts of the same volume.
Cannabinoid Extracts in Alzheimer’s Disease Therapy
To conclude the Israeli team’s presentation, their Spanish colleague Dr. Javier Fernandez-Ruiz from the Complutense University of Madrid shared findings on the role of endocannabinoid dysfunction (such as anandamide and 2-AG) in disrupting CB receptor function in the brain cortex. This disruption can slow or halt the natural regeneration and repair of nerve cells, triggering the onset and progression of neurodegenerative diseases like Alzheimer’s.
According to the WHO, about 35 million people worldwide suffer from Alzheimer’s at various stages. The most widely used pharmaceutical treatment is Donepezil, which inhibits the enzyme acetylcholinesterase, responsible for breaking down the neurotransmitter acetylcholine, which is crucial for higher brain activity, thought processes, emotional responses, and memory formation and recall. Dr. Fernandez-Ruiz noted that, based on animal experiments and some human trials, phytocannabinoids—especially THC—can substitute for endogenous cannabinoids, blocking acetylcholinesterase activity and giving the brain time and resources to repair and replace damaged neurons.
He also cited a clinical trial by Tikun Olam (an Israeli therapeutic cannabis producer) in which 64 elderly patients (average age 79) diagnosed with Alzheimer’s at various stages took purified CBD extract for 16 weeks (6 weeks to determine the effective dose, 10 weeks of regular use). Doctors closely monitored the participants’ physical and psychological health, adjusting for disease progression and other medications, and conducted weekly medical exams and psychological assessments.
By the end of the trial, 72% of participants reported improved overall health with no side effects from the extracts. In comparison, only 30% of the control group (64 people of similar age taking placebo extracts) reported improved well-being.
Conclusion
Conference participants concluded that, based on practical trials, cannabinoid extracts do not pose a serious risk to the health or psychological state of elderly patients, including those with chronic neurodegenerative diseases. When using standardized, calculated doses of cannabinoid extracts containing equal or CBD-dominant ratios of THC and CBD, and following a regulated schedule (up to two or three times a day after meals), these products are considered safe for seniors. Although only liquid, sublingual extracts were used in the studies cited, experts believe that similar therapeutic effects and safety profiles apply to other forms, such as capsules, tablets, inhaled extracts, and edibles. It is also likely that cannabis flowers with similar cannabinoid concentrations have comparable properties, though there is still some uncertainty about the effects of other compounds, such as terpenes and lesser-known cannabinoids, on the overall therapeutic effect and potential side effects.
Original author: Viola Brugnatelli