The Straight Dpe n Cannabis and Older Peple NOTE: This Backgrunder is designed t prvide helpful infrmatin fr general educatinal purpses nly. It is nt a substitute fr prfessinal medical, plicy r legal advice. Backgrund Medical marijuana has been legal in Canada since 2001. Yet, there is still cnsiderable stigma amng lder peple fr using cannabis t relieve a variety f symptms that they may experience. With the legalizatin f recreatinal cannabis, and the ptential legalizatin f cannabis edibles sn afterwards, lder Canadians may be less hesitant t try cannabis as the reefer madness stigma fades. This CRNCC backgrunder examines sme f the literature n the highs and lws f pt use fr lder peple. The federal gvernment passed Bill C-45 t legalize recreatinal cannabis acrss the cuntry, leaving the prvinces t regulate the distributin and sale f recreatinal marijuana. Canadians will be able t cnsume marijuana recreatinally withut criminal penalties starting in the fall f 2018. Althugh recent data n the number f Canadian senirs using cannabis are unavailable, Health Canada figures fr 2013 shwed that tw-thirds f Canadians registered t purchase medical marijuana were taking it t treat severe arthritis, mre cmmn amng lder adults. Accrding t Health Canada, by the end f 2016, almst 130,000 Canadians had signed up with the cuntry s 38 licensed cannabis prducers (Canadian Press, 2017). Senirs may turn t medical marijuana, because the drugs they have been taking are n lnger helping their cnditin. They are hping that cannabis will help ease chrnic pain, insmnia, depressin and anxiety, after pharmaceutical drugs have failed, and withut the negative side effects that may accmpany pharmaceutical drugs (Bartn, 2017). Fast Facts Medical Marijuana The Access t Cannabis fr Medical Purpses Regulatins (Gvernment f Canada, 2018a) specifies that t qualify, a persn must: live in Canada be 18 years f age r lder nt be registered mre than nce at any time nt have been cnvicted f a marijuanarelated ffence A patient may prcure medical cannabis in the fllwing ways: prduce cannabis as a registered persn; btain cannabis prduced by a registered caregiver; purchase cannabis frm a licensed prducer; btain cannabis frm a health care practitiner in the curse f treatment fr a medical cnditin, r frm a hspital r hspital emplyee in the curse f treatment fr a medical cnditin. It is prhibited t btain cannabis frm mre than ne surce at a time with the same medical dcument.
Ptential Benefits After reviewing the limited available clinical studies, Health Canada ffers the fllwing cautiusly ptimistic summary, with the prvis that further research is needed t cnfirm the findings. Clinical studies and anecdtal reprts supprting the safety and efficacy f cannabis fr therapeutic purpses in a variety f disrders are limited but are slwly increasing in number (Health Canada, 2013). There is mixed evidence thus far t suggest that cannabis may be useful in a number f disrders including the fllwing: alleviating a wide variety f single r cccurring symptms in palliative care settings (e.g., nausea and vmiting assciated with chemtherapy r raditherapy, anrexia/cachexia, severe intractable pain, severe depressed md, and insmnia); stimulating appetite and prducing weight gain amng AIDS and cancer patients; helping patients suffering frm multiple sclersis r spinal crd injury when ther drugs fail r prduce unacceptable side effects; relieving chrnic pain and treating sleep difficulties assciated with chrnic pain; treating pst-traumatic stress disrder; imprving bladder dysfunctin assciated with multiple sclersis r spinal crd injury Please refer t Health Canada (2013) fr a mre extensive discussin and summary f the studies. Anther dcument develped fr the Wrld Health Organizatin (Amat, Davli, Minzzi, Mitrva, Parmelli, Saulle, & Vecch., 2017) presents sme very mixed evidence n the benefits and harms f cannabis (including extracts and tinctures) fr treating adults with multiple sclersis, chrnic pain, HIV/AIDS, Dementia r Turette syndrme, and adults with cancer receiving chemtherapy. A reprt f the Natinal Academies f Sciences, Engineering and Medicine (2017) draws the fllwing cnclusins. There is cnclusive r substantial evidence that cannabis r cannabinids are effective fr: treating chrnic pain in adults --it is wrth nting that rubs, creams and ltins infused with THC can help relieve pain in a lcalized area; treating chemtherapy-induced nausea and vmiting; imprving patient-reprted multiple sclersis spasticity symptms. There is mderate evidence that cannabis is effective fr: imprving shrt-term sleep utcmes in individuals with sleep disturbance assciated with bstructive sleep apnea syndrme, fibrmyalgia, chrnic pain, and multiple sclersis. There is limited evidence that cannabis r cannabinids are effective fr: increasing appetite and decreasing weight lss assciated with HIV/AIDS; imprving clinician-measured multiple sclersis spasticity symptms; imprving symptms f Turette syndrme; imprving anxiety symptms, as assessed by a public speaking test, in individuals with scial anxiety disrders; imprving symptms f pst-traumatic stress disrder. The reprt includes a series f statements that there is limited evidence t supprt r refute the efficacy f cannabis fr a wide range f ther health ailments such as cancers, irritable bwel syndrme, epilepsy, spasticity in patients with paralysis due t spinal crd injury, mtr system symptms assciated with Parkinsn s disease, mental health utcmes in individuals with schizphrenia. 2
As can be seen, the evidence t date is mixed. Thugh recent studies shw sme prmise, mre and larger studies need t be dne n the effects f cannabis n treating the cmmn ailments f lder peple. We again cautin that this infrmatin is nt a substitute fr prfessinal medical advice. Recreatinal Marijuana In June 2018, Bill C-45, the Federal Cannabis Act fr recreatinal marijuana was passed and will becme law n in Canada n Octber 17, 2018. The Cannabis Act will allw adults wh are 18 years r lder t engage in the fllwing activities: Purchase fresh r dried cannabis, cannabis il, plants and seeds fr cultivatin frm either a prvincially r territrially regulated retailer, r where this ptin is nt available, directly frm a federally licensed prducer; Pssess up t 30 grams f dried legal cannabis r equivalent in public; Share up t 30 grams r equivalent f legal cannabis and legal cannabis prducts with ther adults; Cultivate up t 4 plants in their wn residence (4 plants ttal per husehld); and Alter cannabis at hme in rder t prepare varying types f cannabis prducts (e.g., edibles) fr persnal use prvided that n dangerus rganic slvents are used in the prcess. (Gvernment f Canada, 2018b & 2018c). The federal, prvincial and territrial gvernments will share respnsibility fr verseeing the new system. Gvernment f Canada The federal gvernment s respnsibilities will be t: set strict requirements fr prducers wh grw and manufacture cannabis; set industry-wide rules and standards, including: the types f cannabis prducts that will be allwed fr sale; packaging and labelling requirements fr prducts; standardized serving sizes and ptency; prhibiting the use f certain ingredients; gd prductin practices; tracking cannabis frm seed t sale t prevent diversin t the illicit market; impsing restrictins n prmtinal activities. (Gvernment f Canada, 2018b & 2018c). Prvinces, Territries and Municipalities The Bill prvides that prvinces and territries may take respnsibility fr develping, implementing, maintaining and enfrcing systems t versee the distributin and retail sale f cannabis, in clse cllabratin with municipalities. They can als: increase the minimum age in their prvince r territry (but nt lwer it); lwer the persnal pssessin limit in their jurisdictin; set further restrictins n persnal cultivatin, such as lwering the number f plants per residence; restrict where adults can cnsume cannabis, such as in public places, wrkplaces r mtr vehicles (Gvernment f Canada, 2018b & 2018c). Pints t Cnsider Befre Trying Cannabis The literature ffers a number f cautinary ntes, particularly t thse wh have never tried cannabis. Fr example, drwsiness and dizziness, tw knwn side effects f cannabis, can cntribute t instability and falling in lder peple. Dr. Hance Clarke, directr f the painresearch unit at the Trnt General Hspital, advises that nt all marijuana is the same. Nt nly d marijuana plants have different 3
chemical cmpunds which can affect a wide range f prcesses in the human bdy, the amunt f cannabidil (CBD) and tetrahydrcannabinl (THC - the ingredient that makes peple feel high), varies acrss marijuana strains. Currently, there is insufficient reliable scientific evidence regarding standardized dses and treatment prtcls, leaving physicians with n guidelines as t what dse t recmmend. Since there is n prtcl n dsage, peple need t play an active rle in determining their wn mst effective dse (Taylr, 2017). Dr. Arseni Avila, an anesthesilgist and pain specialist at Sunnybrk Health Sciences Centre in Trnt nted that with marijuana sme patients culd reduce their dses f ther pain medicatins, including piids. Since patients tend t develp a tlerance t piids, requiring a higher dsage, patients can gradually reduce the dsage f piids with marijuana and get the same pain relief (Taylr, 2017). Health Canada (2000) includes the fllwing shrt-term effects fr Cannabis. Effects f smking are felt within a few minutes and last tw t fur hurs. Effects frm ingestin (e.g., eaten in baked r cked fds) appear mre gradually and last lnger, and the persn may feel dull and sluggish fr sme time afterwards. The persn feels calm, relaxed, talkative and smetimes drwsy. Cncentratin and shrt-term memry are markedly impaired, and sensry perceptin seems enhanced, clurs are brighter, sunds are mre distinct, and the sense f time and space is distrted. Appetite increases, especially fr sweets. Sme peple withdraw, r experience fearfulness, anxiety, depressin; a few experience panic, terrr r parania, particularly with larger dses. Sme experience hallucinatins with larger dses and symptms wrsen in persns with psychiatric disrders, particularly schizphrenia. Physical effects include impaired crdinatin and balance, rapid heartbeat, red eyes, dry muth and thrat. Usual dses impair mtr skills; especially when used in cmbinatin with alchl; cannabis use befre driving is particularly dangerus chrnic, heavy use may include decreased mtivatin and interest, as well as difficulties with memry and cncentratin. These prblems tend t clear when regular use stps. Hwever, there is increasing research evidence f lasting harmful effects n mental functin in sme peple. The respiratry system is damaged by smking; a single jint f marijuana yields much mre tar than a strng cigarette. Tar in cannabis smke cntains higher amunts f cancer-prducing agents than tar in tbacc smke What Can Cmmunity Service Organizatins D? Cmmunity rganizatins may cnsider the fllwing activities. Cllabrate with a geriatrician, physician and/r licensed prducer t hst an infrmatin sessin r wrkshp t infrm lder peple and their carers abut cannabis as medicine and hw t access cannabis frm licensed prducers as ppsed t cannabis dispensaries that perate illegal businesses; Make infrmatin pamphlets available; Display a pster shwing hw t access mre infrmatin abut medicinal cannabis as an alternative t pharmaceuticals; Create an nline frum and vide infrming lder peple abut cannabis; Educate senirs that there are many strains and types f medical cannabis and many ways t cnsume cannabis, frm smking, t vaping, t cannabis-rich tinctures, ils and capsules. Fr example, pure cannabidil (CBD) il has medicinal prperties t relieve symptms withut the tetrahydrcannabinl (THC), the psychactive ingredient that makes peple feel high. Cannabis capsules als d nt have t give the "high" feeling, but can pssibly help t relieve pain, r prvide a full night's 4
sleep. Again, there is n prtcl n dsage. When edibles becme legal in 2019, lder peple can chse an edible frm f cannabis. The general agreement is that we need mre research and evidence. With the legalizatin f recreatinal cannabis, presumably mre studies will be cnducted t assess the effectiveness f cannabis in prmting the well-being f lder adults. Cite as: Lum, J.M. (July, 2018). Trnt: ON, Canadian Research Netwrk fr Care in the Cmmunity References Amat, L., Davli, M., Minzzi, S., Mitrva, Z., Parmelli, E., Saulle, R., & Vecch, S. (2017). Systematic reviews n therapeutic efficacy and safety f cannabis (including extracts and tinctures) fr patients with multiple sclersis, chrnic neurpathic pain, dementia and Turette syndrme, HIV/AIDS, and cancer receiving chemtherapy. Geneva, Switzerland: Wrld Health Organizatin. Retrieved frm http://www.wh.int/medicines/access/cntrlledsubstances/systematic_reviews_n_therapeutic_efficacy_and_safety.pdf American fr Safe Access. (2018). Aging and medical cannabis. Washingtn, DC: Authr. Retrieved frm https://www.safeaccessnw.rg/aging Bartn, A. (2017, Nvember 12). Senirs turning t cannabis fr relief and businesses are all in. The Glbe and Mail. Retrieved frm https://www.theglbeandmail.cm/life/health-and-fitness/health/senirsturning-t-cannabis-fr-relief-and-businesses-are-all-in/article34760076/ Canadian Institute fr Health Infrmatin. (2014). Drug use amng senirs n public drug prgrams in Canada, 2012. Trnt, ON: Authr. Retrieved frm https://secure.cihi.ca/free_prducts/drug_use_in_senirs_n_public_drug_prgrams_2012_en_web. pdf Canadian Press. (2017, February 23). Number f medical marijuana users sars acrss Canada, nw almst 130K. Glbal News. https://glbalnews.ca/news/3268705/number-f-medical-marijuana-userssars-acrss-canada-nw-almst-130k/ Gvernment f Canada. (2018a). Access t Cannabis fr Medical Purpses Regulatins. SOR/2016-230. Retrieved frm http://laws.justice.gc.ca/pdf/sor-2016-230.pdf Gvernment f Canada. (2018b). Legalizing and strictly regulating cannabis: The facts. Ottawa, ON: Authr. Retrieved frm https://www.canada.ca/en/services/health/campaigns/legalizing-strictlyregulating-cannabis-facts.html. Gvernment f Canada. (2018c). Intrductin f the Cannabis Act: Questins and answers. Ottawa, ON: Authr. Retrieved frm https://www.canada.ca/en/services/health/campaigns/intrductincannabis-act-questins-answers.html Gvernment f Ontari. (2017, December 12). Ontari passes legislatin t ensure safe transitin t Federal cannabis legalizatin. Trnt: ON: Authr. Retrieved frm https://news.ntari.ca/mag/en/2017/12/ntari-passes-legislatin-t-ensure-safe-transitin-t-federalcannabis-legalizatin.html 5
Health Canada. (2013) Infrmatin fr Health Care Prfessinals: Cannabis (marihuana, marijuana and the cannabinids. Ottawa, ON: Authr. Retrieved frm https://www.canada.ca/en/healthcanada/services/drugs-medicatin/cannabis/infrmatin-medical-practitiners/infrmatin-health-careprfessinals-cannabis-cannabinids.html#chp41 Health Canada. (2000). Straight facts abut drugs & drug abuse. Ottawa: ON: Authr. Retrieved frm http://publicatins.gc.ca/cllectins/cllectin/h39-65-2000e.pdf Natinal Academies f Sciences. (2017).The health effects f cannabis and cannabinids: The current state f evidence and recmmendatins fr research. Washingtn, DC: Natinal Academies Press. Retrieved frm https://www.ncbi.nlm.nih.gv/bks/nbk423845/pdf/bkshelf_nbk423845.pdf Taylr, P. (2017, April 20). Dsage, THC levels and ther pints t cnsider befre trying medical marijuana. The Glbe and Mail. Retrieved frm https://www.theglbeandmail.cm/life/health-andfitness/health-advisr/dsage-thc-levels-and-ther-pints-t-cnsider-befre-trying-medicalmarijuana/article34760645/ 6