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Cannabis and Dementia

Topic: Patient Information

According to the Alzheimers society in Canada, by the 2040s it is expected that 20,000+ Canadians will be diagnosed with dementia every month1. In Ontario, 64% of long-term care residents have a diagnosis of dementia2. Neuropsychiatric symptoms (behavioural and psychological symptoms in dementia) are on the rise and can be challenging to treat as our population ages and people with dementia live longer.

The therapeutic potential of cannabinoids has been studied by researchers and clinicians over the past decade. They have investigated a range of topics, including whether cannabinoids can improve the neuropsychiatric symptoms of dementia such as agitation, mood changes, apathy, psychosis, wandering, and aggression.

An exciting, new placebo-controlled, randomized clinical trial has just been published to evaluate the safety and efficacy of CBD-dominant medical cannabis oil for the reduction of behavioural disturbances amongst patients with dementia. The formulation of the CBD oil is 30% (or 295mg/mL) CBD and 1% THC (or 12.5mg/mL). They found a statistically significant reduction in agitation over placebo with non-serious side-effects3.

These research findings are not surprising, given the therapeutic potential of CBD for anxiety and psychosis 4,5. According to studies, CBD may have antipsychotic and anxiolytic benefits, but more importantly, it can protect patients against the negative side effects of some of the available drug therapies.

      

We know that agitation is a common change in behaviour in people with dementia. Many also agree that non-drug treatments should be used before turning to drugs for acute agitation that doesn’t improve with other measures. Existing medications can be used to treat behavioural changes like agitation, but many of them have harmful side effects. For example, antipsychotics often only provide a temporary relief and come with serious risks like the potential of falls, strokes, or even death 6,7.

More than 1 in 5 residents of long-term care centers receive antipsychotics off-label and without a diagnosis, according to recent research8. The Canadian Institute for Health Information (CIHI) reports that since the pandemic started, the off-label use of antipsychotics has increased9.

Cannabinoids, on the other hand, interact with the body different, which means they could be safer and more effective overall for someone experiencing agitation. Some of their actions are even said to help prevent the loss of brain cells, but human clinical trials have not yet shown evidence to support this notion10.

For those who have dementia, weight loss, pain, and sleep issues are major issues that are frequently accompanied by agitation and aggression. Cannabinoids have also been associated with improvements in appetite and pain11.

A diagnosis of dementia may be upsetting for you and your friends and family. If you are a family member or friend, there are things you can do right now to make life a little easier. Find out more at Alzheimer’s Society in Canada.

Potential harms of antipsychotics:

• Side effects including sedation, falls, postural hypotension, confusion, stiffness/rigidity, diabetes, constipation, and weight gain
• Increased risk of stroke
• Increased risk of death

Health Canada noted a 1.6-fold increase in mortality (mostly related to heart failure, sudden death pneumonia). Some data suggests that there will be 1 extra stroke or death for every ~100 people treated with antipsychotics13.

[1] Alzheimer Society of Canada. (2022). Navigating the path forward for dementia in Canada. The Landmark Study Path. Retrieve from https://alzheimer.ca/sites/default/files/documents/Landmark-Study-Report-1-Path_Alzheimer-Society-Canada.pdf
[2] Ontario Long Term Care Association. (2019). This is long-term care 2019. Retrieved from https://www.oltca.com/OLTCA/Documents/Reports/TILTC2019web.pdf
[3] Hermush, V., Ore, L., Stern, N., Misrahi, N., Fried, M., et al. (2022). Effects of rich cannabidiol oil on behavioural disturbances in patients with dementia: a placebo controlled randomized clinical trial. Frontiers in Medicine. Retrieved from https://www.frontiersin.org/articles/10.3389/fmed.2022.951889/full#h15
[4] Zuardi, A.W., Rodrigues, N.P., Silva, A.L., Bernardo, S.A., Hallak, J.E.C., et al. (2017). Inverted u-shaped dose-response curve of the anxiolytic effect of cannabidiol during public speaking in real life. Front Pharmacol, 8, 259.
[5] Schubart, C.D., Sommer, I.E., can Gastel, A., Goetgebuer, R.L., Kahn, R.S., Boks, M.P. (2011). Cannabis with high cannabidiol content is associated with fewer psychotic experiences. Schizophr Re, 130 (1-3), 216-221.
[6] Fraser, L., MMath,K.L., & Naylor, K.L. (2015). Falls and fractures with atypical antipsychotic medication use: A population-based cohort study. JAMA Internal Medicine, 175(3), 450-452.
[7] Wang, P.S., Schneeweiss, S., Avorn, J., Fischer, M.A., Mogun, H., Solomon, D.H., & Brookhart, A. (2005). Risk of death in elderly users of convention vs. atypical antipsychotic medications. The New England Journal of Medicine, 353 (22), 2335-2341.
[8] https://www.cbc.ca/news/canada/antipsychotic-medication-seniors-long-term-care-1.6581304
[9] Canadian Institute for Health Information. Potentially Inappropriate Use of Antipsychotics in Long-Term Care. Accessed November 22, 2022.
[10] Shelef, A., Barak, Y., Berger, U., Paleacu, D., Tadger, S., Plopsky, I., & Baruch, Y. (2016).  Safety and efficacy of medical cannabis oil for behavioural and psychological symptoms of dementia: An open- label, add-on, pilot study. J Alzheimers Dis, 51, 15-9. 5
[11] Volicer, L., Stelly, M., McLaughlin, J., Volicier, B.J. (1997). Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer’s disease. Int J Geriatri Psychiatry, 12(9), 913-919.
[12] Centre for Effective Practice. (April 2016). Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide: Long-Term Care (LTC 2nd Edition)
[13] Health Canada. Atypical antipsychotic drugs and dementia – advisories, warnings and recalls for health professionals [Internet]. 2005. Available from: http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/ hc-sc/2005/14307a-eng.php.
Previous Article
Understand Your Treatment Plan: Dosing and Titration
A tailored treatment plan with customized dosages and regimens is essential for all medical cannabis patients. To maximize the effect and reduce the possibility of adverse effects and impairments of medical cannabis, Healthcare professionals recommend a “Start Low and Go Slow” titration method. A CBD-dominant product is frequently chosen first, with the slow addition of THC if treatment goals are not met. Following initiation, follow-up and monitoring with a healthcare provider are essential.1 A sample treatment plan is provided below, but it should only be used as a general guide. The healthcare provider who authorizes medical cannabis should complete the specific dose and titration schedules.23 Product Dosage Conversion Chart Note: · Inhalation of cannabinoids should be avoided when an existing pulmonary condition such as COPD has been identified. · Patients should keep track of symptoms, responses, and effects to discuss at follow-up visits. · Most patients use 1-2g of cannabis per day. · CBD-dominant products have fewer psychotropic effects and may require higher doses. Smoking produces harmful byproducts that have been linked to respiratory adverse effects including bronchitis, coughing, and phlegm.1 Additionally, 30-50% of cannabinoids (THC & CBD) are lost in the air as smoke and essentially ‘burn away your medicine’. Therefore, vaporization is the preferred method of inhalation as it produces significantly less harmful byproducts than smoking. Cannabis is heated more slowly throughout the vaporization process to prevent combustion, reduce the chance of respiratory side effects, and preserve your medication more affordably.1 It has been shown that dry flower vaporization, like the PAX devices, significantly reduces toxic combustion byproducts and efficiently delivers cannabinoids. References: 1.     MacCallum, C.A., & Russo, E.B. (2018). Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine, 49, 12-19. 2.     Gieringer, D.H. (2001). Cannabis “vaporization”: a promising strategy for smoke harm reduction. Journal of Cannabis Therapeutics,1(3-4), 153-170. 3.     Gieringer, D.H., St. Laurent, J., & Goodrich, S. (2004). Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds. Journal of Cannabis Therapeutics, 4(1), 7-27.
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Starseed Medicinal Celebrates International Women’s Day
International Women’s Day is celebrated annually on March 8th, and serves as a reminder of the progress made towards gender equality and the work that still needs to be done. One important aspect of this is women’s health, which is a topic that continues to be overlooked and underrepresented. Women’s health refers to the physical, mental, and social well-being of women throughout their lives. Despite advancements in medicine and technology, women’s health issues remain a global challenge. From reproductive health or chronic conditions, women often face unique health challenges and disparities. Women are at higher risk for certain chronic conditions such as heart disease, autoimmune diseases, and osteoporosis. Additionally, women's mental health is a significant concern, particularly because they are the backbone of day-to-day motherhood responsibilities ranging from pregnancy to child-rearing. Mothers have much higher rates of depression than the general population. Despite this, they have demonstrated remarkable strength in the face of the challenges associated with balancing paid work, family and household needs, and community expectations. To address these issues and promote women’s health, policymakers, healthcare providers, and the public much work together to ensure that women have access to quality healthcare, education, and support. This includes increasing access to affordable healthcare services and reducing social stigma around mental health and gender-based violence. Medicinal Cannabis and Women’s Health Medicinal cannabis has gained significant attention over the past decade as a potential treatment for a variety of health conditions. While much of the focus has been on its ability to alleviate symptoms in patients with chronic pain, there is also a growing interested in the use of medicinal cannabis in women’s health. Further research is needed, however researchers are discovering possible health benefits for women, such as: • Endometriosis is a condition in which the tissue that normally lines the uterus grows outside of it, causing pelvic pain and discomfort.1 • Menopause is a natural part of the aging process but can be accompanied by a variety of symptoms such as hot flashes, mood changes, and insomnia.2 • Fibromyalgia is a chronic condition that causes fatigue, widespread pain, and tenderness throughout the body. Both sexes are affected by the condition, but women are significantly more likely to develop fibromyalgia.3 While medicinal cannabis may have potential benefits for women's health, there are also risks and potential side effects to consider. For example, cannabis should be avoided by women who are planning to get pregnant, are pregnant, or are breastfeeding. As with any medications, it’s important to speak with a healthcare provider before starting medicinal cannabis and to use it under medical supervision. With further research, we may gain a better understanding of the potential benefits and risks of medicinal cannabis for women’s health. International Women’s Day is an opportunity to recognize the importance of women’s health and the need for continued efforts to promote gender equality and support women’s well-being. By advocating for women’s health and investing in the healthcare system that prioritize women’s needs, we can work towards a future when all women have the opportunity to live health, fulfilling lives. [1] Bouaziz, J., Bar On, A., Seidman, D. S., & Soriano, D. (2017). The clinical significance of endocannabinoids in endometriosis pain management. Cannabis and Cannabinoid Research, 2.1, 72-80. [2] Dahlgren, M. K., El-Abboud, C., Lambros, A., Sagar, K., Smith, R.T., et al. (2022). A survey of medical cannabis use during perimenopause and postmenopause. The Journal of The North American Menopause Society, 29(9), 1028-1036. [3] Russo, E. Clinical endocannabinoid deficiency reconsidered: current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis and Cannabinoid Research, 1(1), 2016.

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