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Medical Cannabis – cannabinoids for symptom management in seniors

Topic: I'm a Caregiver looking for Help

Chronic pain affects 1 in every 5 Canadians, but it is more common in older persons, with ¼ to ¾ of older adults suffering from chronic pain, which limits their movement and dexterity. Chronic pain is significantly more common among elderly people who live in long-term care settings.

The Invisible Epidemic: Senior’s over-index for chronic pain

The most used medications to treat chronic pain are opioids. However, there is no evidence of the benefit of opioids in long-term chronic pain management. In fact, observational studies show how prescribed long-term opioids for chronic pain is associated with increased risk of abuse, overdose, fractures, and heart attacks.

Considering 66% of seniors take at least five medications, there is rising concern about the risks associated with polypharmacy. Polypharmacy increases the risk of adverse events such as falls, fractures, and hospitalizations. And among seniors in long-term care, >60% take ten or more medications, some of which may be used to manage symptoms associated with the ‘Pain Triad,’ such as opioids, benzodiazepines, anti-depressants, and anti-psychotics. Most of these medicines are sedating, increasing the risk of delirium, falls, fractures, pulmonary embolisms, and cerebrovascular accidents (CVA).

The Potential for Cannabis-based Medicines

Medical cannabis is a promising alternative to opioids for the treatment of chronic pain, which is the most common reason for its use. Areas where cannabis has shown promise to date, are in fact covered by drug classes corresponding to the three pillars of the pain triad. More importantly, cannabis is likely to spare patients the side effects associated with opioid use.

In addition to chronic pain, many seniors suffer from poor appetite and cachexia. Cannabis has the ability to be a potent anti-nauseant and appetite stimulant.

The fastest-growing demographic is those aged 65 and up, which will account for 23% of the population by 2031. They are also the fastest-growing demographic of cannabis users, with a strong desire to learn more about the medication’s use.

Know someone who might need the access to medical cannabis? Contact our Client Care Team for more information at 1-844-756-7333 or info@starseed.com.

References:
1. Schopflocher, D., Taenzer, P. & Jovey, R. The prevalence of chronic pain in Canada. Pain Res Manag 16, 445–450 (2011).
2. Matsuno, R., Wallace, L., Glanzman, R., Martell, B. & Coplan, P. Long-term efficacy and safety of opioid therapy for chronic non-cancer pain: evidence from randomized and open-label studies. The Journal of Pain 14, S77 (2013). Due to FDA regulatory guidelines, most contemporary phase III RCTs of opioid analgesics for chronic non-cancer pain (CNCP) are 3 months long. Furthermore, conducting placebo-controlled, double-blind RCTs ≥3 months presents ethical and operational challenges. (Purdue Pharma)
3. Chou, R. et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann. Intern. Med. 162, 276–286 (2015)
4. Vogel, L. Two-Thirds of Seniors in Long-term Care Take 10 or More Drugs: CIHI. CMAJ June 10, 2014 186 (9) E309.
5. Abrams, DI. Integrating Cannabis into Clinic Cancer Care. Curr Oncol. 23 (2): S8-S14, 2016
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British Columbia Exemption from Controlled Drugs and Substances Act
The province of British Columbia (BC) announces that starting January 31, 2023, adults (18 and over) in BC will not be subject to criminal charges for the possession of up to 2.5 grams of certain illegal drugs for personal use. The exemption only covers possession for personal use with no intent to traffic, produce or export. Instead, all individuals found in possession of substances of up to 2.5 grams for personal use will be provided with local health and social services support. Additionally, the Government of Canada announced $11.78M in funding for projects in BC to address and prevent substance related harms and to help save lives. Given BC’s record rates of substance abuse and overdose fatalities, this is a step in the right direction to make out healthcare system more compassionate. We need to rethink how emergency support and mental health resources are made accessible to individuals who need them. Why? British Columbia has been significantly impacted by overdose deaths and related harms, which has worsened with the pandemic. This exemption will ensure that those possessing a small amount of certain illegal drugs for personal use will not be subject to criminal charges, and instead, will be supported with social and health services. According to studies, punishing people with substance use disorders with criminal charges can exacerbate their physical, emotional, psychological, and financial issues, as well as burden them with the criminal justice system's complexities. Substance us is a complex public health issue, many of which can be beyond an individual’s control. This is Canada's first exemption of its sort, and the federal government will monitor whether it achieves its goals of reducing stigma and harms associated with substance abuse while also increasing access to health and social services. Cannabis is a Gateway Exit Drug Is cannabis able to help in the fight against the opioid crisis? One in every five Canadians suffers from chronic pain. Canada is the world's second-largest consumer of opioids per capita (the U.S. is the highest). This, combined with the usage of illegal heroin and fentanyl, has resulted in an opioid epidemic that has resulted in 5,368 deaths between January and September 2021, or around 20 deaths per day. In addition, 4,532 hospitalizations with opioid-related poisoning occurred throughout the same time period, averaging 17 per day. Cannabis was once thought to be a ‘gateway drug’, leading to the use of more dangerous drugs and addiction. This idea has been substantially debunked since we have seen time and time again how cannabis may be used to effectively replace potentially harmful drugs like opioids and benzodiazepines. At the very least, we can replace a medicine that has the potential to kill people (opioids) with one that does not (cannabis). According to data from the United States, medical cannabis laws have lowered opioid prescribing in every state where they have been implemented. Naloxone Naloxone is a fast-acting drug used to temporarily reverse the effects of opioid overdoses. Naloxone can restore breathing within 2 to 5 minutes. When you take an opioid, it affects certain receptors in your brain. Naloxone works by kicking opioids off the receptors in your brain and binding to those receptors instead. This reverses or blocks the effects of opioids on your body. Click here to find out where to get naloxone in your province or territory: • Take-home naloxone kits are available at most pharmacies. • A prescription is not needed. • Ask the pharmacist. 1. https://bc.ctvnews.ca/health-care-over-handcuffs-b-c-first-to-decriminalize-simple-drug-possession-1.5925897 2. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants 3. Bradford, A. C., Bradford, W. D., Abraham, A. & Adams, G. B. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population. JAMA Intern Med (2018). 4. Wen, H. & Hockenberry, J. M. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. JAMA Intern Med (2018). 5. Bradford, A. C., Bradford, W. D. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D. Health Aff (Millwood) 35, 1230–1236 (2016). https://www.canada.ca/en/health-canada/services/opioids/naloxone.html
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Nutritional Considerations in Medical Cannabis
Good nutrition is essential to maintain your health throughout your life. A healthy diet lowers the likelihood of developing chronic disease. People with chronic diseases can manage their symptoms and prevent complications by eating healthy. Furthermore, by knowing what types of meals to consume, or avoid, prior to administering cannabis dosages, patients can develop better wellness regimens for their situation. Let's look at some important nutritional factors to take into account when discussing medical cannabis! What are Omega-3 fats? Omega-3 fatty acids are essential for overall health in people of all ages. They are well-known for their benefits in preventing heart disease in older adults and their involvement in brain and eye development in babies. Omega-3 and omega-6 fatty acids can be found in foods such as meat, eggs, fish, and nuts. Omega-3 fatty acids act as an anti-inflammatory and support optimal health when consumed in sufficient amounts. Omega-3s And Your Endocannabinoid System Most people are unaware of the relationship between omega-3 fatty acids and the endocannabinoid system (ECS), which is thought to be maintained in balance by omega-3 fatty acids. The ECS is a crucial system of neurotransmitters throughout the entire body that plays an important role in: -        Pain -        Hunger -        Stress response -        Inflammation -        Sleep -        Muscle movement -        Energy -        Mood Patients may respond more favourably to their cannabis therapy if their diet contains enough omega-3. According to preclinical mice studies, eating enough omega-3 fats results in increased endocannabinoid signalling and stronger sensitivity to the cannabinoids THC and CBD.[1] Can you combine caffeine with cannabis? Each day, billions of people rely on caffeine to wake up, or to get through that night shift or an afternoon slump. Chemically speaking, caffeine has been found to increase the secretion of adrenaline and cortisol, which increase wakefulness, increase blood pressure and energy levels. They are the cause of caffeine-induced body stimulation. It turns out that cannabis functions similarly. Different cultivars interact with the ECS differently due to their distinct genetic make-up (i.e., cannabinoids, flavonoids, and terpenoids). Some cultivars have a stimulating effect similar to that of caffeine. However, other patients with a history of anxiety or cardiac issues may react negatively to this combination. On the other hand, some patients who battle with low energy and low mood may find this beneficial. Medical Cannabis and Gastrointestinal Health The gastrointestinal (GI) system has cannabinoid receptors, which is why some illnesses, such as irritable bowel syndrome (IBS), often respond effectively to medical cannabis. The GI tract's cannabinoid receptors seem to control symptoms including pain, inflammation, and nausea, which are all frequent IBS symptoms. Bacteria in the GI tract (microbiome) may influence endocannabinoid tone. Bacteria quality can influence mood, gut motility, and brain health. It's interesting to note that some researchers are looking into the relationship between chronic diseases like Parkinson's disease and the gut-brain axis. There have been some theories and proposed mechanisms for how cannabinoids, and CBD in particular, may benefit the microbiota. In one study, cannabinoids were used to improve the health of people with alcohol use disorder (AUD)[2]. AUD frequently results in inadequate nutrition as well as liver, intestinal, and brain injury from alcohol. The study discovered that cannabinoids decreased inflammation, regulated gut bacteria, and decreased intestinal permeability in AUD, all of which were beneficial for the microbiome's general health. If you have questions about your dietary with medical cannabis regimen, please speak to your healthcare practitioner for a tailored medical cannabis treatment plan to your needs! Don’t have a medical cannabis document yet? Book an appointment with a healthcare practitioner today!

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