Cannabis and Dementia
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.
 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
 Ontario Long Term Care Association. (2019). This is long-term care 2019. Retrieved from https://www.oltca.com/OLTCA/Documents/Reports/TILTC2019web.pdf
 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
 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.
 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.
 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.
 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.
 Canadian Institute for Health Information. Potentially Inappropriate Use of Antipsychotics in Long-Term Care. Accessed November 22, 2022.
 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
 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.
 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)
 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.
Construction Workers Disproportionately Impacted by Opioid-related Deaths
The risks of opioid-related harms and deaths in the construction industry have been raised in a number of media reports over the past year.
In an article published last week by CBC News, construction workers in Alberta said that “isolation, lifestyle and physicality of job pushes some to drug use.” Three out of four people who die of overdoses in Alberta are men, and 30 to 50% of those employed at the time of their death, were employed in trades.
In July 2022, Public Health Ontario and Health Canada released several reports and tweets about this issue and the growing concern saying nearly one in 13 opioid-related deaths in Ontario occurred among construction workers.
The construction industry is a crucial part of our economy, and its workers play a very important role in building and maintaining our infrastructure. The growing opioid-related harms in recent years are a problem that demands further attention.
Why are opioid-related harms more prevalent among construction workers?
Workers describe the physical pain of their jobs as a reason for their drug use. According to a report by Public Health Ontario, 78% had an injury or pain diagnosis prior to death (mainly fractures, dislocations, strains or sprains, as well as low back pain).
Opioids are a class of drugs that are used to relieve pain and include prescription painkillers like OxyContin, as well as street drugs like heroin and fentanyl. These drugs have become a major public health concern due to their high potential for abuse and dependence.
Opioid use and abuse in the construction industry have serious consequences for workers and their families. Opioids can impair a person's ability to perform their job safely. Workers who are dependent on opioids are also more likely to miss work and have decreased productivity, which can lead to job loss and financial instability.
In addition to the personal and economic harm caused by opioid use and abuse, the construction industry is also facing increased costs due to the opioid epidemic. The cost of treating opioid addiction and overdose, as well as the cost of replacing workers who are unable to perform their jobs, is a growing burden on the industry.
To address this problem, it is important that the construction industry takes steps to prevent opioid use and abuse. This can include offering support and access to resources for workers who are struggling with substance use disorders and promoting alternative forms of pain management.
Medical cannabis is a promising alternative to opioids for the treatment of chronic pain. Compared to opioids, cannabis has a better safety profile with no overdose-related deaths reported. Furthermore, the endocannabinoid system and opioid system in our bodies work together with the major pain pathways to relieve pain without increasing the risk of overdosing and dying.
We also know that chronic pain is rarely treated alone; it is typically accompanied by emotional distress and sleep problems. Medical cannabis is a promising alternative because it is likely to avoid the undesirable side effects associated with prescription pharmaceuticals to treat pain, sleep, and anxiety all at once.
In conclusion, the opioid epidemic is a serious problem in the construction industry, and its impacts are felt by workers, their families, and the industry as a whole. To prevent further harm, it is important that everyone works together to promote safe and healthy work environments and support those who are struggling with addiction. By addressing this problem, we can help protect the health and well-being of construction workers and ensure that this important industry remains strong and productive.