Medical cannabis for seniors: short answer
Medical cannabis is an option in most US states for adults with a qualifying condition. Adults 65 and older use it most for chronic pain, sleep problems, and nausea. The evidence is strongest for chronic pain, chemotherapy-induced nausea, and multiple sclerosis spasticity. Risks rise with age. Older adults have more drug interactions, higher fall risk, and slower clearance of THC. Start with a low dose of THC and wait before adding more.
Elderly Medical Cannabis Use Guide
Who uses medical cannabis and why
Survey data show rising use among adults 65 and older. Past-year cannabis use in this group rose from 2.4% in 2015 to 4.2% in 2018, per JAMA Internal Medicine. Common reasons:
Senior Citizens Using Medical Cannabis: A Practical Guide
- Chronic pain from arthritis, neuropathy, or back problems
- Sleep problems
- Nausea and appetite loss
- Muscle spasticity from multiple sclerosis
Some adults use CBD products and some use products with THC. Medical cannabis programs require a clinician certification and a state card in most states. Rules differ by state.
Medical Cannabis for Older Adults: A Comprehensive Guide
What the evidence shows
A 2017 National Academies review found substantial evidence for three uses:
Elderly and Medical Cannabis Benefits: A Practical Buying Guide for Older Adults
- Chronic pain in adults
- Chemotherapy-induced nausea and vomiting
- Spasticity from multiple sclerosis
Evidence for sleep, anxiety, and dementia is limited or insufficient. The FDA has approved three cannabinoid drugs: dronabinol, nabilone, and cannabidiol (Epidiolex). The FDA has not approved the cannabis plant as a medicine. State medical cannabis programs operate under state law.
Risks for adults 65 and older
THC can raise heart rate and lower blood pressure. That can cause dizziness and falls. THC can also cause confusion, memory problems, dry mouth, and impaired balance. These effects last longer in older adults because body fat rises and liver clearance falls. Risks include:
- Falls and fractures
- Delirium or confusion
- Fast heart rate or palpitations
- Impaired driving
- Worse balance with alcohol or sedatives
Adults with heart disease, arrhythmia, or a history of falls should talk with a clinician before use.
Drug interactions to check
CBD can change blood levels of some drugs. THC can add to sedation. Check these classes with a pharmacist:
- Blood thinners such as warfarin
- Seizure drugs such as clobazam
- Sedatives, benzodiazepines, and opioids
- Alcohol
- Blood pressure drugs
CBD inhibits CYP2C19 and can raise levels of drugs cleared by that enzyme. CBD also affects CYP3A4. A pharmacist can review a full drug list.
Dosing and product choice
A common starting dose for older adults is 1 to 2.5 mg THC. Use a product with a label that states THC and CBD content per dose. Oral oils and capsules start in 30 to 90 minutes, peak at 2 to 4 hours, and last 4 to 8 hours. Inhaled cannabis starts in 5 to 15 minutes and lasts 2 to 4 hours. Wait at least 2 hours before a second oral dose.
- Start with 1 to 2.5 mg THC or less.
- Record the dose, time, and effects.
- Increase by 1 to 2.5 mg after 3 to 7 days.
- Avoid driving for 4 to 6 hours after THC.
Topical CBD products have low systemic absorption. They are an option for localized pain, but evidence is limited.
What to ask before buying
Ask for a certificate of analysis (COA) from a third-party lab. The COA should list cannabinoid potency, pesticides, heavy metals, mold, and residual solvents. Check the batch number. Ask if the product is hemp-derived or cannabis-derived. Hemp-derived CBD products can contain THC above the legal limit in some cases. Check state rules.
Bottom line
Medical cannabis can help some older adults with chronic pain, nausea, or spasticity. It carries risks for falls, heart rate, and drug interactions. Start low, go slow, and tell your clinician and pharmacist about every product you use.