6. Marijuana’s stoner stigma persists
Whether it’s a holdover from America’s decades-long war on drugs or pot’s still-illegal federal status, many older proponents of medical marijuana continue to hide their use. The lingering stigma associated with pot keeps some people from telling their doctor, too, says Hillary Lum, a geriatrician and associate professor at the University of Colorado School of Medicine. “In a recent survey, 30 percent of older adults didn’t answer the question about whether or not they used medical marijuana,” she says. “If people feel uncomfortable with it on an anonymous survey, they may also feel uncomfortable telling their doctor. That could have ramifications for their health.”
7. Many doctors are in a quandary
Half of the primary care doctors working at Mayo Clinic medical offices said in a 2019 survey that they weren’t prepared to answer patients’ questions about medical marijuana — even though 58 percent believed it was a legitimate medical therapy for terminal illnesses, untreatable pain and cancer symptoms.
That hasn’t stopped some users — especially older adults — from approaching their doctors.
“My patients want to talk about it,” Lum says. “But I’m in an information vacuum. We don’t have many clinical studies to show effectiveness. Medical schools, pharmacy schools and nursing schools haven’t taught it. It’s not in the pharmacy database we use for prescribing, so I don’t have a lot of information about potential drug interactions and side effects.”
A few institutions have declined to embrace its use. The Cleveland Clinic announced it would not recommend medical marijuana to its patients when it became legal to buy in Ohio in January. Says Paul Terpeluk, a doctor of osteopathic medicine and medical director of the Cleveland Clinic’s Employee Health Services, “We’re just beginning to understand the effects of cannabinoids in the body. We do not believe states should be in the business of regulating and promoting medications.”
But other doctors prefer not to create obstacles to medical marijuana use. Peter Grinspoon, a primary care physician at Massachusetts General Hospital and a Harvard Medical School instructor, took the unusual step of getting trained so he could certify his patients as medical marijuana users.
“I grew up with this, so it’s hard not seeing it as medicine,” Grinspoon explains. His father, the Harvard psychiatrist Lester Grinspoon, is considered the “grandfather of medical marijuana” and wrote a book about the history and cultural use of medical marijuana in the 1970s; there’s even a marijuana strain in Europe named after him. His brother used marijuana while battling leukemia, too.
“It makes sense to try cannabis when you consider the track record of other medications a lot of older adults take, especially for pain, sleep and anxiety,” Grinspoon says. “Nonsteroidal anti-inflammatories like ibuprofen and naproxen can affect your kidneys, threaten your heart and cause gastrointestinal bleeding. Few people want to be on opiates — they haven’t proven to work well for long-term relief, you get constipated and they can be addictive. Sleep and anxiety drugs can leave you sedated and may affect memory. Cannabis can be as effective as anything.”
Even nursing homes are experiencing a profound shift toward acceptance. One program at the Hebrew Home in Riverdale, New York, allows residents to use cannabis capsules or cannabis oil drops and has found that it eases pain, improves appetite and even reduced one resident’s opioid use. The program stays compliant with federal rules by having residents buy and administer cannabis themselves or with the help of a caregiver who’s not on the home’s staff.
“The benefits are nothing short of amazing and should be more widely available to residents of long-term care facilities,” says Daniel Reingold, the CEO of RiverSpring Health, which operates the Hebrew Home. The nursing home is now leading a group of nonprofit long-term care facilities in several states planning to launch a large study this fall of medical marijuana’s effects in older adults.
(Note: The purchase of medical marijuana from a dispensary is not covered by the U.S. Department of Veterans Affairs, Medicare, Medicaid or private insurance, though in some cases all may cover FDA-approved prescription drugs, such as Marinol, that are based on cannabis.)