Pubdate: Thu, 28 Jul 2016
Source: SF Weekly (CA)
Column: Chem Tales
Copyright: 2016 Village Voice Media
Author: Guy Kovner


Marijuana can make life better for some of the more than 5 million 
Americans afflicted with Alzheimer's disease, but despite an 
encouraging new study, it remains a long shot as an antidote to the 
brain disorder that claims about 85,000 lives a year, experts say.

Some assisted living facilities and physicians in Sonoma County are 
quietly administering medical marijuana to patients - with consent 
from legally responsible parties - for behavioral management, 
quelling aggression and agitation in people who are losing 
recognition of their surroundings.

In appropriate dosage, typically using edibles and tinctures, 
cannabis can have a "robust therapeutic effect," says Dr. Phillip 
Grob, a Santa Rosa geriatric psychiatrist who has recommended 
marijuana for 50 to 100 patients since 2003.

For managing patients with "complicated dementia," such as extreme 
agitation, cannabis is safer than the anti-psychotic drugs typically 
prescribed, Grob says. No pharmaceuticals have Food and Drug 
Administration approval for such use, and the anti-psychotics come 
with an official "black box warning" that they carry an "increased 
risk of death" when used to treat dementia's neuropsychiatric 
symptoms, he says.

"We use them," Grob says, including himself in that practice, because 
cannabis "is not for everybody." Some patients have a negative 
reaction to marijuana, such as paranoia or anxiety, he says.

When he puts a dementia patient on marijuana, Grob says his approach 
is to "start low and go slow" with the dosage. "In my book, cannabis 
is much safer than [anti-psychotic] prescription medications," he says.

Dan O'Brien, who works at a Sonoma County assisted living facility, 
says use of cannabis for behavior modification is "well known and 
very popular" in residential care for Alzheimer's patients.

Patients with dementia may think they are being attacked by aides who 
have come to wash and dress them, and react violently, O'Brien says. 
"They may not understand these people who have their hands all over 
them are helping them," he says.

Tony Fisher, marketing director at Healdsburg Senior Living 
Community, says the facility is considering cannabis as an 
alternative to psychotropic medication. "We're definitely exploring 
the idea," he says. "It just makes sense."

But it's important to broach the idea cautiously, he says, because 
marijuana "is not a very popular subject in the senior world."

About 40 of the Healdsburg facility's 100 residents are diagnosed 
with dementia, Fisher says.

Care facilities that depend on Medicare funding are wary of 
dispensing marijuana, local experts says, because it remains illegal 
under federal law, which classifies pot as a drug "with no currently 
accepted medical use."

Alzheimer's disease, the most common cause of dementia among older 
people, afflicts 5.4 million Americans and is a looming public health 
crisis as the oldest of the 76 million baby boomers hit age 70 this year.

Already, someone in the United States develops Alzheimer's every 66 
seconds, and the cost of health care for people with Alzheimer's and 
other dementias is expected to swell from $236 billion a year now to 
$1 trillion by 2050.

"There's a wave coming," says Michele Boudreau, spokeswoman for the 
Alzheimer's Association Northern California chapter. "The human toll 
is going to be dramatic."

Use of cannabis to moderate the behavior of Alzheimer's patients is 
"pretty minimal," she says, adding that most physicians "do not feel 
comfortable prescribing it" and the association has no official position on it.

Researchers at the Salk Institute in La Jolla recently announced 
findings that tetrahydrocannabinol (THC) and other compounds in 
marijuana can remove the amyloid plaque associated with Alzheimer's, 
suggesting a potential treatment for the incurable disease.

Salk Professor David Schubert says in a press release that the study 
was the "first to demonstrate that cannabinoids affect both 
inflammation and amyloid beta accumulation in nerve cells."

Fisher says the study was "pretty fantastic news," noting that if 
cannabis really can dissolve plaque it "could change everything overnight."

But Schubert says that any THC-related treatment for Alzheimer's was 
a long way off and would require lengthy testing in clinical trials 
before it could be made available to the public.

David Greenberg, a neurologist and professor emeritus at the Buck 
Institute for Research on Aging in Novato, says there was a "huge 
leap" between the Salk study and an Alzheimer's therapy.

First, he says, the study involved neurons grown in a laboratory 
dish, providing no guarantee that the plaque-cleansing effect would 
occur in the human brain. And there is no clear answer to the 
question of whether plaque is the cause or an effect of Alzheimer's, 
so its removal "cannot be equated with a therapeutic clinical 
response," says Greenberg, a Sonoma resident.

Grob, the psychiatrist, says marijuana has proven helpful for 
treating numerous conditions, including chronic pain, seizures, 
anxiety and paranoia. But there is "pushback from the established 
medical community," he says, due to both federal law and mainstream 
medicine's close ties to the "pharmaceutical complex."

In states where medical marijuana is legal, Medicare's prescription 
drug costs have been lowered, University of Georgia researchers 
reported earlier this month.
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MAP posted-by: Jay Bergstrom