Pubdate: Tue, 23 Mar 2021
Source: New York Times (NY)
Copyright: 2021 The New York Times Company
Author: Paula Span


For years, Harry B. Lebowitz spent the cocktail hour at his home in
Delray Beach, Fla., sitting in his backyard overlooking a lake and
smoking a joint while his partner relaxed with her vodka and club soda.

Mr. Lebowitz, 69, a mostly retired businessman, qualified for a state
medical marijuana card because he suffered from anxiety, sleep apnea
and back pain. He credits cannabis with helping to wean him off
several prescription drugs.

Then came Covid-19, heightening both his anxiety and his boredom. "It
was like the world stopped," Mr. Lebowitz said. "We're all suffering
from some form of PTSD, all of us."

He found himself smoking several times a day instead of once, and
downing three to five shots of anejo tequila daily, too.

Even before the pandemic, researchers were reporting on the growing
popularity of cannabis among older adults, although the proportion
using it (or at least acknowledging its use) remained small.

Last spring, an analysis based on the National Survey of Drug Use and
Health found that marijuana use in the prior year among people over 65
had jumped 75 percent from 2015 to 2018, from 2.4 percent of that
group to 4.2 percent. By 2019, use had reached 5 percent.

"I would expect it to continue to increase sharply," said Dr. Benjamin
H. Han, the lead author of the analysis. The data showed use rising
particularly among women and among people with higher education and

A team using a different national data set documented a similar trend
last fall. From 2016 to 2018, the proportion of men ages 65 to 69 who
reported using marijuana or hashish within the past month had climbed
to 8.2 percent from 4.3 percent. Among women, it grew to 3.8 percent
from 2.1 percent.

"It's rare to see that much change in a three-year period," said
William Jesdale, an epidemiologist at the University of Massachusetts.
"It shocked us."

Maybe it shouldn't be so surprising, though. During that period, "you
had the backlash against opioids," said Donna M. Fick, a researcher
who directs the Center of Geriatric Nursing Excellence at Penn State.
With addiction and overdoses so prevalent, "clinicians are wary of
prescribing them to older adults anymore, so people are looking for a

The inexorable increase in legalization plays a part, too. In
November, voters in four states (Arizona, Montana, New Jersey and
South Dakota) approved recreational use; the Virginia Legislature did
the same last month, with the governor expected to sign the bill.

That would bring the total to 16 states, plus the District of
Columbia, that permit "adult use" marijuana. Mississippi and South
Dakota legalized medical cannabis in November, too, joining 34 other

"It's easier to get and it's also less stigmatized," Dr. Jesdale said.
With less punitive policies and just-say-no rhetoric, "people who used
in their youth and may have stepped away might have come back, now
that it's not Demon Weed anymore," he added.

There are no data yet on how the pandemic, with its stress and
isolation, affected use among older people. But legal cannabis sales
grew by 20 percent last year, according to the National Cannabis
Industry Association. Leaf411, a nonprofit, nurse-staffed information
hotline, received 50 percent more calls, most from older adults.

Researchers therefore expect the numbers will show greater geriatric
use. Mental health surveys of older people last year showed rising
anxiety and depression, conditions frequently cited as reasons to try

"I've definitely seen my patients who were stable returning for
tuneups," said Eloise Theisen, president of the American Cannabis
Nurses Association and a geriatric nurse-practitioner in Walnut Creek,
Calif. "Their anxiety was worse. Their insomnia was worse."

The effects of the pandemic varied, of course. Ileane Kent, 80, a
retired fund-raiser in Lantana, Fla., has vaped nightly for years,
"just to chill out," she said.

She became a legal user for the first time in June, because she no
longer wanted to risk entering her supplier's house. With a medical
marijuana card, and as a longtime breast cancer survivor - "Honestly,
they don't turn anyone away," Ms. Kent said - she now patronizes a
dispensary whose Covid protocols she finds more reassuring.

Barbara Blaser, 75, a nurse who worked at a dispensary in Oakland,
Calif., had for years dealt with pain and anxiety after extensive
surgery. She had come to rely on five milligrams of edible cannabis,
in the form of one chocolate-covered blueberry, each morning and each
evening. But after being laid off last year, she no longer faced a
stressful commute or spent hours on her feet, so her use has diminished.

Still, the $17.5 billion legal cannabis industry keeps seniors
squarely in its marketing sights. Major retailers offer dispensary
discounts of 10 to 20 percent on "Silver Sundays" or "Senior
Appreciation Days." Some offer older customers free delivery.

The pandemic suspended promotions like the free bus that ferried
customers from a retirement development in Orange County, Calif., to a
dispensary in nearby Santa Ana called Bud and Bloom, which offered
them a catered lunch, new product information and a senior discount.
But Glen Turiano, a general manager at the dispensary, hopes to revive
the service this summer.

Trulieve, another retailer, similarly plans to resume its monthly
Silver Tour, which sent a cannabis advocate to assisted living
facilities across Florida, where he told residents how to qualify for
and use medical cannabis. Green Thumb has reached potential older
users at a senior recreational center in Waukegan, Ill.; at a Lunch &
Learn event at Century Village in Deerfield Beach, Fla.; and at senior
health expos in Pennsylvania.

All of which makes health care professionals who treat seniors uneasy.
"Older people need to know that the data is very unclear about the
safety of these medications," Dr. Fick said. "Whether or not they
actually help is also unclear."

A recent review in JAMA Network Open, for instance, looked at clinical
trials of cannabinoids containing THC, the psychoactive ingredient in
marijuana, and found associations with dizziness and lightheadedness,
and with thinking and perception disorders, in users over 50. But the
authors called the associations "tentative" because the studies were
limited and included few participants over 65.

A major 2017 report from the National Academy of Science, Engineering
and Medicine found evidence that cannabis could alleviate nausea and
vomiting from chemotherapy, muscle spasms from multiple sclerosis and
certain kinds of sleep disorders and chronic pain, although
researchers deemed its effect "modest." But evidence for a long list
of other conditions, including neuropathic pain, remains limited or

"It's hard to weigh the benefits and the risks," Dr. Han said. As a
geriatrician and addiction medicine specialist at the University of
California, San Diego, he fears for older patients already susceptible
to fall injuries, to interactions from taking multiple drugs and to
cognitive impairment.

"I worry about any psychoactive substance for older adults," he said.
Moreover, his study showed that cannabis use is increasing among
seniors who drink alcohol, a combination that is potentially riskier
than using either substance alone.

Like other health care professionals whose patients try cannabis, he
advocates a "start low, go slow" approach, asking them to monitor the
results and report side effects. He also warns patients who haven't
used much weed since the 1960s and 70s that THC concentrations are
often stronger now than in their youth.

"Older adults generally need less, because their metabolism has
slowed," Ms. Theisen said. That also means that "they can have a
delayed onset, so it's easier to over-consume, especially with
products that taste good," she continued. She urges older adults to
consult health care professionals knowledgeable about cannabis - who,
she acknowledges, are in short supply.

More research into the pros and cons of cannabis use would help answer
these questions. But since marijuana remains a federally outlawed
Schedule I drug, mounting studies can prove difficult. So its growing
use among older people constitutes an uncontrolled experiment, with
caution advised.

Mr. Lebowitz said he is regaining his equilibrium. Recognizing that he
was drinking too heavily, and disliking the resulting hangovers, he
has backed off the booze. "It's really not my drug of choice," he said.

But he is still smoking somewhat more marijuana - preferring strains
called Dorothy, White Fire and Purple Roze - than before the world
- ---
MAP posted-by: Matt