Medical marijuana

As of June, 38 states have legalized medical marijuana, and some senior living communities have opted to allow its use on site as part of their personalized care and wellness programs.

One such operator, Inspīr Carnegie Hill in New York City, saw an upswell of questions after New York state in March signed the Marihuana Regulation & Taxation Act, legalizing recreational adult use of marijuana, effective September 2022.

The state had already legalized medical marijuana in 2014, but the new law “led to an increase in interest from residents and family to treat pain, behavioral symptoms associated with dementia, fibromyalgia, sleep disorders and more,” Brian Geyser, APRN-BC, MSN⁠, chief clinical officer at Inspīr, told McKnight’s Clinical Daily.

To field their questions, the senior living operator in June hosted a panel of local clinician providers, including physicians who certify patients for medical marijuana use and a dispensary pharmacist.

Brian Geyser, APRN-BC, MSN

Billed as “Weeding Out Fact From Fiction,” the discussion explored the benefits and risks of using the substance to treat a variety of ailments common among aging adults.

In addition to the regulatory hurdles that long-term care operators must navigate to allow use, it is crucial that residents and their families about the complexities of using cannabis as a medical treatment, and even the risks of self-treatment, the panelists told McKnight’s Clinical Daily in an email exchange.

Getting the dose right

Etain Health, a medical cannabis dispensary which contracts with long-term care facilities among its roster of clients, has seen an uptick of questions along with a general acceptance of cannabis among older patients who wish to add to their regimen of current medications, said dispensary director Sang Choi, RPh. 

“We have also noticed an increase in foot traffic into the dispensaries asking similar questions as well,” Choi told McKnight’s. In her experience, senior living residents often are looking for solutions for chronic pain, sleep and appetite issues. 

Each state that allows use has different regulations, but generally, patients must be certified for use by a physician. In New York state, medical marijuana must be dispensed via a legal dispensary after the patient is certified for use by a physician. The pharmacist will then consult with the patient or their caregiver and do the prescribing. In the case of long-term care communities, the built-in clinical oversight is a plus, Choi said.

“Dosing can be complicated, and can be handled easier in a senior living community where the medications are given by staff at the required times,” she said. “It can be hard to assess the effects at times because it takes some time to figure out the dose and the ratio, since one size does not fit all. It can take a few weeks to see concrete results.”

Interdisciplinary approach

An interdisciplinary approach is critical in order to manage medical marijuana effectively as a treatment, Kenneth R. Weinberg, MD & chief medical officer of Cannabis Doctors of New York, a concierge physician service, told McKnights.

“In many cases, it is the pharmacist that is giving the advice on [types], dosage, etc. The primary care physician needs to be involved and if the patient is seeing a psychiatrist, they also need to be a part of the process.”

The panelists were quick to note that medical cannabis, while effective, isn’t right for everyone. 

“While it is not a cure, it can be an extremely effective treatment. Patients are constantly saying, ‘this is a game changer,’” Weinberg said. But he also advised caution.

Certifying patients

“Cannabis works because, just like opiates attaching to opioid receptors in the brain, there are endocannabinoid receptors in the brain and throughout the body that chemicals in the plant attach to. They are diffused and help explain why so many conditions are helped by cannabis,” he explained. 

But marijuana remains a Schedule 1 drug on the federal level, technically making it illegal to purchase, sell or consume, and leaving clinical studies on medical marijuana off the table. “This severely limits our ability to take full advantage of the potential of the plant,” Weinberg said.

Weinberg certifies patients to use medical marijuana, which in New York requires a diagnosis of certain debilitating or life-threatening conditions. He said he advises patients at length about the different treatment effects of tetrahydrocannabinol ​(THC), the main psychoactive compound in marijuana, and cannabidiol (CBD), the active ingredient in cannabis — alone and in combination. The patient will then consult with a dispensary pharmacist, and they or the doctor will provide follow-up monitoring for side effects.

“No two people respond in the same way to cannabis,” he noted. “There is often a trial period at the beginning, after it is added to a patient’s list of medications.”

Self-treatment risks

There are potential complications with self-treatment with marijuana, including not only dosing but contraindications with other drugs and product quality. This is why it is key for patients to involve clinical professionals in their care, said Choi, the pharmacist.

“The dosing and ratio aspect of marijuana can be difficult to navigate which makes the medical program so important. In New York, the regulations are very strict when it comes to testing so we know that the medical products will be free of contaminants, pesticides, heavy metals and fungus.”  

Weinberg worries about the use of recreational marijuana to treat medical issues now that New York state has legalized the recreational drug.

“I am concerned, as an MD, that we will be seeing medical and psychiatric problems, as well as legal- and work-related [problems], because not much is being done to educate the public and practitioners about possible reactions people may have to using cannabis,” he said. ​​He addresses the issue with patients and has reached out to state legislators as well.

Operator hurdles

In states where medical marijuana use has been legalized, long-term care operators are responsible for determining if residents will be allowed access to it. Those who make the leap then must navigate the medication management process. 

A lot needs to be considered, including who is prescribing, what is being prescribed, where and how to store it and what delivery method to use, Weinberg told McKnight’s

“A care provider also has to know how it will operate a medical marijuana program. The regulatory components to starting the operation and the training for staff are vital components to review as a senior living clinician,” he said.

Inspīr manages cannabis the same way it manages controlled substances, “with a tight process for receiving, storing, administering and counting that is in compliance with state licensure requirements,” said Geyser, the company’s chief clinical officer.

Related articles:

‘Contradictory’ state, federal cannabis laws create conundrum for senior living operators

Medical marijuana use in assisted living is possible, with careful planning