Be Wise – Cannabis and Older Adults - MP3 E-Publication

Section: Facts about cannabis

THC and CBD are the two active chemicals in the cannabis plant. The plant can be used in a dried form, or the oil from the plant can be removed and then made into various cannabis products.

Two varieties of the plant are used

The leaves and flowers of cannabis contain hundreds of compounds, called phytocannabinoids. The amount of these compounds in any product depends on the cannabis strain, the soil and climate the plant grows in, and how it is cultivated.
The two compounds that we know the most about are:

THC (delta-9-tetrahydrocannabinol) and, CBD (cannabidiol).
THC is the psychoactive compound (alters brain function and affects the mind) in cannabis that makes you feel 'high'.
CBD is not psychoactive, and is being researched for both potential medical and therapeutic effects.

THC and CBD have different therapeutic uses

Depending on how they are made, cannabis products can have a range of potencies or ‘profiles’ of THC and CBD:

• THC dominant
• CBD dominant
• Balanced THC & CBD.

The most common types of cannabis, indica or sativa are often combined to form a hybrid subspecies of these two types.

Each subspecies is marketed for different physiological effects.

Cannabis plants also contain compounds called terpenes. These give the plant its distinct odor and flavor.

The effects of cannabis strains vary with the mixture of terpenes and cannabinoids.

Ways people can consume cannabis

Smoke it: As a dried plant (dried flower buds).
<picture caption> A pre-rolled cannabis cigarette rests on a dried cannabis flower.

Vaping: Inhale the dried plant as a vapour.
<picture caption> Electronic cigarettes and vaporizers with cartridge.

Cannabis oil: Extract diluted in oil. Oil products show number of grams of cannabis in the oil.
<picture caption> Brown glass bottle with eye-dropper in front of a cannabis leaf.

Spray it: Into the mouth or under the tongue. It is absorbed through the mouth lining.
<picture caption> White bottle with eye dropper lid. White bottle with spray attachment.

Edibles: Food products using a fat or oil infused with dried cannabis.
<picture caption> Two chocolate cupcakes with a cannabis leaf between them.

Topical:  A thick oil extract is applied as a gel or cream and absorbed through the skin.
<picture caption> A tube of ointment. A jar of cream with its lid off, the cream is faint green.

Comparing ways of consuming cannabis

The effects of cannabis and how long they last vary. It depends on how you consume it.

Be careful and be patient.

For example, if you are inhaling, it can take seconds to minutes to begin to feel the effects. The full effects might take 10 to 30 minutes.

If you are swallowing a food product or a soft gel, it can take 30 minutes to 2 hours to begin to feel the effects, and up to 4 hours to feel the full effects. For example, if you take a soft gel to help you sleep, you should take your dose at least 30 minutes before your bedtime.

Page 6, Producers note, there is a table with four columns headed:

Method of Consumption
About this method
How quickly it takes effect
How long effects last

The table reads:
Method of consumption
Inhaled – smoking 
About this method
Dried cannabis made into a joint, or used in a pipe or bong
How quickly it takes effect
Within seconds to minutes
How long effects last
up to 6 hours, effects can last up to 24 hours

Method of consumption
Inhaled – vaping  
About this method
Dried cannabis in a vaporizer, oil cartridges in a vape pen or e-cigarette
How quickly it takes effect
Within seconds to minutes
How long effects last
up to 4 hours

Method of consumption
Sublingually (under the tongue)
About this method
Sprays, oral dissolve strips
How quickly it takes effect
10–30 minutes
How long effects last
6–12 hours

Method of consumption
Ingested (oil based)
About this method
Cannabis oil, capsule or soft gel
How quickly it takes effect
10–60 minutes
How long effects last
up to 12 hours

Method of consumption
Ingested (food)
About this method
Edibles (baked or cooked into food)
How quickly it takes effect
30 minutes to 2 hours
How long effects last
up to 12 hours or more

Method of consumption
Topicals (on the skin)
About this method
Creams, lotions
How quickly it takes effect
not fully understood
How long effects last
Up to 6 hours or more

Recreational cannabis

Cannabis with THC produces feelings of euphoria or relaxation. Recreational cannabis means a person is using cannabis for enjoyment rather than for medical reasons. While medical and recreational cannabis can come from the same plant sources, the products will focus on different chemical properties depending on the desired results.

Label for cannabis product with predominantly THC content.

THC per unit: 20mg
Total THC 200mg
CBD 0 mg/g
Total CBD 0 mg/g

Self-therapeutic cannabis

Many people try various types of cannabis products on their own for various health conditions. This is called self-therapeutic use.

These people obtain cannabis without a prescription through a licenced provider. Some people choose cannabis as a way to self-medicate for reasons such as to reduce anxiety or for pain management.

Label for cannabis product with predominantly CBD content.

THC <1.00 mg/mL
Total THC <1.00 mg/mL
CBD  20.0 mg/mL
Total CBD 20.0 mg/mL

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ACTIVE AGING and MODERATION
Remember, the key to good health is all things in moderation. When you start exercising, take it easy and give yourself time to adjust. If you're taking a cannabis product, go slow, pay attention to the effect, and be patient.

Medical cannabis

Medical cannabis is prescribed by a doctor to treat specific health conditions and symptoms. The prescription is filled by a licensed producer. The prescription could be for natural cannabis products in the form of THC or CBD. It could also be for a synthetic cannabis drug, only available by prescription.

In addition to natural cannabis products, pharmaceutical preparations are available. These are either created from the cannabis plant or recreated in a laboratory. They have a defined potency and dosing information.

Prescription cannabinoids that mimic THC have been approved by Health Canada for use in Canada. These are Marinol, Cesamet (or nabilone), and Sativex (or nabiximol). They are for the treatment of multiple sclerosis spasticity and pain due to cancer.

As cannabis is now legal in Canada, you might ask if a medical prescription is still needed.

Reasons why a person might want to get medical cannabis with a prescription include:

• Access to prescription synthetic cannabis.
• Workplace insurance plans are starting to cover medical cannabis, and a prescription receipt is needed to make a claim.
• If you are on government social assistance or are considered low-income, you may qualify for a discount.
• The Canadian Revenue Agency allows people with prescriptions to file their cannabis costs as a medical expense.

Section Cannabis and the law

The Canadian Cannabis Act currently permits the sale of these products by licensed distributors:

• fresh cannabis
• dried cannabis
• cannabis oil
• cannabis plants
• cannabis seeds
• edible cannabis
• cannabis extracts
• cannabis topicals

These products can be sold in a variety of formats

Federal law says adults can:
Possess up to 30 grams, dried, or the equivalent amount in a non-dried form in public.
Share up to 30 grams of legal cannabis with other adults.
Buy dried or fresh cannabis and cannabis oil from a provincially-licensed retailer.
Purchase cannabis online from federally-licensed producers if there is no regulated retail framework in their province or territory.
Grow, from licensed seed or seedlings, up to 4 cannabis plants per residence for personal use.
Make cannabis products, such as food and drinks, at home. This is allowed as long as people do not create concentrated products.

Average cannabis costs

In 2021, the average price of cannabis in Canada was $10.30 per gram. The cost varies depending on the province, the type of cannabis purchased, and your dose. This chart gives examples of the range of prices for various products.

These prices are from 2018.

Producer’s note there is a table titled Cannabis Cost. It shows the Retail cost and Monthly cost

For the dried product, oil and capsules. The table reads:

Retail cost

Dry Product $5-15/g
Oil. $50-200 per bottle
Capsules. $100-200 for 60 capsules

Monthly cost

Dry Product  1g/day x 30 days = $150-450
Oil, 1 Bottle can last 1-3 months
Capsules 1-2 capsules/ day x 30 days  = $100-400

Where to obtain cannabis

The answer to this question depends on the province. In general, the only legal sources of cannabis are:

• licensed private retail stores
• government-operated stores
• online or by telephone
• by mail for medical use.

Depending on the province there may be only a few or many retail locations.

Where cannabis can be used

You can use cannabis in the privacy of your own home.

If you rent, your landlord may make rules in your lease about cannabis smoking, or growing.

Condominiums and apartment residences may also have their own rules.

Some provinces ban smoking or vaping cannabis in public. Or, it may only be permitted where smoking tobacco is also permitted.

Purchasing medical cannabis

To purchase medical cannabis, ask your health care provider for a prescription. You then register with a licensed producer to receive cannabis by mail.

Across Canada there are also independent medical cannabis clinics. These clinics take referrals from doctors.

A cannabis clinic may be an alternative if your family physician cannot counsel you on cannabis use.

The clinics can arrange consultations with doctors who assess patients and write prescriptions for those who qualify.

Clinic staff then educate the patients on how to use medical cannabis.

They register them with a licensed producer who provides legal cannabis by mail.

How cannabis is sold

Provinces and territories are responsible for deciding how cannabis is distributed and sold within their jurisdictions.

Each province and territory also has its own rules for cannabis, including:

• legal minimum age
• where adults may buy it
• where adults may use it
• how much adults may possess.

You are responsible for knowing what is legal in the province or territory where you live or visit.

www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/provinces-territories.html

The cannabis plant contains a variety of chemical compounds called cannabinoids. The most well-known of these are tetrahydrocannabinol (THC) and cannabidiol (CBD).

There are hundreds of strains of cannabis in a variety of product forms. Depending on how they are made, these products can have a range of potencies of THC and CBD.

THC is what makes people feel "high". It causes a psychoactive response in the brain, which some people may enjoy and others may find unpleasant. Unlike THC, CBD does not produce a ‘high’ or cause a psychoactive response.
Higher THC potency products have greater health and safety risks and should not be used by anyone new to cannabis. It is important to make an informed decision, especially if you are inexperienced or trying a new product.

Be sure to read the label carefully. If you are buying cannabis for therapeutic purposes, the "Total THC" should be low to zero.

Producer’s note, a cannabis content label appears on this page that reads as follows:

THC ## mg/g
Total THC | THC total ## mg/g

CBD ## mg/g
Total CBD | CBD total ## mg/g

Identifying legal cannabis products

Legal cannabis products are only sold through retailers authorized by your provincial or territorial government.

• Legal cannabis products (except products with less than 0.3% THC or no THC) have an excise stamp on the package.
• Each province and territory has a differently coloured excise stamp.
• The stamp has security features to prevent forgery, just like passports and banknotes.

<Producer’s note there is an example of a cannabis duty stamp highlighting its unique features.>
anti-copy line work, colour shifting, intaglio latent symbol, unique identifier and jurisdiction.

Packaging labelling

All legal cannabis products sold in Canada require these labels.

Standardized cannabis symbol as required by the Canadian Government on all products containing THC.

There will be a statement of the amount of THC &/or CBD in each unit of the product as well as a statement of the total THC and CBD in the product. This will always appear in a white box.

If the product is edible it will state the total equivalent amount of dried cannabis in it.

If the product is edible, there will be the standard Nutrition Facts label.

There will be a two sentence warning on the packaging. The warning will always be on a yellow background.

This example is for edible cannabis products. There are eight different warning messages in total.

WARNING: The effects from eating or drinking cannabis can be long-lasting. The effects can last between 6 and 12 hours following use.

Travelling with Cannabis

Don't bring it in. Don't take it out.

Leaving Canada

It remains illegal to take cannabis or any product containing cannabis—including edible cannabis, cannabis extracts and cannabis topicals—across the Canadian border, whether you are entering or leaving the country.
Cannabis is illegal in most countries. If you try to travel internationally with any amount of cannabis in your possession, you could face serious criminal penalties both at home and abroad.

Travel to U.S.

Although the possession of cannabis is legal in some U.S. states, it remains illegal under U.S. federal laws. Do not attempt to cross the Canada-U.S. border with any amount of cannabis in any form, even if you are travelling to a U.S. state that has legalized possession of cannabis.

Travelling with cannabis within Canada

When you travel within Canada, if you meet the minimum age requirement of the province or territory you are in, you may possess up to 30 grams of dried cannabis or the equivalent.

You are responsible for learning the laws of the province or territory you are going to visit. If you use cannabis, follow the laws in that jurisdiction.

While you are travelling between two Canadian destinations, pay attention if your flight has a stop-over in the U.S. Cannabis is not legal in the U.S. Also keep in mind flights can be redirected to the U.S. due to weather or mechanical issues.

Cannabis safety

Always store your cannabis products where children or pets cannot reach them.
Cannabis edibles and their packaging may lead children to think it's candy.
Clearly label and securely store any food products that contain cannabis.

Childproof lock
<picture caption> A child's fingers hold a lock that keeps a cupboard closed.

Childproof bottle
<picture caption> Image of childproof bottle. The cap reads "Open, Push Down & Turn".

Do not store with regular food
<picture caption> A red line frames an open refrigerator. There is a red line through the picture indicating "Do Not".

Keep out of reach of children & pets
<picture caption> A picture of a line of pets includes a budgie, iguana, cat, dog, rabbit and ferret.

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ACTIVE AGING and MODERATION

It's good to share information and experiences. Don't be afraid or ashamed to tell friends or family if you're trying cannabis. You might be surprised to find out other people you know have tried cannabis as well. Be open to new information. Listen and learn.

Cannabis help with health issues

Cannabinoids are similar to naturally occurring compounds in the human body, known as endocannabinoids. They act on the endocannabinoid system. Research on the endocannabinoid system is still very limited.

The system runs throughout the entire nervous system, including the brain. It has receptors throughout the human body. It is thought to impact the nervous system, immune function, mood and appetite, and other body functions.

The two most well-known cannabinoid receptors are CB1 and CB2. CB1 receptors are responsible for the psychoactive effects of THC. They may play a role in memory, mood, sleep, appetite and pain levels. The CB1 receptors are also found in brain areas related to motor control and cognition. CB2 receptors are found mostly in the cells of the immune system and in muscle and bone tissues. They may play a role in reducing inflammation. 

Medical researchers are testing the potential of cannabinoids to reduce stress, build appetite, promote sleep, and modulate pain and inflammation.

There may be a role for cannabis to play in various health issues and healthy aging. In some cultures, cannabis is considered an ancient herbal medicine.

But right now, the scientific evidence is limited.

The human endocannabinoid system regulates a number of physiological functions. Researchers are still learning about this system. Cannabinoids (from cannabis) interact with the endocannabinoid system. This produces a broad range of effects on our bodies and minds.

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THE HUMAN ENDOCANNABINOID SYSTEM

CB1 Receptors are primarily found in the brain and central nervous system, but are also present in nerves and in some organs.

CB2 Receptors are mostly in the peripheral organs especially cells associated with the immune system.

THC and CBD fit like a lock and key into existing human receptors.

*CBD does not directly "fit" CB1 or CB2 receptors but has powerful indirect effects still being studied.

The endocannabinoid system also regulates

Temperature regulation
Memory
Cardiovascular function
Energy balance and metabolism
Digestion

Cannabis and medical conditions

Cannabis is said to have many health benefits. But there is limited scientific evidence to support many of the therapeutic claims. More research is needed to understand the benefits and risks. 

Health Canada allows the use of cannabis for any medical condition, as long as a doctor prescribes it. However, cannabis has not gone through the regulatory processes required to approve a drug. A few synthetic cannabinoid products have been approved for clinical use for specific conditions. These are Cesamet (nabilone) and Sativex (nabiximol).

Benefits of cannabis

Cannabis products can work for some older adults and not others. Although research is still limited, older adults do report the benefits in anecdotes.
When those who use medical cannabis are asked what the benefits are, they say:

• better quality of life
• helps with sleep
• helps with pain
• allows them to stop using prescription drugs. 

The effectiveness of medical cannabis appears to be very individual. It depends on the reason for its use and finding the right type and dosage.

The research we have shows three conditions that do benefit from medical cannabis:

• chronic, unrelieved, severe pain in palliative care
• nausea and vomiting caused by chemotherapy
• muscle spasms due to multiple sclerosis or spinal cord injury.

Older adults’ interest in cannabis as a therapy is increasing.  As a result, the medical community is taking a practical approach.

Conditions being treated with medical cannabis include:

Certain kinds of pain
Arthritis
Palliative care
Sleep and insomnia
Lack of appetite
Glaucoma
Dementia
Anxiety and depression

Certain kinds of pain

Often, cannabis is promoted as a universal option for pain relief.  But current research only shows positive results for nerve pain related to:

• multiple sclerosis
• diabetes
• pain related to HIV  (sensory neuropathy)
• postsurgical or  posttraumatic pain
• fibromyalgia.

Neuropathic pain is associated with nerve damage. It includes shooting or burning pain as well as tingling and numbness. It can be severe and come in waves. This type of pain is common with diabetes, nerve or spinal cord compression, and chemotherapy. 

Cannabis-based medicines showed moderate neuropathic pain reduction. Test results show that herbal cannabis, plant-derived THC (dronabinol), synthetic THC (nabilone), or a plant-derived THC/CBD combination worked.
The effectiveness varied according to:

• length of the treatment
• type of cannabis used.

There was a trend for best results by either eating, or putting a drop under the tongue, followed by mouth or nose sprays and inhaled (smoked) cannabis. 

The Canadian Pain Society, in line with most professional bodies, currently recommends cannabinoids as ‘third-line agents’.  That means to try it if other treatments do not work.

Arthritis

Osteoarthritis or joint pain is common among older adults. The pain is thought to be caused by damage to the joint, inflammation, or nerve damage. 

There are endocannabinoid receptors in joints, and cannabis has anti-inflammatory properties. The theory is that maybe cannabis could reduce nerve pain from osteoarthritis. Research studies in animals appear promising, but there are no studies in humans yet.

The story is the same with rheumatoid arthritis. There is very little research, but an early study has shown promise. It found that a mouth spray called Sativex reduced pain related to rheumatoid arthritis.

Both the Arthritis Society of Canada and the Canadian Rheumatology Association understand the interest in cannabis.  They suggest a practical approach.

Palliative care

Pain and symptom control are common concerns in the final stage of life. Palliative doctors are exploring cannabis more and more as an alternative to opioids. 

Treatment in palliative care often focuses on cancer pain. There is evidence that cannabinoids (combined THC/CBD) are modestly effective in reducing cancer-related pain.

The medical community in palliative care has recommended cannabis-based Cesamet (or nabilone or nabiximol), but only after other pain relief therapies have been unsuccessful.

Cannabis use as pain relief is well-tolerated, but as with all treatments, there has to be a discussion about side effects. Delirium is common in the final stages of life. This may be exaggerated with higher doses of cannabis. Cannabis can induce dissociative-like states, which create “distancing” from pain. Patients may not be receptive to these types of effects.

Although treatment in palliative care often focuses on pain, many patients may want to address other common symptoms at end of life, such as anxiety, depression, nausea, loss of appetite, or insomnia. 

Sleep and insomnia

Many older adults have trouble with sleeping. Since cannabis can make you sleepy, older adults try it for sleep issues. This is one benefit commonly reported by cannabis users.

However, research is limited on the topic. The research we have often describes sleep as a secondary outcome to another condition. 

Research participants reported better sleep with certain strains of smoked THC and THC-derivatives, alone or in combination with cannabidiol. These treatments may improve sleep quality, decrease sleep disturbances, and decrease time to fall asleep for people with:

• fibromyalgia
• chronic pain
• multiple sclerosis.

Lack of appetite

The THC in cannabis is thought to stimulate the appetite. Cannabis users often get hungry. There is no research that proves this is true for older adults. There is some limited research that shows THC can increase appetite in people with HIV/AIDS and cancer patients.

Glaucoma

One of the main causes of vision loss among older adults is glaucoma, which is caused by pressure inside the eyeball. Cannabis can reduce swelling and it does have the ability to reduce eye pressure. But the dose required could produce other unwanted physiological responses.

The Canadian Ophthalmological Society does not support cannabidiol use for treatment of glaucoma.

Parkinson’s disease

Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease and in Canada, 79% of individuals with Parkinson’s are 65 years or older.  Parkinson’s disease causes tremors to develop, muscle movements become slower and more rigid, and reflexes become impaired contributing to a loss of balance.  It is thought that the part of the brain affected by Parkinson’s disease can be positively affected by the antioxidant and anti-inflammatory properties of CBD to reduce the above symptoms. Currently there is promising research in animals, but not yet in humans.

Be Wise sidebar

ACTIVE AGING and BRAIN HEALTH

Most experts agree that light to moderate physical activity is one of the best protectors against the loss of both body and brain function. In fact, the ideal recipe for enhanced brain health may be the combination of physical activity, intellectual stimulation, and social interaction, all at the same time.

Alzheimer's

Alzheimer’s is the most common form of dementia. Researchers think that one factor is inflammation of neurons in the brain. Because CBD from cannabis has anti-inflammatory properties, they think it might help to slow down the progress of the disease. Animal studies have shown some success, but there is no conclusive evidence of this in humans.

Cannabis has shown some success in easing the agitation and aggression that can come with dementia. But more studies are needed to confirm this and to identify a therapeutic dose.

There are some very early research studies that show very low doses of cannabidiol (CBD) in healthy people may protect neurons and help maintain their growth in older adults. Although promising, much research still needs to be done.

Mental health

Aging means we continue to change. That means we must continue to adapt. Some older adults have mental health issues such as anxiety and depression. But mental health issues are not necessarily a part of normal aging.

The evidence is mixed about using cannabis to treat mental health issues. Recent studies show some promise, but we need more and larger studies on the effects of cannabis on older people.

Studies show that cannabis can heighten anxiety in people who have certain types of anxiety such as public speaking and social anxiety.

Health professionals do not recommended cannabis to treat depression. Depression is a risk factor that may cause problem cannabis use.

Section: Cannabis side effects and risks

Possible side effects of using cannabis

A side effect or adverse event is any unwanted effect of using a medical product. 

Some short-term side effects reported by older adults include:

dry mouth;
drowsiness;
dizziness;
headache;
cognitive problems such as reduced memory, reduced attention span, slowness to react, poor judgment or problem-solving ability;
impaired co-ordination and balance;
distorted perception;
feeling anxious or an increased heart rate.

Not everyone has unwanted side effects. Choosing a product with both THC and CBD can help lessen the unwanted effects of THC.

Anyone choosing to use therapeutic cannabis has to take an active role in finding the dose that works for them.

Older adults who should NOT use cannabis

Older adults who have mental illness, or a family history of mental health conditions such as depression, anxiety, and psychosis should avoid using cannabis.

Anyone who has a cardiovascular disease or unstable blood pressure should not smoke cannabis. Any type of smoking will worsen heart problems.

Older adults with impaired balance should not use cannabis, because it increases loss of balance.

Older adults who use cannabis may have increased risk of injuries requiring emergency room visits.

Risk of falls

THC is thought to connect with receptors in the body that affect coordination, balance and depth perception. These are all abilities that decline with age. The added changes in balance or gait in cannabis users may increase the risk of falls.

Drowsiness and dizziness, two known side effects of cannabis, can also contribute to instability and falling in older people.

There is very limited research on this topic. Small percentages of older cannabis users report feeling uneasy on their feet.

If you are thinking about using cannabis products, you should take this into account until you see how it affects you.

You should also take this into account whenever you plan to use a cannabis product, so that you can ensure you are safe.

Driving risk

There is no evidence for safe levels of cannabis use for driving. Driving after cannabis consumption is illegal in Canada.

Some effects of cannabis use, such as drowsiness, can last up to 24 hours – well after other effects may have faded.

The time it takes for the effects of cannabis to wear off depends on:

• how much and how often you consumed it
• whether you smoked or ate it.

Addiction risk

Older adults have the same risk for addiction as younger people do.

Addiction is also called ‘substance use disorder’ or ‘dependence’. All of these terms mean that there is “clinically significant impairment or distress.” In other words, your need for the drug has taken over and is causing big problems in your life and relationships.

Older adults who have other substance use disorders, such as alcohol addiction, should avoid cannabis use.

When an older adult is using cannabis, their family, friends, and health care providers should be aware of the common signs and symptoms of cannabis use disorder.

Withdrawal risk

The brain adapts to the presence of cannabinoids. That may lead to dependence. If a person suddenly stops using, they may go through withdrawal. About 15% of older cannabis users have withdrawal symptoms when they stop use. Often, these are prolonged users.

Research on withdrawal in older adults is very limited. The research we have shows that older adults have withdrawal symptoms similar to those of younger adults.

The symptoms can include:

• irritability
• restlessness
• insomnia or interrupted sleep
• anxiety
• loss of appetite. 

It can take a few days and up to four weeks for all withdrawal symptoms to go away.

Risk of overconsumption

Cannabis is often seen as a ‘soft’ drug that causes less or no harm. But cannabis potency has increased over the years. The potency of THC in cannabis can vary. In dried cannabis, it has risen from 3% in the 1980's to about 15% today.

When CBD is taken orally, some reported side effects include dry mouth, low blood pressure, light headedness, drowsiness, and diarrhea. A rare side effect is liver damage. CBD can also interact with some prescription medications.

People who have not used cannabis in many years may be surprised by how much stronger it is now. Older adults who begin to use cannabis in later life may be at risk because they do not have experience with the product.

These factors can lead to overconsumption. It is important to treat cannabis as a drug and learn about concentrations of THC in various products.

Determining a safe dose of products such as salve, oils, and edibles may be challenging. For example, the effect of edible cannabis products are difficult to predict for new users. For the same reason caution is recommended with homemade edibles. There's a risk with homemade edibles the drug is not evenly distributed.

Because the effect may not happen right away, users may take more to achieve the desired effect faster. That causes the risk of overconsuming.

People who have consumed too much cannabis will often report feeling sleepy, anxious, fearful, or nervous. They may report having visions. People will often feel nauseous and may vomit.

If you experience any of these symptoms, stay calm. Often these effects will pass in a few hours.

Risks for lifelong cannabis users

The effect of long-term cannabis use on aging is currently being studied. Older adults who have used cannabis throughout their life may be a high-risk group for cognitive impairment. There is some research to show that life-long users have changes in the brain. These could increase age-related mental decline.

Using cannabis and alcohol

Using alcohol and cannabis (THC) at the same time is likely to result in greater impairment than when using either one alone. THC acts on cannabinoid receptors in the brain, which can lead to cognitive effects and impairments. Alcohol heavily impacts motor skills because of how it influences the central nervous system but can affect cognition as well. When people drink and smoke THC together, alcohol may increase the amount of THC that is absorbed into the body.  This may cause higher THC levels and increased experience of the uncomfortable side effects of THC, increased risk of alcohol poisoning, and higher risk of behaviours like impaired driving.

There is not sufficient research yet on combining alcohol and CBD.  However, alcohol and CBD are both relaxants and so these effects could be stronger and last longer when the two substances are taken together. CBD may be able to reduce the effects of alcohol in the body, but not enough is known. It is also theorized that alcohol can interact with CBD even if you use it within hours of each other. When using both, keep the doses low until you know how you will react to them.

Risks with cannabis use and aging

When a person is deciding whether to use cannabis, education and counselling are important to help them understand its safe use.

Risk assessment is an important part of this process. Aging adds risks for older people, for example, they may have a chronic illness. They may be taking other medication that could put them at risk when using therapeutic cannabis.

Most research into cannabis describes the risks of THC rather than CBD. That is because THC is addictive and psychoactive — it affects the brain and nervous system. Excessive THC use has been linked to increasing depression, anxiety, panic attacks, and worsening symptoms for people who have post-traumatic stress disorder (PTSD) .

Using cannabis may also lead to greater risks for heart disease and stroke. It may lead to increased hardening of the arteries. Older adults with heart conditions are at greater risk. Smoking cannabis can raise blood pressure and heart rate.

This increases the risk of stroke, heart attack, or arrhythmia (irregular heart rhythm) for those who have heart conditions. Cannabis can also lower blood pressure, which can cause people to faint and fall.

Cannabis smoke contains many of the same harmful substances as tobacco smoke. Like smoking cigarettes, smoking cannabis can damage your lungs and can cause bronchitis-like symptoms, like coughing and wheezing. Vaping is thought to be less harmful than smoking, but it is not completely without harm.

Cannabis and its effect on the aging body

We know very little about how the body processes cannabis as we age. There is limited research and it is currently being studied. 

We do know that our bodies change with age

Cannabis may produce effects in older people that are different from younger users. For example, cannabis affects parts of the brain that are involved in learning, memory, and decision making. These same parts of the brain change with age and do not work as well. It is possible that the effects of cannabis could further impair brain function in older adults.

When doctors prescribe any drug, they must think about these factors:

1. The movement of the drug into, through, and out of the body (pharmacodynamics).  This includes the time it takes for the body to absorb it, how much it circulates and has an active effect (bioavailability and distribution), and how quickly it leaves the system (metabolism and excretion).
2. How the drug affects the body (pharmokinetics).

As well, medical professionals must think about the dosage. There are age-related changes in liver and kidney function, body fat, and the digestive system. These changes can impact how effective a medication is, and at what dosage. 

Age-related body changes also affect how quickly the body eliminates cannabis. This may take longer than for a younger adult.

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ACTIVE AGING and AEROBIC FITNESS

Aerobic fitness is a measure of how well your body can move or work for longer than two minutes. To get aerobically fit, you need to practice moving the large muscles, such as those in your legs, trunk, and shoulders. You need to do this continuously for 10 minutes or more at a time, and your total activity should add up to at least 150 minutes (2. hours) per week.
Research clearly shows that this is the minimum amount of moderate to vigorous physical activity we need to stay healthy.

Drug interactions with cannabis

Cannabis can interfere with other prescriptions and over-the-counter medications.

Here are some examples:

Cannabinoid levels can be increased by other medications.
Cannabis can affect the levels of other drugs in the body.  This can have additive effects.
Using cannabis by smoking can increase clearance of other drugs.
Cannabis may influence sedative medications. Increasingly, anaesthesiologists ask patients about their cannabis use before operations because it may affect the amount of sedation required.

Recreational cannabis use and older adults

Today’s older adults are ‘baby boomers’. They had greater exposure to ‘marijuana’ as young people and are more tolerant toward its recreational use than the generations that came before. 

In the current generation of older adults, there are people who are life-long users, people who only used in early life, and new users in later life. We know very little about the effects and risks of cannabis for life-long users.

The THC in cannabis has become much more potent over the years. THC in dried cannabis was on average less than 3% in the 1980's. There are strains that can contain up to 30% THC today.

This is not something that many would have paid attention to when younger. But older adults need to pay closer attention now.

As we get older, changes in our body can affect how cannabis is metabolized and how it will affect you. It may not be the same experience as when you were younger. It may also stay in your system longer.

It’s important to tell your health care provider if you use cannabis, whether your use is medicinal or recreational. It is part of your overall medication profile.

They need to know what and how much you are taking. That means you need to use products that give that information. That way they can assess the danger of interaction with other medications.

If you are starting to use cannabis (or starting again) in later life

Be aware of the amount of THC that is in the cannabis product or strain you plan on using.

Start at the lowest possible level and slowly increase the dose until the desired effect is reached.

Avoid illegal synthetic cannabis such as K2 or Spice. There is a greater risk of bad side effects among older users because of the high potency.

Do not combine cannabis with any other recreational drug, including alcohol. If you have an addiction to alcohol or any other drug, you are at increased risk for cannabis addiction.

Use cannabis in a safe environment. THC is thought to connect with receptors in the body that affect coordination and balance. As we get older, falls become a greater concern.

Do not drive after consuming cannabis, it is illegal in Canada. Impairment can last for up to 24 hours.

Cannabis and age-related change

When younger people use THC recreationally, the concern is the impact on their developing brain. For older adults, the concern is that cannabis affects the same parts of the brain that show age-related changes. We do not know yet if cannabis increases age-related mental decline.

Smoking cannabis can lead to respiratory problems. It can increase heart rate and blood pressure, both risk factors for stroke and heart disease. Smoking anything is harmful to your lungs and can bring the same risks as cigarettes, cigars, pipes, and so on.

Vaping cannabis (inhaling the vapour through an electronic device) is now a popular option. While less harmful than smoking, it is not completely without harm. We do not know what the long-term health effects are of inhaling the substances in vaping products.

If you, or your family, have a history of mental illness or if you have a mental health issue now, avoid using cannabis recreationally.

Section: Talking to your doctor about cannabis

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ACTIVE AGING and AGEISM

Has anyone ever suggested you “take it easy” now that you are older?

Do you feel too old to be physically active?

In Canada we put a lot of value on helping older people once they get sick, but we don’t do much to encourage people to stay healthy.

Research shows elders can benefit more than anyone from being active 30 to 60 minutes every day. Generally, the more you do, the better you will feel. You may reduce your risk of disease by up to 50%. So, be active!

Therapeutic cannabis use and older adults

Therapeutic or medical cannabis use by older adults should be tailored to each person. It should take into account:

• symptoms that need treatment,
• severity of symptom(s),
• other health problems, and
• possible unwanted side effects.

The chart on page 44 is a suggested sequence of questions you may want to ask yourself if you are considering using cannabis for therapeutic reasons.

Page 44

Topic: Why use cannabis
Details: Examples: pain, agitation, weight loss, insomnia, anxiety

Topic: Treatment options
Details: Have you explored other treatment options? Examples: psychological therapy, physical therapy, other medications

Topic: What do you expect
Details:  What does the science say about treating this condition with cannabis? How does that compare to anecdotal information (stories) from other people who have tried it?

Topic: Possible side effects
Details: Examples: 

risk of heart disease or stroke
risk of falling   
mental health issues  
interaction with other medications     
cognitive impairment
driving impairment

Topic: Assess risk
Details: Does the potential improvement in your symptoms and quality of life outweigh the risks?

Topic: Begin use
Details: Start with the lowest possible dose. If you are a new user, think about having someone with you on your first try. Find a safe and comfortable place. Keep a log or journal of your intake and how you feel (see page 50). Involve your family or friends to monitor side effects and assure your safety.

Topic: Evaluate
Details:  Was there a benefit with use?   Were there any side effects?   Did the benefits outweigh the side effects? Should you change the dose? Higher or lower? Should you try a different way of taking it?

Talking with your doctor

Cannabis is being promoted more and more for its health benefits, but many members of the medical community hesitate to prescribe it or may recommend against using it.

That is because there is still so little scientific evidence about the risks and benefits, especially for older adults. The Canadian Medical Association has said that this makes it hard for physicians to give good advice to their patients and to manage doses and side effects.

This requires a frank and open conversation between you and your health care provider. The chart on page 46 may help you organize your thoughts and questions, so you can make a treatment plan together.

If your family doctor does not feel comfortable advising on cannabis use or have training in cannabis prescription, you may choose to go to a cannabis clinic or licenced dispensary. 

But your family doctor still plays an important role. For instance, your family doctor can identify risks for you such as drug interactions. You will need this information when you go elsewhere to get cannabis.

Questions to ask your doctor

Can cannabis work for me?
Are there health impacts or side effects

I should be concerned about?
Will cannabis interact with any medications I am taking? 
Will using cannabis allow me to stop taking other prescription medications?
What is the best or safest method for me to take cannabis, given my health history?
How often should I follow up with you?
Am I at risk for becoming dependent on cannabis? Are there signs to watch out for?

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ACTIVE AGING and HEART HEALTH

The habit of being physically active over many years can help protect against heart disease. Researchers have found that being physically active can lower your resting heart rate, lower your blood pressure, improve your fitness.

Studies show that older men and women who exercise live longer and do not develop heart disease as often as people who do not exercise.

Thirty minutes of moderate exercise on most days of the week is quite easy to manage. The only rule is that your heart has to beat a little faster and make you breathe a little harder. Walking more quickly than normal gives you a good idea of how hard you need to work.

Approved dosing instructions for my health condition

There is very little research on cannabis for older adults, so there are no formal rules for dosing or choosing formulations (ways to take cannabis).

Right now, the best advice on finding out how your body reacts to cannabis is: “Start low and go slow.”  Slowly starting and increasing the dose is called “titration.”

Here is another current guideline — if you are trying for the first time, take your dose in the evening or at night. That helps to limit problems from any side effects. Begin with just one dose a day. This is so that you can assess how long the effects last. You want to avoid double dosing as this might lead to bad side effects.

Please remember: this section is intended for information purposes only. It is not intended to offer medical advice or be interpreted or used as a standard of medical practice.

Guidelines on starting dosages for recreational use

Products with higher THC

A starting dose of THC is 2.5 mg, once per day, but this could start as low as 1.25 mg for older adults, especially people who have no experience with cannabis.

This dose can increase by 1.25 mg to 2.5 mg until you get the desired effect.

Warning: Doses over 25–30 mg of THC a day increase the risk of bad side effects.

Oral THC preparations are usually easier to judge than inhaled products. That is because the producer can be more precise about the concentrations.

If you are using a product that you inhale, like a ‘joint’ (called a "pre-roll"), or a vaping device, the starting dose is 1 inhale of a product with 9% maximum THC once a day. This can be increased to 1 inhale, 4 times a day. Four times a day would result in about half a 'joint' a day or 400 mg. The amount of THC you absorb by inhaling is around 25% of the total THC in a 'joint'. But this absorption is affected by how long you hold your breath after inhaling and how many puffs you take.

Guidelines on starting dosages for therapeutic use

Edible oil products with high CBD and low THC

We know that CBD is generally well tolerated, even at higher doses. The starting dose of CBD is often listed as 5 mg, once a day.

For example, a CBD chewable often equals 5 mg of CBD. A softgel may have 5 mg or 0.25 ml of cannabis oil that contains 20 mg per ml of CBD.

How much you take, and whether you increase the dosage, depends on your condition(s) and health reason for taking CBD.

• With CBD oil, start with a low dose of 0.1 ml of oil (i.e., 2 mg CBD with 1.5 mg/ml of THC or less or none) once a day, and increase slowly if needed. Increase the dose by 0.1 ml every day or every other day until you achieve your desired effect for your symptoms.
• Oil products from licenced producers often include a syringe that you use to measure the oil you are taking. This allows you to increase the dose in 0.1 ml increments if required.
• Once you have found a dose that works for you in an oil product, you will likely not need to increase your dosage. Usually, you will not develop a tolerance to the benefits. That means you will not need to take more and more.

Your personal usage log

Date _________Product _______________Dose _______
Symptoms prior to use _____________________________
Symptoms after use _______________________________
Duration of effect _________________________________

References and resources

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ACTIVE AGING and HEALTHY EATING

Sometimes people assume that falls and injuries, cancer, and chronic diseases such as diabetes and heart disease are a natural part of growing older. But research tells us that these conditions might occur because we are not active enough or are not eating a healthy diet. If we choose to be active and eat a healthy diet, in combination, we can slow down the progress of diabetes, heart diseases and some cancers. They also help to prevent falls and injuries.

Literature Review
www.activeagingcanada.ca/assets/pdf/practitioners/cannabis/Older-Adults-and-Cannabis-Use.pdf

Provincial Territorial Regulations
www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/provinces-territories.html

Government of Canada – Cannabis in Canada: Get the Facts
www.canada.ca/en/services/health/campaigns/cannabis.html

Cannabis – Government of Canada
www.canada.ca/en/health-canada/services/drugs-medication/cannabis.html

Medical Use of Cannabis – Government of Canada
www.canada.ca/en/health-canada/topics/cannabis-for-medical-purposes.html

Canadian Public Health Association – Cannabasics
www.cpha.ca/cannabasics

Cannabis Information for Older Adults – Ottawa Public Health
www.ottawapublichealth.ca/en/public-health-topics/cannabis-information-for-older-adults.aspx

Medical Cannabis and Arthritis – Arthritis Society of Canada
arthritis.ca/support-education/online-learning/medical-cannabis-and-arthritis

Cannabis and the Treatment of Dementia – Alzheimer’s Society of Canada
alzheimer.ca/en/Home/About-dementia/Treatment-options/cannabis-and-treatment-dementia

Cannabis and Your Medications [Infographic] – Canadian Centre for Substance Abuse and Addiction
www.ccsa.ca/cannabis-and-your-medications-infographic

Canadian Coalition For Seniors' Mental Health – list of online resources for cannabis use disorder
ccsmh.ca/cannabis-guidelines/

Canadian Centre on Substance Abuse and Addiction – Cannabis
www.ccsa.ca/cannabis

Cannabis and International Travel
travel.gc.ca/travelling/cannabis-and-international-travel

Cannabis Use Demographics
www150.statcan.gc.ca/n1/daily-quotidien/191030/dq191030a-eng.htm

Cannabis Product Labeling
www.canada.ca/en/health-canada/services/cannabis-regulations-licensed-producers/packaging-labelling-guide-cannabis-products/guide.html

Active Aging
www.activeagingcanada.ca/participants/get-active/healthy-living/active-living-tip-sheets.htm

Cannabis Use and Canadian Adults
www.activeagingcanada.ca/practitioners/resources/cannabis.htm

It's easy to order your copy of Be Wise

To order one free copy of the Be Wise booklet for personal use you can order through our website, call us or use the mail. If you wish more than one copy for an organization, please order through the website.

Online activeagingcanada.ca

Phone 1-800-549-9799

Mail
Active Aging Canada
P.O. Box 143, Stn. Main
Shelburne ON
L9V 3L8

Consultants

Facilitation: Patsy Beattie-Huggan The Quaich
Administration: Tonia Hearst
French Translation: Claire Jobidon
Art Direction:  Ward Maxwell
Clear Language: Sally McBeth Clear Language and Design
Digital Marketing: Kyle McTaggart  Park House Solutions
Web Management: Andrew Wilczynski  New Concept Design
Language Translation: Lilia Zaytseva Universum Translation & Consulting

You have just listened to Be Wise, Cannabis and Older Adults. A publication produced by Active Aging Canada. The audio book was recorded at CNIB Toronto studios. It was narrated by Mark Nicholas Dimeda, and editing, mastering and production was completed by the CNIB Beyond Prints Audio Publishing Team, all rights reserved, 2021.