Cannabis poisoning among elderly persons has increased, according to a research.

 Cannabis poisoning among elderly persons has increased, according to research

Cannabis poisoning among elderly persons has increased, according to research.

One may imagine that young people are the only ones enjoying the freedom of legalized marijuana, but in Canada, the highest increase in users following legalization was among older folks, and it sometimes sent them to the hospital, according to new research.

According to a research letter published Monday in the journal JAMA Internal Medicine, the rate of emergency department visits for cannabis poisoning in older adults increased significantly from October 2018 to December 2022, when dried cannabis flower and edibles were legalized in Canada.

According to senior study author Dr. Nathan Stall, a geriatrician and clinician scientist at Sinai Health in Ontario, edibles such as baked goods, candy, and beverages are becoming increasingly popular.

 However, some older persons may be ignorant of the potency of today's weed, and little is known about the health impacts of legalizing edible cannabis on older adults - the age group with the greatest increase in total cannabis use a year after dried cannabis flower was allowed in Canada, Stall stated.

"There's an age-related bias in which many health care practitioners, and indeed society, believe that older persons do not use medications. "That's not true," Stall responded. "

We found that the largest increases in emergency department visits for cannabis poisoning among seniors occurred after edible cannabis became legal for retail sale in January 2020."

The authors used administrative data from the Ontario Ministry of Health to examine the rates of emergency room visits for cannabis poisoning among older adults during the pre-legalization period (January 2015 to September 2018) and the two legalization periods: October 2018 through December 2019, which allowed only the sale of dried cannabis flower, and January 2020 through December 2022, which legalized cannabis edibles.

According to Stall, cannabis poisoning can include confusion, psychosis (including hallucinations), anxiety or panic attacks, rapid heartbeat, chest pain, nausea, and vomiting.

During the eight-year study period, there were 2,322 emergency room visits for cannabis poisoning among older persons, with an average age of 69. 

Nearly 17% of the adults were also inebriated with alcohol, while 38% had cancer and 6.5% had dementia.

 Compared to pre-legalization, the first legalization era witnessed twice as many emergency department visits for cannabis toxicity.

The rate tripled during the second legalization phase compared to pre-legalization.

"This study provides a cautionary tale of substance legalization without adequate research, education, and counseling of users regarding adverse effects and safe usage, particularly in older adults," said Drs. Lona Mody and Dr. Sharon K. Inouye, who were not involved in the research, in a commentary on the study.

Mody is the Amanda Sanford Hickey Professor of Internal Medicine at the University of Michigan, Ann Arbor. Inouye is a Harvard Medical School professor and the director of the Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research in Boston.

:The subtle effects of food

Experts believe that both incidental and intentional usage of edible cannabis should be included when explaining the higher rates.

"Edible cannabis products may be particularly dangerous because they are often indistinguishable from non-cannabis-containing foods and may contain high amounts of THC (delta-9-tetrahydrocannabinol), the major active ingredient in both medical and recreational cannabis," stated Mody and Inouye.
In his own practice, Stall has observed a common scenario stemming from the absence of differentiation, he said: An emergency room doctor is unable to determine why an older adult patient is neurologically impaired using standard procedures, only for a toxicology check to return positive for cannabis, much to the patient's astonishment.

"The other thing is that cannabis today is very different than cannabis was as recently as the early '90s and mid-'80s," Stall said. Today's cannabis extracts can contain up to 30 times higher THC. Older folks who haven't used cannabis in decades and are trying again in the post-legalization era may be unaware."
Furthermore, age-related changes in organ function and drug distribution throughout the body, as well as having health issues or using prescription medicines, particularly psychoactive ones, can make it simpler for an older adult to become poisoned with cannabis, according to Stall.

 

Some people who purposely take cannabis edibles may be unaware that this form has a longer-lasting effect than an inhalant, which enters the bloodstream right away, he said. Thinking the edible isn't working, they take another one too quickly and end up receiving more than they bargained for.
There are also persons who do not respond to prescription drugs for pain management, insomnia, or dementia symptoms, so they ingest edibles for therapeutic purposes without first contacting a doctor, according to Stall.

Reducing the harm associated with cannabis use:

Although abstaining from cannabis use may be "appropriate" for some people, "I would be hesitant to give a blanket recommendation (that) no other adults should be using this because there are people who will use it even if that recommendation is given," Stall stated.
As a result, minimizing cannabis-related risks in older adults necessitates a multifaceted approach, he continued, which includes storing cannabis edibles in secure areas and in clearly labeled packaging.

Products that older persons intentionally use should include dose information with special instructions for older adults, "recognizing that the amount of drug they may need is a lot less than that of younger populations," Stall said. "In geriatric medicine, we have a mantra: Begin low and progress slowly. "That same mantra applies here."
The extent to which cannabis can become hazardous is dependent on a variety of personal circumstances, but some studies suggest that people should wait at least three hours before taking a second dose, Stall said.
He also suggested that health care clinicians have open and judgment-free conversations with older persons regarding cannabis use, including its advantages and hazards.