"When it comes to substance abuse disorders, we have those stereotypical images of someone who’s homeless and living under a bridge, not someone’s grandmother or grandfather, sitting at the kitchen table sipping on a cup of tea,” said certified elder law Attorney RJ Connelly III. "But we know that older adults and seniors are using illicit drugs more than ever before. And with the legalization of marijuana, we are also seeing a tremendous increase in its use by this age group. Many think it is just a harmless "high," but we are now finding out that marijuana may carry with it some profound health consequences for older adults."
A 54-year-old Fall River, Massachusetts woman, we'll call Carol, came into counseling after her use of marijuana became a major problem for her. "I work in healthcare," she told me, "And I have no problem at all going to work and I did my job pretty well, at least according to my supervisors. So, I didn't think smoking three or four bowls of marijuana was a big deal when I came home from work." She rationalized her behavior by comparing her use of marijuana to her fellow staff members who went home from work and had "a few glasses of wine to relax."
But the problems started for Carol after her place of work instituted drug testing and a zero-tolerance policy. "I had to quit; I didn't think it would be a problem because I didn't think marijuana was addictive."
After a few days, she began to feel sick. "It started with feeling nauseous followed by severe headaches. Then I started getting dry heaves and mood swings, so bad that my co-workers noticed it, and of course made jokes about menopause. Then my depression, which I struggled with for years, became unbelievably bad, to a point that I even thought about jumping off the Braga Bridge, something that never, ever entered my mind before."
Carolyn went through an intensive treatment program for her marijuana addiction and was referred back to her medical provider for an evaluation of her medications for depression. She hasn't touched marijuana since. "I thought it wasn't a big deal, and I know people who use it without a problem, but it sure didn't do me good."
Is Marijuana Addictive?
Carol believed what many older adults believe - that marijuana is not addictive, and that is usually based on their earlier use of the drug. But despite what some pot peddlers say, marijuana is indeed an addictive substance and addiction treatment providers are increasingly seeing older adults presenting with this disorder.
When we look at the numbers, addiction is much more prevalent among those who start using it at a younger age (about 17 percent develop an addiction) and among those who use the drug daily (estimates range between twenty-five and fifty percent), and overall, among those of all ages who use marijuana, the addiction rate is around 9 percent -- and on the rise.
There are several reasons why addiction rates to marijuana continue their upward trajectory. First, marijuana is now legal in most states, so more people of all ages are using it and abusing it, second, some people have genetic predispositions to addiction, and third, the potency of the drug is much higher than your mother's marijuana of the 1970s and 1980s, which may be the number one cause of increased addiction among users.
In a Business Insider's report, Andy LaFrate, president, and director of research at Colorado potency testing lab Charas Scientific told the Insider that at the American Chemical Society meeting last year that the amount of THC (tetrahydrocannabinol) — the active ingredient in marijuana that's responsible for the high — has tripled in the last 30 years. In the 1980s, he said that marijuana THC levels were well below 10%, while the average today is about 20%, and has even measured up to 30% THC in some especially potent strains.
But interesting enough, according to LaFrate, CBD (cannabidiol) levels — the part that's responsible for marijuana's therapeutic effects — haven't changed over time. He's seen little to no increase in CBD percentages and has tested some samples with CBD levels so low that his machines can't detect it. So, as the THC levels rise (the high), the CBD levels, (the therapeutic portion) have stayed the same or gone down meaning those using marijuana therapeutically rather than recreationally must use more and are getting higher levels of THC, leading to tolerance, addiction, and withdrawal.
A Closer Look at THC
What happens when you smoke marijuana? First, the THC (the high), passes quickly into the bloodstream, which carries it to the brain and other organs throughout the body. If it is in the form of edibles or drinks, it is more slowly absorbed, but regardless of how it enters the body, it ends up on the brain's cannabinoid receptors.
"...the body produces THC-like chemicals as part of the neural communication network called the endocannabinoid system, which plays a significant role in normal brain development."
The receptors occur in the highest density in parts of the brain that influence pleasure, memory, thinking, concentration, sensory and time perception, and coordinated movement. THC over-activates the endocannabinoid system, causing the "high" and other effects that users experience, such as:
Altered perceptions and mood
Difficulty with thinking and problem solving
Disrupted learning and difficulty recollecting memories
Marijuana abuse has also been associated with other mental health problems, such as:
Suicidal thoughts (among adolescents)
Lack of motivation to engage in typically rewarding activities
As a quick aside, I have heard more than a few marijuana legalization advocates say that having cannabinoid receptors in the body is proof that "humans are genetically set up to use marijuana, otherwise, why would they have these receptors?" In truth, the body itself produces THC-like chemicals as part of the neural communication network called the endocannabinoid system, which plays a significant role in normal brain development, which is why these receptors exist.
Marijuana Use and Seniors
Unlike other age groups and quite concerning, marijuana use among seniors has risen precipitously. Dr. Joseph Palamar, associate professor in the Section on Tobacco, Alcohol, and Drug Use in the Department of Population Health at NYU Langone, said, "Marijuana use among seniors is not bouncing up and down like with other drugs. It's a straight line up."
In 2006, only 0.4% of seniors over sixty-five reported using marijuana products in the past year, they said. The newly published study found that by 2015, the number had doubled to 2.4%. By 2018, it had doubled again, with 4.2% of seniors over sixty-five using marijuana.
Palamar's co-author of the study, Dr. Benjamin Han, a geriatrician, addiction medicine physician, and clinician-researcher in the Division of Geriatrics, Gerontology, and Palliative Care in the Department of Medicine at UC San Diego, found that use was highest among women, racial or ethnic minorities, and seniors who were married, college-educated, had mental health issues and had incomes of $20,000 to $49,000 and $75,000 or higher.
According to Han, "I was curious to see if it was people who are sicker, with say, multiple chronic conditions, trying cannabis or is it the healthier people, perhaps with only one health condition? And it appears it's the healthier older people who are trying cannabis more."
"One of the most disturbing findings was an increase in cannabis use among older adults who also use alcohol...in 2015 only 2.9% used both...by 2018, it had jumped to 6.3%."
Han also found some other disturbing findings among this age group. "A startling rise in use was found in seniors over sixty-five with diabetes -- a 180% relative increase over the study period. Unlike cancer or Parkinson's, diabetes is not a disease for which marijuana would typically be considered. I'm not sure why older people with diabetes are increasingly using cannabis."
One of the most disturbing findings, said Han, was an increase in cannabis use among older adults who also use alcohol. In 2015, only 2.9% of seniors reported both alcohol and cannabis use (although the data cannot say if they use simultaneously). By 2018 it had jumped to 6.3%.
Marijuana and the Heart
In a review of medical evidence published in the Journal of the American College of Cardiology, researchers described a broad range of risks to the heart and blood vessels associated with the use of marijuana. The authors, led by Dr. Muthiah Vaduganathan, a cardiologist at Brigham and Women’s Hospital in Boston, pointed out that “marijuana is becoming increasingly potent, and smoking marijuana carries many of the same cardiovascular health hazards as smoking tobacco.”
“Although marijuana is smoked with fewer puffs, larger puff volumes and longer breath holds may yield greater delivery of inhaled elements,” said Dr. Vaduganathan. In other words, when compared to tobacco smoking, exposure to chemicals damaging to the heart and lungs may be even greater from smoking marijuana.
Edible forms of marijuana have also been implicated as a possible cause of heart attacks, especially when high doses of the active ingredient THC are consumed. Regarding smoking marijuana, Dr. Vaduganathan explained in an interview, “The combustion products a tobacco smoker inhales have a remarkably similar toxin profile to marijuana, so the potential lung and heart effects can be comparable. When dealing with patients, we really have to shift our approach to the use of marijuana.”
"...even when tobacco use was considered, marijuana use was associated with twice the hazard of death among those under age 50 who suffered their first heart attack."
Dr. Vaduganathan said he was especially concerned about the increasing number of heart attacks among marijuana users younger than fifty. In a registry of cases created by his colleagues, in young patients suffering a first heart attack, “marijuana smoking was identified as one factor that was more common among them.” The registry revealed that, even when tobacco use was considered, marijuana use was associated with twice the hazard of death among those under age 50 who suffered their first heart attack.
Cannabinoids can also interfere with the beneficial effects of various cardiovascular medications, including statins, warfarin, antiarrhythmic drugs, beta-blockers, and calcium-channel blockers, Dr. Vaduganathan's team noted.
What other effects does marijuana have on the heart? A research team headed by Dr. Carl J. Lavie of the John Ochsner Heart and Vascular Institute in New Orleans, writing in the journal Missouri Medicine, cited case reports of inflammation and clots in the arteries and spasms of the coronary arteries in young adults who smoke marijuana, which could lead to heart attacks in older adults.
"Another damaging effect that has been linked to marijuana is disruption of the heart’s electrical system, causing abnormal heart rhythms like atrial fibrillation that can result in a stroke. In one survey of marijuana smokers, the risk of stroke increased more than threefold."
Another damaging effect that has been linked to marijuana is disruption of the heart’s electrical system, causing abnormal heart rhythms like atrial fibrillation that can result in a stroke. In one survey of marijuana smokers, the risk of stroke increased more than threefold.
These various findings suggest that a person need not have underlying coronary artery disease to experience cardiovascular dysfunction resulting from the use of marijuana. There are receptors for cannabinoids, the active ingredients in marijuana, on heart muscle cells and blood platelets that are involved in precipitating heart attacks.
Researchers also found that in an analysis of thirty-six studies among people who suffered heart attacks, the top three triggers were the use of cocaine, eating a heavy meal, and smoking marijuana. And 28 of 33 systematically analyzed studies linked marijuana use to an increased risk of what is called acute coronary syndromes — a reduction of blood flow to the heart that can cause crushing chest pain, shortness of breath, or a heart attack.
Finally, Sittinun Thangjui, MD, of Bassett Healthcare Network in Cooperstown, New York, released a study that found marijuana users with cardiac arrhythmias are much more likely to die when hospitalized. “People should be aware of this devastating outcome and be careful when using cannabis if they have a concomitant heart problem,” he said.
"This blog does not reflect our view one way or the other on the use of marijuana, rather it is to point out that for older adults and seniors, there are heart-health effects that must be considered if you are going to use it," said Attorney Connelly. "The plethora of research studies that exist on this subject should make any older adult or senior wary about using this substance without consulting with their healthcare provider first."