Kari L. Franson, PharmD, PhD, BCPP, of the University of Colorado Skaggs School of Pharmacy described the evidence for using medical marijuana in older patient populations during a session at the 2015 American Society of Consultant Pharmacists (ASCP) Annual Meeting and Exhibition in Las Vegas, Nevada.
Although many states have approved medical marijuana use for certain conditions, Franson reminded session attendees that “no product out there, pharmacological or otherwise, is without risk.”
Because marijuana is still a Schedule I controlled substance, handling and administering it in a pharmacy or hospital without some degree of approved protocol is considered a federal offense. Therefore, providers should err on the side of caution when dispensing cannabis.
Here is a list of conditions that can be legally treated with cannabis, though both patients and pharmacists should check their individual state regulations to see which conditions are approved in their state:
Twenty-three states allow medical marijuana to be used as a treatment for cancer and cancer-related symptom relief.
Cannabis generally promotes appetite to curb the weight loss that may occur during chemotherapy, and it also acts as an agent to control chemo-related nausea and vomiting.
Dr. Franson said that medical marijuana “always performs poorer than oral megestrol acetate.”
Fifteen states allow providers to treat patients with Crohn’s disease or other gastrointestinal disorders such as inflammatory bowel disease (IBD) with medical marijuana to alleviate pain.
Even the Crohn’s & Colitis Foundation of America Patient Education Committee released a statement in January 2012 that said, “IBD patients have been found to have higher levels of cannabinoid receptors in their colonic tissue. Several small studies have shown that a significant portion of patients with IBD report smoking marijuana to relieve IBD-related syndromes.”
The organization stopped short of endorsing marijuana smoking by IBD patients.
Currently, 22 states allow medical marijuana to be used to treat patients with muscle spasticity issues.
“The slow reaction time associated with marijuana is actually helpful in treating diseases with spasticity issues, like multiple sclerosis,” Dr. Franson explained.
It’s also noteworthy that 24 different states allow the use of medical marijuana to treat patients, primarily children, with epilepsy and seizure disorders.
Most data relate to pediatric refractory epilepsies.
“Nobody is really suggesting we use cannabis for adults having seizures,” Dr. Franson said. “Evidence shows seizure exacerbation after discontinuation.”
Twenty-one states allow medical marijuana to be used for glaucoma, for which it has been a treatment since the 1970s.
Systemic administration of cannabis decreases intraocular pressure by 30%, though Dr. Franson explained that this effect might not last.
“Patients appear to develop a tolerance, but there may still be neuroprotective effects,” she said.
As Jeanette Wick, RPh, MBA, FASCP, previously noted, “In the medical community, however, the general consensus is that conventional therapies for reducing intraocular pressure outperform cannabinoids.”
The American Academy of Opthalmology stated in 2014 that it does not recommend marijuana or other cannabis products for the treatment of glaucoma.
In 1992, the FDA approved the use of dronabinol, a synthetic delta-9- tetrahydrocannabinol, as a treatment for the loss of appetite from HIV/AIDS-related cachexia. Currently, 21 states permit the use of medical marijuana as a cachexia treatment.
Cachexia is common among older adults because it can be linked to bedrest, which many older patients are confined to toward the end of life.
Bedrest decreases cytokine production, which creates a pro-inflammatory state and can lead to cachexia and reduced circulating antibodies.