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5 Benefits of Marijuana, Says Dr. Sanjay Gupta

Over the last 10 years, CNN’s Chief Medical Correspondent Dr. Sanjay Gupta has been investigating the effects of smoking marijuana and publically changed his stance on the drug. ” I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis. Instead, I lumped them with the high-visibility malingerers, just looking to get high. I mistakenly believed the Drug Enforcement Agency listed marijuana as a schedule 1 substance because of sound scientific proof. Surely, they must have quality reasoning as to why marijuana is in the category of the most dangerous drugs that have ‘no accepted medicinal use and a high potential for abuse,'” he wrote back in 2013 for CNN.com . Dr. Gupta now believes marijuana offers significant medical benefits and recently did a special report titled WEED 6: Marijuana and Autism where he showed how families are turning to marijuana to help relieve pain and symptoms of certain health conditions. Read on to see his thoughts—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID .

Biased View on Marijuana

In October 2021, Dr. Gupta went on Joe Rogan’s podcast and explained how much of the U.S. data on marijuana was skewed to show the harmful effects and not any benefits. He told Rogan, “If you’re just looking at papers—well, this one [says there’s] potential long harm, this one possible addiction, this one gateway—you know, you’re seeing all those individual studies, but at a broader level, one step upstream, you realize that most of the studies that are getting funded are designed to look for harm. When I saw that, that was the first time I thought, ‘well, why are the studies that are getting out there, why are they all designed to look for harm?” he said. “Then I started looking at other countries, and some really good research out of places like Israel in particular.”

Marijuana and Pain

Dr. Gupta told Rogan on the podcast about a specific study Israel conducted with pain and the use of m arijuana with Raphael Mechoulam, a world renowned scientist known for his research on cannabis. “Now he was the first guy to ever isolate THC and then synthesize it,” Dr. Gupta said. “He’s 91 and he’s been doing this work forever. He may get the Nobel prize before he dies for his work in this. They were talking about the use of cannabis for all sorts of ailments, including refractory seizures in kids. Hmm. And that one really, that really got to me for a couple reasons. One is that I think when you’re trying to do studies on things like pain, it’s hard, it’s a subjective thing. Right. And so you think, how, how do you, how do you really have conclusive proof that this is working the way that you think it is? Someone says their pain is better and that’s important, but how do you measure that a little child who’s having 300 seizures a week and is now not having seizures is a much more specific sort of metric.” 6254a4d1642c605c54bf1cab17d50f1e

Marijuana and Seizures

More research is being done on how marijuana helps with seizures and Dr. Gupta told Rogan, “it seemed to work really well in kids who did not respond to existing seizure drugs, which was kind of amazing to me. And I think I told you when we’ve spoken before that, to me, in some ways that wasn’t just a medical issue at that point, it was a moral issue because nothing worked for these kids. They were thinking about even compounding veterinary medications for them. And these parents are like, you know, in their kitchen sinks, stirring up, you know, cannabis, trying to get the formulation, right. To turn it into an oil or a tincture. They could put it underneath the kid’s tongue and, and it was working. And, you know, I did stories on these kids and they were emblematic of thousands of more kids. These weren’t just anecdotal stories. And that’s when I said, you know, there’s something here, but I gotta tell you, when I wrote the article saying, I changed my mind on this, you know, you hit send at night and then you wake up in the morning and I work at a university, I’m a practicing physician.”

Marijuana and Autism

Dr. Sanjay Gupta explores in WEED 6: Marijuana and Autism how families are turning to cannabis to help relieve the symptoms, and in some cases aggression associated with autism, and believes marijuana is the answer for many people. ” Cannabis is a medicine. Over the last six years, through countless articles and essays, and now five documentary films, my team and I have made that case and we have provided the proof. At times, it can heal when nothing else can. Denying people this substance represents a moral issue just as much as a medical one,” wrote in a 2019 article for CNN.com. “I have always let science and facts lead the way. That isn’t advocacy; that is speaking truth to power. But yes, when you are certain of the evidence and people’s lives depend on it, then shout it from the rooftops, trumpet it loudly in medical conferences and make sure the world knows. If being called an advocate means you took the time to faithfully learn the issues, allowed yourself to change and even admit where you were wrong, then I will proudly own the title and honorably wear the badge.”

Dr. Gupta’s Thoughts on Medical Marijuana

For CNN.com Dr. Gupta wrote, “There’s one thing I can’t stress enough: The core story of cannabis has never required me or anyone else to follow blindly. With medical marijuana, you aren’t asked to sacrifice your objectivity or your skepticism. You too will discover it if you diligently study the evidence from all over the world, spend days in the lab to really understand the cannabis molecules – and visit patients whose lives truly depend on it. The real story of cannabis has always been rooted in facts, not faith. An Israeli agricultural engineer inspects marijuana plants at the BOL (Breath Of Life) Pharma greenhouse in the country’s second-largest medical cannabis plantation, near Kfar Pines in northern Israel, on March 9, 2016. The recreational use of cannabis is illegal in the Jewish state, but for the past 10 years its therapeutic use has not only been permitted but also encouraged. Last year, doctors prescribed the herb to about 25,000 patients suffering from cancer, epilepsy, post-traumatic stress and degenerative diseases. The purpose is not to cure them but to alleviate their symptoms. … For too long, the real story of cannabis was drowned out in those echo chambers. Marijuana was preordained as having ‘no currently accepted medical use and a high potential for abuse’ despite plenty of evidence to the contrary. My team and I wanted you to hear the other side, the voices that had been drowned out by decades of this noise.”

WEED 6: Marijuana and Autism airs on CNN and to protect your life and the lives of others, don’t visit any of these 35 Places You’re Most Likely to Catch COVID.

Heather Newgen has two decades of experience reporting and writing about health, fitness, entertainment and travel. Heather currently freelances for several publications. Read more

Medical Cannabis for Older Patients—Treatment Protocol and Initial Results

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Abstract

Older adults may benefit from cannabis treatment for various symptoms such as chronic pain, sleep difficulties, and others, that are not adequately controlled with evidence-based therapies. However, currently, there is a dearth of evidence about the efficacy and safety of cannabis treatment for these patients. This article aims to present a pragmatic treatment protocol for medical cannabis in older adults. We followed consecutive patients above 65 years of age prospectively who were treated with medical cannabis from April 2017 to October 2018. The outcomes included treatment adherence, global assessment of efficacy and adverse events after six months of treatment. During the study period, 184 patients began cannabis treatment, 63.6% were female, and the mean age was 81.2 ± 7.5 years (median age-82). After six months of treatment, 58.1% were still using cannabis. Of these patients, 33.6% reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Of the respondents, 84.8% reported some degree of improvement in their general condition. Special caution is warranted in older adults due to polypharmacy, pharmacokinetic changes, nervous system impairment, and increased cardiovascular risk. Medical cannabis should still be considered carefully and individually for each patient after a risk-benefit analysis and followed by frequent monitoring for efficacy and adverse events.

1. Introduction

The recent interest and use of medical cannabis (MC) are growing substantially in many countries. The regulations on its use vary among countries, affecting medical practice and experience [1]. Current public opinion is that cannabis has the therapeutic potential to treat and cure a long list of diseases, but there is a large gap between that opinion and the current evidence in the medical literature [2]. Another common opinion is that MC is mainly used by young adults. However, the use of MC by older adults is increasing [3], and studies show variable prevalence, ranging from approximately 7% to more than one-third, depending on the country [4,5]. Recreational use of cannabis by older adults is also increasing substantially, especially in the United States [6].

Relief of suffering and promotion of functional status and quality of life are major goals of geriatric medicine. Chronic pain, Parkinson’s disease, depression, sleeping disorders, and malnutrition are all common among older adults [7,8,9,10,11,12]. Current medical treatments of these syndromes can have serious adverse events, frequently endangering patients’ health. For example, some non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal bleeding, renal impairment, and cardiovascular adverse events [13]. Sedative hypnotics can cause psychomotor impairment, dizziness, confusion, increased risk of falls, next-day somnolence, impairment of driving skills, orthostatic hypotension, and blood electrolyte impairment [14]. Opioid treatment causes constipation, nausea, vomiting, drowsiness, delirium, sedation, anticholinergic effects, falls, and respiratory depression, which is the most serious potential adverse effect [13]. Beyond individual factors, current concerns about opioid-related deaths have greatly influenced our thinking about pain management and medication treatment [15].

1.1. Efficacy and Indications for Medical Cannabis in Older Adults

The geriatric population may benefit from cannabis treatment for a variety of symptoms, such as chronic pain, sleep difficulties, tremor, spasticity, agitation, nausea, vomiting, and reduced appetite. Cannabis may also be useful in palliative care. However, currently, there is a dearth of evidence about the efficacy of cannabis in older adults for any of these symptoms. This has been emphasized in several reviews [16,17,18] and in large reports such as the report of the National Academies of Sciences in the United States [19] and the Information for Health Care Professionals in Canada [20].

1.2. Chronic Pain

Chronic pain is one of the most common indications for prescribing MC. The report by the National Academies of Sciences concludes that cannabis is effective for the treatment of chronic pain in adults [19]. Despite this conclusion and a large number of studies, including randomized controlled trials, the efficacy for cannabis as a chronic pain medication remains in dispute [21]. Pain relief is very often cited as a reason for MC use among older individuals. For example, 89.7% of the older patients in the Colorado MC registry listed pain as their primary or secondary condition [4]. All the large studies that evaluated cannabis for pain have included older adults in the inclusion criteria, but their number was small, or they were not analyzed separately for safety and efficacy [21,22].

1.3. Parkinson’s Disease

Parkinson’s disease (PD) is a common neurodegenerative disease found mostly among older adults, which is caused by dopaminergic neuron loss. It is mainly characterized by motor symptoms that include bradykinesia in combination with resting tremor or rigidity [23]. PD also has a distinct prodromal stage identified by non-motor symptoms, such as olfactory dysfunction, constipation, urinary dysfunction, depression, anxiety, and pain [24]. Two small-scaled randomized controlled trials failed to demonstrate the efficacy of cannabis in treating the motor symptoms of PD [25,26]. However, cannabis might improve quality of life in PD and relieve other non-motor symptoms [27].

1.4. Sleep Difficulties

Approximately 50% of people above age 65 complain about sleeping difficulties, and there is an increase in sleep disturbances in old age [28]. Care must be taken not to mistake geriatric sleep complaints for physiological aging, as these complaints are mainly attributable to medical, psychiatric and health-related burdens [29]. It should be noted that sleep disturbances are among the most frequent complaints of cannabis withdrawal, and are a major cause for continued use after attempts to quit [30]. Both pharmacological and non-pharmacological treatments are used to address sleep disorders among older individuals [31]. A meta-analysis evaluating the therapeutic effect of cannabis on sleeping disturbances has not reached a decisive conclusion. The effects of cannabis on the sleep–wake cycle are also unclear [32], though some research suggests that cannabis might aid in sleep disorders due to its anxiolytic effect [30].

1.5. Nausea and Vomiting

A Cochrane review concluded that “Cannabis-based medications may be useful for treating refractory chemotherapy-induced nausea and vomiting” [33]. A more recent review states that there is low-quality evidence that cannabinoids prevent nausea and vomiting as compared to other agents or a placebo [34]. The only study that addressed this issue in older adults was in 1982, and it found no difference between tetrahydrocannabinol (THC) and prochlorperazine in reducing nausea and vomiting [35].

1.6. Post-Traumatic Stress Disorder (PTSD)

The efficacy of cannabis treatment for PTSD in older individuals was not evaluated thus far in any study. Several studies evaluated the efficacy of cannabis treatment for PTSD in younger adults, but these studies also failed to demonstrate a clear effect of MC treatment for these patients [21].

1.7. Dementia

Dementia is a prevalent condition in older adults causing cognitive decline [36]. Small studies that used Dronabinol, oral synthetic Δ 9 -THC, or an extract of THC from plants, showed it improved neuropsychiatric symptoms, agitation, nocturnal motor activity, sleep duration, and meals consumption in dementia patients, while only a few serious adverse events were observed [37,38,39].

However, a study conducted with Namisol, an oral tablet containing ≥98% natural ∆ 9 -THC, showed it did not reduce neuropsychiatric symptoms, agitation, activities of daily living, or improved quality of life in dementia patients [40].

1.8. Palliative Treatment

A recent systematic review and meta-analysis were unable to make any recommendation about the use of cannabis in palliative care after evaluating studies that included mainly younger adults and a small number of older adults [41].

2. Special Considerations and Precautions

2.1. Pharmacokinetics, Pharmacodynamics, and Drug Interactions

It is well known that aging is associated with substantial changes in pharmacokinetics and pharmacodynamics. For instance, hepatic drug clearance, as well as renal elimination, are both decreased in older adults. Furthermore, aging is associated with increased body fat and decreased lean body mass [42], which increases the volume of distribution for lipophilic drugs, such as cannabis. Two small studies evaluated the pharmacokinetics and pharmacodynamics of older adults who received an oral drug containing pure THC. These phase I and phase II trials included 12 healthy older adults and 10 older adults with dementia, respectively, and found smaller pharmacodynamic effects of THC in both groups, although the pharmacokinetic data showed substantial inter-individual variation [43,44]. Interaction between cannabis products and other drugs is also largely unknown, as the current evidence from human studies is sparse [45]. Concomitant administration of cannabis with other drugs that influence the hepatic CYP family enzymes may greatly alter the metabolism of the cannabinoids [46]. This issue is especially important in the geriatric population, where polypharmacy is common [47].

2.2. Nervous System Impairment

The common adverse effects experienced by patients due to cannabis use include dizziness, euphoria, drowsiness, confusion, and disorientation [16]. These effects are particularly important in the geriatric population, which may have conditions such as dementia, frequent falls, mobility problems, hearing, or vision impairments [48]. The long-term effect of adult cannabis use on cognition is unclear. Two systematic reviews showed evidence that long-term use of cannabis is associated with negative effects on some cognitive functions, but evidence of enduring negative effects was weak [49,50].

2.3. Cardiovascular Risks

The effects of cannabis on cardiovascular diseases are not yet well established. In recent years, however, there has been an increasing number of case series and reports concerning young, healthy recreational cannabis users who suffer from arrhythmias, myocardial infarction, and even sudden cardiac death [51]. Direct causality has not been proven, but the implication is that care must be taken concerning older adults since they have more cardiovascular comorbidities and risk factors.

The acute cardiovascular effects of cannabis, based on studies performed on younger individuals, include an increase in sympathetic activity that causes an increase in heart rate, cardiac output, and myocardial oxygen demand. Tolerance of the effects of cannabis on heart rate develops rather quickly in young people [52].

This article aims to present a novel medical cannabis treatment protocol in older adults and the initial results from its use. The protocol will be presented in the Discussion segment of the manuscript.

3. Methods

3.1. Patients and Methods

Israeli medical cannabis regulations include a number of indications and recommendations for its use [1]. We have adopted the general recommendations to suit the physiological and pathophysiological needs of the elderly. In 2017, NiaMedic established a specialized geriatric clinic to provide MC therapy within a comprehensive geriatric platform. We have followed 184 consecutive patients above 65 years of age prospectively who were treated with MC from April 2017 to October 2018. The patients were followed for at least six months since treatment initiation. The inclusion criteria were age of 65 years and above and any of the following indications for cannabis treatment: chronic cancer pain and non-cancer pain, Parkinson’s disease, sleep disorders, anorexia, post-traumatic stress disorder, spasticity, and palliative treatment. The exclusion criteria were severe cardiovascular diseases, such as heart failure or a recent major myocardial infarction, liver failure, psychotic comorbidities, and those with a history of addictions. The follow-up evaluation includes detailed questioning regarding adverse events, adherence to treatment, and its efficacy.

3.2. The Treatment Protocol

As previously mentioned, the regulations of cannabis and its products vary by country, which affects the clinical experience of physicians. In Israel, cannabis can be prescribed for the following conditions: nausea and vomiting due to chemotherapy treatment, cancer-associated pain; Crohn’s disease, ulcerative colitis; neuropathic pain; AIDS patients with Cachexia; multiple sclerosis, Parkinson’s disease, Tourette syndrome, epilepsy (both adult and pediatric population); palliative treatment; post-traumatic stress disorder [1]. The initially approved dosing is 20 grams of cannabis compound per month (0.6 grams per day), with a cannabis product that contains the lowest concentration of active ingredients, but without limitation to the ratio of the different cannabinoids. The only cannabinoid-based medicine that is approved at the time of this manuscript preparation is Nabiximols, and its use is infrequent. Thus, we provide here our approach that is based on the available literature, data analysis, and our clinical experience with treating older adults with herbal cannabis, which includes the cohort above and previously published data [53]. We offer many recommendations consistent with Minerbi et al. and MacCallum et al. [17,54].

3.3. Ethics

Our study collected all the relevant clinical data as a part of the routine medical practice. Thus, Soroka University Medical Center institutional review board (IRB) Committee approved the protocol and waived the request for informed consent (confirmation number 0036-18-SOR). All clinical investigations were conducted according to the principles expressed in the Declaration of Helsinki.

4. Results

We present here initial data from a cohort of patients who initiated MC therapy between April 2017 and October 2018. Most of our patients, 83.2% (n = 153) were 75 years of age or older, and 63.6% (n = 117) were females. The demographic characteristics, the comorbidities of the patients, and the indications for cannabis treatment are detailed in Table 1 . When we evaluated the patients after six months of MC treatment, we found that 58.1% were still using cannabis, 8.1% discontinued the treatment, 10.9% were lost to follow-up, and 17.9% did not complete six months of treatment by the time of the analysis. Of the 122 patients eligible to respond, 91.8% (n = 112) globally assessed the effect of cannabis on their general condition, with 84.8% of them reporting some degree of improvement ( Figure 1 ). Of the patients who were still treated with cannabis, 33.6% reported adverse events, the most common of which were dizziness (12.1%), sleepiness and fatigue (11.2%), dry mouth (5.6%), and psychoactive sensation (5.6%). Since well-established and evaluated protocols for treatment of older adults with cannabis do not exist, we have developed our own approach based on close follow-up of effects, adverse events, and slow titration.