CBD and the elderly – what you need to know
By Maryanne Damiano-Hojnacki, FNP- BC, MSN ~
Products containing cannabidiol (CBD) have infiltrated the market, including lotions, creams, smoothies, coffee and alcohol. CBD has been touted as a sleep aid, pain remedy and effective treatment for cancer-related side effects. What is CBD and how does it affect you? Is it really a miracle drug or is that just hype?
Like many medicines, CBD is derived from nature, but that does not necessarily make it safe. Aspirin, a product of willow bark, is the classic example of an effective medication produced from a plant, not synthesized in a lab. Even though aspirin has been used for years and is available over-the-counter, it too can cause side effects like heartburn, ulcers, and upset stomach and increased bleed risk.
CBD is marketed as a supplement and not a medication, and as such is not regulated by the Food and Drug Administration (FDA). Consequently, it is difficult to know the purity, safety, or even the quantity of CBD in the product you are taking.
What is CBD:
CBD is an ingredient in marijuana (cannabis), and it can be derived directly from the hemp plant, which is a cousin to the marijuana plant. Marijuana is comprised of over 400 chemicals, of which CBD is one. CBD is a non-psychoactive compound, unlike tetrahydrocannabinol (THC), the active cannabinoid in cannabis that causes a “high.”
The U.S. government’s position on CBD is confusing and depends in part on whether the CBD comes from hemp or marijuana. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it does not enforce laws against it. Also, there is limited research that has been conducted on the chemicals in marijuana. Therefore, it is important to understand that if you try CBD, you are flying blind. And, because of the lack of research for certain conditions, outcomes are purely anecdotal. So, err on the side of caution.
How does it work:
The human body produces certain cannabinoids on its own. It appears as if CBD does not attach to receptors the way THC does. Instead, CBD signals the body to use more of its cannabinoids.
From insomnia to chronic pain, studies suggest that CBD may help patients fall and remain asleep, and lower pain and inflammation due to arthritis. For example, a study presented at PAIN Week 2019, held September 3-7, 2019 in Las Vegas suggested patients using CBD may perceive improvements in pain, sleep, anxiety and depression. This study acknowledges several limitations, so the overarching message is to speak to your medical provider to obtain an individualized risk/benefit analysis before starting CBD oil.
Even though there is limited research on CBD, the strongest evidence for its effectiveness is in treating epilepsy in children. In several studies, CBD was able to reduce the number of seizures and in some cases was able to stop them entirely. Recently, the FDA approved the first-ever cannabis-derived medicine for these conditions.
Things to consider:
As we age, we also develop chronic diseases such as high blood pressure, diabetes, and arthritis. Consequently, older people take more drugs than younger people to manage them. According to merckmanual.com, “Nearly 90% of older adults regularly take at least one prescription drug, and 36% regularly take at least five different prescription drugs.” As we get older, the total amount of water in our body decreases and the amount of fat tissue increases. Drugs that dissolve in fat accumulate more, and drugs that dissolve in water reach higher concentrations because there is less water to dilute them. Because of this, older people are more than twice as vulnerable to the side effects of drugs as those who are young. Side effects are also likely to be more severe.
Side effects of CBD include nausea, fatigue and irritability. It also can increase the level of the blood thinner Coumadin in your blood. If you are on a blood thinner, you may have heard to eliminate grapefruit juice from your diet because of the reaction that occurs between the two. CBD has the same mechanism and can raise the levels of certain medications in your blood the same way. So, if you’re on a blood thinner, you should probably think twice before adding CBD to your regimen.
The jury is still out on the benefits of CBD, and whether it is the snake oil of the 21st century or not.
What we do know is that it has a positive effect on some conditions. And, the more we can study it, the more we will determine what conditions it affects (positive and negative). The bottom line is — we need more research. Without additional research, we can’t determine effective doses, and because it’s available as an unregulated supplement, we can’t tell what you are getting.
If you decide to try CBD, talk with your physician, nurse practitioner or pharmacist. They can tell you how it might affect the other medications you are taking. It is also suggested that you begin with the lowest dosage possible and slowly increase the amount if needed. We highly recommend being cautiously skeptical of claims.
Maryanne Damiano-Hojnacki is a Nurse Practitionernurse at CU Family Clinic at Belleview Point, a University of Colorado College of Nursing nurse-led clinic in Parker. Maryanne holds a MS, MSN, FNP,MSN and presents in the community on a variety of topics that affect the elderly.