Cannabis poisoning among the elderly has tripled, study finds

TORONTO (CNN) — You might think that young people would be the main group benefiting from the freedom of legalized weed, but in Canada, the biggest increase in users post-legalization has been seen among older adults – and that sometimes sends them to hospital, according to a new study.

The rate of emergency department visits for cannabis poisoning among seniors during the period of legalization of dried cannabis flowers and edible products – from October 2018 to December 2022 – in Canada was significantly higher than in the period before the legalization, according to a published research letter. Monday in JAMA Internal Medicine.

Edible products, which include baked goods, candies and drinks, are increasingly popular, said lead author of the research Dr. Nathan Stall, a geriatrician and clinician-scientist at Sinai Health in Ontario. But some older adults may not be aware of the potency of today’s weed, and little is known about the health effects of legalizing edible cannabis among older adults – the group d he age with the highest growth in overall cannabis consumption one year after the legalization of dried cannabis flower. Canada, Stall said.

“There is an age bias where many health professionals, and frankly society, believe that older people do not use drugs. And that’s not true,” Stall said. “We found that the largest increases in emergency room visits for cannabis poisoning among older adults 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 rates of emergency room visits for cannabis poisoning among seniors during the period before legalization — January 2015 to September 2018 — and two legalization periods: from October 2018 to December 2019, which allowed the sale of dried cannabis flowers only, and from January 2020 to December 2022, which marked the legalization of cannabis edibles.

According to Stall, when people are intoxicated with cannabis, they may experience 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 people with an average age of 69. Nearly 17% of these adults had concurrent alcohol intoxication, approximately 38% had cancer, and 6.5% had dementia. Compared to the period before legalization, legalization period #1 saw twice the rate of emergency room visits for cannabis poisoning. The rate during the second legalization period tripled compared to pre-legalization.

“This study cautions against legalizing substances without adequate research, education, and counseling users regarding adverse effects and safe use, especially among older adults,” said Dr. Lona Mody and Dr. Sharon K. Inouye , who weren’t involved in the research, in a comment on the research.

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

The sneaky effects of edibles

When it comes to explaining the higher rates, intentional and unintentional consumption of edible cannabis is worth discussing, experts say.

“Cannabis edibles can be particularly dangerous because they are often indistinguishable from non-cannabis foods and can contain high amounts of THC (delta-9-tetrahydrocannabinol), the main active ingredient in medical cannabis and recreational,” Mody and Inouye said. .

In his own practice, Stall has observed a common scenario resulting from the lack of distinction: an emergency department doctor is unable to understand why an older adult patient is suffering from neurological disorders using typical tests – only to a toxicological examination. comes back positive for cannabis, much to the patient’s surprise.

“The other thing is that cannabis today is very different than it was in the early ’90s and mid-’80s,” Stall explained. “Today’s cannabis extracts contain up to 30 times more THC. …Older adults who may not have used cannabis in decades and are now trying again in this post-legalization era may not know this.

Additionally, age-related changes in organ function and the way medicine is distributed throughout the body – as well as having medical conditions or taking prescription medications, especially psychoactive medications – can facilitate cannabis intoxication in an elderly person, Stall added. .

Some people who intentionally consume cannabis edibles may not know that this form has a more delayed effect than an inhalation, which goes directly into the bloodstream, he said. Thinking the edible isn’t working, they take another one too soon and end up getting more than they bargained for.

There are also people whose prescription medications to manage pain, insomnia or dementia symptoms are not effective, so they consume edibles for therapeutic purposes but without first consulting a doctor, Stall said .

Reducing the harms of cannabis use

Abstaining from cannabis may be “appropriate” for some people, but “I would hesitate to make a blanket recommendation that no other adult should use it because there are people who will use it even if this recommendation is given. ” Stall said.

Therefore, preventing cannabis-related harm among older adults requires a multi-pronged approach, he added, including storing cannabis edibles in locked locations and in clearly marked packaging.

Products that older adults use intentionally should have dosing information with specific advice for older adults, “recognizing that the amount of medication they may need is much less than in younger populations,” Stall said . “In geriatric medicine, we have a mantra: start small and go slow. This same mantra applies here.

The amount at which cannabis can become toxic can depend on several personal factors, but some studies have indicated that people should wait at least three hours before taking a second dose, Stall said.

Health care providers should also have open, non-judgmental conversations with older adults about cannabis use, its benefits and risks, he added.

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