Cannabinoids in the Older Person: A Literature Review.

William Beedham,Roisin Coary,David Shipway,Isabel Allison,Magda Sbai

doi:10.3390/geriatrics5010002

Abstract

Introduction: Medical cannabinoids have received significant mainstream media attention in recent times due to an evolving political and clinical landscape. Whilst the efficacy of cannabinoids in the treatment of some childhood epilepsy syndromes is increasingly recognized, medical cannabinoids may also have potential clinical roles in the treatment of older adults. Prescribing restrictions for medical cannabinoids in certain jurisdictions (including the UK) has recently been relaxed. However, few geriatricians have the detailed knowledge or awareness of the potential risks or rewards of utilizing cannabinoids in the older person; even fewer geriatricians have direct experience of using these drugs in their own clinical practice. Older persons are more likely to suffer from medical illness representing potential indications for medical cannabinoids (e.g., pain); equally they may be more vulnerable to any adverse effects. Aim: This narrative literature review aims to provide a brief introduction for the geriatrician to the potential indications, evidence-base, contra-indications and side effects of medical cannabinoids in older people. Methods: A search was conducted of CENTRAL, Medline, Embase, CINAHL and psycINFO, Cochrane and Web of Science databases. Reference lists were hand searched. s and titles were screened, followed by a full text reading of relevant articles. Results: 35 studies were identified as relevant for this narrative review. Conclusions: Cannabinoids demonstrate some efficacy in the treatment of pain and chemotherapy-related nausea; limited data suggest potential benefits in the treatment of spasticity and anxiety. Risks of cannabinoids in older patients appear to be moderate, and their frequency comparable to other analgesic drug classes. However, the quality of research is weak, and few older patients have been enrolled in cannabinoid studies. Dedicated research is needed to determine the efficiency and safety of cannabinoids in older patients.

Highlights

Medical cannabinoids have received significant mainstream media attention in recent times due to an evolving political and clinical landscape
We aim to provide a summary of the current evidence pertaining to the use of medical cannabinoids and any potential risks which must be considered in the older person
There is little evidence to suggest that cannabinoids are effective for bladder dysfunction, pain and spasticity in multiple sclerosis (MS) patients

Summary

Introduction

Medical cannabinoids have received significant mainstream media attention in recent times due to an evolving political and clinical landscape. Medical cannabinoids have received significant attention in recent years, owing to legal changes in the status of the drugs for medicinal use in various European and North American jurisdictions. Few European clinicians have experience in the prescription of medical cannabinoids; this is partly attributable to a lack of experience around indications and side effect profiles In this narrative review, we aim to provide a summary of the current evidence pertaining to the use of medical cannabinoids and any potential risks which must be considered in the older person. The medicinal properties of cannabis have been recognized since at least 1500 BC, when the drug was listed in the ancient Chinese pharmacopeia as a treatment for rheumatic pain [1]. CBD in isolation reduces proinflammatory cytokine release and displays antioxidant properties [2]

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Conclusion