Among the fastest-growing users of marijuana in Colorado are adults, ages 65 and older.

Doctors and public health experts can’t promise older adults that marijuana is safe or effective. Even so, many patients are giving it a try for a range of issues from pain to depression to poor sleep.

“I get 90-year-olds who come in and say, ‘Do you think I should try marijuana? My daughter said I should,’” said Dr. Gretchen Orosz, an internal medicine doctor with a specialty in geriatrics. She practices at the UCHealth Seniors Clinic at the Anschutz Medical Campus.

“It’s surprising how many older adults, who never used marijuana back in the 60s or who smoked a little back in school, are open to using it for medicinal purposes,” Orosz said. “We’re getting more people being open about it and inquiring about it.”

And when they ask, “Is marijuana safe for older adults?” doctors and pharmaceutical experts have few answers.

“It’s a big unknown. We just don’t have studies that support the use,” Orosz said. “We know that THC (tetrahydrocannabinoal) is psychoactive and the aging brain is more vulnerable to psychoactive drugs. So we tell our patients that they have to be very careful when using THC.”

Marijuana use on the rise among Colorado adults – young and old

In 2014, only about 3 percent of older Coloradans reported that they had used marijuana over the previous 30 days, according to the Colorado Department of Public Health and Environment’s annual Behavioral Risk Factor Surveillance Survey.

By 2017, the survey found that use among adults ages 65 and over had nearly doubled to 5.6 percent.

The percentage of older adults who say they’re using marijuana is far lower than comparable figures among young adults. In 2017, about 29 percent of 18-to-25-year-olds reported using weed in the previous month. And use among adults ages 26-to-34 is growing fast. From 2016 to 2017, marijuana use jumped from 19.4 percent to 26.4 percent among 26-to-34-year-olds.

That’s a significant increase, said Mike Van Dyke, Chief of Toxicology for the Colorado Department of Public Health and Environment. He said the annual health survey is also showing increases in Colorado adults who use marijuana on a daily basis.

Since Colorado legalized marijuana for both recreational and medical use, stigma has decreased, and that could be one reason that reports of marijuana use are on the rise.

Like doctors, public health experts also have concerns about safety.

“There are definitely some adverse effects of marijuana and the adverse effects in older adults are under-studied,” Van Dyke said. “We don’t know a lot about how marijuana use might increase risks for falls and balance problems. There are also concerns about people with pre-existing cardiovascular conditions. It just hasn’t been studied enough.

Hardly a ganja grandmother

Arlene Galchinsky, 78, is one of the older people who has given marijuana a try. She’s a patient at the UCHealth Seniors Clinic, and has coped for decades with chronic pain.

Back when she was in her 30s, she had to have back surgery for the first time. Since then, she’s had three more spine surgeries. And for the last 10 years, she had been using an opioid medication and was eager to try an alternative.

“My spine is a train wreck and I have terrible arthritis,” said Galchinsky, who has two grown children and four grandchildren.

“I have a lot of pain and I’m not allowed to take anti-inflammatories (like ibuprofen). I was on Vicodin for a long time, but it stopped working, so my only alternative was marijuana,” she said.

Hardly a ganja grandmother, Galchinsky never smoked marijuana in her youth.

Seeking a medical alternative, she soon found herself in a world that felt totally foreign, and to her, a bit “sleazy.”

“It’s such a mess out there. The whole marijuana situation is ridiculous,” Galchinsky said.

Little advice for older adults in marijuana stores

Her husband, an 80-year old retired judge named Herb Galchinsky, tried to help her navigate the system.  First, they had to pay $90 and find a facility where they could get an application for a medical marijuana card for Arlene and a quick check up by the in-house doctor. Then they headed out to stores that they found both mystifying and perplexing to an older clientele.

In medical marijuana stores, Herb could not go in with his wife where medical marijuana was sold.  Once inside, Arlene found young “budtenders” who knew little about what form of marijuana might help an older woman coping with pain.

“I didn’t get any advice about what I should take. Should I take drops or edibles?  What should I do?  So, I started with the drops, but because of my pain levels, I had to take so much that it would be very expensive and not that effective,” she said.

The first time Galchinsky tried marijuana, she trusted the advice of a young person working in a store that a friend had recommended. The clerk sold her marijuana with equal parts THC, the component that makes people high, and cannabidiol or CBD, the chemical believed to reduce inflammation.

Glachinsky inadvertently did a number on herself.

“I got so high. It was awful. I was having all kinds of hallucinations. My poor husband was freaked out. We got home and it was worse and worse. We called 911. I didn’t know if you could overdose,” Galchinsky said.

Paramedics came right away because Galchinsky also was still taking Vicodin and they were concerned about drug interactions. Fortunately, she was able to sleep off her bad trip and later called her doctor for help.

Avoid marijuana with high levels of THC

Galchinsky sought help from her primary care provider, Dr. Rebecca Boxer.

While UCHealth doctors do not prescribe marijuana, it’s important for them to know if their patients are using it. So, Boxer connected Galchinsky with Danielle Fixen, a pharmacist who works in the Seniors Clinic and is also an assistant professor for the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

As more patients have begun asking about marijuana use, Fixen has had to educate herself on drug interactions and how marijuana might affect older patients. After three years of working with older patients and researching the issue, Fixen’s key advice is that if seniors are going to use marijuana, they should look for forms that contain a higher CBD component, as it does not have psychoactive properties like THC.

That’s what Fixen recommended to Galchinsky. Now, she is no longer taking any Vicodin and she has found some relief by using marijuana occasionally when her back pain flares up.

After extensive research and shopping around, Galchinsky and her husband found an edible that seems to work best for her. It’s a black cherry gummy edible that has a 10-to-1 CBD to THC ratio.

Galchinsky said the edibles can be expensive. She pays about $4 per edible and takes one at a time.

“I only take (marijuana) when I have a lot of pain. It doesn’t work for that long. But it works for a couple of hours and it’s the last thing I can take,” Galchinsky said.

Fixen followed up with Galchinsky regularly to see how she’s doing.

“She’s been absolutely amazing. She called me every four or five days. She is something else,” Galchinsky said of Fixen.

Among patients who are using marijuana, Fixen has found that those who are avoiding high-THC doses seem to be doing well.

“They don’t feel dizzy. They’re not euphoric (like they’re high) and they feel it adequately controlled their pain,” Fixen said.

Survey of older patients: 16 percent using marijuana

Because so many older adults have come to the Seniors Clinic asking about marijuana, Fixen and Orosz teamed up to do a study on marijuana use among patients. Their research is expected to be published later this year in the Journal of the American Geriatrics Society.

The clinic serves patients ages 75 and older.

The women created an anonymous survey and asked patients to fill it out late in 2016 and early in 2017. They found that a relatively large percentage of patients had used marijuana at least once in their lives: one-third of the 345 respondents.

Among their other findings:

• About 16 percent of patients reported that they were current users of marijuana.
• About 16 percent also reported that they had experienced a side effect from marijuana, including loss of balance, dizziness, a “strange feeling,” blurred vision, dry mouth or anxiety. One respondent clearly got high and wrote “I couldn’t even read the newspaper.”
• Patients said they were using marijuana for a variety of reasons including pain and sleep problems, but also for anxiety and depression. Of current users, 64 percent cited pain, while 34 percent said they needed help sleeping, 24 percent cited anxiety, 22 percent were coping with depression and 18 percent said they were boosting their appetite. About 9 percent were using marijuana for Parkinson’s and 7 percent for seizures.
• While medical providers warn that marijuana can cause anxiety and depression, 100 percent of patients using it for anxiety and 92 percent of those seeking help for depression said the marijuana was helpful.
• Of those struggling to sleep, 86 percent said marijuana was helpful. For those with pain, 83 percent said marijuana was helping.
• Those with migraines, Parkinson’s and glaucoma said the marijuana was least helpful.
• The most common form of marijuana that patients used was edibles, the choice of 42 percent of current users, followed closely by smoking and lotions. Nearly 30 percent of respondents said they were smoking marijuana while 27 percent used lotions and fewer than 4 percent were vaping.
• About one-third of those using marijuana reported daily use while 12 percent said they use marijuana at least once a week and 38 percent reported using marijuana once a month or less.
• Among the current users, most were white women in their 70s. (The clinic serves patients who are 75 and older and thus they didn’t survey patients ages 65 to 74.)

Anecdotally, Fixen, Orosz and other providers say more patients are asking about marijuana.

“We have definitely seen an increase,” Fixen said. “I used to get one question about marijuana every one or two months. Now I get about one a week.”

Marijuana can conflict with older drugs older patients use

As for safety, Fixen warns patients about THC.

“THC is definitely addictive,” she said. “I don’t think THC alone is safe for older adults. CBD is a lot safer and has been shown to be effective for young people as an anti-inflammatory for arthritis. It also seems to be effective for some other types of pain.”

Fixen said marijuana can also interfere with blood thinners like Warfarin, also known as Coumadin. And, smoking marijuana can harmful to patients with lung disease.

“I don’t recommend smoking, especially in older adults,” Fixen said.

Older adults, in general, have a slower metabolism and that means that it can take their bodies longer to process and excrete all drugs, including marijuana.

If a patient says they want to use marijuana, Fixen urges them to “start low and go slow,” meaning they should use very little at first and be cautious when trying it.

She said more information and much better studies of marijuana use in older adults would be tremendously helpful.

“We need to acknowledge that people are using it and be open and non-judgmental,” she said.

She also hopes that there will soon be a way to document marijuana use along with other drugs in patients’ medical records. At the moment, providers can only document marijuana use in a patient’s history. Because it doesn’t come up as a drug, conflicts with prescribed medications don’t automatically come up.

Patients are curious as doctors search for answers

Orosz, who teamed up with Fixen to survey patients, has only been in Colorado for a little over two years. Previously, she practiced medicine in Arkansas and prior to that in New York.

She said attitudes among older adults about marijuana use are strikingly different in Colorado than in the South.

“Within my first week, I had a patient who had a lot of nausea from renal failure and he wanted to know if it’s OK to use a foil packet. It was a THC patch. And I thought, ‘Welcome to Colorado.’ I think I have to learn more than my limited knowledge about smoking weed,” Orosz said.

In previous years, doctors had to encourage patients to be honest about their use of non-prescription drugs and herbal remedies.

“I had to pry it out of them. Now, they’re soliciting my opinion,” Orosz said.

When asked, is marijuana safe for older adults, Orosz steers patients to low THC products, but she wishes she had better research to support advice she gives.

“CBD is known to potentially anti-inflammatory properties. But, since marijuana is not federally recognized as legal, getting grant support for research is pretty impossible,” Orosz said. “We don’t know how much is a placebo effect.”

Currently researchers can only study limited forms of marijuana produced at government labs.

“It would be more interesting to study what’s out there and patients are actually using,” Orosz said.

She has some patients suffering from pain who do not want to use opioids.

“They’re afraid of getting addicted. Some had used opioids earlier or relied on them chronically and want to reduce that use. There are not as many patients on opioids as you would see in a younger chronic pain population. We worry about side-effects, so we don’t start out giving opioids,” she said.

In addition, older adults cope with different kinds of pain depending on varying illnesses.

“Cancer pain is different than nerve pain,” Orosz said.

In the past, Orosz’ research has focused more on health literacy and how providers can communicate effectively with older patients. She has no desire to become known as “the pot doc,” she said.

Nonetheless, Orosz, Fixen and others in the Seniors Clinic are considering follow-up research.

“There are some interesting questions. Could we do more in-depth focus groups to get more information on how patients are using marijuana? Our next step is to look at providers in internal medicine to learn what their perspectives about marijuana are, what questions their getting asked and what advice they’re giving to patients,” Orosz said.

Older adults want more information

As for Galchinsky, she uses marijuana sparingly, both because it’s expensive and because she doesn’t want to become reliant on another drug, as she was with Vicodin.

She’s very careful about what she buys because she has no desire to get high again.

“Never. Oh my God. It was very disorienting,” Galchinsky said.

She and her husband both continue to work and love spending time with their family. Along with marijuana, Galchinsky also uses exercise to reduce her back pain.

“I do Pilates, massage and physical therapy. I’ve been doing those things for years,” she said.

Galchinsky thinks both the marijuana industry and government regulators have done a poor job of providing practical, straightforward information that’s helpful to older adults.

She still remembers the first time she went into a marijuana store.

“My heart was pounding. They had no clue how to deal with older people. They’re all young kids. They know about getting people high and they’re happy to talk about it. But they didn’t know how to talk about what I needed. I had to go all over the place,” Galchinsky said.

“I just think there needs to be an instruction booklet for seniors talking about marijuana and how they can go through the process. It’s really hard,” she said.

“We’re at an age where we’re really looking for help.”