Seniors left out of cannabis public health information push

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Throughout months of public awareness efforts leading up to the legalization of pot, Canadians have heard a lot about the potential health risks to youth, pregnant women and people who might be prone to mental illness.

But one group that was hungry for information about how cannabis might affect them, but found very little, was Canadians over age 65.

That's an unfortunate oversight, given that "the rates of use among seniors is growing the fastest across the Canadian population," said Fiona Clement, an associate professor of public health policy at the University of Calgary.

"There definitely is a gap between the business strategy and the recognition of the [seniors] market versus the public health messaging," she said.

People who own cannabis shops have told Clement that they are deliberately targeting seniors as a valuable market, she said. On the other side of the coin, many seniors have told her they want to use cannabis responsibly but are "really struggling to get the information" they need address their health concerns.

One of their worries, she said, is how cannabis might interact with prescription drugs they're taking.

"We know almost nothing about this," Clement said, noting it's not uncommon for seniors to take multiple medications for conditions such as high blood pressure, cholesterol or diabetes.

Seniors have also told her that they've raised their concerns with their doctors — but health-care providers also have limited information to draw upon.

"From the point of view of older adults, there's actually very little literature [about cannabis] out there. And what is out there is not of great quality," said Dr. Jennifer Watt, a geriatrician at St. Michael's Hospital in Toronto.  

Watt said she's been getting a lot of questions from her patients and their families about cannabis use — and has researched the limited amount of literature that could help them make informed decisions.  

"I'm ... very careful to say, you know, 'we don't know a lot at this point,'" she said. "I tell them what I can to help them understand the limitations of the evidence we have right now."

The two main types of questions her patients are asking, she said, are about whether she thinks cannabis can help them with issues such as feelings of depression, sleep and pain management, and what side effects they should be aware of.

Because the answers to those questions aren't clear, Watt said, she advises patients who choose to use cannabis to start with a small dose, make sure they are tolerating it well, and then perhaps gradually increase it.  

Some side effects might be obvious, she said, such as a patient becoming more sedated than normal.

But Watt worries about other possible side effects that seniors and their family members might not spot. At this point, there's no way to know if cannabis might hinder the effectiveness of other medications, for example.

"In that case, it really will be up to clinicians to understand the potential interactions and to, you know, be asking patients whether or not they're using cannabis and then to monitor [them]," she said.

Doctors treating seniors will need to look for linkages, Watt said. For example, if a patient's blood pressure has been previously controlled by medication, but goes up once they start taking cannabis, physicians will need to consider the possibility that the two are related.

Other possible side effects of cannabis that Watt is "very concerned" about are confusion and dizziness, which could increase the risk of falling — as falls can be devastating for seniors.

To help seniors manage these risks, it's critical that their doctors know if they're using cannabis or considering using it, Watt said.  

But that's information that patients don't always volunteer, so she and her colleagues at St. Michael's Hospital have changed their routine assessments to specifically ask all geriatric patients about cannabis use.

In the long-term, Watt and the hospital are starting to conduct research on possible safety concerns for older adults using cannabis.

Those kinds of studies will help fill "a huge area of untapped knowledge," Clement said. "There's definitely a need for the research community to respond to this."

But health officials also need to "broaden up the conversation" about cannabis use and offer more information geared to people over age 65, she said.  

"Yes, it's important to think about youth [and cannabis use]. But alongside that, we do need to be thinking about different groups and seniors being a really prominent one."

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