Deconstructing Stigma: Cannabis and Older Adults
Q+A with researcher Dr. Brian Kaskie
Cannabis may be legal across Canada, but its legality in the United States is still in limbo. Laws vary from state to state, which causes issues in accessing medical cannabis for older adults, including those living with dementia. In addition, researchers in the U.S. are restricted in the studies they can conduct surrounding all topics cannabis-related. But one of these researchers is aiming to change this, and he’s looking to Canada as a model for cannabis legalization and research.
Dr. Brian Kaskie is a faculty member and researcher at the University of Iowa’s College of Public Health. His study, called the Cannabis and Older Persons Study, is examining the motives, patterns and outcomes of increased cannabis use among older adults. The study began in January 2016 and is being conducted in Illinois, as it was one of the first states to legitimize cannabis as a substitute to opioids. Kaskie’s aim is to expand cannabis research so it can be used to change cannabis use policy and stigma while improving life for older adults.
Furthermore, Kaskie is looking to magnify the study nationwide and to cross over to Canada to take advantage of existing opportunities for research following its cannabis legalization in October 2018. He hopes Canada’s example will pave the way for cannabis research — and cannabis itself — to be more accessible to older adults living in the United States.
Kaskie spoke with Dementia Connections about how he became interested in this field of research, the risks and benefits of cannabis use among older adults living with dementia and his opinion on what the future holds for cannabis.
Q: How did you become interested in cannabis and dementia research?
A: I'm interested in the role of public policy and providing support for and protecting the aging population. And so, within that broader scope, I became interested in the role of cannabis in the lives of older adults.
As my team of researchers and I looked more at older adults, the issue of Alzheimer's came up and we noticed a few states had extended eligibility to their medical cannabis program for people with Alzheimer's or their caregivers. We interviewed some of these folks and found about 20 per cent of the caregivers reported that they, or the person with dementia they cared for, were using cannabis. So, use is increasing for older adults and, by and large, they see it as helpful.
Also, when I became interested in this, I was helping to investigate doctors overprescribing opioids and other medications for older persons in nursing homes. That’s when I thought, rather than being laid out on opioids, maybe cannabis could offer them an alternative. Now we're trying to pursue that research further and figure out whether cannabis is beneficial, and for whom.
"Nobody is thinking that marijuana is going to somehow reverse the progression of Alzheimer's and neural decay. Their use of cannabis is about managing agitation, sleep and pain."
– Dr. Brian Kaskie
Q: How do you plan to find these answers?
A: The proposal we're working on is about trying to create classes of people and outcomes experienced. We're proposing to do surveillance of persons with dementia and their caregivers across the country. That will allow us not only to find out what's happening to the individuals but also to distinguish whether people in, for example, South Carolina are having a different experience than people in California because South Carolina doesn't allow for any cannabis.
Q: Has your early research determined why there seems to be an increased use of cannabis among older adults and care partners?
A: Nobody is thinking that marijuana is going to somehow reverse the progression of Alzheimer's and neural decay. Their use of cannabis is about managing agitation, sleep and pain. Being able to manage symptoms improves quality of life not only for individuals living with dementia, but the caregiver.
There are public benefits, too. Cannabis could make it possible to postpone moving into a long-term care home. If fewer people rely on nursing facilities and fewer people go broke at the end of life, that's a good thing.
The other benefit is that cannabis can be a substitute for opioids. Physicians will prescribe opioids because they're FDA-approved. Yet, some physicians were prescribing in a pathway that led to addiction, and that addiction led to harm. If cannabis can get people off that pathway, I don't know why you wouldn't want to consider it.
Q: Are there any risks when it comes to cannabis use among older adults or their care partners?
A: Most users who want pain reduction say it helps, and others say it doesn’t. Then some say it does help but now they have memory problems. But at least 95 out of 100 older persons who use cannabis are either fine, or they don’t have any benefits and stop using it.
I don't see harms that are so tremendous we would want to continue with this outright criminalization. We let people self-determine other things, such as how much education they want or whether they want to bear arms. Why aren’t we letting them determine whether to use cannabis, especially if it’s used to help reduce the behavioural and psychiatric symptoms among people with dementia and to help caregivers?
Q: What are the roadblocks you’re facing in studying cannabis use in the United States, and how do you plan on getting around them?
A: First, the current generation of older adults grew up in an era where [cannabis use] was illegal, so there’s stigma surrounding cannabis. Second, one of the hindrances in doing any sort of good science around this is that at our federal level cannabis remains a narcotic. The studies being done using cannabis are pretty narrow [in terms of] what they can do and how they can do it.
This is why I'm so intrigued about opportunities to work with folks in Canada. Because, one, they have an aging population as well, and this is a salient issue. And two, they’ve legalized it. So, we can do the experimentation that tells us things like when a person is at the end of life, do they have better experiences with cannabis than without?
We just started doing those studies in the U.S., and half of my more established colleagues don't want to touch the subject. They have their statuses to protect, and they don't want the liability of doing research on something that's still illegal.
"Recognize that cannabis is more like coffee than it is opioids."
– Dr. Brian Kaskie
Q: So why are you doing it?
A: I'm not scared. I’ve seen those experiences and what [cannabis] can do. I like how policy intersects with aging, and I like to challenge and deconstruct to figure out a better way. Safe research is great, it'll get you your next grant, but it’s boring.
Q: How do you see the future for cannabis use among older adults?
A: It will continue to boom. Policy, attitudes and need are going to trend upward and drive the use of cannabis. For example, the baby boomers themselves are more tolerant than the generation before, which means stigma is fading.
Medical changes that come with aging make this conversation more salient, especially when there aren't other treatments available that work. We haven't figured out how to manage pain or reduce tremors, so people are going to look to cannabis. And as science progresses, the more we will understand it as a public benefit, and then policy will push it forward.
Q: Before we go, is there anything you want to make sure older adults and care partners know about using cannabis?
A: Just go out and read about it — the starting place is information and education. Recognize that cannabis is more like coffee than it is opioids, meaning the genetic makeup of the plant doesn't have the same structure or the same addictive properties as opioids. And this is key: once you try it, you must also manage your expectations. It's not going to cure your Alzheimer’s or your cancer, but it could help. So, why not?
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