Cannabis use among seniors on the rise – and related emergency department visits

Bob McBride, 80, uses cannabis recreationally and to manage what he calls “age-related pain.”

“I smoke cigarettes sometimes and I use gummies,” said McBride, who is from the Ottawa Valley in southeastern Ontario. The Current Matt Galloway. “I do one or both two or three times a week.”

McBride said he's used cannabis for most of his life, so he knows his limits and how to consume it safely.

“It's fun, it's relaxing, it stimulates conversation and it enhances a lot of the things I do throughout the day,” he said. “I've learned how to use it responsibly and I think it's a user-friendly drug.”

Seniors like McBride are one of the fastest growing age groups using cannabis in Canada. Statistics Canada report According to the survey, more than 400,000 seniors reported using cannabis in the past three months in 2019, up from 40,000 seniors who reported use in 2012. More recent data This suggests that the trend is continuing.

Meanwhile, the number of elderly people taken to emergency rooms Marijuana addiction New research shows that marijuana use has also skyrocketed since legalization, leading some experts to call for more education and improved guidelines for seniors on safe marijuana use.

Dr. Nathan Stoll, a geriatrician at Toronto's Mount Sinai Hospital, recalls a patient in his 80s who showed up to the emergency room.

“This elderly person was exhibiting symptoms consistent with someone very seriously ill, including decreased level of consciousness, hallucinations, high blood pressure and elevated heart rate, nausea and vomiting,” Stoll said.

Stoll said a standard battery of tests revealed no obvious reason for the man's illness, before a toxicology test came back positive, revealing he had marijuana in his system.

“When people think about cannabis addiction or cannabis overdose, I think they think of someone who is floating and euphoric and maybe asking for food. I don't think a lot of people would consider this to be someone who is pretty unwell,” Stoll said.

The culprit was an edible cannabis product that belonged to a family member and that the patient had unknowingly consumed, thinking it was a snack. Stoll remembers her family turning red with embarrassment when they found out what had happened.

“Cannabis edible products are now so socially accepted that they're not necessarily treated as a potentially dangerous substance when ingested by people who don't intend to ingest them,” Stoll said.

'The tip of the iceberg'

The stall is A study published last month A paper investigating cannabis addiction among older adults was published in the peer-reviewed medical journal JAMA Internal Medicine.

The study found that the number of people aged 65 and older visiting emergency departments in Ontario with cannabis poisoning tripled between 2015 and 2022.

The report breaks down the data into three time periods: pre-legalization (January 2015 to September 2018), legalization allowing the sale of only dried cannabis flower (October 2018 to December 2019), and legalization opening up the market to edible cannabis (January 2020 to December 2022).

The study found that emergency room visit rates for cannabis poisoning among older adults rose sharply after the first phase of legalization. Once edible cannabis was legalized, visit rates rose again. (The study did not distinguish between intentional poisoning, such as self-medication, and unintentional poisoning, such as accidental ingestion.)

Overall, the study recorded 2,322 emergency department visits over an eight-year period, a “relatively small number” compared to the roughly 3 million seniors in Ontario, Stoll acknowledged. Relatively low The figure is 7 percent compared to other age groups.

Still, Stoll said the increasing trend is concerning and he believes the emergency room numbers are just “the tip of the iceberg.”

First, he says, some people may be unaware that they have cannabis poisoning and stay home while suffering from symptoms. Second, because edible cannabis was legalized just before the COVID-19 pandemic lockdowns, some people may be discouraged from going to the emergency room.

Higher potency, age factor

The findings come after other studies similarly showed an increase in the number of children hospitalized for accidental cannabis poisoning after marijuana legalization.

A study published in the New England Journal of Medicine in 2022 found that in three provinces – Alberta, British Columbia and Ontario – The number of hospitalized children has doubled Sales of edible cannabis increased in Quebec after it was legalized, compared to Quebec, where the sale of edible cannabis was not permitted at the time of the study.

Like children, seniors can ingest cannabis unintentionally, as in the case of Stoll, the patent holder mentioned above. But even seniors who use cannabis intentionally face certain risks.

Dr. Hans Clark, a pain specialist at Toronto General Hospital who was not involved in the study, says a third of his clinic's patients ask about cannabis for a variety of reasons, including pain management, sleep, anxiety and depression.

Clark, who is also president of the Canadian Cannabinoid Research Association, said some patients who don't respond to pharmaceutical drugs turn to cannabis for a plant-based product.

Some preliminary research suggests therapeutic uses for CBD, a compound found in the cannabis plant that, unlike the better-known THC, doesn't get you high. Inflammatory diseases, including arthritis, anxiety more.

Like Stoll, Clark points out that the increased potency of modern cannabis is a factor in the increased risk of addiction among older adults.

“The marijuana that people were smoking in the '60s and '70s is very different from the cannabis that's available to people today,” Clark said.

When it comes to edible cannabis, Clark says many of the products Canadians favor contain far more of the psychoactive compound THC than the 2.5mg he considers the standard amount.

Another factor is the nature of edible cannabis itself, whose effects take longer to kick in than those of smoking a joint.

“With edible cannabis, the high, or peak, actually starts around three hours in,” Stoll says. When people don't feel anything right away, “they tend to take more doses before the peak effect occurs, a process known as dose stacking.”

Age also plays a role: Slower cannabis metabolism and changes in the fat makeup of older adults mean cannabis stays in the body longer, Stoll said.

Older adults are also more likely to take other prescription drugs, some of which have psychoactive effects, and are more likely to have a higher incidence of cognitive impairment.

“Around 6.5% of people who were taken to the emergency department in our study actually had dementia. [which means] They are more susceptible to falls and sensory problems,” Stoll said.

Two medical experts say the findings show there is still work to be done to reduce the risk of cannabis addiction in older adults.

Stoll said edible cannabis should be stored in a locked place at home and cannabis products should be clearly labelled. Stoll and Clark also called for dosage guidelines for seniors.

Stoll said many people don't think much about seniors like McBride talking openly about their drug use, and he thinks that prevents health care providers from having conversations with seniors about marijuana use.

“Healthcare professionals should have open, non-stigmatizing conversations about cannabis use,” Stoll said.