Cannabis Use Disorder Among Older Adults

Patient Guideline Summary

Publication Date: January 1, 2020

Objective

Objective

This patient summary means to discuss key recommendations from the Canadian Coalition for Seniors Mental Health (CCSMH) for Cannabis (marijuana) Use Disorder Among Older Adults. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Cannabis Use Disorder describes excess use of cannabis leading to adverse consequences.
  • We will use the abbreviation Cannabis Use Disorder " data-src-type="PatientSummary" data-src-id="2015717" data-dest-type="Abbreviation" data-dest-id="2015727">CUD throughout this summary to refer to Cannabis Use Disorder Among Older Adults.
  • The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) lists 11 criteria relevant to the diagnosis of CUD. The more criteria that are met, the more serious the condition.
  • Symptoms include functional impairment, craving, tolerance, withdrawal symptoms, failure to end use of cannabis, use during hazardous activities, reduction of social and recreational activities, and disruption of previous obligations to work, family, or school.
  • This patient summary focuses on managing and reducing CUD.

Assessment

Assessment

  • All patients should be screened for CUD.
  • Diagnosis is based on the number of DSM-5 criteria that are met.
  • Clinician assessment should include:
    • signs and symptoms of cannabis use and withdrawal
    • awareness of cannabis hyperemesis (vomiting)
    • the variable accuracy of some screening tools
    • modes of use, frequency, and dosage of cannabis
    • available support programs
    • the variety of psychosocial approaches available.
  • The clinician should consider using Screening, Brief Intervention, and Referral to Treatment) (SBIRT) approach.
  • Cannabis should be avoided in patients with mental health disorders, problematic substance use, cardiovascular disease, heart arrhythmias, coronary artery disease, unstable blood pressure, or impaired balance.
  • Most medical uses of cannabis are without evidence and officially unapproved.
  • Newer strains of cannabis are much more potent than earlier strains.
  • Synthetic cannabinoids are illegal and can cause serious harm.
  • The elderly are at risk of changes in depth perception risking balance instability and falls, changes in appetite, cognitive impairment, cardiac arrhythmia, anxiety, panic, psychosis, and depression from cannabis use.
  • Cannabis can impair driving for up to 34 hours.
  • The several methods of delivering cannabis have different associated risks that should be included in counseling.
  • Long-term use may cause respiratory symptoms, cognitive changes, and mental deterioration.
  • Cannabis information should be provided verbally and in writing to the elderly and their caregivers to enhance retention.
  • Caregivers should be aware of cannabis symptoms that are similar to age-related drowsiness, dizziness, memory impairment, and falls, and should evaluate their charges for such signs of CUD.

Treatment

Treatment

  • There are currently no validated safe and effective pharmaceutical agents for cannabis treatment.
  • Accredited residential treatment should be considered.

Abbreviations

  • CCSMH: Canadian Coalition For Seniors Mental Health
  • CUD: Cannabis Use Disorder
  • DSM–5: Diagnostic And Statistical Manual Of Mental Disorders
  • SBIRT: Screening, Brief Intervention, And Referral To Treatment

Source Citation

Bertram JR, Porath A, Seitz D, Kalant H, Krishnamoorthy A, Nickerson J, Sidhu A, Smith A, Teed R. Canadian Guidelines on Cannabis Use Disorder Among Older Adults. Can Geriatr J. 2020 Mar 30;23(1):135-142. doi: 10.5770/cgj.23.424. PMID: 32226572; PMCID: PMC7067149.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.