Federal Law Complicates Medical Marijuana Use in Nursing Homes

While California law now allows adults to possess and use up to an ounce of marijuana, a remaining barrier to elders’ ability to use medical marijuana could be their living situation.  If their living facility   receives federal funding, as many nursing homes do, all marijuana use is illegal under federal law. Photo by GoToVan / CC by 2.0

Carol Stevens, 88, has multiple chronic pulmonary disease and would like to try edible marijuana to help her sleep and improve her flagging appetite. So her daughter, Sandra Atkins, who helps care for Stevens, is trying to track down some pot. Atkins, 65, is planning to call her mother’s primary-care doctor and ask him to prescribe medical marijuana for Stevens, who lives in Claremont.

“The idea of medication that could make her more content and she may even get the munchies and want to eat for a change—I’m interested,” Atkins said. So is Stevens, who tried marijuana at a party when she was in her 40s.

California was the first state to approve marijuana for medical purposes, in 1996. In November, California voters went further and approved a ballot measure—which passed with more than 57 percent of the vote—to decriminalize the recreational use of marijuana for adults age 21 and older. Adults are now allowed to possess and use up to an ounce of marijuana. Recreational sales of marijuana will go into effect January 1, 2018.

Eighty-eight-year-old Carol Stevens, who has a lung disease and suffers from anxiety, is ready to try a new medical treatment: marijuana. Photo courtesy Carol Stevens.

But a remaining barrier to elders’ ability to use medical marijuana could be their living situation, particularly if they live in facilities, such as nursing homes that receive federal funding, as all marijuana use is illegal under federal law.

Even though federal law prohibits marijuana use, California and 25 other states have legalized the drug for either recreational or medicinal purposes, and that has meant that state and local police generally will not cite adults who are using it. The federal agency that enforces marijuana laws was, under the Obama Administration, seen as lenient. It remains to be seen whether the Trump Administration will step up enforcement.

Deborah Pacyna, director of public affairs for the California Association of Health Facilities, which represents 75 percent of nursing homes in the state, is very clear on their policy. Marijuana use by residents is not allowed because the facilities they serve receive federal aid. “What they do in their off hours is their own business,” Pacyna said, “but in a federally-funded facility they have to abide by the rules.”

Facilities that don’t rely on federal dollars have more leeway. The California Assisted Living Association said medical marijuana policies and practices in the 600 assisted living communities it represents can vary widely. Some communities might not allow marijuana at all; others might treat marijuana like any other medication, but only allow it if the resident can self-administer the drug, said Sally Michael, president of the association. She added that any community that allows marijuana use also has to have clear policies on where smoking is allowed and how to store the drug securely.

Prescriptions for Pot

Medical marijuana is used by a wide-range of Californians, according to a 2014 survey by the Public Health Institute that looked at gender, region and age. About 5 percent of adults in California reported ever using marijuana for medical purposes. About 2.2 percent of people over 65 said they’d used the drug. Researchers with the Sacramento-based Institute and the Centers for Disease Control reported that 92 percent of those they interviewed who used marijuana said it helped treat or relieve symptoms of a serious medical condition, including pain, arthritis and cancer.

Medical marijuana has been shown to ameliorate health conditions that disproportionately plague the elderly. A 2010 Canadian study showed that patients who inhaled herbal cannabis three times daily for five days reported a reduction in the intensity of chronic pain and improved sleep. A new study in the peer-reviewed journal Nature Medicine also showed that cannabis can help reverse aging processes in the brain and improve memory. Though preliminary, the results could lead to better treatments for people who suffer from dementia, Alzheimer’s and other degenerative diseases of the aging brain.

Use is not without some risk, because the drug can have negative side effects as well, such as marijuana intoxication. These brain changes include “alterations in short-term memory, sense of time, sensory perception, attention span, problem solving, verbal fluency, reaction time and psychomotor function,” according to a policy report from the California Society of Addiction Medicine. These brain function alterations make driving and operating heavy machinery hazardous when under the influence of marijuana.

Elizabeth A. Landsverk, a gerontologist in the Bay Area, prescribes marijuana to patients if it makes clinical sense.

“It’s not my go-to, but it is one thing in my toolbox,” she said. One of her patients who had lung cancer found that pot lessened the pain of chemotherapy. Another patient’s appetite improved after using marijuana. But Landsverk has taken other patients off the drug because of the negative side effects they experienced, such as confusion or agitation.

Before she writes a prescription, Landsverk first does a complete assessment of which medications are working and which are not. Then, if the patient wants to try marijuana and “it works well, we keep it,” she said.

The Freedom to Choose

Many doctors, however, aren’t willing or knowledgeable enough to prescribe pot. Physicians should be aware of any counter-indications in elderly patients before prescribing the drug, and because many aren’t familiar with marijuana, they don’t want to take the risk.

Lisa Williams, who lives in the Bay Area, said her “straight arrow” 82-year-old mother didn’t like the multiple medications she was on for her debilitating pain. The opioids she took upset her stomach. However, her mother’s primary-care doctor wouldn’t prescribe marijuana, so she and her mother went to an out-of-network doctor and then to a dispensary where they were given educational materials about marijuana in its many forms and a menu of what the dispensary offered. Her mother tried marijuana in a vaporizer and then took home a cannabis chocolate bar.

“She tried it for a couple of months but felt woozy,” Williams said. When her mother was taking marijuana, “she was not of clear mind,” Williams added. “She didn’t like the day to day of being high, and she stopped taking it.” The experience left Williams wishing that her mother had had a full medical consultation that detailed the costs, benefits and side effects of marijuana before trying it.

Atkins wants the same for her mother, Carol Stevens. Stevens and her husband, Jack, 92, live in a private, senior-living facility called the Claremont Manor. There they have the freedom to choose to try pot or not, which Stevens is grateful for.

Jack Stevens, meanwhile, said he’s “not interested in trying marijuana,” for the chronic pain in his hips and knees—at least not yet. “I’d like to see how Carol gets along with it first,” he said.

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