Cannabinoids in the Older Person: A Literature Review
Abstract
:1. Introduction
2. Background
3. Aims
4. Methods
5. Results
6. Potential Indications for Medicinal Cannabinoids in the Older Person
7. Pain
7.1. Smoked Cannabis
7.2. Nabilone
7.3. Dronabinol
7.4. Nabiximols
8. Chemotherapy Related Nausea
9. Spasticity
10. Appetite Stimulation
11. Behavioral Problems in Dementia
12. Anxiety
13. Movement Disorders
14. Potential Hazards of Medical Cannabinoids in Older Adults
14.1. Smoked Cannabis
14.2. Nabilone
14.3. Dronabinol
14.4. Nabiximols
15. Safety and Adverse Effects
16. Medication Interaction
17. Long Term Safety
18. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Author | Year | Study Type | Main Findings |
---|---|---|---|
Minerbi A. [7] | 2019 | Review | Evidence for efficacy is sparse, and considerable adverse effects have been documented on cognitive, cardiovascular and gait function. |
McMaster University [8] | 2019 | RCT protocol | Protocol for a trial that will assess the efficacy of CBD versus a placebo for post-operative pain following knee arthroplasty. |
Van Den Elsen G. [9] | 2019 | RCT | THC had no significant effect on neuropsychiatric symptoms, but was well tolerated by participants. |
Beauchet O. [10] | 2018 | Mini review | Some studies report improved outcomes. However, studies are not focusing on an elderly population, and are of limited quality, making any conclusions difficult to draw. |
Abuhasira R. [11] | 2018 | Prospective study | Therapeutic cannabis is both effective and safe in an elderly population. In particular, its ability to reduce other prescriptions, such as opioids, is advantageous. |
Agornyo P. [12] | 2018 | Survey | Regular cannabis use in older patients resulted in reduced pain, reduced medication side effects and the discontinuation of other pain medications. |
Briscoe [13] | 2018 | Review | The volume of current research is increasing, but there is still insufficient evidence to make robust recommendations. |
Mücke M. [14] | 2018 | Systematic review | The risks of cannabinoid treatments for neuropathic pain appear to outweigh any potential benefits. |
Torres-Moreno M. [15] | 2018 | Systematic Review | Results favored cannabinoids over the placebo. However, there is little evidence to suggest that cannabinoids are effective for bladder dysfunction, pain and spasticity in MS patients. |
Grayson L. [16] | 2018 | Case report | Observed reaction between cannabidiol and warfarin. INR more than doubled. |
Stockings E. [17] | 2018 | Systematic Review | The effectiveness of cannabinoids is minimal for non-cancer pain. Studies show very high NNT for cannabinoids. |
Mahvan T.D. [18] | 2017 | Review | There are considerable risks for elderly patients using cannabis, especially those with comorbidities. |
Katz I. [19] | 2017 | Review | For Parkinson’s Disease (PD), cannabis can be useful as a last resort. For dementia, cannabis can help with behavioral problems. Sleep disturbance and weight loss are also areas of potential benefit from cannabis. |
Bellnier T. [20] | 2017 | Retrospective study | Cannabis led to improved quality of life, reduced pain, reduced opioid use and led to reduced costs. |
Hansra D.M. [21] | 2017 | Survey | Dronabinol led to significant improvements in QoL, appetite and anxiety, amongst cancer patients. |
Schimrigk S. [22] | 2017 | RCT | Dronabinol was non-significantly better at reducing pain in MS patients. However, Dronabinol was associated with much higher rates of adverse events. |
Lim K. [23] | 2017 | Systematic Review | Studies indicate that cannabinoids could potentially benefit anxiety, psychotic symptoms, PTSD and dyskinesia in PD. |
Stampanoni M. [24] | 2017 | Review | The evidence for cannabinoids in PD patients is currently inconclusive. |
Tafelski S. [25] | 2016 | Systematic review of systematic reviews | Cannabinoids should not be recommended for chemotherapy-induced nausea and vomiting, as either a first- or second-line treatment. Anti-emetics are currently superior. |
Ahmed A.I. [26] | 2015 | RCT | THC was well tolerated by elderly participants with dementia. There were more adverse events within the placebo group. Adverse events experienced by THC users were most commonly: dizziness, fatigue and agitation. |
Smith L.A. [27] | 2015 | Systematic review | Cannabinoids may have potential at reducing chemotherapy-induced nausea and vomiting. |
Liu C. [28] | 2015 | Review | Some studies show significant improvement in agitation and aggression in Alzheimer’s Disease (AD) patients, but evidence is insufficient to make robust conclusions. |
van den Elsen G.A. [29] | 2014 | Systematic Review | Studies show that THC may be useful for anorexia and behavioral symptoms in dementia. Adverse symptoms were common in the cannabinoid groups, with sedation being the most frequent. |
Ahmed A.I. [30] | 2014 | RCT | THC was associated with more adverse events than placebo. Increasing the dose of THC increased the frequency of adverse events. |
Lotan I. [31] | 2014 | Open label study | Smoking cannabis significantly improved sleep and reduced pain in PD patients. |
Chagas M.H. [32] | 2014 | RCT | Cannabidiol had no significant impact upon PD symptoms, but showed an improved quality of life (QoL). |
Ahmed A.I. [33] | 2014 | Letter | There is scanty evidence for the safety and effectiveness of cannabis and cannabinoids in the elderly. We also cannot extrapolate results from the studies of younger individuals onto an elderly population. |
Wolff V. [34] | 2013 | Case series | It is highly likely that there is an association between cannabis and stroke. |
Yamaori S. [35] | 2012 | In vitro study | THC and CBD both inhibited CYP2C9 activity. |
Bergamaschi M. [36] | 2011 | RCT | CBD significantly reduced anxiety in participants giving public speeches. |
Patel T. [37] | 2010 | Review | Cannabinoid agonists have been shown to reduce chronic pruritis in patients with atopic dermatitis, lichen simplex, prurigo nodularis, and CKD-related itching. |
Fusar-Poli P. [38] | 2009 | RCT | CBD reduces autonomic responses to fear, whereas THC augments the autonomic response. |
Narang S. [39] | 2008 | RCT | Dronabinol resulted in additional pain relief for individuals already using opioids for noncancer-related chronic pain. |
Strasser F. [40] | 2006 | RCT | THC and cannabis extract were no better than the placebo at increasing appetite or QoL for patients with cancer-related cachexia. |
Sutton L.M. [41] | 2003 | Review | Cannabinoids can be useful for dyspnoea at the end of life. However, there must be caution with these agents due to the psychotropic effect and reflex tachycardia and hypotension. |
Jatoi A. [42] | 2002 | RCT | Megestrol acetate performed better than dronabinol for palliating anorexia in cancer patients. |
Sieradzan F. [43] | 2001 | RCT | Nabilone significantly reduced dyskinesias in PD patients. |
Yeh S. [44] | 1999 | Review | Anecdotal evidence has shown Dronabinol to be effective at increasing appetite in HIV patients and Alzheimer’s patients. |
Volicer L. [45] | 1997 | RCT | Body weight increased more within the dronabinol group than with the placebo. |
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Beedham, W.; Sbai, M.; Allison, I.; Coary, R.; Shipway, D. Cannabinoids in the Older Person: A Literature Review. Geriatrics 2020, 5, 2. https://doi.org/10.3390/geriatrics5010002
Beedham W, Sbai M, Allison I, Coary R, Shipway D. Cannabinoids in the Older Person: A Literature Review. Geriatrics. 2020; 5(1):2. https://doi.org/10.3390/geriatrics5010002
Chicago/Turabian StyleBeedham, William, Magda Sbai, Isabel Allison, Roisin Coary, and David Shipway. 2020. "Cannabinoids in the Older Person: A Literature Review" Geriatrics 5, no. 1: 2. https://doi.org/10.3390/geriatrics5010002
APA StyleBeedham, W., Sbai, M., Allison, I., Coary, R., & Shipway, D. (2020). Cannabinoids in the Older Person: A Literature Review. Geriatrics, 5(1), 2. https://doi.org/10.3390/geriatrics5010002