Not Your Mama's Cannabis - Understanding the Risks of Modern-Day Cannabis-Webinar Slides

Pdf Summary

This comprehensive guide, authored by Dr. Carrie Hempel-Sanderoff, addresses the risks and considerations of cannabis use in elderly and terminally ill patients, particularly within hospice and palliative care settings. It presents an overview of the evolving U.S. cannabis legal landscape, highlighting 40 states with medical legalization and 24 states allowing adult recreational use, but also notes significant variability in regulations, product availability, and THC limits across jurisdictions. Older adults increasingly use cannabis, with 7% reporting past-month use and rises from 1% to nearly 9% in past-year use over recent years. Common indications include chronic pain, cancer symptoms, sleep disturbances, mood disorders, and appetite loss.<br /><br />The pharmacology of cannabis varies by route—smoking/vaping produces rapid onset but higher cardiovascular and pulmonary risks, edibles have delayed effects but greater overdose risk, and topicals offer local benefits with minimal systemic absorption. Modern cannabis potency (18–23% THC in flower, up to 90% in concentrates) far exceeds historical levels, increasing overdose and adverse event risks, especially in frail elders.<br /><br />Key health risks include neurological effects (dizziness, delirium, falls, cognitive impairment), cardiovascular risks (tachycardia, myocardial infarction, arrhythmias, stroke), pulmonary harms (chronic bronchitis, bullous disease), gastrointestinal issues including cannabinoid hyperemesis syndrome, and heightened risk for psychosis, dementia, and cannabis use disorder (CUD). Cannabis-related emergency visits among older adults have surged dramatically post-legalization.<br /><br />Significant drug interactions with opioids, benzodiazepines, anticholinergics, antipsychotics, and CYP450-metabolized drugs warrant cautious use and monitoring in this population. Synthetic cannabinoids and unregulated hemp-derived products like delta-8 THC pose serious safety concerns due to unpredictable potency and adverse effects.<br /><br />Hospice and palliative physicians should routinely inquire about cannabis use, clarify goals, provide balanced counseling emphasizing both benefits and age-specific risks, and coordinate care with interdisciplinary teams. Slow titration starting with CBD-predominant or low-THC products is recommended, avoiding high-potency concentrates. Harm reduction strategies include avoiding smoking in pulmonary disease, careful storage to prevent accidental ingestion, and monitoring for adverse effects and drug interactions. Shared decision-making and documentation are vital.<br /><br />Overall, the guide calls for clinicians to be knowledgeable about local laws and products, vigilant about cannabis-related harms in elderly and terminally ill patients, and proactive in ensuring safe, informed cannabis use aligned with patient goals.

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Cannabis use patterns