Cannabis for Seniors: No Further Research Needed
From the headline of the recent The Atlantic article, A Tiny, 25-Year-Old Study Still Drives Opinion on Pregnancy and Pot, you might expect to read that a federal government-funded study, designed from the get-go with baked-in bias for digging up harmful effects of cannabis, has been exposed on laughably flimsy grounds for any sort of credible risk claims.
It turns out it’s the opposite: the study has been cited in multiple contexts as evidence that cannabis use can be beneficial for pregnant women and their babies. But a quote in that Atlantic article from Henning Tiemeier, who has run the largest longitudinal study of women, cannabis, and pregnancy outcomes in the world, with a ten-year follow-up of their children, nails it:
“People are opinionated on the basis of very poor facts. Those that say cannabis is safe during pregnancy do not really know. Those that say it is not [safe] do not know either.”
Once again tons of money spent on research, over a decade, and — we’re still sitting here with the fence creasing our butts.
I have run about a dozen different IRB (Institutional Review Board)-approved, randomized, controlled clinical trials of dietary supplements. I am intimately familiar with the spectrum of results you get with even the most carefully circumscribed clinical trial (i.e., not trying to do it all and answer every possible question). Let me tell you, when you’ve done all the work and reached the finish line, and taken a cold, hard look at the combo platter of results, good, bad, and indifferent, along with some that seem to be deliberately mocking some of your most cherished assumptions (save those for later, they could be clues to promising new research avenues), the temptation to engage in data dredging and post-hoc speculation (putting a subtle positive spin on the whole mess) becomes strong.
Journal rankings exist to save everyone time. You can’t read ’em all. The top journals have the best peer reviewers with the keenest noses to sniff out humans’ astonishingly creative ways to justify their biases. Anything to make the job of physician who needs a quick and reliable answer to the question: should I recommend this drug to my patient? Yes, or no?
Should pregnant women consume cannabis? Should pregnant women NOT consume cannabis?
They probably shouldn’t, in my opinion. But as Tiemeier said, we don’t have enough facts. Risk-benefit calculations involve ethics, and in this case involving unborn babies and their mothers, if a single, small, unreplicated study from a quarter century ago is all we have to support the use of cannabis by pregnant women, more research is needed. For that question.
More research is almost always needed.
But that’s not the nectar here in the heart of the flower of knowledge. Let’s dig deeper.
In California, and in many other places with adult-use cannabis laws, if you want to try cannabis for various aging-related ailments, it’s your decision. If you happen to be living in a nursing home, though, you might be out of luck. Because cannabis is still illegal under federal law, nursing home operators risk losing their licences and funding if they are in any way associated with promoting or facilitating access to Schedule I drugs. So most seniors living in retirement homes can’t get their hands on the stuff.
Why is this a problem?
Well, because it could alleviate many minor ailments of aging; it could help some seniors feel more up to leaving their rooms to enjoy some company.
Society should embrace the return of this plant out of the shadows of prohibition, and legislatures should make laws to allow it to happen as soon as possible.
No further research is needed to justify this policy change.
Ah! There it is: an opinion! WTF, “no further research”?
Where are my facts?
Thank you for asking. Let’s look at this rationally.
In the late 1950s, doctors saw high rates of birth defects in babies of mothers who’d taken a morning-sickness drug recently launched by a German company. In 1962 it was withdrawn from the market (and later reintroduced as a cancer treatment), but the thalidomide crisis caused an enduring shift in risk-benefit calculations. The risk of approving a drug that could cause harm came to be seen as more serious than the risk of preventing a potentially beneficial treatment from reaching patients.
A “No” to the proposed innovation might even make the gatekeeper a hero: in 1962, Dr. Kesley, the FDA pharmacologist who had blocked thalidomide from the U.S., received a President’s Award for Distinguished Federal Civilian Service from President Kennedy. In 1995, a German astronomer named an asteroid after her. And in 2010, after she retired at age 90, the FDA named a medal after her — not bad for a Canadian from Cobble Hill, British Columbia.
The problem is that since Dr. Kesley’s honorable “no” in 1962 (and she was right to say no), there has always been more political pressure to disapprove than to approve drugs.
For drugs, this lopsided balance of power was rectified somewhat in the 1990s by AIDS activists. Patients basically told the government: I’m going to die, I’ll take my chances with this experimental drug, thanks. I don’t need your approval.
This is sensitive territory. There are people desperate in the face of imminent agony and death from rare diseases, or diseases with no approved treatments, who are ready to take a chance on something that seems like it might help.
But we’re not talking experimental drugs were, we’re talking cannabis in retirement homes. Is there a better parallel?
The dietary supplement world offers a useful comparison: there, too, you can easily find governmental paternalism.
If, for example, you were to hop on the vitamin D bandwagon (as you should, unless you’re a lifeguard; no, golf doesn’t count, you can’t absorb enough sun from your face and hands for your body to get all the D it needs) and start tossing 2,000 to 10,000 IUs a day down your gullet (depending how much sun you get), you ARE incurring a risk: the risk of wasting money, if all this is later shown to be horse hockey.
If you also happen to be low in magnesium while taking high D, you might have a higher risk of kidney stones or leg cramps. (The smart thing then, in my book, is simply to make sure you’re getting enough magnesium.)
The risks of taking “high-dose” vitamin D (higher than the Institute of Medicine’s recommended 600 IU/day, but no higher than the Council for Responsible Nutrition’s Upper Limit for Supplements for vitamin D of 10,000 IU/day) are minimal or nil. Yet, in its recent review of vitamin D, the IOM not only failed to substantially raise the recommended daily amounts, it actually increased the threshold for deficiency. At one stroke of a bureaucrat’s pen, millions of people — if they just went by the IOM’s recommendation — were to be told they no longer needed to supplement with vitamin D, because they were no longer deficient. That meant that they, too, were incurring a possible risk, with a higher chance of certain kinds of cancer and bone fractures.
I say nuts to that. That recommendation was a government body’s policy recommendation, not a scientifically-proven fact.
One of my favorite scientific journals in the whole wide world is Behavioral Brain Sciences, with its famous Open Peer Commentary. Someone starts by taking a given position in a fully-referenced, cogently-argued paper. Then 20 or 25 other people toss bricks at the argument. The author then responds. It makes the constantly evolving nature of knowledge in science really come to life. “Why can’t we just get along?” In science there are reasonable differences of opinion. No one gets to say, “You’re right, and you’re wrong.” The idea is that it all comes out in the wash, in time.
How long, though? If you wait for definitive answers in this field, you’ll die still uncertain.
If you want to dive deep (and in science, if you want to advance the state of knowledge, you must be comprehensive in your review of previous work in the field) to come up with an informed opinion of cannabis and its risk-benefit trade-offs, you’d have to read and evaluate over four thousand papers. Yes, more research is needed.
If you’re a government regulator, it might be your job to say “it depends, more research is needed,” when faced with claims that cannabis can help seniors enjoy life more.
The top scientists in the world know a lot about cannabis, and know what they don’t know. More research, faster, please! You can sense a delirious pent-up hunger, a joyful hunger to know, to design and carry out scientific research that will translate as soon as possible to real benefits for real people. Because for decades in most of the world research on cannabis was severely restricted and practically impossible (in the US this might soon change).
One of the exceptions is “the homeland of cannabis research”, Israel, which today has a medical system tightly integrated with cannabis research.
In the U.S., where the medical system is clearly not integrated with cannabis, some companies have sprung up to attempt to connect the dots between the little islands of research — little islands of rationality — and individual seniors who might benefit from cannabis.
A model pioneered by Dan Reingold, CEO of Hebrew Home in Riverdale, NY, is one worthy of emulation. That model shows you don’t need research. What you need first, is to design and institute appropriate policies and procedures. Simple.
Now that cannabis is being used more openly by more people, the secret is out. Cannabis has not zonked us all out. While there is an avalanche of confusing new products in the dispensaries, time and again, if you ask and listen, you will hear tales of cannabis providing mild or immense relief from some debilitating condition for the elderly.
Old people, and the ones who care for them and love them, should be able to make up their own minds about the potential use of cannabis to make old age more human. Right now. No more research is needed to have that be a reality.
More research is always welcome, but because of the economics of clinical trials, insisting on a drug model of gatekeeping before we allow seniors and their loved ones to make up their own minds will stack the deck towards Big Pharma who have the deep pockets to fund such research. There’s nothing wrong with Big Pharma versions of cannabis, in fact great things might be coming down the pike soon in that regard.
There is high value to taking care of our old people. Acknowledging the sovereignty of senior home residents and their loved ones does not mean that cannabis use, as a plant, not a medical drug, should take place without any medical oversight. There are obvious ethical imperatives and standards of care that would preclude allowing some residents cannabis because it would stand a good chance of bringing them harm rather than relief. But here, given the slowly-spreading professional openness to the therapeutic and life-enhancing potential of cannabis and the lingering stigma, someone would need to sit down and explore candidly the degree of informed medical judgment behind such a doctor’s “No”. And, if it’s simply based on ignorance, perhaps offer a couple of key papers? If approached with a respectful, humble attitude, out of a place to seeks to understand, not convince, many health care professionals will welcome new information.
We don’t need more research to confidently change policy and allow seniors unfettered access to cannabis just like any other adult in adult-use states.
More than just tolerate cannabis, retirement home operators could choose to love it, and get cracking on shaping those policies and procedures to allow its potential to unfold into actual human benefits in their domains in a reasonable way. All evidence strongly suggests that it would, at least moderately and in many cases dramatically, improve seniors’ health span and enjoyment of life.
They could be having more orgasms, falling in love, playing chess with a friend at four in the afternoon rather than sitting alone staring at a television in their room.
In short, they could be more human.