Anxiety: Evidence is not strong for the use of CBD for anxiety disorders. CBD has demonstrated some benefit for social anxiety disorder and social phobia when patients undergo a simulated public-speaking test. 31,32 However, these trials had small sample sizes and study biases. It is theorized that CBD could be beneficial for anxiety based on its mechanism of action at the serotonin receptor. 31
There are practical concerns regarding CBD use in older adults. The geriatric population may be more susceptible to adverse effects of CBD commonly seen in younger adults, including sedation. CBD is hepatically metabolized, predominantly via CYP2C19 and CYP3A4. 4 Older adults with reduced hepatic function may be more susceptible to adverse effects of CBD.
CBD is FDA-approved for certain types of seizure disorders; for more information, see the manufacturer’s website for Epidiolex (www.epidiolex.com). The following section will focus on the common reasons for off-label CBD use, including pain, sleep disorders, and anxiety, all of which affect older adults.
Adverse Effects and Safety
Pain: An estimated 50 million American adults (20.4%) experience chronic pain, with persons aged 65 years and older constituting 61.2% of those affected. 24 Much of the data on chronic pain (e.g., neuropathic pain, cancer pain, diabetic peripheral neuropathy, fibromyalgia, HIV-associated sensory neuropathy, spasticity associated with multiple sclerosis [MS], and rheumatoid arthritis) involve the use of marijuana and cannabinoids (often THC, combination THC-CBD, or nabiximols [a specific mixture of THC, CBD, other minor cannabinoids, flavonoids, and terpenes]). Formulations used in pain studies range from smoked, oral, or oromucosal spray of THC; synthetic cannabis (nabilone); synthetic THC (dronabinol); and vaporized cannabis, with results suggesting modest reductions in pain and spasticity. 25
CBD has been shown to inhibit hepatic enzymes. 4 In human studies, coadministration of CBD with antiepileptic drugs resulted in increased concentrations of drugs that are substrates of CYP2C9, CYP2C19, and CYP3A4. 35 Given CBD’s known sedative effect, there is also a theoretical concern for additive hypnotic reactions in combination with CNS depressants. TABLE 1 lists potential interactions with CBD.
32%), decreased appetite (16%-22%), diarrhea (9%-20%), and increased liver-function tests (13%). 7 Other side effects are orthostatic hypotension, lightheadedness, and dry mouth. Adverse effects appear to be dose-related. The safety of CBD in the geriatric population has not been fully clarified, and Epidiolex clinical trials did not include patients older than 55 years. 7
In the United States, about two-thirds of states have legislation approving cannabis for recreational use (11 states) and/or medicinal purposes (21 additional states). Seven states mandate pharmacist involvement, such as dispensing activities or consulting to dispensaries. 6 The only FDA-approved (in 2018) CBD product is Epidiolex, which is indicated for treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. 7 The law prohibits the sale of foods or dietary supplements to which CBD has been added; however, a wide variety of products containing CBD are available at retail stores. 8
CBD might be a promising product in the fight against neurodegenerative diseases. A loss of neurons in different parts of the nervous system leads to a corresponding decline in cognitive and motor functions; these conditions, such as Parkinson’s, dementia and stroke, cause the brain and nerves to deteriorate over time. Researchers are actively studying brain receptors to uncover the ways that CBD could help.
There have been few side effects noted in CBD use studies, but they do occur and can include dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. CBD can also interact with other medications, such as blood thinners.
3. Mental Health & Mood-related Disorders
As people age, they experience major changes as a result of getting older. Health usually declines and people are more likely to deal with loss and grief. Additionally, social isolation, depression and loneliness may all play a factor in decreased mental health. CBD has been shown to help with these and other related conditions. CBD may interact with brain receptors that are involved in mood regulation. CBD can promote stress reduction, mindfulness and improvement in cognitive function. This powerful combination can strongly contribute to how the mind perceives its situation while enhancing mood.
Cannabidiol, otherwise known as CBD, is derived from the Cannabis sativa plant, also known as marijuana or hemp. More than 80 chemicals called cannabinoids have been identified in the Cannabis sativa plant. THC, the chemical that causes a “high,” is the active ingredient in marijuana. However, cannabidiol is most often obtained from hemp, and contains just trace amounts
CBD may help alleviate the symptoms of cancer along with the side effects stemming from treatment. In fact, CBD has shown a reduction in tumor growth in animals. It may even help the body absorb medications better or increase their potency.
AR: If a 70 year old woman came into your clinic, would you recommend that she take 40 mg of CBD?
If you’ve been on a sleep aid for many years, and you want to stop taking it and use CBD, I would not recommend that you all of a sudden stop taking the sleep aid and start taking CBD, because your insomnia will get worse. Under the guidance of your physician, you would want to taper in the CBD until you reach a stable dose.
Billionaire Tilman Fertitta To Receive More Than $700 Million In DraftKings Stock After Golden Nugget Online Gaming Acquisition
There is idea that exists that THC is bad and CBD is good, when in actuality, both of these molecules have a very important place in clinical practice. And while THC has received a bad rap, because it is associated with getting high, in actuality, it has more immediate benefits than CBD. With THC there’s a huge misconception that people just use it to get high. But in doses that do not cause you to get high, it can be very beneficial for things such as sleep, pain, nausea, appetite stimulation and muscle spasms.
DS: For someone who wants to access CBD on the open market, that’s absolutely fine – but ideally, they would be doing so under the supervision of their main treating physician.
DS: That’s actually what we’re seeing the most of these days. In Canada, where cannabis has been legalized for recreational use, the greatest increase in our patient population at the clinics are the Baby Boomers and the parents of Baby Boomers who are coming in all the time asking to try that CBD oil.