The concepts of cannabis use in our society are still confusing, as Federal law conflicts with state laws. The majority of states have legalized the use of cannabis for medical use. In recent elections, more are steadily legalizing it for recreational use as well. Federal law still classifies cannabis as a Schedule 1 drug, the same as heroin. States allow its medical use for a variety of conditions that might otherwise be treated with opioids and other drugs. But the legalization of cannabis does not answer the question of how it could help aging adults with dementia-related agitated behaviors.
Some elders with dementia become angry, restless, combative and even violent. People with certain dementias are more likely than others to demonstrate these very difficult behaviors. Families are under serious distress in caring for their loved ones with these behaviors. The aging parent becomes unrecognizable in their actions toward others. Physicians typically use anti-psychotics, tranquilizing, anti-anxiety drugs and other medications in an effort to keep the behavior in check. Anti-psychotics are notoriously overused as reported here:
All of these drugs have interactions with other medications the elder may be taking, as well as significant side effects. Is there any other option?
Medical cannabis research into all potential benefits of its use has been squelched by former Federal public policy for decades. The result is insufficient research data to inform us about cannabis use to help elders with dementia now. No one expects miracles for dementia from cannabis but its potentially calming effects could be very useful for agitated folks. Much of our aging population has chronic pain. We do have good evidence that cannabis is effective in controlling pain, particularly for elders in the last stages of life. But what about agitation and combative conduct in elders with dementia? We just do not have enough studies to reach definitive conclusions.
What we do have is anecdotal evidence, meaning reports from people trying it out, doing small studies or looking at results from their own limited experiences. In our work at AgingParents.com, where we consult with and advise families about their elders, we often hear of difficult dementia-related conduct in the elders. Some families are experimenting with cannabis edibles (no smoking of any product) to help their aging loved ones stop hitting caregivers, getting angry or being ugly in refusing everything offered for care. None of this is focused on recreational use of cannabis. Rather, it is an effort by families and caregivers to help manage what would otherwise be controlled only by heavy drugs such as anti-psychotics. It appears from what they report that cannabis does help control their aging parents’ agitation. They are using it daily, and in combination with very low doses of anti-psychotics.
The problem they all have is that there is no guidance as to how much cannabis to offer the elder to fend off the unpleasant and sometimes dangerous behavior of the elder. They experiment. They start with a few milligrams of the non-psychoactive component of cannabis, CBD, perhaps 10-20mg. If that works some but not enough, they increase it and offer it more than once a day. If that doesn’t work, they sometimes try a combination of CBD with the psychoactive component, THC. Families informally report to us that the combo of CBD with THC appears to work best for them. Essentially, we have no information to help us understand if this is widely applicable or just lucky on the part of those who have tried it out.
It is very frustrating to search all the medical literature, as I have done, and keep seeing no clear conclusions as to how cannabis could, and in what dosages, help control dementia-related agitation. All the reports seem to reach the common conclusion that more research is needed in this area.
Here are my personal takeaways:
- If you live in a state where medical use of cannabis is legal and you have an aging loved one with dementia-related agitation, consider trying out cannabis to help manage the difficult behavior. Ask those in the dispensing field for recommendations as to how much to offer. There is no research data to suggest that anyone has ever died of a cannabis overdose. The same cannot be said of the other medications used to control difficult behavior in elders.
- In some studies, opioid use declined when medical cannabis was available to control chronic pain. The dosages of cannabis to control pain were tracked. Those could serve as some kind of guide though there are significant differences between chronic pain and agitation in dementia.
- Because smoking anything negatively affects the lungs, consider using edible forms of cannabis only. That means candies, like gummies, elixirs, such as drops, or other edibles such as cookies, butters or spreads available to you.
- My take is that heavy use of anti-psychotics and tranquilizing meds “dope up” elders to the point that they are surely easier for caregivers to manage. But the person so treated has no quality of life. If there are less heavy alternatives, please try them. My hope is that continued research will ultimately help us understand how cannabis can help with dementia behaviors and in what amounts. Though there is very little scientific data to go on, it just seems like a kinder way to help an agitated person who can’t control their own behavior due to dementia.
By Carolyn Rosenblatt, RN, Attorney, AgingParents.com
