At this writing a total of 38 states, three territories and the District of Columbia have legally approved the medical use of marijuana in some form. Colorado is one of them. Medical marijuana (MM) is in wide use by people in their later years. The Harvard Medical School says statistics show that use of cannabis among adults age 65 and older has increased eightfold in recent years, and up to 80% of these seniors are using MM to manage pain. Colorado’s Substance Abuse Trend and Response Task Force in one of its recent reports said trends in marijuana use and/or abuse over an 8-year span as measured by “treatment admissions” needed showed usage having doubled in the 55-64 age group in our state and quadrupled in the age 65+ group. A study reported in early 2023 in the Journal of the American Geriatrics Society identified a dramatic increase from 2005 to 2019 in cannabis-related trips to emergency rooms in California among those age 65 and older, with such ER visits going from 366 in 2005 to over 12,000 in 2019.
This increasing usage has led to at least two key questions: 1) How safe and effective is MM? And 2) Will Medicare eventually cover MM for those enrolled in the program?
Marijuana safety for seniors is unsettled
The safety/effectiveness picture is mixed and can depend in part on who’s doing the evaluating. The director of the Marijuana Investigations for Neuroscientific Discovery (MIND) at Harvard-affiliated McClean Hospital says there’s a lot we simply don’t know, but “pain management is an area where both science and personal anecdotes tend to support its use.”
The National Institute of Medicine (NIM), in a report on the potential therapeutic uses for cannabis, found that scientific data “indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation,” but added that smoking marijuana may deliver “harmful substances.” NIM said studies have also found that marijuana is effective in relieving some of the symptoms of HIV/AIDS, cancer, glaucoma, and multiple sclerosis. The Institute did note that the psychological effects of cannabinoids, such as anxiety reduction and euphoria, can influence their potential therapeutic value and can complicate the interpretation of other aspects of the drug’s effect.
In an exhaustive report titled “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research,” an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine offered nearly 100 conclusions related to the health effects of cannabis and cannabinoid use. Those conclusions can be read at https://nap.nationalacademies.org/resource/24625/Cannabis_committee_conclusions.pdf.
Harvard contends the actual science of MM’s effectiveness is thin, partly due to lack of double-blind, randomized, placebo-controlled studies, which are the gold standard for medical research. They point to the fact that the Academies’ report just mentioned above found “substantial” or “conclusive” proof of MM’s effectiveness for only three health problems: pain relief, multiple sclerosis spasms, and chemotherapy-induced nausea and vomiting.
Best option for Colorado seniors is physician consultation before consuming Medical Marijuana
Because each person’s symptoms and causes can vary from those of others, the most common recommendation regarding use of MM is to consult with your physician. Be sure to discuss potential side effects such as impaired mental function, dizziness, heart and blood pressure problems, falls, and interactions with other medications. Also discuss the pros and cons of how MM will be consumed. It can be smoked, inhaled via vaporized leaves, ingested as edibles, taken as an oil or tincture under the tongue, or applied to the skin as a cream or a patch. A common caution is to be wary of over-the-counter cannabis products because these can have variable ingredients, some of which might be dangerous to certain individuals, and inconsistent levels of THC, the component that produces a high. Such products lack FDA oversight because that agency has not yet developed regulations for them. The Colorado “Cannabis” website discusses both the immediate and long-term health effects of marijuana use at https://cannabis.colorado.gov/health-effects-of-marijuana-use.
How Colorado seniors (and others) access medical marijuana
For those who do seek the opportunity to use MM, the Colorado Medical Marijuana Registry is a confidential, statewide program that allows patients with qualifying debilitating or disabling conditions to receive a registry identification card for legal access to MM. Cards are typically valid for one year, available only to Colorado residents and valid only in Colorado. Only physicians with an MD or a DO are able to recommend MM for debilitating conditions. Such conditions include cancer, glaucoma, HIV or AIDS, cachexia (a disorder that causes extreme weight loss and muscle wasting), persistent muscle spasms, seizures, severe nausea, and severe pain.
MDs, DOs, dentists, and advanced practice practitioners with prescriptive authority are able to recommend MM to treat a disabling medical condition. Here the recommending provider will decide how long the MM registry card will be valid based on the patient’s medical needs. Disabling medical conditions include Post Traumatic Stress Disorder (PTSD), an autism spectrum disorder, or any condition for which a physician could prescribe an opioid.
The Colorado Medical Marijuana Registry is managed by the Colorado Department of Public Health and Environment. More information is available through the registry, including application fees and forms.
What about Medicare coverage for medical marijuana?
Medical marijuana isn’t cheap, so many wonder if and when Medicare might pay for it. The general answer to this question appears to be: Not any time soon. For a number of reasons.
At the federal level, cannabis remains classified as a Schedule I substance under the Controlled Substances Act. Schedule I substances are considered to have a high potential for dependency and no accepted medical use. There is plenty of controversy over whether that description fits MM, but that’s the federal stipulation for now. As long ago as 2009, the Obama Administration urged federal prosecutors not to prosecute people who distribute cannabis for medical purposes if they do so in accordance with state law.
In 2013, the U.S. Department of Justice said it expected states like Colorado to create strong, state-based enforcement efforts and reserved the right to challenge the states if DOJ felt it necessary. Some states passed laws allowing MM only to have them overturned. The DOJ has occasionally issued new guidelines, which sometimes confused the picture. Congress once blocked the District of Columbia from legalizing MM, then reversed that decision. One state, Arizona, passed a ballot initiative, but it was found invalid because it allowed doctors to write a “prescription” for cannabis, and federal law prohibits “prescribing” a Schedule I substance. This is why MM “prescriptions” are more often called “recommendations” or “referrals.”
Obstacles currently block path to paid Medical Marijuana usage
The upshot of all this is that Medicare and most insurers remain in a wait-and-see posture. NerdWallet has quoted Kyle Jaeger, a cannabis policy reporter and editor at the cannabis news site Marijuana Moment as saying that just as banking institutions have been reluctant to offer services to marijuana businesses, Medicare and other insurers are likely to be equally hesitant to cover MM as long as marijuana remains a Schedule I drug under federal law. Insurers also generally rely on the FDA to guide which drugs to cover, and the FDA has not formally approved MM as safe and effective on a general level. (The FDA has approved one cannabis-related product for prescription use but has not approved marketing cannabis more generally for medical treatment.)
Dr. Benjamin Caplan, the chief medical officer at a Boston clinic that provides service to people seeking MM, says a further complication at present is that marijuana is in a “free-market dispensary system,” meaning patients, once they qualify for MM, can pretty much buy whatever product they choose. Which is much different from how health care insurance operates, covering drugs that physicians specifically prescribe. Due to these circumstances, Jaeger of Marijuana Moment predicts we are “many years” from having rulemaking and policies for MM that will satisfy the conditions for which Medicare might provide coverage.
To learn more about the overall picture of marijuana use in Colorado, visit https://cannabis.colorado.gov/. There you will find extensive information on both the rules and policies and also on personal circumstances patients should consider, seniors as well as others, when contemplating use of medical marijuana.