Medical Marijuana Use in Older Adults

Symptom management in older adults, including pain and distressing non‐pain symptoms, can be challenging. Medications can cause side effects that worsen quality of life or create other symptoms, and polypharmacy itself can be detrimental in older adults. Cannabinoids may offer a way of managing selected symptoms with fewer side effects. Medical marijuana is an important area of study for older adults because of the side effects of other medications. It is also important for Baby Boomers, who are likely to have more experience with marijuana than older adults of previous generations. Therefore, geriatricians should understand medical marijuana's clinical indications, adverse effects, and legal context. This article reviews the evidence regarding indications for and risks of medical marijuana use in older adults.     

Medical Implications of Marijuana Use

The effect of marijuana smoking was studied in 28 healthy young adult men who had previously smoked marijuana for approximately 5 years each. The subjects were hospitalized on a closed research ward for 31 days during which comprehensive psychological, physiological, and medical observations and tests were done. Physical examinations, neurological examinations, chest X-rays, electrocardiograms, and clinical laboratory tests were all within normal limits. Marijuana produced inconstant changes in pulse rate and blood pressure in these studies. Six subjects were found to have significant reduction in resting vital capacity during the baseline period of the study which were felt to be related to their prior marijuana smoking. In contradistinction to these findings, 12 of 15 subjects had statistically significant increases in peak expiratory flow rate immediately following marijuana smoking. Body temperature tended to be slightly reduced during marijuana use.     

Vietnam Military Service and Marijuana Use

The effect of military service in Vietnam on drug use among veterans is examined on the basis of data obtained from a nationwide random sample of 2,510 young men. It is generally believed that illicit drug use was more extensive in Vietnam in the 1970s than in earlier years of the conflict. Therefore variables were constructed to reflect location of service (United States; overseas, but not Vietnam; and Vietnam) and the time of service (before 1970; 1970 or later). The results of the analysis indicate that: (1) military service in Vietnam had no significant effect on marijuana use while on active duty, (2) service in 1970 or later had a significant positive effect on during service use while in the service, and (3) location of military service and time of service had a signficant interactive effect on rates of marijuana use after discharge from military service. The interaction of service in Vietnam and military service after 1970 has the strongest effect on the veteran's marijuana use in civilian life.     

Factors Associated with Undergraduate Marijuana Use in Cork

To examine cigarette, alcohol and drug use among undergraduates in University College, Cork a preceded questionnaire was mailed to 1 in 7 (458) students, chosen systematically. The response rate was 97 per cent. Twenty-three per cent of males and 13 per cent of females have taken marijuana at least once. Student use of marijuana was significantly related to leisure money available, belief in a God, frequency of attendance at religious services, attitudes to marriage partner drinking and to misdemeanour considered most serious. It appears that peer group pressures as illustrated by friends' drug taking, siblings' drug taking, encouragement by friends to take drugs and faculty, had a greater influence on student marijuana use than family related factors. Current cigarette use, pattern of drinking behaviour, use of other drugs and attitude to future marijuana use also had significant associations with marijuana-related behaviour.     

Complete Heart Block From Chronic Marijuana Use

Marijuana is the most commonly used illicit drug in the world. Over the last decade, the potency of marijuana has increased tremendously. Its use is associated with harmful health consequences including adverse cardiovascular effects, such as arrhythmias, myocardial infarction, cardiomyopathy and stroke. It has been reported to cause bradycardia. This report describes the case of a 51-year-old female with no significant past medical history who presented with complete heart block due to chronic marijuana use, requiring a permanent pacemaker. To our knowledge, this is the first reported case of complete heart block due to chronic marijuana use. Advanced conduction system abnormalities can be a potential complication of chronic marijuana use, which the physicians need to be aware of. With increasing push for medical marijuana, physicians are likely to encounter more of such cases.     

Adverse Reactions and Recurrences from Marijuana Use

Two large representative samples of high school students were examined for their frequency of adverse reactions to marijuana and frequency of recurrences of marijuana effects in a non-drug state. Both adverse reactions and recurrences were found to be higher than might be expected in non-clinical populations. Upward of 1 in 5 students had experienced “anxiety, confusion or other unpleasant effects” on marijuana, and upward of 1 in 7 students had experienced a recurrence of marijuana effects while not using the drug. Evidence was presented that reports of recurrences were not limited to cases of multiple drug use but occurred among marijuana users who had not used other hallucinogenic drugs.     

Values associated with Marijuana Use among College Students

Responses to questions about marijuana use and to the Rokeach Value Survey were obtained from 54 male and 69 female undergraduates. Heavy users valued broadmindedness and imaginativeness more, and obedience less than did nonusers and light users. Nonusers ranked family security higher than did light users and heavy users, and heavy users considered freedom more important than did nonusers. Sex differences suggested conventional sex-role identifications plus a female preoccupation with equality. Marijuana use × sex interactions occured with two inter-personal values. In these cases, men seemed to mellow, and the women to harden with marijuana use. No differences in value hierarchies were found between those who stopped using the drug and those who had never used it. Also, no differences were found, when use level was controlled for, between the value hierarchies of those who slopped using marijuana and those who continued to use it. The findings are discussed and future research directions are suggested.     

Marijuana Use and Renal Function Among US Adults

Background

In recent years, the number of states that have legalized medical marijuana or retail sales has increased, bringing potential changes of marijuana use pattern among the general population. However, health effects of acute and chronic marijuana use on many relevant health outcomes, including renal function, remain largely unexamined. In this study, we aimed to assess the association between recent and past marijuana use and renal function.

Marijuana Use among Young Women in a Primary Care Setting

OBJECTIVE To evaluate the prevalence of marijuana use among young women, ages 18–24, within a primary care setting. DESIGN From 2/05 to 12/05, women completed a brief, anonymous self-report screening instrument in two urban primary care clinics for potential participation in a randomized controlled trial of an intervention to reduce marijuana use and sexual risk-taking behavior. During the last few months of recruitment, women who completed the screening instrument were also asked to provide a urine sample to test for the presence of marijuana and other drugs. RESULTS Of the 607 women who completed the screening instrument, 38.6% reported lifetime marijuana use, 8.4% used marijuana at least monthly, and 1.7% reported using marijuana daily. Within this ethnically diverse sample (45% Hispanic), women who used marijuana at least monthly were more likely to smoke cigarettes (OR = 2.03, 95% CI = 1.04, 3.96), binge drink at least once a month (OR = 2.66, 95% CI = 1.34, 5.28), and to have ever used other drugs (OR = 2.91, 95% CI = 1.31, 6.45). Of the 67 urine samples provided, 60 (89.6%) were concordant with self-reported use, but six of the seven discordant samples were positive despite negative self-report. CONCLUSIONS The prevalence of marijuana use and binge drinking in this ethnically diverse sample of young, female primary care patients was lower than rates reported in national surveys. Providers should consider marijuana use as a part of a process that addresses more prevalent high-risk behaviors, bearing in mind that these behaviors may be underreported during routine screening.     

Alcohol and Marijuana Use Among Female Adolescent Incest Victims

Female adolescent incest victims' use of alcohol and marijuana was compared to national and local adolescent substance use patterns. Incest victims began to use both substances at an earlier age, were more likely to be classified as moderate to heavier drinkers, and were more often classified as misusers of both alcohol and marijuana than other adolescents.     

Pathways from Earlier Marijuana Use in the Familial and Non‐Familial Environments to Self‐Marijuana Use in the Fourth Decade of Life

We examined the longitudinal pathways from marijuana use in the familial environment (parents and siblings) and non‐familial environment (peers and significant other), throughout adolescence and young adulthood, to the participants' own marijuana use in their fourth decade of life (n = 586). Longitudinal pathways to marijuana use were assessed using structural equation modeling. Familial factors were mediated by non‐familial factors; sibling marijuana use also had a direct effect on the participants' marijuana use. In the non‐familial environment, significant other marijuana use had only a direct effect, while peer marijuana use had direct as well as indirect effects on the participants' marijuana use. Results illustrate the importance of both modeling and selection effects in contributing to marijuana use. Regarding prevention and treatment, this study suggests the need to consider aspects of familial and non‐familial social environments.     

Profiles of Patients Who Use Marijuana for Inflammatory Bowel Disease

Digestive Diseases and Sciences - Marijuana is legal in a number of states for indications that include inflammatory bowel diseases (IBD), and patients are interested in its potential benefits. We...     

Marijuana Use and Type 2 Diabetes Mellitus: a Review

Marijuana is used by millions of people, with use likely to increase in the USA because of the trend towards increased decriminalization and legalization. Obesity and diabetes mellitus (DM) rates have increased dramatically in the USA over the past 30 years, with a recent estimate of 29 million individuals with DM. Because there is a plausible link between marijuana use and diabetes due to the known effects of cannabinoids on adipose tissue and glucose/insulin metabolism, it is important to study and understand how marijuana use is related to obesity and diabetes. This paper provides background on the human endocannabinoid system and studies of the association of marijuana use with body mass index/obesity, metabolic syndrome, prediabetes, and diabetes. The studies to date have shown that marijuana use is associated with either lower odds or no difference in the odds of diabetes than non-use.     

A Comparison of Motivations for Marijuana Use in HIV-Positive and HIV-Negative Adults

While medicinal marijuana use is common among persons with HIV, it is not known whether persons with HIV are more motivated to use marijuana medically compared to HIV-negative counterparts. This study examined motivations for marijuana use in a sample of 94 HIV+?and HIV??adults. Participants used marijuana 21.27 days in the last 30 days on average. HIV+?participants reported using marijuana for medical reasons more often than HIV??participants, but HIV+?and HIV??participants did not differ in other domains. Problematic marijuana use was associated with motives, regardless of HIV status. Motives were associated with mental and physical health functioning, but there were no interactions between motivations and HIV status. Overall this study found that motivations were similar for HIV+?and HIV??participants. Future research including qualitative work to further understand motivations would benefit the field, as would research examining the effectiveness of marijuana in treating physical symptoms.     

Exploring the Mediational Role of Coping Motives for Marijuana Use in Terms of the Relation between Anxiety Sensitivity and Marijuana Dependence

This study evaluated the prediction that coping motives for marijuana use would mediate the relation between anxiety sensitivity and a marijuana dependence diagnosis after controlling for other co‐occurring marijuana use motives. Participants were 136 current marijuana users (47.1% women; M_age= 21.9, SD = 7.2). Results were consistent with a mediational effect, with the relation between anxiety sensitivity and marijuana dependence being explained by the addition of coping motives into the model. These results provide novel information related to the putative explanatory role of coping motives for marijuana use in the relation between anxiety sensitivity and marijuana dependence. (Am J Addict 2010;19:277–282)