Israel: Ben Gurion University Developed a New Medical Cannabis Treatment Protocol for Geriatric Patients

December 18, 2019

Israeli researchers have developed a medical protocol detailing how cannabis in the elderly should be best treated, and also examined in a preliminary study. The results are impressive - 85% reported an improvement in their health, and researchers recommend that doctors consider the treatment of elderly cannabis as an alternative to narcotic drugs.

Shay Friedman
Cannabis treatment is effective for elderly people with chronic pain, sleep deprivation, loss of appetite, nausea, and post-traumatic stress disorder (PTSD), helping to reduce their use of narcotic drugs In the elderly with cannabis in the best way.

Researchers at Ben Gurion University, Soroka Hospital's Cannabis Clinical Research Institute, and Niamedic Clinic conducted a study designed to test the efficacy of the medical protocol they developed, which involved 184 elderly patients treated with cannabis according to the protocol and monitored for six months.

The results of the study, together with the therapeutic protocol itself, were published last month in the Journal of Clinical Medicine, entitled "Medical Cannabis for Older Patients - Protocol of Treatment and Preliminary Results". The research was carried out by Dr. Ran Abuchatzira, Dr. Adi Ron and Inbal Sikorin.

Medical Cannabis for the Elderly - Treatment Protocol
"Because there are no established protocols with proven efficacy in treating elderly people with medical cannabis, we have developed one of ours that emphasizes close examination of the effects and side effects, and a slow and gradual start of THC oil, CBD oil, or a combination of the two [and not smoking]," says D. ”Dr. Abuhtsira of the Faculty of Medical Sciences at Ben-Gurion University.

According to the protocol, there are two cornerstones on which the treatment of cannabis in the elderly should be based: starting the lowest dose and gradual increase, and frequent monitoring and review. The goal is to reduce the side effects of treatment as much as possible, with the key phrase for researchers being 'non-harmony primacy' ('first, do no harm') - a fundamental principle of medical ethics.

The first steps, therefore, are designed to ensure that cannabis treatment is indeed appropriate for the patient. The appropriate contraindications for treating elderly cannabis by protocol are chronic pain, Parkinson's disease, sleep disorders, post-traumatic anorexia, convulsions, and palliation (alleviating the suffering of terminally ill patients). Severe cardiovascular disease, risk factors for psychosis, history of addictions, and problems with posture are the contraindications that the physician should consider as reasons to avoid cannabis treatment.

The treatment protocol also places special emphasis on the issue of polypharmacy (multi-drug) in the elderly, with the end goal being that successful cannabis treatment will allow the geriatric patient to reduce the doses of the other drugs he is taking, and even stop taking them. This is actually the last step in the treatment protocol, as seen in the diagram:

Figure 3.png

“If the treatment is effective and the side effects are not severe, a change in the concomitant treatment with other drugs, especially discontinuation or dosing of opioids, benzodiazepines, and psychotropic and other analgesics, can be considered. Our experience shows that cannabis has the potential to reduce the use of these drugs, ”said Dr. Abuhtsira.

The protocol also addresses concerns that may arise in older patients about the use of cannabis: "The stigma associated with the use of 'cannabis' may prevent patients from agreeing to medical cannabis treatment - even though it is a relatively safe and effective drug," it said. “It is therefore very important to explain to the patient and his / her family the potential benefits and dangers before starting cannabis treatment. This explanation should be given by a nurse or doctor who is proficient in cannabis treatment. ”

Cannabis dose I started to treat the elderly: 5 mg / day
The next step is to determine the cannabinoid ratio and the appropriate dose for the patient. The recommended method of consumption, according to the protocol, is always a sub-lingual drizzle of cannabis oil. For most labels, researchers recommend oil with an equal ratio of THC to CBD ('balanced'), or a combination of dominant THC oil with dominant CBD oil, so that an equal dose of both is obtained.

For the labels of chronic pain from neuropathic origin, sleep disorders and post-traumatic stress, it is recommended to treat only CBD-containing oil with as little as THC.

Figure 2.png

The recommended starting dose is 5 mg of THC and CBD (or only CBD, depending on the schedule) per day, divided into three daily doses - 1.7 mg per dose. This is exactly the dose that contains every drop of cannabis oil with a concentration of 5% THC and 5% CBD, so it is the ideal concentration for starting treatment.

The dose should be increased by 5 mg every 3 days, until an effective dose is reached. In case of side effects, you should reduce back to the previous dose for another 3 days, then try raising again.

The maximum daily dose recommended in the protocol is up to 40 mg THC per day. For those who are treated with CBD alone, they do not have a maximum dose of 40 mg, but CBD therapy is recommended to start with the same dose and gradually in combination with THC and CBD.

Elderly care for cannabis: 85% satisfied
184 patients with an average age of 81.2 participated in the study through a customized geriatric clinic. After 6 months of cannabis use 58.1% of them chose to continue cannabis treatment and the rest discontinued for such and other reasons, which probably shows that treatment is not suitable for everyone.

Of those who continued treatment, 84.8% reported that there was a moderate or significant improvement in their health status from the start of treatment, and 44% reported that there was a significant improvement in their health status since the start of treatment.

33.6% of patients reported any side effects, with the most common being dizziness (12.1% of patients) and fatigue / fatigue (11.2% of patients). It is important to remember that this is an adult population that is sensitive to side effects, and according to the researchers "the rate of side effects, especially the serious side effects, was relatively low".

"האם חל שיפור או החמרה במצבך הרפואי לאחר חצי שנה של טיפול בקנאביס?" - תשובות המטופלים הקשישים בסוף המחקר