pamstegma Asked September 2013
Should nursing home residents have Marijuana?
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Dronabinol is a capulated oil form of THC that is prescribed for nausea, vomiting, wasting syndrome, and appetite loss. Would you allow your elderly to take such a drug? If they took it in the past, did it help them at all?
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I guess if I want to do any further pot smoking, it should be now, in my 60's, while I'm healthy enough to survive. Here in Massachusetts, they're working on setting up medical marijuana dispensaries, but thankfully, I don't have any relevant medical conditions.
1) Would it be alright for nursing home patients to use medical marijuana judiciously for its benefits including that in prescription drug form called Marinol and the forms offered in the dispensary.
2) Would it be alright to let Grammie and Gramps to pass doobies and gobble spiked brownies in the SNF because they need a little fun and enjoyment before they pass on to the next world?
For the first question, I don't see where there is a moral or legal issue at all. Anyone suffering deserves relief and a trial of medications that can provide that relief is standard of care. However, the elderly need to be watched much more than younger individuals as they are vulnerable to being conveniently reduced to a zombie state so that they are no problem to others. Also, they become a fall risk if not monitered for tolerance as centrally acting medications affect balance and judgement when senior livers and kidneys do not clear it from the body faster than it is given and when the brain it is working on has lost more than its fair share of neurons and synapses. All I am saying is these medications are good when they are used correctly and the patient tolerates them.
As far as question number two, I think that would be fun to watch :)
However, the elderly are fighting to have as much preserved cognition as possible. If they are flying too high on pot their judgement gets impaired. If their judgement gets impaired, then someone is going to swoop in and evoke a power of attorney and the patient loses any of their freedom and are deemed mentally incompetent. Also, if they are flying high with osteoporotic hips, they run the risk falling and breaking. Newer studies show that once mobility is shot, brain function starts to physically decline. The precious amount of time they have left on earth should not be recovering from a hip fracture or redecorating their new room in the lock-up section of the local skilled nursing facility because they have been diagnosed with dementia.
It is used in the elderly when food no longer tastes good and they have the dwindles. Sometimes it works wonderful and the individual becomes happily hungry and all is well. However, with the elderly and their tendency to have cognitive difficulties, its use is very individualized. One would want to start with a very small dose. It may need increased but then again if it causes mental status changes (other than making them happy) then it should be stopped.
There are other medications that can be used for appetite in the elderly. There is Megace. The problem with megace is that it can increase coagulation and the elderly already are at risk for clots, heart attacks, and strokes.
The other medication which really works well is Remeron. It is a wonderful antidepressant that works great especially, it seems, on the elderly. However, its use over the years has not taken off because it makes people who take it happily fat. Food tastes wonderful on it and people enjoy eating again. For a skinny and sad little elderly person, Remeron is certainly a viable option. Since, again the elderly may have some cognitive decline a few do not respond well to it and could have some mental status changes. Therefore, it is good to start at a very low dose at bedtime and in a skilled nursing facility setting they can be watched closely in the beginning for this. If mental status changes are encountered then the medication would need to be stopped.
My daughter is not on Hospice and the craniotomy simply buys more time. We want this time to be relaxed and happy, with good appetite.
I did find a link on thealzheimerspouse where caregivers report rapid improvement with only 2.5mg a day. I'm not saying it will work for every patient, but when my time comes, put some in my tea, please.
Maybe the real questions are more:
=What form is allowed?
=What variety of plant[s] are allowed?
=How is it going to be aligned with other meds patients must take?
Working with cancer patients, when early pharmaceutical version of THC came out, [back in about 1986 or so?] It failed to control pain much at all. Everyone complained who got it.
OTH, when patients w/cancer & a few other conditions were allowed to smoke actual marijuana, in their room with window open and door sealed closed,
... all those got actual pain relief; nausea from chemo relief; seizure & muscle spasm relief; were able to eat when otherwise couldn't, and so much more good it has done, and can do.
It's mainly the CBD factors in that herb, that do the good things it does.
The THC's in the herb mostly tranquilize [sometimes that's a good thing!].
Downsides:
--Smoking works fastest, lasts shortest, but smoke is a problem for breathing issues.
--Vaporizing still has aromas in the air that others breath unwittingly.
--Even though State Legal in some, it's still Federally illegal, which could cause some issues if Feds got snarky about it.
--Many Docs are clueless how to integrate it into what else they prescribe, & are still stuck in historic disinformation campaign started almost 100 years ago.
Whoever is on call, says what goes for prescriptions; in many cases there might be some Docs who go for it, and others covering same facilities that don't.
Grey Areas:
--Some varieties of plants cause unwanted side effects, like increased anxiety or depression, while others actually help resolve these conditions.
Good sides:
--Tinctures act fairly fast, last far longer, and there's no smoke or vapors.
--Cremes act slower to control pain in painful body parts, but again, no smoke.
--Medibles are both yummy -and- deliver dose of needed relief, and perhaps calories for patients needing calories.
--The stuff really, really works, used properly: It works far better and far fewer adverse effects, than what's been being promoted by mainstream medicine [prescription pharmaceutical pain meds] .
If it's got high CBD's, patients keep their levels of consciousness; if it's got more THC's, they will be calmed, tranquil, sleep usually better than sleeping pills can offer them. Some varieties even help unblock constipation...a significant problem in nursing homes and other elder care facilities.
I cannot think of a single -real- problem with allowing it, other than the feds have yet to legalize it at the Fed level, and Big Pharma stands to lose profits as more people use Marijuana to resolve medical issues, instead of so many drugs with adverse effects.
States that have legalized it, reversed Constitutional procedures doing it before Feds did it. It's just a matter of time before something will dramatically change.
Queen Victoria was supposed to have taken this for period pain!
They don't seem to have a problem with Marinol that explain quite clearly why Marinol doesn't work for every patient and why medical marijuana should still be available above and beyond the Marinol, especially for those in whom Marinol is not effective.
Since we have heard from ps about the cost of Marinol, I would add that not legalizing medical marijuana is a form of discrimination for low income and disadvantage persons who would never be able to afford Marinol.
I did VIEW a medical video
they have generally sound microscopic particles OF organic marijuana fibers
as TO WHETHER your daughters Marinol is and stage palliative
50 years ago, my Physiological Psych professor said that smoking is NEVER good, no matter what you smoke (HE was a smoker and said that smokers smoke because they're neurotic and that the Surgeon General's "new" warning on cigarette packages would just serve to make smokers smoke more, haha).
the National Organization to Reform Marijuana Laws - norml.org - and other medical marijuana groups, as well as many patients who have needed long term use of marijuana, seem to be in favor of "cannabis vaporization". I haven't as yet completed my research however I did you a medical video where they explained this did not I mean the use of a bong, rather collection of the marijuana smoke in a bag and then inhaling it, rather than directly smoking it, from out of the bag. This may have satisfied my professor in that his physiological explanation for the damage to the lungs caused by smoking was directly related to the superheated hot air being drawn in.
Now I am on a path of further research to discover whether molds and fungi are present in the captured smoke and could also contribute to pulmonary cavities. When these cavities have been medically excised and sent to the pathology lab, my understanding is that they have generally found microscopic particles Organic marijuana fiber. I have never read that they have sound free mold or fungi cells, although they may be too small to find. lf anyone has more about this, please jump in.
ps - is your daughters Marinol covered by her insurance or Medicaid, whichever she is on? That $900 is surely more expensive than marijuana, which is of course why the drug companies get involved in manufacturing a product in the first place.
As 200 Marinol is end stage palliative, is your daughter on hospice? lf she could have the craniotomy that is currently on hold, is that expected to either cure her or give her a much longer life, or is it just to stave off the inevitable?
As we all know and have heard before: none of us are getting out of this alive. So it seems to me that your daughters comfort should be everyone's prime consideration. As most of our current health POA's state today, we want pain control even if it hastens our death.
As is often the case in medicine, when an original herb is fractionated, the so-called active ingredient isolated, synthesized then duplicated, the new and miraculous "drug" often has more side effects then nature's original. Hmmm...
Due to restrictions for posting links to any "dot com's", I won't give you the link directly but will tell you that you can google "marinol" followed by the dreaded "dot com" (any Internet users will be able to easily do this), you will find information about Marinol, its uses and contraindications.
While taking Marinol, these include NOT smoking marijuana (haha) - and I would add not EATING it either), not drinking alcohol, not taking tranquilizers or sedatives, telling the doctor in advance if you have heart problems or a seizure history etc, being aware it can cause confusion and dizziness as well as knowing that the effects can be amplified in the elderly.
Just so you know...
My next post will be information about comparing Marinol with marijuana...
Analysis:
11 are in favor of using medical marijuana
1 says "NEVER" (and HE is a suffering 71 year old, how sad!)
2 address the morality of obtaining it even though it is illegal
1 is concerned about the fire hazard of smoking
and 1 addresses the nature of prescribing marijuana
YIKES ... the question as asked by "ps" and the title placed on this question by the moderator are completely different and I'm afraid this has led to a lot of confusion. The title asks about nursing home residents having marijuana, whereas "ps" is asking about the prescribing of "dronabinol", which is the generic name for Marinol, a synthetic cannabinoid.
So that this post is not too long, please see two additional posts in this thread which I am going to make, one discussing Marinol and the second discussing marijuana vs Marinol. My hope is to bring some clarity to this.
Smoking pot is as dangerous as cigarettes from the burn, fire danger perspective.
I would not want to work in an enclosed environment where people are smoking cigs or joints.
Hmmmm......
But yes, I totally support it and think it's ridiculous that it's not legal.