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Older adults – the population most vulnerable to the novel coronavirus – have plenty to be anxious about. Particularly for those residing in long-term care facilities, this stress can only be compounded.
After COVID-19 swept through the Kirkland, Washington’s Life Care Center, and now appears to have spread to other nursing homes in the region, the vulnerability of a confined community of elders is alarmingly clear. In response, most long-term care facilities are drastically restricting movement of residents and visitors in or out of their facilities.
Deprived of visits from family and friends, and personal connections with the outside world, and exposed to a steady stream of bleak news, residents are understandably anxious and distraught.
Cannabis for coping
History shows that cannabis helps people cope with anxiety. These days, stress is considered one of the factors fueling the sharp uptick in cannabis sales, as customers rush to stock up before quarantining. Cannabis medicine can also effectively address anxiety’s sister affliction, insomnia.
In the current crisis, making cannabis medicine (oral and topical) available to distraught institution-bound seniors can be an act of compassion.
Most long-term-care facilities are wary of allowing a Schedule-1 controlled substance on their premises, for fear of jeopardizing their federal funding. But the experiences of two large elder-care institutions – MorseLife in Florida and the Hebrew Home at Riverdale, New York – demonstrate that, by applying original thinking, medical cannabis can be made available to residents while still working within state and federal guidelines.
A Pilot Program Studying Cannabis Access
MorseLife, a company that owns and manages long-term care and assisted living facilities in Florida, recently launched a pilot program that offers some residents the opportunity to access and use medical cannabis in their facilities.
Because it is a teaching institution, MorseLife requested and received approval from the Florida authorities to conduct the pilot as part of a larger research program it is now administering. Data from participants is being collected on cannabis products used, outcomes on health and quality of life measures, effectiveness for specific conditions, side-effects, and reductions in other drugs, including opiates, among this elder population.
Dr. Melanie Bone, an independent physician and cannabis medicine specialist who is authorized to qualify eligible patients in the State of Florida, is the medical coordinator of the project. Her role, under normal circumstances, is to evaluate potential participants in the program on-site and guide them in their medical cannabis use.
Participation in the pilot is currently being offered to residents in MorseLife’s assisted living and memory care units. According to Dr. Bone, in the latter setting, patients with dementia are receiving a CBD medication, without THC, and the reduction in anxiety and aggressive behavior has been notable. Residents in the assisted living setting are able to access medicine with THC, and are guided by Dr. Bone on how to use it.
A new kind of anxiety
Since the coronavirus outbreak, Dr. Bone is fielding more requests for consultations from MorseLife residents dealing with anxiety. “People are expressing anxiety related to COVID-19, the lack of visitors and the isolation. And we also see anxiety among our patients who are afraid that they won’t be able to go out and get their cannabis medicine.”
According to Dr. Bone, the MorseLife administration is working to develop a creative solution for this problem as well.
In the meantime, Dr. Bone is using telemedicine to keep in contact with her MorseLife patients. In light of the crisis, Florida’s Surgeon General has mandated that medical marijuana recommendations and consultations can be conducted using telemedicine.
According to Keith Myers, CEO of MorseLife, if all goes well, the program will eventually be expanded to make medical cannabis available to interested patients across their continuum of care settings, which include rehab and hospice facilities.
Getting Cannabis into the Institution
The Hebrew Home at Riverdale also instituted a series of creative policies and procedures that enable residents to receive, store and administer their medical marijuana, without the direct involvement of staff. This way, the institution is protected in terms of its compliance with federal policy, while enabling residents to access cannabis medicine similarly to any other New York citizen.
A venerable New York skilled nursing facility, the Hebrew Home has been running its medical marijuana program since the state first legalized medical marijuana in 2016. And while anxiety is not an approved condition in the New York’s medical marijuana program, Dan Reingold, CEO of the Hebrew Home, explains that the residents using medical cannabis have other conditions that make them eligible, so that anxiety relief is an added benefit. And while they haven’t collected any data, at least anecdotally, Reingold is hearing from residents that their cannabis medicine is helping them cope with the current coronavirus crisis.
Harm Reduction
At the Hebrew Home, like most institutions, smoking of any kind is prohibited. Even so, Reingold emphasizes that, because COVID-19 primarily affects the respiratory system, inhaling cannabis is out of the question.
Experts generally concur that for older adults living in institutional settings, the most appropriate forms of cannabis medicine are either orally administered, in the form of a tincture, capsule or edible, or as a topical applied to the skin.
In terms of safety, both MorseLife and Hebrew Home have observed almost no complications in patients participating in their medical marijuana programs.
When asked about adverse events among patients at the Hebrew Home, Reingold replies: “There have been none. I wish I could say the same about pharmaceutical prescription drugs.”
Dr. Bone reports only one adverse event at MorseLife, a patient who had an unpleasant response after experiencing difficulty self-titrating her medicine. The patient decided to discontinue using the cannabis medicine, but, as Dr. Bone relates, when the symptoms the patient had been controlling with medical cannabis returned, she was eager to go back to it.
Cannabis, Dr. Bone clarifies, is not for everyone. About 20% of patients, she reports, have dropped out of the study, a rate consistent with what she sees in her own cannabis practice.
“But when it works well” she observes, “it works really well.”
A Time for Creative Thinking
Under these extraordinary circumstances, directors of long-term care institutions may consider how to enable their anxious, isolated elderly residents to benefit from cannabis, without endangering their funding resources. MorseLife and the Hebrew Home demonstrate that it can be done.