The Current18:35Seniors are using cannabis — and ending up in the ER
Many seniors are turning to cannabis for recreational or medicinal use — but a new study suggests some are ending up in the ER with accidental cannabis poisoning. Matt Galloway speaks with Dr. Nathan Stall about how to help seniors reduce the risk and enjoy the benefits.
At 80, Bob McBride uses cannabis both recreationally and to manage what he calls “age-related pain.”
“I smoke it occasionally and I use gummies,” McBride, who’s from the Ottawa Valley in southeastern Ontario, told The Current’s Matt Galloway. “I do either or both, maybe two or three times a week.”
Having used cannabis for most of his life, McBride says he knows his limit and how to take cannabis safely.
“It’s enjoyable. It’s relaxing. It stimulates me in conversation. It enhances a lot of the things that I do through the day,” he said. “I think of it as a user-friendly drug that I have learned how to use responsibly.”
Seniors, like McBride, are among the fastest-growing age group in Canada for using cannabis. A Statistics Canada report found that more than 400,000 seniors reported using cannabis in the past three months in 2019, up from 40,000 seniors who reported using in 2012. More recent data suggests that trend has continued.
Meanwhile, the number of seniors ending up in emergency departments with cannabis poisoning has also risen sharply since legalization, new research shows. It’s led some experts to call for more education and better guidelines around safe cannabis consumption for older adults.
Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, recalls a patient in his 80s who came to the ER.
“This older adult was presenting in the way that individuals would present with very serious illness: decreased level of consciousness, hallucinating, high blood pressure and heart rate, nausea and vomiting,” Stall said.
The usual litany of tests didn’t reveal an obvious cause for why the man was so unwell, Stall said. Then a toxicology screen came back positive showing the man had cannabis in his system.
“I think when people think about cannabis poisoning, or taking too much cannabis, they think about someone who’s coming in giddy, euphoric, maybe asking to eat — I don’t think many people think of this as someone who’s, you know, quite ill,” Stall said.
The culprit: an edible cannabis product belonging to a family member that the patient had unknowingly consumed, thinking it was a snack. Stall remembers the family member turning “beet red” with embarrassment upon learning what had happened.
“Because it’s so socially acceptable now, edible cannabis products aren’t necessarily always treated as a potentially dangerous substance, if someone who’s not intending to take it can get into it,” Stall said.
‘Tip of the iceberg’
Stall is the lead author of a study published last month in the peer-reviewed medical journal JAMA Internal Medicine looking into cannabis poisoning in seniors.
It found that the number of people 65 and older visiting Ontario emergency departments with cannabis poisoning tripled between 2015 and 2022.
The report broke the data down into three periods: pre-legalization (January 2015 to September 2018); legalization permitting the sale of dried cannabis flowers only (October 2018 to December 2019); and legalization opening the market to edible cannabis (January 2020 to December 2022).
It found the rate of ER visits for cannabis poisoning among seniors saw a spike following the first phase of legalization. Once edibles were legalized, the rate rose yet again. (The study did not differentiate between which poisonings were intentional, such as self-medication, and which were unintentional, such as accidental ingestion.)
Overall, the study recorded 2,322 emergency department visits over the eight-year span, which Stall acknowledges are “relatively small numbers” compared to the approximately three million seniors in Ontario. As well, cannabis use among older Canadians is relatively low compared with other age groups, at seven per cent.
Still, the trend of increase is cause for concern, according to Stall, who says he believes the ER numbers are just “the tip of the iceberg.”
For one, some people may not realize they have cannabis poisoning and stay at home while suffering from symptoms, he says. Secondly, edible cannabis was legalized just before the COVID-19 pandemic lockdowns, which may have deterred some people from going to the emergency department.
Higher potency, age factor
The study’s findings come after other research has similarly shown an increase in the number of children hospitalized for accidental cannabis poisonings after legalization.
A 2022 study published in the New England Journal of Medicine found that three provinces — Alberta, B.C. and Ontario — saw twice the increase in pediatric hospitalizations after edibles were legalized compared to Quebec, which did not permit edible sales at the time of the study.
A study into unintentional cannabis hospitalization rates for children found a spike in provinces where edibles were legal between January 2020 and September 2021, compared to where they were not.
Like children, older adults can unintentionally ingest cannabis, as in the case of the patent Stall described above. But even seniors who use cannabis intentionally face certain risks.
Dr. Hance Clarke, who was not involved in the study, is a pain specialist at Toronto General Hospital. He says a third of his patients at the clinic ask him about cannabis for a variety of reasons, including pain management, sleep, anxiety and depression.
Clarke, who is also president of the Canadian Consortium for the Investigation of Cannabinoids, says some patients turn to cannabis out of a desire for a plant-based product when pharmaceutical medications don’t work for them.
Some preliminary research suggests therapeutic uses for CBD — a compound found in the cannabis plant that, unlike the more well-known THC, doesn’t get you high — for inflammatory conditions including arthritis, anxiety and more.
Like Stall, Clarke points to the higher potency of today’s cannabis as a factor in increased risk of poisoning for seniors.
“The joints that people might have been smoking in the ’60s and ’70s are very different than the cannabis that people have access to right now,” said Clarke.
When it comes to edibles, Clarke says many of the products Canadians turn to contain much more than 2.5 mg of the psychoactive compound THC, which he considers a standard dose.
Another factor is the nature of edibles themselves, as their effects take longer to kick in compared to smoking a joint.
“With edible cannabis, the onset of the high, the peak, is actually about three hours,” Stall said. If those using cannabis don’t feel anything immediately, “they’re liable to do something called dose stacking, where they take additional doses before peak effect has kicked in.”
Then there are the age-related factors at play. Declines in metabolism of cannabis and changes in the fat composition of older adults’ bodies mean that cannabis sticks around longer, Stall said.
Older adults are also more likely to take other prescription medications, some of which may be psychoactive, and there are higher rates of cognitive impairment.
“About 6.5 per cent of the population in our study that ended up in the emergency department actually had dementia, [which means] they’re more susceptible to falls and to sensory impairment,” Stall said.
The two medical experts say the study’s findings show there’s more to be done to lower the risks of cannabis poisoning among seniors.
Edible cannabis should be kept in locked locations in homes, and any cannabis products should be clearly labelled and marked, Stall said. Stall and Clarke also called for senior-specific dosing guidance.
Stall said many people don’t often think of older adults like McBride talking openly about using drugs, which he believes hinders the ability of health-care practitioners to engage in conversations with seniors about using cannabis.
“Health-care providers should have open and judgment-free conversations about cannabis use,” Stall said.