Cannabis in Old Age: Specifics for Older Consumers

Older adults aged 60 and over are the fastest-growing group of cannabis consumers in Germany and the USA. Many use cannabis to treat chronic pain, sleep disorders or anxiety – often as an alternative to medications with stronger side effects. At the same time, age brings physiological changes that require a particular approach to cannabis.

## Changed Pharmacology With Age

As we age, the way the body processes substances changes. These changes also affect cannabis:

Volume of distribution: Older people generally have a higher body fat percentage. Since THC is lipophilic (fat-soluble), it distributes more strongly in fat tissue and remains in the body longer. This leads to longer duration of action and potentially stronger effects.

Liver metabolism: The liver enzyme systems (particularly CYP3A4 and CYP2C9) that break down THC work more slowly with age. This prolongs the half-life and can lead to accumulation with regular use.

Brain sensitivity: The ageing brain is more sensitive to psychoactive substances. Low THC doses that are mild for younger adults can produce more pronounced effects in older people – including disorientation, anxiety or confusion.

Conclusion: The "start low, go slow" principle applies especially to older consumers. The usual starting dose for older adults should be about half that for younger adults, and the step to the next dose should be considerably slower.

## Fall Risk: A Serious Danger

Falls are one of the most common causes of serious injuries and hospitalisation for older people. Cannabis – particularly THC – can increase fall risk for several reasons:

Orthostatic hypotension: Cannabis can briefly lower blood pressure, especially when standing up. In older people who are already more prone to blood pressure fluctuations, this can lead to dizziness and falls.

Impaired balance: THC affects the cerebellum and thus balance regulation.

Slowed reaction: The slowed reaction time caused by THC can mean that trip hazards are not recognised in time.

Recommendation: Older consumers should not climb stairs or engage in other activities with fall risk after consumption. The consumption setting should be safe and comfortable.

## Drug Interactions: Special Risk

Older people often take several medications simultaneously. Cannabis – particularly CBD but also THC – can interact with various medications:

Blood thinners (warfarin/Marcumar): CBD inhibits the enzyme CYP2C9, which breaks down warfarin. This can lead to elevated warfarin levels and increased bleeding risk. Regular INR monitoring is important.

Blood pressure medications: Cannabis can enhance the effect of antihypertensives and lead to undesirable blood pressure drops.

Sleep aids/sedatives: Additive effect with benzodiazepines and other CNS-depressant substances. Increased risk of sedation and breathing problems.

Heart medications: THC increases heart rate and can be problematic for cardiac patients. People with arrhythmias or coronary artery disease should use cannabis only under medical supervision.

Basic rule: Older cannabis consumers with regular medication should inform their doctor and discuss possible interactions.

## Consumption Methods for Older Adults

The consumption method significantly influences the risk profile:

Inhalation (smoking, vaping): Smoking is unsuitable for older people with impaired lung function (COPD, asthma). Vaporising is less harmful to the lungs but requires technical skill.

Oral intake (oils, capsules, edibles): The preferred form for many older consumers. Advantages: no lung stress, discreet, precise dosing possible. Disadvantages: delayed onset of effect (1–3 hours), risk of overdose if the effect doesn't come quickly enough.

Topical application (ointments, creams): For local pain relief (arthritis, muscle pain), topical CBD is an option without systemic effects.

## Positive Applications for Seniors

Despite the risks, many older consumers report considerable benefit:

Chronic pain: One of the most common reasons for cannabis use among seniors. Arthritis, back pain, neuropathic pain – cannabis can be a complementary therapy option.

Sleep disorders: Age-related sleep loss is widespread. THC can shorten sleep onset time; CBD can improve sleep quality.

Loss of appetite: For cancer-related cachexia or age-related reduced appetite, THC can promote food intake.

Anxiety and wellbeing: Low-dose CBD can relieve anxiety symptoms without the risks of benzodiazepines.

## Conclusion

Cannabis can be a sensible complement to existing therapy for older adults – but only with heightened caution. Start low, go slow applies here more than anywhere else. A doctor's consultation before starting, especially with polypharmacy, is essential.