Pubdate: Mon, 20 Feb 2017
Source: New York Times (NY)
Copyright: 2017 The New York Times Company
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Winnie Hu

WHEN OLDER AGE COMES WITH DAILY DOSES OF MEDICAL MARIJUANA

Ruth Brunn finally said yes to marijuana. She is 98.

She pops a green pill filled with cannabis oil into her mouth with a
sip of vitamin water. Then Ms. Brunn, who has neuropathy, settles back
in her wheelchair and waits for the jabbing pain in her shoulders,
arms and hands to ebb.

"I don't feel high or stoned," she said. "All I know is I feel better
when I take this."

Ms. Brunn will soon have company. The nursing home in New York City
where she lives, the Hebrew Home at Riverdale, is taking the unusual
step of helping its residents use medical marijuana under a new
program to treat various illnesses with an alternative to prescription
drugs. While the staff will not store or administer pot, residents are
allowed to buy it from a dispensary, keep it in locked boxes in their
rooms and take it on their own.

>From retirement communities to nursing homes, older Americans are
increasingly turning to marijuana for relief from aches and pains.
Many have embraced it as an alternative to powerful drugs like
morphine, saying that marijuana is less addictive, with fewer side
effects.

For some people, it is a last resort when nothing else
helps.

Marijuana, which is banned by federal law, has been approved for
medical use in 29 states, including New York, and the District of
Columbia. Accumulating scientific evidence has shown its effectiveness
in treating certain medical conditions. Among them: neuropathic pain,
severe muscle spasms associated with multiple sclerosis, unintentional
weight loss, and vomiting and nausea from chemotherapy. There have
also been reports that pot has helped people with Alzheimer's disease
and other types of dementia as well as Parkinson's disease.

Across the nation, the number of marijuana users who are in their
later years is still relatively limited, but the increase has been
significant, especially among those 65 and older, according to recent
studies.

"It's a bigger issue than we thought," said Brian Kaskie, a professor of 
health policy at the University of Iowa who co-wrote a study published 
in January, "The Increasing Use of Cannabis Among Older Americans: A 
Public Health Crisis or Viable Policy Alternative?" "This is an elephant 
we're just starting to get our hands on."

A medical marijuana education and support club started by residents of
Rossmoor Walnut Creek, a retirement community east of San Francisco,
has grown to 530 members - so many that it has changed meeting rooms
three times.

"I would be in a lot worse shape if I wasn't using cannabis, both
physically and mentally," said Anita Mataraso, 72, a grandmother of
six who is the program director and takes marijuana daily for
arthritis and nerve pain, among other ailments.

In the state of Washington, at least a dozen assisted living
facilities have formal medical marijuana policies in response to
demands from their residents, said Robin Dale, the executive director
of the Washington Health Care Association. The association, an
industry group, has posted a sample medical marijuana policy on its
website.

In March, an influential group of medical providers, AMDA - The
Society for Post-Acute and Long-Term Care Medicine, will tackle the
issue at its annual conference. Cari Levy, the group's vice president,
will offer a "Marijuana 101" lesson on the benefits, the risks and the
potential pitfalls for providers.

"People are using it, and we need to know how to respond," she
said.

But as older people come to represent an emerging frontier in the use
of marijuana for medical purposes, questions are being raised about
safety and accessibility. Even in states where medical marijuana is
legal, older people who stand to benefit often cannot get it. Most
nursing homes do not openly sanction its use, and many doctors are
reluctant to endorse pot use, saying not enough is known about the
risks in the oldest age groups.

"This is a target demographic that may have their access limited, if
not cut off altogether, simply because they reside in a facility,"
said Paul Armentano, deputy director of NORML, a group that advocates
the legalization of marijuana. "It is a problem that may infringe on
their quality of life."

While there is no shortage of research on marijuana, relatively little
of it has focused explicitly on older users even as their numbers grow
- - and not just in the United States. In Israel, for instance, older
people have been treated with medical marijuana for years. And
Americans for Safe Access, an advocacy group, helped open a research
center in the Czech Republic that is evaluating its impact on older
people.

"It's an area that's very important to look at," said Dr. Igor Grant,
the director of the Center for Medicinal Cannabis Research at the
University of California, San Diego, adding that older people are now
one of the center's research priorities.

"Older people can be more sensitive to medicine," he said. "It's
possible a dose safe for a 40-year-old may not be in an
80-year-old."

Dr. Thomas Strouse, a psychiatrist and palliative care doctor at the
University of California, Los Angeles, said that just as sleeping and
pain medications could harm older people, marijuana could possibly
make them confused, dizzy or more likely to fall.

"There is no evidence that it is particularly helpful to older people,
and some reason that it could be harmful," he said.

Most nursing homes have also taken a cautious position, often
resorting to a "don't ask, don't tell" approach.

"If residents are taking it, they are taking it undercover without the
staff knowing so it's not part of their care plan," said Dr. Cheryl
Phillips, senior vice president for public policy and health services
for LeadingAge, an industry group representing more than 2,000 nursing
homes. "I think that creates a safety problem."

Fred Miles, a Colorado lawyer who represents nursing home operators,
said nursing homes - unlike assisted living facilities - were
regulated by the federal government, and were fearful of jeopardizing
their Medicare and Medicaid funding. Staff members who administer
marijuana could also theoretically face criminal prosecution under
federal law, he said, though he has never heard of that happening.

The federal Centers for Medicare and Medicaid Services said no nursing
home had specifically lost financing or been penalized for permitting
the use of marijuana. In New York State, which started a medical
marijuana program in 2016, its use is restricted to people with
designated medical conditions, including neuropathy, epilepsy,
multiple sclerosis, Parkinson's, H.I.V., AIDS and cancer.

At the Hebrew Home in the Bronx, the medical marijuana program was
years in the making. Daniel Reingold, the president and chief
executive of RiverSpring Health, which operates the home, said he saw
its powers firsthand when his own father, Jacob, was dying from cancer
in 1999. To ease his father's pain, Mr. Reingold boiled marijuana into
a murky brown tea. His father loved it, and was soon laughing and
eating again.

"The only relief he got in those last two weeks was the tea," Mr.
Reingold said.

When Mr. Reingold requested approval from the nursing home's board
members, there were no objections or concerns, he said. Instead, they
joked that they would have to increase the food budget.

Then Dr. Zachary Palace, the medical director, developed a program
that seeks to offer marijuana as an option but also comply with
federal regulations: Though the nursing home recommends and monitors
its use, residents are responsible for buying, storing and
administering it themselves.

Last fall, the first three residents started taking marijuana pills.
Their families obtain the pills at a dispensary in Yonkers run by
Etain, a company licensed by the state to sell medical marijuana to
qualifying patients or their designated caregivers, who must live in
New York. Dr. Palace said that as the program expanded this month, as
many as 50 residents could be using marijuana.

Marcia Dunetz, 80, a retired art teacher who has Parkinson's, said she
worried at first about what people would think. "It's got a stigma,"
she said. "People don't really believe you're not really getting high
if you take it."

But she decided to try it anyway. Now, she no longer wakes up with
headaches and feels less dizzy and nauseated. Her legs also do not
freeze up as often.

For Ms. Brunn, the marijuana pills have worked so well that she has
cut back on her other pain medication, morphine.

Her daughter, Faith Holman, 61, said the pills cost $240 a month,
which is not covered by health insurance. Ms. Holman, who lives in New
Jersey, also has to ask a family friend to go to the Yonkers dispensary.

"Obstacles had to be overcome," Ms. Holman said. "But I think she was
meant to have it because everything has worked out."
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MAP posted-by: Matt