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Older Adults Increasingly Use Medical Marijuana for Nausea, Pain

It's still controversial, even where it's legal

The boisterous crowd of residents who gathered for a recent potluck at Laguna Woods Village senior community in Southern California weren't there to talk about their latest cruise or how cute their grandchildren are.

Carrying dishes of potato salad, tamales, southern fried chicken and cookies, they came to talk about something rarely mentioned at senior potlucks: Pot.

I've been able to cut back on prescription painkillers by 50 to 60 percent.

"We've already got a medical marijuana collective for people with prescriptions from their doctors," says Lonnie Painter, 64, who has lived in Laguna Woods Village for 11 years. "Now we're trying to set up a medical marijuana club so people who are interested can learn more about the medicinal benefits of marijuana." Painter, a retired restaurant owner, smokes marijuana to ease the chronic pain of osteoarthritis. "I've been able to cut back on prescription painkillers by 50 to 60 percent," he says.

Another resident at the potluck, Margo Bouer, 75, a retired psychiatric nurse, uses marijuana to relieve nausea and vomiting from advanced multiple sclerosis, which has damaged her gastrointestinal tract. "I was sick, vomiting spontaneously. Nothing helped," she says. "It was so bad that I'd actually begun to think about suicide." A doctor suggested medicinal marijuana. It worked like a charm. "The nausea went away," says Bouer. "I started eating again. I got my energy and control back. It basically made life worth living again."

The residents of Laguna Woods Village first made headlines a year ago, when they opened their own medical marijuana dispensary. Since then, champions of pot both there and across the country have learned firsthand how contentious the issue can be.

Just saying no

Although California's Compassionate Use Act, passed in 1996, allows people with a prescription to use and cultivate medicinal marijuana, Laguna Woods Village is trying to bar marijuana plants from its community garden. The retirement community has a marijuana dispensary, but not in the form of a bricks-and-mortar storefront. Instead, residents get together in one another's homes to distribute prescribed amounts of the weed. Their source? They either grow it themselves or get it from out-of-town dispensaries or from friends.

"More and more municipalities are moving to ban cultivation or prohibit or limit dispensaries, despite state law that makes medical marijuana legal," says Jonathan Adler, 69, a retired lawyer who helped set up the marijuana dispensary at Laguna Woods Village. Adler thinks that's wrong: "We're talking about elected officials on public safety and zoning committees who are taking it into their own hands to prevent legal access to medicinal marijuana."

A longtime advocate for legalizing marijuana, he discovered its medicinal benefits firsthand after being diagnosed with cancer. Marijuana helped relieve vomiting and nausea after chemotherapy treatments, he said. It also helped restore his appetite.

In Walnut Creek — home to a large retirement community called Rossmoor — city officials this year shut down a marijuana dispensary, despite protests from some older residents. But the nearby city of Oakland, just east of San Francisco, recently voted to allow large-scale cultivation within its city limits. "This is going to grow as an industry," Oakland City Council member Jean Quan said during the debate.

A vote on the issue

Nowhere is the contentious divide more striking than in California, where voters next week will decide the fate of a referendum to legalize general marijuana use. On this same November Election Day, residents in South Dakota and Arizona will vote on whether to legalize medical marijuana. In Oregon, where medical marijuana is already legal, there is a proposition to license farmers to grow pot for medical use.

Critics say the medicinal marijuana movement has simply provided a cover for people who want to get high. Certainly, many of the people lining up at dispensaries with prescriptions for marijuana in Denver and San Francisco don't appear to be seriously ill. Opponents also worry that the presence of storefront dispensaries could make it easier for young people to get access to marijuana.

To date, 14 states and the District of Columbia have legalized medical marijuana. And it's no surprise that some of the most impassioned advocates for access are seniors. Many of the purported health benefits of marijuana target problems that typically plague older people, such as chronic shingles, arthritis pain, loss of appetite and symptoms of multiple sclerosis.

Pot for pain

Researchers acknowledge that they're only beginning to study medical applications of marijuana. "But what we already know suggests that the active compounds in marijuana have tremendous potential," says Mark Ware, M.D., a researcher at McGill University in Montreal and executive director of the Canadian Consortium for the Investigation of Cannabinoids.

Cells throughout the body, he explains, possess receptors for cannabinoids, the active ingredients in marijuana. Interestingly, our bodies produce natural cannabinoids, which are believed to play a role in controlling nerve impulses, immune function and even bone growth. The existence of this naturally occurring system explains why marijuana, by delivering a potent dose of cannabinoids, has far-ranging effects, Ware says.

Marijuana appears to be particularly effective at easing pain related to nerve damage, or neuropathy.

Among the best-studied benefits are pain control and nausea relief. "Marijuana appears to be particularly effective at easing pain related to nerve damage, or neuropathy," says Stephen Yazulla, professor of neurobiology and behavior at Stony Brook University in New York. Neuropathy is a common complication of diabetes, cancer therapies and herpes zoster infections, or shingles. Marijuana has also been shown to help restore appetite, which can be zapped by cancer treatments. There's emerging evidence that cannabis helps control spastic muscle contractions associated with multiple sclerosis. It may also slow the course of the devastating degenerative nerve disease amyotrophic lateral sclerosis, or Lou Gehrig's disease.

Mainstream medical support

Mainstream medical organizations have acknowledged marijuana's promise. In 2008, the American College of Physicians released a position statement arguing that promising results from small studies should be an impetus to more research into the health effects of marijuana. A 2009 interim report issued by the American Medical Association also argued for more research, pointing to a variety of health benefits.

This isn't the first time the AMA has argued in favor of marijuana. Cannabis was commonly used for medicinal purposes in the United States until 1937, when the weed was declared an illegal substance by the federal government — despite the AMA's objections at the time.

Still illegal after all these years

One reason researchers don't know more about marijuana's potential benefits today is that the federal Controlled Substances Act still classifies marijuana as a Schedule I drug, a category reserved for dangerous drugs with a high potential for abuse and "no currently accepted medical use."

Many researchers dispute both parts of that description. There's growing evidence for medical uses of the weed, they insist. "And when people use it medicinally, there's very little reason to think it leads to abuse," says Yazulla. "No one has ever died from using marijuana, as far as we know."

I don't like to be on pain pills. I don't like what they do to me. I don't like how I feel. I was given some pot, and it really helped me.

But as long as marijuana remains a Schedule I drug, researchers face enormous hurdles in winning approval to conduct research. "It's a real catch-22," says Diane Hoffmann, an expert on medical marijuana laws at the University of Maryland School of Law in Baltimore. "Because marijuana is a Schedule I drug, it's very difficult to do the research required to move it to Schedule II."

Conflicting state and federal laws, meanwhile, have created a legal landscape fraught with uncertainties. Despite laws in some states making medicinal marijuana legal, cultivating and using marijuana remains a federal offense. In 2009, the Justice Department announced that federal resources would not be used to enforce the law against medicinal marijuana. "But that's a matter of enforcement," says Hoffmann. "It doesn't change the law." The federal government can always reverse course and begin cracking down, she points out, even in states that have legalized marijuana.

'Just like ordering a pizza'

Already, a number of medical marijuana distribution services operate out of Oakland, delivering medical cannabis to nearby towns and cities, including Walnut Creek and Vallejo. "It's just like ordering a pizza for delivery, except it's marijuana," says Gilbert Doubet, 69, a Rossmoor resident, who estimates that five different delivery services regularly visit the retirement community.

Surprisingly, even some pot users have mixed feelings.

One 65-year-old resident of Rossmoor, who smoked marijuana in the 1970s says, "I gave it up when I became a mother." When she began to suffer chronic pain after shoulder surgery, she tried it again. "I don't like to be on pain pills. I don't like what they do to me. I don't like how I feel. I was given some pot, and it really helped me," she says.

Still, this pot user would rather her grandchildren didn't smoke marijuana. "I don't like the idea of them being caught up in that culture."

Erika Whiteway, 56, another Rossmoor resident, also tried marijuana when she was young but didn't like it. "It made me paranoid," she says. She tried it again, years later, to ease pain after knee replacement surgery, and it proved much more effective, with fewer side effects, than prescription painkillers. Recently diagnosed with multiple sclerosis, she now smokes marijuana occasionally to relieve muscle spasms caused by the disease. "It's been very helpful to me," she says. "And it's so much less harmful than other medications."

Indeed, she recently took up recreational boxing. Says Whiteway: "That's how much better I feel."

Peter Jaret writes about medicine and health policy from his home in northern California.

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