Pubdate: Tue, 26 Jul 2016
Source: Press Democrat, The (Santa Rosa, CA)
Copyright: 2016 The Press Democrat
Author: Guy Kovner
MARIJUANA AIDS SONOMA COUNTY ALZHEIMER’S PATIENTS
Marijuana can make life better for some of the more than 5 million Americans afflicted with Alzheimer’s disease, but despite an encouraging new study, it remains a long shot as an antidote to the brain disorder that claims about 85,000 lives a year, experts say.
Some assisted-living facilities and physicians in Sonoma County are quietly administering medical marijuana to patients – with consent from legally responsible parties – for behavioral management, quelling aggression and agitation in people who are losing recognition of their surroundings.
In appropriate dosage, typically using edibles and tinctures, cannabis can have a “robust therapeutic effect,” said Dr. Phillip Grob, a Santa Rosa geriatric psychiatrist who has recommended marijuana for 50 to 100 patients since 2003.
For managing patients with “complicated dementia,” such as extreme agitation, cannabis is safer than the antipsychotic drugs typically prescribed, Grob said. No pharmaceuticals have Food and Drug Administration approval for such use, and the antipsychotics come with an official “black box warning” that they carry an “increased risk of death” when used to treat dementia’s neuropsychiatric symptoms, he said.
“We use them,” Grob said, including himself in that practice, because cannabis “is not for everybody.” Some patients have a negative reaction to marijuana, such as paranoia or anxiety, he said.
When he puts a dementia patient on marijuana, Grob said his approach is to “start low and go slow” with the dosage. “In my book, cannabis is much safer than ( antipsychotic ) prescription medications,” he said.
Dan O’Brien, who works at a Sonoma County assisted-living facility, said use of cannabis for behavior modification is “well known and very popular” in residential care for Alzheimer’s patients.
Patients with dementia may think they are being attacked by aides who have come to wash and dress them, and react violently, O’Brien said. “They may not understand these people who have their hands all over them are helping them,” he said.
Tony Fisher, marketing director at Healdsburg Senior Living Community, said the facility is considering cannabis as an alternative to psychotropic medication. “We’re definitely exploring the idea,” he said. “It just makes sense.”
But it’s important to broach the idea cautiously, he said, because marijuana “is not a very popular subject in the senior world.”
Care facilities that depend on Medicare funding are wary of dispensing marijuana, local experts said, because it remains illegal under federal law, which classifies pot as a drug “with no currently accepted medical use.”
Alzheimer’s disease, the most common cause of dementia among older people, afflicts 5.4 million Americans and is a looming public health crisis as the oldest of the 76 million baby boomers hit age 70 this year.
Already, someone in the United States develops Alzheimer’s every 66 seconds, and the cost of health care for people with Alzheimer’s and other dementias is expected to swell from $236 billion a year now to $1 trillion by 2050.
“There’s a wave coming,” said Michele Boudreau, spokeswoman for the Alzheimer’s Association Northern California chapter. “The human toll is going to be dramatic.”
Use of cannabis to moderate the behavior of Alzheimer’s patients is “pretty minimal,” she said, adding that most physicians “do not feel comfortable prescribing it” and the association has no official position on it.
Researchers at the Salk Institute in La Jolla recently announced findings that tetrahydrocannabinol ( THC ) and other compounds in marijuana can remove the amyloid plaque associated with Alzheimer’s, suggesting a potential treatment for the incurable disease.
Salk Professor David Schubert said in a press release that the study was the “first to demonstrate that cannabinoids affect both inflammation and amyloid beta accumulation in nerve cells.”
Fisher said the study was “pretty fantastic news,” noting that if cannabis really can dissolve plaque it “could change everything overnight.”
But Schubert said that any THC-related treatment for Alzheimer’s was a long way off and would require lengthy testing in clinical trials before it could be made available to the public.
David Greenberg, a neurologist and professor emeritus at the Buck Institute for Research on Aging in Novato, said there was a “huge leap” between the Salk study and an Alzheimer’s therapy.
First, he said, the study involved neurons grown in a laboratory dish, providing no guarantee that the plaque-cleansing effect would occur in the human brain. And there is no clear answer to the question of whether plaque is the cause or an effect of Alzheimer’s, so its removal “cannot be equated with a therapeutic clinical response,” said Greenberg, a Sonoma resident.
Grob, the psychiatrist, said marijuana has proven helpful for treating numerous conditions, including chronic pain, seizures, anxiety and paranoia. But there is “pushback from the established medical community,” he said, due to both federal law and mainstream medicine’s close ties to the “pharmaceutical complex.”
In states where medical marijuana is legal, Medicare’s prescription drug costs have been lowered, University of Georgia researchers reported earlier this month.
MAP posted-by: Jay Bergstrom