Dr. Kiran Rabheru is a Full Professor of Psychiatry at the University of Ottawa and Geriatric Psychiatrist at The Ottawa Hospital . He serves as Medical Director of the Geriatric Psychiatry, Electroconvulsive Therapy , and the Behavioral Support Programs at TOH. He obtained his medical degree from University of Western Ontario. He is a Certificant and Fellow of the College of Family Physicians of Canada (CCFP, FCFP). He went on to complete his specialty training in Psychiatry, subspecializing in Geriatric Psychiatry, in which he is Board Certified in Canada (FRCP) and the United States (DABPN).
He is designated as a Founder of the subspecialty of Geriatric Psychiatry by the Royal College of Physicians and Surgeons of Canada. He is recipient of the Outstanding Achievements in Geriatric Psychiatry in Canada award by the Canadian Academy of Geriatric Psychiatry (www.cagp.ca) and has served as its President of the CAGP He serves as Chair of the Board of the International Longevity Centre (www.ilccanada.org), Board member of the International Psychogeriatric Association (www.ipa-online.org ), and Chair of the Section of Positive Psychiatry of the World Psychiatric Association (https://www.wpanet.org/). Dr. Rabheru was honoured to be elected as Chair of the Steering Committee for the Global Alliance for the Rights of Older People (https://rightsofolderpeople.org), a network of over 380 members from over 80 counties worldwide, united in the work to strengthen and promote the rights and the voice of older persons globally.
Cannabis and older adults in Canada
Kiran Rabheru, Canadian Coalition for Seniors’ Mental Health, Canada
Recent National Cannabis Survey results that indicate cannabis consumption among older adults has been accelerating at a much faster pace than other age groups in Canada. Early indications also suggest that use has increased during the Covid -19 pandemic. Internationally, an increasing number of countries and US states have legalized medical and non-medical cannabis.
Despite the reality of increased use, communication between older adults and healthcare providers often remains limited regarding cannabis. Cannabis use is not often part of a standard assessment by most healthcare providers and older adults do not always report their cannabis use.
The Canadian Coalition for Seniors’ Mental Health (CCSMH) assembled a Scientific Planning Committee including multi-disciplinary subject matter experts to create a series of e-learning modules. An anonymous needs assessment survey was conducted in the Fall of 2020. Over 1500 respondents (physicians, nurse practitioners, other healthcare providers, healthcare students, older adults and caregivers) responded to the survey.
Results indicated that, although 89% of physicians and nurse practitioners are aware of older patients in their practice using cannabis, only 39% agreed or strongly agreed that they have sufficient knowledge and expertise to address older patients’ and their caregivers’ questions about cannabis. 37% of older adults using cannabis indicated that they are using cannabis without a prescription or medical authorization from a physician / nurse practitioner for medical /therapeutic reasons and 25% reported using cannabis for non-medical reasons. The most common reasons for cannabis use were reported to be related to pain, sleep and anxiety.
Some of the concerns about Cannabis and Older Adults identified by physicians and Nurse Practitioners are: interactions with other medications (79%); chronic adverse effects e.g., cognitive effects (65%); acute adverse effects e.g., cardiovascular, GI, exacerbating psychiatric symptoms (62%); intoxication / impairment (58%); legal considerations (39%); and effects of cannabis on driving and older adults (38%). An Ontario survey of physicians, on attitudes toward medical cannabis reported three main themes: reluctance to authorize cannabis, concern over harms associated with cannabis and lack of knowledge surrounding administration of cannabis.
Healthcare provider interest in learning more about cannabis and older adults is high, 70% of CCSMH Needs Assessment respondents indicated that they would be interested in attending an accredited online course to learn more about cannabis and older adults.
In order to provide the best care to older adults regarding cannabis use, consensus is high around the viewpoint “start low, go slow, stay low”. Clearly identified therapeutic goals, discussion with patients about adverse affects and well-defined follow-up plans are considered essential prior to initiating cannabis use.
Although there is a reported gap in knowledge regarding cannabis and older adults, healthcare providers reported they are eager to learn more about how to talk with patients, how to authorize and prescribe appropriately, how to mitigate risks and assess for cannabis use disorder in older adults. CCSMH will be offering an accredited asynchronous e-learning course on Cannabis and Older Adults, launching January 2022.