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Lighting up during twilight years

  • NEW YORK TIMES / MARCH 19
                                Harry Lebowitz, 69, smokes a joint in his backyard in Delray Beach, Fla. Last spring, an analysis based on the National Survey of Drug Use and Health found that cannabis use among people over age 65 had jumped 75% from 2015 to 2018, from 2.4% of that group to 4.2%. Use had reached 5% by 2019.

    NEW YORK TIMES / MARCH 19

    Harry Lebowitz, 69, smokes a joint in his backyard in Delray Beach, Fla. Last spring, an analysis based on the National Survey of Drug Use and Health found that cannabis use among people over age 65 had jumped 75% from 2015 to 2018, from 2.4% of that group to 4.2%. Use had reached 5% by 2019.

For years, Harry B. Lebo-witz spent the cocktail hour at his home in Delray Beach, Fla., sitting in his backyard overlooking a lake and smoking a joint while his partner relaxed with her vodka and club soda.

Lebowitz, 69, a mostly retired businessman, qualified for a state medical marijuana card because he suffered from anxiety, sleep apnea and back pain. He credits cannabis with helping to wean him off several prescription drugs.

Then came COVID-19, heightening both his anxiety and his boredom. “It was like the world stopped,” Lebowitz said. “We’re all suffering from some form of PTSD, all of us.”

He found himself smoking several times a day instead of once, and downing three to five shots of anejo tequila daily, too.

Even before the pandemic, researchers were reporting on the growing popularity of cannabis among older adults.

Last spring an analysis based on the National Survey of Drug Use and Health found that cannabis use among people over 65 had jumped 75% from 2015 to 2018, from 2.4% of that group to 4.2%. By 2019 use had reached 5%.

“I would expect it to continue to increase sharply,” said Dr. Benjamin H. Han, lead author of the analysis.

That isn’t a big surprise. During that period “you had the backlash against opioids,” said Donna M. Fick, a researcher who directs the Center of Geriatric Nursing Excellence at Penn State. With addiction and overdoses so prevalent, “clinicians are wary of prescribing them to older adults anymore, so people are looking for a solution.”

There are no data yet on how the pandemic, with its stress and isolation, affected use among older people. But legal cannabis sales grew by 20% last year, according to the National Cannabis Industry Association. Leaf411, a nonprofit, nurse-staffed information hotline, received 50% more calls, most from older adults.

Researchers therefore expect the numbers will show greater geriatric use. Mental health surveys of older people last year showed rising anxiety and depression, conditions frequently cited as reasons to try cannabis.

“I’ve definitely seen my patients who were stable returning for tuneups,” said Eloise Theisen, president of the American Cannabis Nurses Association and a geriatric nurse-practitioner in Walnut Creek, Calif. “Their anxiety was worse. Their insomnia was worse.”

The $17.5 billion legal cannabis industry keeps seniors squarely in its marketing sights. Major retailers offer dispensary discounts of 10% to 20% on “Silver Sundays” or “Senior Appreciation Days.”

All of which makes health care professionals who treat seniors uneasy.

A recent review in JAMA Network Open looked at clinical trials of cannabinoids containing THC, the psychoactive ingredient in cannabis, and found associations with dizziness and lightheadedness, and with thinking and perception disorders, in users over 50. But the authors called the associations “tentative” because the studies were limited and included few participants over 65.

“It’s hard to weigh the benefits and the risks,” Han said. As a geriatrician and addiction medicine specialist at the University of California, San Diego, he fears for older patients already susceptible to fall injuries, to interactions from taking multiple drugs and to cognitive impairment.

He advocates a “start low, go slow” approach, asking patients to monitor the results and report side effects.

Lebowitz said he is regaining his equilibrium. Recognizing that he was drinking too heavily, and disliking the resulting hangovers, he has backed off the booze.

“It’s really not my drug of choice,” he said.

But he is still smoking more cannabis than before the world stopped.

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