Maryland Rolls
A Fat One…

In October, tempered possession of marijuana will no longer
considered a criminal offense in Maryland. Ten grams or less is the threshold, unless used
medically. A doctor’s
recommendation is required for cannabis as therapy.
If caught, recreational pot smokers and minor dealers will
no longer be stock piled at our local prisons and lumped in with hardened criminals. They will simply be issued a ticket,
the equivalent of a minor traffic violation. That’s definitely a good thing
especially for nonviolent users and young adults with no previous record.
I have never had a problem with adults smoking pot in
private, away from children. As a
matter of fact, a my neighbor got high from last Thursday afternoon until
Saturday night. The stench was potent
and had no trouble floating over to our side of the street. When the kids asked what that weird
smell was, I simply told them that the neighbor was "burning weeds." Literally. But, whatever, it’s their house and their property. Who cares? The kids and I sat inside and had a "Frozen" marathon in four
languages. Watching the movie in
Malay gave me an opportunity to explain the term "Pacific Islander" to the kids
and my five year old son now has a major crush on the girl who sings "Let It
Go" in Italian. Figures he’d go for the brunette since
he resembles a Q-Tip.
What does concern me is the new medical marijuana legislation.
It supports marijuana dispensed
straight from the grower, with no pharmacist involvement or oversight, which
means no quality control. Once the
doctor’s note is traded with the grower for product, the outcome will be
difficult for physicians to track. How much and how often? Are there going to be pillboxes for pot
I didn’t give the issue much thought until I had dinner with
a new friend the other night. My
new friend was completely unaware of my work in eldercare advocacy. Red flags immediately went off in my head after hearing of
her plan to "help" her declining elderly mother with medical marijuana. It was obvious to me that my new friend
had already made up her mind to encourage use by her mother without considering
the potential for a poor outcome.
The mother was experiencing significant weight loss with Parkinson’s
disease. My new friend, the
daughter and caregiver, was anxious to use medical marijuana as an appetite
stimulant for her mom. Problem is her mom has significant
symptoms of dementia including hallucinations and wandering from the home at
night. Better yet, her very frail mom lives in a waterfront home
which is very dangerous for night wanderers. Is her mom being high going to help the situation?
To make matters worse, her mother is at high risk for
falling. If the hallucinations
increase after smoking pot and she ends up falling down the stairs will the doctor
who wrote the script be found guilty of medical negligence? Has anyone considered the legal ramifications of this new
piece of legislation?
When I worked as an eldercare consultant in northern
Virginia, I remember hearing from an attorney friend about a case in which a
demented assisted living resident jumped out of a third floor window and died
while hallucinating without drugs. And this was at a reputable assisted living chain. Could this type of tragedy happen to elderly folks still residing
in their own home if they get high on top of dementia-related hallucinations? Could this happen to my new
friend’s mother?
Undiagnosed memory loss is a problem. You wouldn’t believe how many older
Americans can hide their own increasing forgetfulness, especially from their
doctor. I had a client named Miss
F who lived alone in her home. She knew the memory evaluation process
very well and had memorized the abbreviated version of the "Mini Mental Exam." She was doing great until I started asking the questions in
the wrong order.
I knew that she had the habit of leaving her gas burners on
and nearly torched her house on more than one occasion. Yet, no formal diagnosis of Dementia. This particular client also called me at four in the morning
on several occasions convinced that there was "a black man outside watching her"
and she asked me to come over. I
called the police on each occasion and they checked out her home and the
surrounding streets and found nothing.
Miss F also told me that her dead husband still sleeps with
her. Perhaps he does. But if Miss F gets a script for cannabis to
help with arthritic pain and ends up chasing the imaginary black man outside with
her shotgun, that could be a problem that even her dead husband can’t fix. Undiagnosed dementia coupled with
medical marijuana could result in potentially dangerous situations. It certainly would for someone like Miss
Smoking marijuana could decrease anxiety and tremors, assist
with depression, stimulate appetite, and help with pain management. However, there are five hundred and
forty-seven known drugs that have heavy to moderate risks when paired with
cannabis. Among the highly
clinically significant are the common over the counter drugs aspirin and
Tylenol. Caffeine also made it to
the top of the dangerous interactions with cannabis list for elderly seniors.
Today’s seniors are savvy consumers. They watch a lot of television, and ask
for new drugs after seeing ads and watching the news. I remember when Viagra hit the market. My elderly male clients were well
versed in Viagra’s benefits, but not so much on it’s potential risks (not that
they would have cared). Doctors
were feeling pressured to prescribe the drug before it’s side effects and
interactions with other drugs were confirmed, and granted their male patient’s
requests. I’m afraid that the use
of medical marijuana will have a similar fate in our elderly population. Use will be widespread before the
negative attributes of medical use surface.
Our seniors are mature adults and do not want or deserve to
be patronized. However, among them are those who do need advocates, someone to
advise them because disease has effected their capacity to make conscious
decisions for themselves.
What about my new friend? Her mother has lost weight and should be encouraged to eat
more. But, there are appetite
stimulants available from her doctor with specific dosages for her height and
weight that will not make her more confused. My new friend is a tired and emotionally beat caregiver. Can she make reliable, objective decisions on behalf of her
mother? Would her prompting the
use of cannabis to increase appetite also offer the added bonus of a sedative? Would that be best for mom or the
There is also the issue of potential drug abuse by hired
caregivers and family members.
Stealing pain medications from an elderly person is both illegal and
abusive. How will the physician
know for sure that the elderly person is the end user? Can that possibly be determined? I have been involved in cases where an
elderly client was being relieved of pain medicine for cancer by family
caregivers who were also addicts. How
would situations like this be avoided with medical cannabis?
Lastly, the cost of medical marijuana will need to be paid
by someone. Will the elderly
patient pay or will the purchase be reimbursable through Medicare or Medigap insurance
because it was prescribed by or recommended by a physician? If marijuana is indeed a much needed
medical drug then will the cost of the drug be waved for low income medicinal
users on Medicaid? Will the
Maryland taxpayers be paying for that medicinal pot?
Our population is graying and sometimes vulnerable. They are
already at risk for clinically significant drug interactions, memory loss, and abuse
by caregivers. State lawmakers did
not consider the vulnerable elderly when deciding to decriminalize marijuana.