In October, tempered possession of marijuana will no longer be 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 stockpiled 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 never had a problem with adults smoking pot in private, away from children. As a matter of fact, 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 directly from the grower with no pharmacist oversight or quality control. Once the doctor’s note is exchanged for product, it will be difficult for the physician to track how much and how often the patient is using. Perhaps someone should invent a marijuana pillbox.
I didn’t give the issue much thought until an acquaintance told me about her plan to help her declining mother who has Parkinson’s Disease and is losing weight. She was pursuing medical marijuana as an appetite stimulant for her mom. Problem is that mom already has significant symptoms of dementia including hallucinations. Mom is also at high risk for falling and wanders from the waterfront home at night. Even if the pot increases her appetite, it presents greater risks for mom’s physical and mental health.
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). This was at a reputable assisted living chain. Could this type of tragedy occur with elderly folks if they are high on top of dementia-related hallucinations?
Undiagnosed memory loss is a problem. You wouldn’t believe how many older Americans hide increasing forgetfulness, even from their doctor. A good example is Miss F, who lived alone in her home. Her performance at her annual checkup was Oscar worthy. She knew the memory evaluation process quite well and had memorized the abbreviated version of the "Mini Mental Exam".
But Miss F had a habit of leaving her gas burners on after making tea and nearly torched her house on more than one occasion. She had also just "given" a long lost niece seventy-five thousand dollars to buy an entry-level Honda, but the car was never purchased and the niece was still showing up for more money.
Miss F had become afraid of driving and her registration had expired. She was also fearful of leaving her home. She was very thin, but refused groceries because she had shelves full of canned goods in the basement (all expired). Miss F. had difficulty maintaining her personal care and was at risk for fall. She was also becoming increasingly paranoid. She called a friend at four in the morning convinced that there was "a black man outside watching her". Her friend called the police who checked her home and neighborhood and found nothing. Miss F spent most of her days sitting in a chair. Ambulating was painful due to arthritis and joint pain.
Miss F’s behavior at home suggested dementia but no formal diagnosis had been given because her physician was truly unaware of her decline. If Miss F. was given a script for pain or an appetite stimulant her situation could only be further aggravated. But there are many memory-impaired at-risk seniors like Miss F. living in the community who will now have access.
Smoking marijuana can 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 moderate to heavy risks for the elderly 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 or hearing about new therapies on 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 its potential risks (not that they would have cared). Doctors were feeling pressured to prescribe the drug before its side effects and interactions with other drugs were confirmed. I’m afraid the use of medical marijuana will have a similar fate with elderly users. Use will be widespread before the negative attributes become common public knowledge.
There is also the issue of potential drug abuse by hired caregivers and family members. Stealing medications from an elderly person is both illegal and abusive. How will the physician know for sure that the elderly patient is the end user? Can that be determined? I have been involved in cases where an elderly client was being relieved of narcotics for cancer pain by a family member who was also an addict. 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 policies because it is was prescribed by a physician? If pot is indeed a much needed medical drug then will the cost be waived for medicinal users on Medicaid? Will the Maryland taxpayers end up paying for medicinal pot?
Our seniors are mature adults who do not want or deserve to be patronized. However, our older gray population is sometimes vulnerable. They are already at risk for clinically significant drug interactions, untreated memory loss, and abuse by caregivers. State lawmakers did not consider the vulnerable elderly population when deciding to decriminalize pot. Making marijuana accessible through medical providers could negatively effect our elderly community members who are already aging poorly.
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