Case studies from the field of medical cannabis for gerontology
Eloise Theisen keeps a jumbled voice mail from a patient diagnosed with dementia permanently saved on her phone.
It’s a reminder to the 43-year-old Concord nurse practitioner why she does the work she does: education and consulting about medical marijuana for seniors and senior living facilities. And why she’s considered a rock star of pot gerontology.
A year after the patient left the message on Theisen’s phone, Theisen says the same dementia patient was the “picture of health,” chatting in the hallway and joking about her “happy pills” — the nickname she gave to the cannabis capsules she takes daily, per Theisen’s recommendation.
Because of the physical realities of aging — pain, neurological dysfunction, fatigue, disease — seniors are popping a wide range of prescription pills at alarming rates. Americans ages 65 and over make up 14 percent of the U.S. population but account for more than 30 percent of pharmaceutical use, according to Centers for Disease Control and Prevention statistics. Many of America’s elders end up hooked on highly addictive and often disabling opioid painkillers.
Theisen — who has a master’s in nursing administration — is among those health practitioners seeking to connect seniors with cannabis, which she has witnessed provides a safe alternative to those pharmaceuticals. For more than 15 years she has treated seniors and others for a variety of autoimmune and neurological diseases, and she says the results in patients using cannabis medicine are very encouraging. She’s a leader in education, teaching at assisted-living facilities throughout the Bay Area, and serving on the board of the American Cannabis Nurses Association — which sports 300 member nurses in 30 states.
Seeking to address a growing demand among her nursing patients for cannabis education, she founded her cannabis consultation business, Green Health Consultants, in 2014. She gets new patients through referrals from other patients and groups that know her work. She’s a regular guest speaker at regional meetings of hospice nurses and other gerontology groups. Theisen estimates that 80 percent of the more than 3,000 patients she has worked with since then have had success using cannabis. But it’s not easy getting them to, she says.
“Eighty-five percent of my patients have never even tried cannabis before,” Theisen said.
… Often they’ll say, ‘Well I don’t want to feel out of control, and I don’t want to hallucinate.’… I’m trying to re-educate them about how you can control the euphoria, that low doses are often really effective with minimal side effects.”
Narrowing down the ideal dose and delivery method for each patient (vaporizers, tinctures, capsules, smoke and more) is another significant task, Theisen said. In cannabis medicine, what works for one Alzheimer’s patient, for example, does not necessarily work for the next — even if their symptoms are identical. This is because of the way the plant affects the nervous system.
“Cannabis gets promoted as working well for so many things — it starts to sound like snake oil,” she said. “If you explain the endocannabinoid system, and the science behind why it does work so well for so many different things, most practitioners (and others) start to let up on their bias.”
Theisen estimates that, based on her experiences, in about 20 percent of patients cannabis simply doesn’t appear to work. But when it does, the results can be significant. Here are some of the most powerful patient case studies she has observed, as dictated by Theisen:
‘Given me my mom back’
“One of my very first patients was the 89-year-old woman diagnosed with advanced-stage dementia and in assisted living. She’d been falling a lot, and the facility was talking about putting her in a memory care unit. She’d been on opiates for about 40 years, and never had real pain control. Her daughter was basically hoping to get her mom’s pain under control. Nobody was expecting a miracle.
“We started her on tincture (a cannabis-infused liquid), which is administered in capsules and distributed by the med techs in the assisted-living facilities. After about three months using cannabis, we were able to take her off of all of her pharmaceuticals, except for a high blood pressure medication.
“Within that three months, she started to regain her memory, she stopped falling, and the daughter called me one day and said, ‘You’ve given me my mom back.’
“Now she is 90. She knows she’s using cannabis, and she calls it her happy pill. At the time we started her on cannabis she couldn’t engage with me, she couldn’t even make eye contact.
“When I went back to recertify her (cannabis recommendation) a year later, she was the picture of health. In fact, I just talked to her the other day and she’s getting ready to go on a trip to France, where she’s from, for the first time in years. The messed-up thing is she has to stop her cannabis to go to France.”
Treating chronic pain
“Another patient I had was a chronic back pain patient in her 70s. She was not a surgical candidate, and basically got so desperate she said , ‘Fine, I’ll try cannabis. What do I have to lose?’ She was isolated. She and her husband are both retired, and her husband essentially was out there living his life, and here was his wife who was almost nonfunctional.
“It took about three months before we finally found the right combination, the right product for her. We tried edibles, tinctures, vaporizers and all that stuff. Finally I was like, ‘I think you just need to smoke an old-fashioned joint.’
“I think many of the products out there can destroy the actual medicinal value of the plant, so we just went back to basics. That was when her pain started to get better. Significantly. She is out doing yoga again, she’s going out to dinner again. She and her husband are traveling again, and she’s able to have more stamina than she had before.”
“Another patient I had was a Parkinson’s patient with dementia. He was a retired pediatrician, and his behavior was aggressive. Every night around 11 o’clock his wife was getting a phone call because he’d go into other residents’ rooms and break things, and scare the residents.
“His wife was beside herself when I came in, she was just a mess. She was sobbing, and telling me, ‘I’m not sleeping,’ and it was hugely dysfunctional for everyone.
“We got him on cannabis capsules full of cannabis tincture. Within a few days I checked in with her and she hadn’t gotten a phone call in three nights.
“He’s two years now on the same dose and continues to do well. His aggression has decreased and he’s just doing much better.
“We focused more on the dementia for this patient, but cannabis does seem to work for Parkinson’s symptoms in some patients.”
“One patient I have is a highly educated woman with a Ph.D. in psychology. She developed Parkinson’s and was experiencing tremors, fatigue and depression. We started her on cannabis and her results were so good that she and her family probably sent me 10 new patients.
“She is vaping and using tinctures. Her mood elevated, her energy improved and her tremors decreased significantly — within two weeks.”
“The top three things people come to see me for are sleep, pain, and anxiety and depression.
“This patient was a retired physician who had a stroke, and hadn’t slept well in several years. I put him on a tincture at night, and he’s done well. We haven’t had to increase his dose or anything. He’s been able to maintain the same dose for almost two years now. Often this is the case, if a patient responds to a low dose, we don’t usually have to increase the dose over time.”
“One anxiety patient came into my office with his wife, who was his caretaker. He was exhibiting some signs of dementia, but he had this severe anxiety. When he was in my office he would have moments of outburst where his whole body would shake, and at first I thought he was having a seizure. I looked at the wife and asked if this was something he did, and she said that was part of his anxiety symptoms.
“So, I let him use a vaporizer in the office, just because I was really worried about how he might respond. Within 15 minutes he had totally calmed down. He was relaxed, his demeanor had totally changed. He asked if I wanted to hear a dirty joke! It was pretty great. He was pretty fun.”