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Cbd oil dosage for elderly

Seniors Using CBD – Ultimate 2022 Beginner Guide

This is the ultimate guide for seniors using CBD – and the only guide you’ll ever need! Find out how to pick the best CBD products for seniors here.

As I noted in an earlier article, there are known health benefits of CBD for seniors. CBD has gained immense popularity in recent years and there are great reasons behind this new health and wellness trend. This compound can help older adults manage or overcome a myriad of issues but it might seem overwhelming at first to navigate the CBD world.

In this guide, we’ll start by giving you a simple six-step process to choose the best CBD products where we’ll explain all the CBD jargon you need to know to make well-informed decisions when buying CBD products. Then, we’ll go over our suggestions of the best CBD products for seniors, including products for arthritis, anxiety, sleep, and back pain among others.

We’ll finish by answering the most commonly asked questions about seniors using CBD.

How to Choose a CBD Product in 6 Simple Steps

The CBD world might seem a bit overwhelming at first. There are so many different products and jargon that you may feel intimidated. We’ve compiled the six steps you need to take to start your CBD journey in the simplest way possible.

Step 1 – What Do You Want to Achieve by Using CBD?

First and foremost, you need to define what your goals in using CBD are. There are so many different products in the market that if you don’t narrow them down by intent you’re left with… well, all of them!

That’s way too many products to browse through, analyze, and compare. After you know your purpose, you’ll know if products with CBD only are more helpful than those that also have THC. We’ll go through your options shortly, on step two.

You’ll also want to know what delivery method suits you best. If you have a skin condition, for instance, topical products may be better for you than CBD oil. This is just a simplified example to show you the importance of knowing your goal. We’ll get into detail on step three.

Step 2 – What Are the Different Variants of CBD Products?

There are three major variants of CBD products:

  1. Isolate CBD: only contains CBD at a high purity level.
  2. Broad-spectrum CBD: contains CBD and all other compounds in cannabis, including cannabinoids, terpenes, and flavonoids, except for THC.
  3. Full-spectrum CBD: contains all compounds in cannabis, including THC.

CBD is federally legal across all of the United States as long as it was derived from hemp plants containing less than 0.3% of THC, but THC is still illegal in most states. So, all the above types of CBD products are legal where you live as long as they were made from hemp plants within the legal limits.

Note: some states have purposefully made it illegal or restricted it to medical use, so make sure you know the regulations where you live. But you can also find full-spectrum CBD with a higher percentage of THC if you live in a state where cannabis is legal.

All of these type have advantages and disadvantages. Broad-spectrum and, especially, full-spectrum CBD are believed to be the most beneficial since all the compounds in cannabis act together synergistically to produce better and stronger results – this scientific theory is known as “the entourage effect.”

If you’re using a product with a high percentage of THC, you’ll most likely fail a drug test if you’re subjected to one – so that’s one point you must consider. Broad-spectrum CBD is a great alternative in this case.

Regarding isolate CBD, its greatest advantage is that you’ll be sure you won’t get an allergic reaction to any other ingredient since it only contains CBD.

The bottom line is that you need to consider your individual needs and the pros and cons of each one of these before going into each type of product – from simple oils to topicals you can find these variations in all of them.

Step 3- What Are the Different Ways of Consuming CBD?

After you’ve chosen between isolate, broad-spectrum, and full-spectrum CBD, you can start browsing through the different products available. There are plenty of options – you’ll surely find something that suits your taste, your lifestyle, and the issue you’re targeting.

CBD Oils and Tinctures

Oils and tinctures are some of the most versatile and effective options. You can simply ingest them, leave them under your tongue for at least one minute before swallowing, or add them to food or drinks.

The main difference between CBD oil and tinctures is their formulation – tinctures have more bioavailability, meaning that your body will absorb it faster due to certain ingredients in their composition. With these, it’ll take at least 30 minutes to feel the effects, which is longer than with most other options, but they’re also more long-lasting and act on your whole body.

Moreover, there are plenty of flavors to choose from. You can go for natural flavor or others, like the ones Plant Power offers – mint, rosemary, lemongrass; orange, cinnamon, ginger; or coconut, pineapple, lemongrass.

CBD Edibles and Capsules

If you don’t want to add CBD oil to food or beverages, you can choose to buy pre-made edibles. You’ve got plenty to choose from but the most common are gummies. As previously mentioned, you can find full-spectrum gummies or gummies containing only CBD.

Capsules are a great alternative to oils and tinctures if you want to make dosing easier. Each one comes with a specified concentration and you can have one or more at a time depending on your regimen.

You can find CBD products, including gummies and capsules, that were specifically formulated to target certain issues or go for general ones if you just want to feel more balanced. Avid Hemp is a great shop here. They offer a great variety of gummies with different concentrations and flavors.

Both of these types work the same way as oils and tinctures. You ingest them and the effects take at least 30 minutes to be felt but they last longer than with most of the other options and act on your whole body.

CBD Vapes

CBD vapes work like regular vapes – you just take a deep breath and hold the vapor in for as long as you want – the longer, the greater the absorption. Vapes are incredibly convenient since you can easily take and use them anywhere. They’re also discreet and you’ll feel the effects in less than ten minutes – making them perfect for quick relief.

If you’re just getting started, you should wait those ten minutes before you take a second puff and repeat the process until you’ve attained the desired effects. However, vaping can be quite harsh to your lungs, especially if you buy from untrustworthy brands that use low-quality materials and harmful chemicals in their CBD e-liquid composition.

If you want to try out vaping, our recommendation is that you go for Sauc’s vaping device. They are the first and only brand offering a lead-free, leak, clog, and tamper-proof cannabinoid delivery system.

You can also buy CBD vape pods, fillable pods, and e-liquids on their website or choose CBD e-liquids (a.k.a. vape juices) from other manufacturers once you feel like trying something new.

Since they only have three CBD e-liquid flavors available, we recommend you get Sauc’s fillable pods and Danker’s vape juices to fill them up. They have so many flavors to choose from!

CBD Flower

CBD flower is like regular cannabis flower but with a high CBD concentration and no psychotropic effects – no, you won’t get high! You can smoke it with a bong, pipe, or in joints or blunts. It offers quick relief, just like vaping.

Jeffrey’s is one of the best retailers of CBD flower. They offer premium, indoor-grown, 100% organic, AAA quality, craft hemp flower. You can opt for a relaxing strain to help you cope with anxiety or sleep problems or for an energizing strain that’ll keep you active and creative throughout the day.

CBD Topicals

CBD topicals encompass a wide variety of products, like creams, lotions, salves, massage oils, and shampoos, among others. These are the best option for targeted action. You can simply apply them over the affected area if you have a skin problem, like acne, eczema, or psoriasis, or muscle, joint, or bone aches or discomfort. They are great for people suffering from arthritis, for example.

A great CBD cream for seniors is PurCBD’s hemp intensive relief rub. It comes with 500 mg of CBD and menthol. It uses cryotherapy to help the cream penetrate quickly, offering fast relief for muscle and joint aches.

But there are also CBD cosmetic creams, like PurCBD’s wrinkle serum. Thanks to its composition, it brightens uneven skin tones, nourishes dehydrated skin, and increases circulation.

What You Need to Know About CBD Product Labels

You need to know what to look for in labels to find the best CBD products. You also need to remember that hemp seed oil is not the same as CBD oil – it might not even contain CBD at all.

A trustworthy brand has nothing to hide – they’ll include all relevant information in their labels or, at least, make it available on their website. A reputable CBD brand usually includes the following in its product description:

  • The manufacturer or distributor’s name;
  • The Supplement Facts panel;
  • The list of ingredients;
  • The net weight;
  • The amount of CBD per serving, the total amount, or the potency in percentage;
  • Whether it’s full or broad-spectrum or isolate CBD;
  • The batch or date code.

How to Find a Reputable CBD Manufacturer or Seller

Finding a reputable seller is very important when searching for the best CBD products. It all starts with quality hemp – preferably grown without chemical fertilizers, herbicides, and pesticides.

Then, you have to look at the CBD extraction method. Some methods are cleaner and lead to purer CBD than others. The C02 extraction method is the best one – hemp goes through high pressure and low temperatures without using harsh chemicals, like ethanol and butane.

But what really makes a trustworthy seller stand out is third-party testing. These analyses search for impurities and confirm the CBD potency and THC content. The results come as Certificate of Analysis (CoA) that companies make available to customers on their websites.

When you buy from sellers who openly show their CoA’s, you can be sure of the CBD and THC content and that their products are free of pesticides, herbicides, heavy metals, solvent residues, and chemical thinning agents.

Mind the Cost of CBD Products

Sometimes prices might seem too high for such small amounts of CBD but those products usually last for a while since you don’t need much of them. A high price doesn’t always equal quality but when it comes to high-quality CBD products, the licensing, expensive and labor-intensive processes, and third-party testing all contribute to the final price tag.

If you find cheap CBD products, those brands are likely cutting corners and lowering the quality of their products. Never compromise on third-party testing and quality raw materials and processes – always choose high-quality CBD products.

Best CBD Products for Seniors

In this section, we’ll give you product recommendations for specific issues you might have to help you get started on your CBD journey. It’s important to know that you will interact differently to different types of CBDs, how they are consumed, and that how one CBD treats one person could have a very different effect on someone else. What follows are suggestions rather than absolutes. To know what truly works best for you you have to try a product and monitor the effects it has on you.

What’s the Best CBD Oil for Seniors With Arthritis?

This CBD oil comes with 33.33 mg of full-spectrum CBD per serving. It also contains turmeric oil, peppermint oil, and ginger oil – each bringing more beneficial properties to the table.

You should shake the bottle well and then have 1 mL orally. Just hold it under your tongue for 30 to 60 seconds before swallowing.

Client reviews highly praise this oil. People report pain and discomfort relief in their joints, bones, and muscles. Some clients have said that after starting using this oil, they no longer needed painkillers – “No aspirin or ibuprofen for the last 8 months!” stated one happy customer.

Others report better sleep, more clarity during the day (even for Alzheimer’s patients), quicker muscle recovery, and decreased muscle spasms.

CBD capsules are incredibly convenient and easy to use. These in particular are full-spectrum, non-GMO, and were made from hemp grown with no pesticides. Each contains 25 mg of CBD – you can choose to have more than one.

They were specifically formulated to help with muscle and joint issues, making them perfect for those suffering from arthritis. They also have other beneficial ingredients in their composition, including turmeric root powder and a special herbal blend.

What’s the Best CBD for Seniors With Anxiety?

This oil has the same composition and ingredients as the previous one, just a lower concentration of CBD – 16.66 mg per serving.

According to customer reviews, this is the best CBD for anxiety and anger. Additionally, we chose this lower concentration since, usually, you don’t need as much CBD to calm your anxiety as you do for pain relief but you can use them interchangeably and this one is more beginner-friendly.

One client review reads “This product helped my anxiety so much!” while another stated, “I was pleasantly surprised how much this full-spectrum CBD helps my anxiety!” Moreover, customers report that WelCel’s 500 mg CBD oil helps them keep a clear head, sleep better, and lower heart rate and blood pressure.

What Are the Best CBD Products for Back Pain?

CBD patches aren’t too common – yet! They’re only starting to gain popularity this year. But we believe these are the absolute best for targeted pain relief – not just for back pain but anywhere you need!

They can help you relax tense muscles and soothe pain. And SOAR’s patches come with 50 mg of CBD each, while other brands’ patches usually only have 25 mg.

What makes patches great is that you can place them on your skin and forget about them. They’ll offer you a soothing feeling for up to 72 hours – whether you’re sleeping or going about your day.

SOAR’s customers love these patches! They claim that they’re helpful for tense neck, shoulders, back, and arms. A client stated that this was the first real solution she found for debilitating, chronic pain.

Best CBD for Sleep For Seniors

This lemon-flavored CBD tincture was specifically made to help you sleep better and wake up feeling refreshed and energetic. It combines broad-spectrum CBD with cannabinol (CBN), melatonin (the sleep hormone), lemon flavor, and stevia (a natural sweetener).

Customers love this tincture! One stated that “This tincture not only tastes great, [but] it [also] allows me to sleep through the entire night…which is worth its weight in gold!” And added that it helps you fall asleep and prevents you from waking up multiple times throughout the night.

SOAR recommends you place 1 mL under your tongue, before sleep, for 30 seconds and then swallow. But a client mentioned that 0.5 mL is all it takes for her to sleep like a baby. “It’s a miracle product,” she added.

If you find that SOAR’s tincture isn’t potent enough for you, Avid Hemp’s 1,000 mg oil is the best alternative. It also contains melatonin in its composition but comes with a minty flavor, fractionated coconut oil, and full-spectrum CBD instead of broad-spectrum.

Best CBD Edibles for Seniors

These capsules come with 25 mg of CBD each. They offer full body and mind support since they have broad-spectrum CBD and a blend of ancient, adaptogenic herbs – you’ll always feel at the top of your game!

These adaptogenic herbs include ashwagandha, known to decrease stress and support cognitive function; astragalus, which stimulates the immune system; and Rhodiola to promote endurance and strength.

One customer stated that these capsules are her greatest ally against everyday stress, while another claims to be using them to manage back and neck pain. Another customer said: “I love this product. I feel like my memory and brain fog has improved!” So, yes, you just found your miracle pill!

What Are the Best CBD Gummies for Seniors?

Aside from having 20 mg of CBD per gummy, which helps fight pain and inflammation, they each contain 200 mg of Boswellia, a natural joint-restoring herbal extract.

According to research, Boswellia decreases inflammation and can help those suffering from osteoarthritis and rheumatoid arthritis. By decreasing inflammation, it allows your body to heal your joints instead of perpetuating the chronic inflammation cycle.

A customer reported that after four days of taking one of the gummies before bedtime, his pain was gone, which also helped him sleep better. Another customer stated that they work better than any over-the-counter medication and that her joint stiffness and pain were gone in two days with just one gummy per day.

Prosper Wellness has made its products available in bundles, as well, so you can save a few bucks on your orders.

Best CBD Cream for Seniors

This cream is packed with awesome ingredients, including CBD, aloe, castor oil, peppermint oil, arnica, green tea extract, willow bark extract, menthol, and vitamin E.

This powerful combination is perfect to manage pain in specific areas and its high menthol percentage makes sure all those other ingredients penetrate deep and quickly into your skin.

All client reviews agreed that it reduces their pain, whether it’s on their joints or muscles. However, some state that its effects are immediate, others claim that it takes around 30 minutes, and one said that it took repeated use over some days to start noticing improvement.

Best CBD Beauty Products

This stellar cream has broad-spectrum CBD oil, retinol, jojoba oil, pro-vitamin B5, coconut oil extract, vitamin E, vitamin C, and spilanthes flower extract in its formulation.

First, it can smooth wrinkles and fine lines thanks to CBD’s ability to repair collagen and elastin and to eliminate inflammation and redness, which is especially beneficial if you suffer from eczema, psoriasis, or other autoimmune skin condition.

Additionally, retinol speeds up cell replacement leading to fresher and smoother skin – as proved by 17,426 clinical studies!

Vitamins C and E repair damaged skin and support collagen growth – your skin will get thicker, smoother, and more vibrant.

Finally, jojoba oil, coconut oil extract, spilanthes flower, and pro-vitamin B5 act on the muscle structure under your skin, restoring its strength.

Following is a sampling of some client reviews:

“I’ve tried many natural products but this one really does make a difference! My skin looks brighter and firmer! I highly recommend [it]!”

“I am 62 and have very dry skin. I have seen improvement already.”

“I’ve been using this product for a couple of months and noticed sagging skin on my neck has tightened. Very pleased!”

As you could see from the last client review we included, you can use the previous cream on your neck as well. But if you’re looking for something specially formulated for this area, PurCBD’s cream is by far the best option.

This cream was specifically formulated to reduce inflammation and itchiness, protect against wrinkles, moisturize, and recover skin elasticity in your neck, shoulders, upper chest, and cleavage.

Best CBD Massage Products

CBD massage oils are a great way to incorporate CBD into your routine. You can even bring it in and ask your masseuse or physiotherapist to use them instead of their regular oils.

Besides full-spectrum CBD it also comes with lavender oil, sunflower oil, safflower oil, sesame seed oil, jojoba seed oil, olive oil, vitamin E, and vitamin A – leading to a powerful synergy between all ingredients for the ultimate massage experience.

CBD for Seniors – FAQ

In this final section, we’ll answer the most commonly asked questions regarding CBD and seniors.

1 – Is CBD Good for Older Adults?

Yes, CBD helps your body return to balance faster. When your body is out of balance, you can feel pain, notice excessive inflammation, or have anxiety and upside-down sleep cycles.

These are all problems commonly affecting older adults that CBD can reduce or manage. Preliminary research also indicates it might help prevent diseases like Alzheimer’s.

2 – Is CBD Oil Safe for Senior Citizens?

Most doctors believe CBD is safe for older adults while others classify it as “possibly safe.” There haven’t been any documented CBD overdoses. Side-effects caused by CBD are usually mild and harmless – somnolence, dry mouth, lack of appetite, and headaches are among them.

What’s important to remember is that side effects are correlated to dosage. The higher the dose, the more likely you are to experience them. You should always start with a very low dose and progress from there.

3 – Does CBD Help Anxiety?

A 2018 research study concluded that CBD does have anxiolytic properties. This has been corroborated by plenty of other clinical studies and anecdotal evidence.

4 – Is CBD Good for Arthritis?

CBD can improve the life quality of people suffering from arthritis by suppressing persistent inflammatory pain and chronic neuropathic pain.

Even though most of the research in this area is still at an early stage, results are promising and there’s plenty of anecdotal evidence supporting these claims as well.

5 – Which CBD Products Actually Work?

The problem with CBD products that don’t work is that there’s no CBD in them. A lot of less-reputable companies are taking advantage of the lack of regulations to sell CBD products that contain less cannabidiol than stated on the label or none at all.

If you follow the steps above, you’ll be able to find trustworthy brands that can get you the desired results – you can also purchase from the tried-and-tested brands we’ve suggested throughout the article.

All there’s left is figuring out your ideal CBD dosage and regimen. Of course, everyone is different – you might not respond to CBD therapy like some people don’t respond to traditional therapies but this way you know you’re actually getting CBD.

6 – What Are the Strongest CBD Products?

The strongest CBD oil that we found is from Avid Hemp. They developed a 30 mL oil with a total of 5000 mg of CBD – about 167mg/ml. Just beware that this is not recommended for beginners.

Seniors Using CBD – The Bottom-line

For someone new to the CBD world it might seem a bit hard to navigate. We hope this guide on CBD for seniors has been helpful for those looking to get into this new trend.

Every time you buy a CBD product, don’t forget to check the label for CBD potency, THC content, and other ingredients. This way, you can predict how long the product will last you and be sure there aren’t any harmful chemicals.

We also hope we’ve enlightened you on CBD terminology by explaining terms like isolate, broad, and full-spectrum as well as the Certificate of Analysis and third-party testing. You should always check the CoA and past client reviews of products and brands.

Finally, we hope we’ve answered the questions that all seniors using CBD might have and that our product picks suit you and any ailments or issues you’re trying to target.

Sources Cited

  1. HSOA Journal of Alternative, Complementary & Integrative Medicine:Cannabidiol and Contributions of Major Hemp Phytocompounds to the “Entourage Effect”; Possible Mechanisms
  2. Leafly:What is CBN (cannabinol) and what are the benefits of this cannabinoid?
  3. Healthline:12 Proven Health Benefits of Ashwagandha
  4. Healthline:Astragalus: An Ancient Root With Health Benefits
  5. Healthline:7 Science-Backed Health Benefits of Rhodiola Rosea
  6. Healthline:Boswellia (Indian Frankincense)
  7. NCBI:Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Age
  8. NCBI:Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors

About the Author

Inês is a freelance SEO writer and copywriter specializing in helping cannabis and CBD businesses increase traffic and sales. Outside of work, you can find her traveling, getting lost in nature, or cooking (and indulging in the outcome) – always with a smile on her face and a contagious smile. Find her on LinkedIn or on her website.

Cannabidiol Use in Older Adults

ABSTRACT: Cannabidiol (CBD) is a nonpsychoactive component of the Cannabis sativa plant. CBD products, which have become popular in the United States, are frequently used to treat pain, anxiety, and sleep disorders—conditions that affect older adults. Evidence is insufficient to recommend the use of CBD for these disease states. OTC CBD products are widely available, and there are significant concerns regarding their safety, including mislabeling, standardization issues, and drug interactions. The informed pharmacist will be a valuable resource for discussing the use and safety of CBD with older adults.

Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) are among the many cannabinoids, or components, of the Cannabis sativa plant. CBD is nonpsychoactive, whereas THC has psychoactive properties such as euphoria and psychosis. Two common strains of Cannabis sativa are marijuana and hemp. 1 CBD may be derived from either marijuana (which often contains more than 15% THC) or hemp (having a THC concentration of no more than 0.3%). 2 In addition, CBD may be extracted from Cannabis indica and hybrid plants, which may have higher concentrations of CBD than THC. A recent survey revealed that one in seven Americans uses CBD products, with the most common reasons for its use being pain, anxiety, poor sleep, and arthritis. 3

Endogenous cannabinoids and phytocannabinoids such as CBD and THC modulate the endocannabinoid system (ECS). THC is a partial agonist on the cannabinoid (CB) 1 receptor that results in central nervous system (CNS) effects, such as the “high” associated with marijuana; it also has limited CB2 agonist activity in the immune system. CBD has minimal activity on CB receptors, but it affects the ECS and the non-ECS. 4 Some of the proposed mechanisms of CBD include agonist activity at serotonin 1A, transient receptor potential vanilloid 1, G protein–coupled receptor 55, and adenosine A2A receptors, which may explain some of the possible analgesic, anti-inflammatory, anxiolytic, and antiepileptic effects of CBD. 1,5

In the United States, about two-thirds of states have legislation approving cannabis for recreational use (11 states) and/or medicinal purposes (21 additional states). Seven states mandate pharmacist involvement, such as dispensing activities or consulting to dispensaries. 6 The only FDA-approved (in 2018) CBD product is Epidiolex, which is indicated for treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. 7 The law prohibits the sale of foods or dietary supplements to which CBD has been added; however, a wide variety of products containing CBD are available at retail stores. 8

Formulations

CBD formulations used in clinical trials include oral capsules, sublingual spray, oil-based solution, and topical gel. OTC CBD products are available in numerous other formulations, including topical balms and creams, e-liquid for inhalation, and infused foods and drinks. 1,9 Given the many formulations and manufacturers, nearly all CBD products lack standardization. The exception is Epidiolex, which is available as an oil-based oral solution formulated with sesame oil and standardized to contain 100 mg/mL of pure CBD extract. 7

CBD levels in commercially available products vary widely. The FDA has issued warning letters every year since 2015 to companies marketing unapproved new drugs that allegedly contain CBD. 8,10-13 As part of these warnings, the FDA tests the chemical content of CBD compounds, and it has found that many products do not contain the claimed level of CBD. Commercially available products have been assessed in laboratories, whose findings support the FDA’s concerns about product inconsistency and mislabeling. A laboratory assessment of OTC CBD products sold in the U.S. demonstrated that only 26 of 84 (31%) products tested were accurately labeled. 14 Not only was the amount of CBD in products overlabeled or underlabeled, but 21% of products contained THC even though it was not listed in the product information. In addition, the FDA has cited concerns regarding reports of contaminants such as pesticides and heavy metals. 8

The mislabeling of CBD products results in dosing uncertainty in the use of any commercially available OTC product. This is an important caveat in the extrapolation of dosages used in clinical research. In such research, a range of dosages have been used for different indications and routes of administration. For example, Epidiolex oral solution is approved for weight-based dosing from 5 mg/kg/day to a maximum of 20 mg/kg/day. 7 CBD has been given orally at dosages of 100 mg to 800 mg. 15,16 CBD topical gel has been used for fragile X syndrome at a dosage of 50 mg to 250 mg daily. 17 For smoking cessation, a CBD metered-dose inhaler has been administered at a dosage of 400 mcg as needed. 18

Administration and Absorption

CBD absorption depends on the product formulation. In animal and human studies, CBD administered orally has been shown to be poorly absorbed, with bioavailability of 13% to 19%. 19,20 CBD’s bioavailability is believed to be reduced by first-pass metabolism. Poor bioavailability can be avoided with the use of alternative formulations. There is an emerging market for novel delivery methods to increase CBD’s oral bioavailability. 21

Absorption of CBD may also be altered by food intake. In clinical trials, coadministration of Epidiolex with a high-fat, high-calorie meal increased plasma levels of CBD fourfold to fivefold compared with administration on an empty stomach. 7 In one study using a purified (99%) CBD capsule, coadministration with food resulted in a maximum concentration and AUC of 14-fold and fourfold higher, respectively, compared with administration on an empty stomach. 22 CBD inhalation in humans has an average bioavailability of approximately 31%, with the use of one type of metered-dose inhaler demonstrating bioavailability of more than 65%. 18,23 Transdermal absorption of CBD is variable in animal studies and has yet to be fully elucidated in humans. 4

CBD Uses

CBD is FDA-approved for certain types of seizure disorders; for more information, see the manufacturer’s website for Epidiolex (www.epidiolex.com). The following section will focus on the common reasons for off-label CBD use, including pain, sleep disorders, and anxiety, all of which affect older adults.

Pain: An estimated 50 million American adults (20.4%) experience chronic pain, with persons aged 65 years and older constituting 61.2% of those affected. 24 Much of the data on chronic pain (e.g., neuropathic pain, cancer pain, diabetic peripheral neuropathy, fibromyalgia, HIV-associated sensory neuropathy, spasticity associated with multiple sclerosis [MS], and rheumatoid arthritis) involve the use of marijuana and cannabinoids (often THC, combination THC-CBD, or nabiximols [a specific mixture of THC, CBD, other minor cannabinoids, flavonoids, and terpenes]). Formulations used in pain studies range from smoked, oral, or oromucosal spray of THC; synthetic cannabis (nabilone); synthetic THC (dronabinol); and vaporized cannabis, with results suggesting modest reductions in pain and spasticity. 25

Sativex (nabiximols), an oromucosal THC-CBD spray, is approved in several European countries for treating symptoms of moderate-to-severe spasticity associated with MS, and a phase II/III clinical trial is currently under way in the U.S. to evaluate nabiximols for advanced cancer pain with inadequate analgesia from chronic opioids. 26 There is a paucity of data on CBD used for pain; most studies are in preclinical stages. 5,25,27

Sleep Disorders: Sleep disorders are disproportionately more prevalent in older adults. 28 Patients have commonly reported that cannabis is helpful for sleep. 29 CBD is used for alleviation of insomnia, but little is known about its effectiveness. One study that compared CBD with placebo for insomnia in 15 patients suggested that 160 mg of CBD may improve sleep duration without next-day sedation. 30 Somnolence was reported in nearly one-third of patients taking Epidiolex in clinical trials, which provides additional support for CBD’s benefits for sleep in some patients. 7 However, more research is needed to determine whether CBD is useful for individual components of insomnia, such as sleep latency, wakefulness after sleep onset, sleep duration, and overall sleep quality.

Anxiety: Evidence is not strong for the use of CBD for anxiety disorders. CBD has demonstrated some benefit for social anxiety disorder and social phobia when patients undergo a simulated public-speaking test. 31,32 However, these trials had small sample sizes and study biases. It is theorized that CBD could be beneficial for anxiety based on its mechanism of action at the serotonin receptor. 31

Other Disease States: Data on the use of CBD for various other conditions are mixed, and evidence is insufficient to recommend this practice. The efficacy of CBD has been studied in bipolar disorder, Crohn’s disease, diabetes, dystonia, fragile X syndrome, graft-versus-host disease, Huntington’s disease, opioid withdrawal, Parkinson’s disease, schizophrenia, and smoking cessation. 33 In addition, CBD has been reported to be useful for addiction, possibly by modulating dopamine and serotonin. 1

Adverse Effects and Safety

The use of CBD is considered “possibly safe” when used appropriately, based on some clinical evidence. 33 However, insufficient high-quality data exist to recommend CBD for most older adults. The most common adverse effects associated with CBD, reported in clinical trials of Epidiolex, are somnolence (~32%), decreased appetite (16%-22%), diarrhea (9%-20%), and increased liver-function tests (13%). 7 Other side effects are orthostatic hypotension, lightheadedness, and dry mouth. Adverse effects appear to be dose-related. The safety of CBD in the geriatric population has not been fully clarified, and Epidiolex clinical trials did not include patients older than 55 years. 7

There are practical concerns regarding CBD use in older adults. The geriatric population may be more susceptible to adverse effects of CBD commonly seen in younger adults, including sedation. CBD is hepatically metabolized, predominantly via CYP2C19 and CYP3A4. 4 Older adults with reduced hepatic function may be more susceptible to adverse effects of CBD.

Commercially available CBD products may not contain the CBD concentrations claimed on the label, and the FDA warns consumers to be aware of this inconsistency when using such products. 13 Of particular concern is the THC component in mislabeled CBD products. Older adults may be predisposed to adverse effects caused by the psychoactive properties of THC. The use of marijuana in older adults has been associated with increased risk of injury and adverse events. 34

Drug-Drug Interactions

CBD has been shown to inhibit hepatic enzymes. 4 In human studies, coadministration of CBD with antiepileptic drugs resulted in increased concentrations of drugs that are substrates of CYP2C9, CYP2C19, and CYP3A4. 35 Given CBD’s known sedative effect, there is also a theoretical concern for additive hypnotic reactions in combination with CNS depressants. TABLE 1 lists potential interactions with CBD.

The Pharmacist’s Role

A recent survey by the Arthritis Foundation revealed significant use of and interest in CBD for arthritis. The Foundation acknowledges the possible efficacy of CBD for treating pain, insomnia, and anxiety while also recognizing the lack of rigorous clinical studies. 36 Despite a scarcity of evidence for CBD use in the geriatric population, education on known and potential benefits and risks is vital to a patient’s decision-making process. The pervasive direct-to-consumer advertising and ubiquity of CBD products may foster misinformation or misinterpretation of actual evidence. The pharmacist should be prepared to give an unbiased assessment of CBD, including concerns about product mislabeling, underlabeling and overlabeling of CBD, and lack of THC labeling in a product containing it.

The pharmacist should consider patient-specific factors when discussing CBD use. A review of potential drug-drug interactions is warranted prior to using CBD. Counseling on pharmacokinetic variables, such as oral administration with or without food, may be relevant. Comorbidities may also be pertinent to the discussion, and safety concerns should be reinforced. For example, a patient with preexisting respiratory disease should avoid inhalation as the route of CBD administration. An honest and impartial discussion will facilitate a stronger patient–healthcare provider relationship.

If a patient has decided to use CBD, the pharmacist can direct the patient toward a top-quality CBD product. TABLE 2 provides questions to consider when recommending a CBD product. Given the increasing number of states and U.S. territories legalizing marijuana for medicinal or recreational use, the informed pharmacist will be a valuable resource for discussing the use and safety of CBD with older adults. 6

CBD Safety For Seniors

Almost one in five Americans over 50 now uses some kind of CBD product, according to a recent Gallup poll. And they are doing so undeterred by the total lack of FDA oversight or guidelines. But to what extent is CBD use a public health concern for seniors? And what do older adults need to consider when they start using CBD?

Fake product alert

Hemp-derived CBD oil is now poised to overtake olive oil in the category of most counterfeited plant extract on the planet, making authenticity a prime concern for older consumers. Random samplings of CBD products consistently detect misrepresentation between their labels and their contents. In some cases, the nominal cannabinoid is entirely absent, in others, more nefarious substances have been found.

One of the many organic, third-party lab-tested CBD products on the market.

Hence, until the FDA gets its regulatory house in order, responsibility for finding a safe product lies with the consumer. According to the Brightfield Group, seniors tend to prefer ingesting CBD in oils, vape cartridges and edibles, which entails a lot of label-reading for seniors. When evaluating a CBD product, make sure it uses CBD from organic hemp, preferably grown in the United States, and that it is third-party lab tested to verify the CBD content and rule out the presence of contaminants.

Once you get it, how do you use it?

While CBD products have never been easier to access in the US, actually getting the desired results from them can be more complicated.

I spoke with Dr. Danial Schecter, an Ontario-based family physician who is the co-founder of a network of cannabis-based medicine clinics that have served over 60,000 patients in Canada, and who recently became Director of Global Medical Services at Canopy Growth Corporate, about the guidance he suggests for seniors interested in using CBD.

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Danial Schecter (DS) I’ll start with a few basics: CBD is a molecule derived from the cannabis plant. It is what we call non-euphoric-inducing, in that it doesn’t cause you to feel high, but it is still what we call psychoactive, meaning that it has an effect on the neurotransmitters and the chemistry of your brain, just like an antidepressant or a sleep aid would have.

Abbie Rosner (AR): How do you approach CBD dosage for seniors?

DS: When we’re talking about CBD, in terms of dosing it in particular, we know that doses of CBD are very safe, that there has been no documented overdose of CBD, that it does not cause euphoria and that it is safe to be used in quite high quantities. We have studies where it’s been used in as low as 5-10 mgs per day, and studies that are using it in as high as 1500 mgs a day.

The supposed effects of CBD are that it has anti-inflammatory, antidepressant and anxiolytic (anti-anxiety) properties – but we still don’t really know exactly how it works. Yet there have been studies done in humans, for example, where subjects were given 600 mg of CBD in a single dose or a placebo, and then had them do a simulated public speaking exercise. And those who had the CBD had a significantly easier time, with less anxiety.

But, in clinical practice, we never give doses like that. It’s just not affordable. What I see in my clinical practice is that the majority of people will respond to somewhere between 40 and 100 mgs of CBD/day.

AR: If a 70 year old woman came into your clinic, would you recommend that she take 40 mg of CBD?

DS: No. What I would say is, we don’t know what your dose is going to be. Everyone’s endocannabinoid tone is different, their metabolism is different, you’re on a certain number of medications that will potentially affect the metabolism of CBD and the only way to know if it is going to work and what the dosage is, is by taking a standardized approach, starting low and going slow.

AR: And what would the starting dose be?

DS: In a healthy adults a starting dose would usually be 5 mg of CBD, but in people who are elderly, who are potentially on a number of medications, and who are very sensitive to side-effects of medications, we like to cut that dose in half, and start at 2.5 mgs of CBD. The 40-100 mgs a day of CBD a day that I mentioned previously, that’s usually for people who are using it for pain or for anxiety and wellbeing.

AR: Pain and anxiety are two of the main issues that older adults are facing – so the picture that I’m getting is that, if an older adult comes in and says, I have pain and I’d like to start with CBD – you’d start low but you might theoretically get up to 40-100 mgs of CBD to actually address the effects.

DS: Exactly – so what we usually do is, we encourage people to start at a very low dose – 2.5 mgs – and then increase in 2.5 mg increments – depending on how aggressive they want to be – over anywhere between 2 days and one week. And then wait to see if they feel any kind of response.

Usually, the psychological symptoms will take longer to actually improve or respond to CBD than the physical symptoms. So we would often recommend a slower titration for anxiety or depression, and for the physical symptoms that have a quicker response, we could recommend a quicker titration.

AR: What do you recommend for seniors who want to supplement or replace their medications with CBD?

DS: Whenever we want to start a new medication, one of the very basic principles is that we should really not be playing around with another medication. So you only want to introduce or remove one medication at a time.

If you’ve been on a sleep aid for many years, and you want to stop taking it and use CBD, I would not recommend that you all of a sudden stop taking the sleep aid and start taking CBD, because your insomnia will get worse. Under the guidance of your physician, you would want to taper in the CBD until you reach a stable dose.

AR: Is CBD alone a potent medication?

DS: It can be. But it’s probable that the best benefits – at least what I see in clinical practice – is when we can use a combination of both THC and CBD.

There is idea that exists that THC is bad and CBD is good, when in actuality, both of these molecules have a very important place in clinical practice. And while THC has received a bad rap, because it is associated with getting high, in actuality, it has more immediate benefits than CBD. With THC there’s a huge misconception that people just use it to get high. But in doses that do not cause you to get high, it can be very beneficial for things such as sleep, pain, nausea, appetite stimulation and muscle spasms.

AR: That’s all fine and well in Canada. But in most of the United States, older adults need to get a medical marijuana card to access those products –with all the bureaucracy that entails. And now they can access CBD in almost any drugstore – and that’s what they’re doing!

DS: For someone who wants to access CBD on the open market, that’s absolutely fine – but ideally, they would be doing so under the supervision of their main treating physician.

AR: In your practice, are you seeing older adults who are asking for CBD products?

DS: That’s actually what we’re seeing the most of these days. In Canada, where cannabis has been legalized for recreational use, the greatest increase in our patient population at the clinics are the Baby Boomers and the parents of Baby Boomers who are coming in all the time asking to try that CBD oil.

But the other thing is that, even when they want CBD, once we start examining them, getting their history and understanding what it is they are looking for, we find that very often they would benefit from a low dose of THC in addition to CBD. Here in Canada, you can very easily say, I know you’ve heard about CBD, but you could benefit even more from something with a little THC.

AR: And there’s the beauty of full legalization – that you don’t have to jump through so many hoops to get a little THC in your medicine.