11 CBD Health Benefits for Seniors
CBD is becoming more widely used by the general public as social acceptance and understanding of its medicinal benefits become better known. One population that may be left out of this trend are older adults, but they too can benefit. Let’s look into the benefits of CBD for seniors.
68% of all adults aged 65 or more live with two or more chronic conditions, while 80% live with one. Though some conditions may cause mild discomfort only, others are quite debilitating and can significantly impact your life quality.
Nowadays, there are plenty of therapeutic options to manage these conditions but not everyone responds to these treatments. On top of that, some medications can bring about undesired side effects.
CBD can help you manage or prevent several ailments and symptoms. And given that it is non-intoxicating, non-addictive, and rarely leads to negative side effects, a lot of people are now seeing it as a life-changing option – CBD might just be the answer you’ve been searching for.
In this article, we’ll cover everything you need to know about CBD and seniors. First, we’ll let you know what CBD is and how it interacts with your body, as well as whether or not it is safe for seniors.
Then, we’ll give you eleven backed-by-research health benefits of CBD for seniors. And, finally, we’ll provide you with all the practical tips you need to choose CBD products that help and suit you and teach you how to find out your ideal dosage.
What Is CBD?
Cannabidiol, or CBD, is one of the most abounding cannabinoids found in the stalks, stems, leaves, and flowers of cannabis plants.
This compound is non-addictive and non-intoxicating, meaning that CBD can’t get you ‘high.’ The infamous compound responsible for the psychotropic effects of cannabis is tetrahydrocannabinol (THC).
How Does CBD Interact with the Human Body?
The mechanisms behind how CBD interacts with the human body are not fully known yet. However, what we do know is that CBD binds to the many receptors of the endocannabinoid system (ECS).
The ECS’s goal is to maintain homeostasis – or body balance. It consists of a complex network of neurotransmitters and receptors spread throughout the body. Some places where you can find endocannabinoid receptors include:
- The central and peripheral nervous system, including in the brain and bone marrow
- The immune system
- The vascular system
- The respiratory system, including in the lungs
- The digestive system, including in the pancreas, liver, and gastrointestinal tract
- The reproductive organs
- The muscles
- The skin
When CBD binds to these receptors, it optimizes how the ECS works, helping your body return to balance faster.
The most interesting thing about the mechanism that makes CBD superior to so many other therapeutic options is that it’ll only target what is, in fact, out of balance in each person’s body.
- Decreasing anxiety, nausea, pain, excessive inflammation, blood pressure, seizures, and spasms;
- Improving cognitive function;
- Stabilizing the appetite and mood;
- Regulating processes like immune response, metabolism, memory, sleep, and communication between cells, among others.
Is CBD Safe for Seniors?
While some doctors believe CBD is safe for seniors, others claim that the research available so far is insufficient but still classify CBD as “possibly safe.” There are no documented CBD overdoses.
The most common side effects of CBD reported by older adults are somnolence, decreased appetite, diarrhea, and increased liver function. Other possible side effects include lightheadedness, dry mouth, and orthostatic hypotension.
Researchers highlighted that undesired side effects appear to have a strong relation to dosage. To attain the desired effects, you must know your perfect dose and regimen.
And remember that starting with a high dose might not be safe. We’ll teach you how to figure out your perfect dosage at the end of the article.
If you’re taking other medication, you should set an appointment with your health provider before you start taking CBD.
Additionally, you shouldn’t stop your current medication abruptly to replace it with CBD. It should be a progressive transition.
Health Benefits of CBD for Seniors
CBD is still a relatively new therapy option and researchers are constantly finding new benefits of this molecule. CBD is mostly used to relieve symptoms like pain, anxiety, and insomnia.
This compound can be beneficial to people of all ages, including seniors. Let’s take a look at the potential advantages of CBD for seniors.
1. Pain Relief
Chronic pain is a very common symptom among seniors. It has a plethora of possible causes, including diabetes, surgery, musculoskeletal disorders (like arthritis), and heart or renal disease.
Studies have shown CBD’s efficacy at managing pain, especially when caused by osteoarthritis, rheumatoid arthritis, cancer, fibromyalgia, and multiple sclerosis.
Studies have also shown that using CBD consistently can drastically relieve pain and improve mobility and life quality. It is also a great alternative to some prescribed or over-the-counter medications that have notoriously negative side effects.
2. Anxiety Management
Usually, seniors suffering from anxiety already carry it from a younger age. However, it can intensify when you experience abrupt life changes, like retirement, the death of a loved one, or new health concerts.
CBD has antidepressant and anxiolytic-like abilities that can reduce anxiety – especially in social situations.
A study conducted on over 70 adults suffering from anxiety showed that after one month of using CBD, anxiety decreased in almost 80% of them.
3. Improved Sleep
A lot of seniors struggle to get a good night of sleep because as we age the neurons that regulate sleep start to die.
The greatest problem is that seniors start to go through less time of deep and REM sleep, which are necessary to restore our physical and cognitive functions. Additionally, sleep deprivation increases the odds of developing dementia and Alzheimer’s and weakens the immune system.
CBD targets some of the causes of poor sleep quality, like pain or anxiety. But it also provides a deep relaxation that can help you fall asleep faster, stabilizes your sleep pattern, makes you feel alert and fresh during the day, and reduces sleep apnea.
4. Boosted Immune System
The immune system is pivotal to keep us healthy. It eliminates malign particles, like viruses and bacteria, and plays a role in cancer prevention.
The endocannabinoid system regulates the immune system and CBD can act as both an immunosuppressant or an immunostimulant – meaning that it can normalize an underperforming or overperforming immune system.
So, depending on the problem you’re facing, CBD can boost your system’s ability to fight invaders or help those with autoimmune diseases, like psoriasis, Crohn’s disease, arthritis, Parkinson’s disease, or lupus.
5. Bone and Joint Health – Is CBD Good for Arthritis?
According to the Arthritis Foundation, there are plenty of people reporting “pain relief, sleep improvement, and/or anxiety reduction” when taking CBD.
However, they also point out that there are only animal studies suggesting the effectiveness of CBD as an anti-inflammatory and pain-killer.
Still, they highlighted that there’s plenty of anecdotal evidence in CBD’s favor. Many people report sleeping better and a decrease in anxiety and pain.
In theory, CBD is beneficial for people suffering from arthritis due to its anti-inflammatory and painkiller properties but it is not a substitute for your prescription medicine and you should always talk with your health provider before starting to use it.
6. Decreased Likelihood of Alzheimer’s, Type 2 Diabetes, Heart Disease, Cancer, and Autoimmune Diseases
By reducing excessive inflammation in your body, CBD can be a great therapeutic for diseases like irritable bowel syndrome or arthritis.
But CBD can also prevent a myriad of health complications that are a consequence of inflammation. Those include type 2 diabetes, heart or autoimmune diseases, cancer, and Alzheimer’s.
In the specific case of Alzheimer’s, CBD can have both a preventive and reversive effect. One study suggested it can act as a neuroprotective agent by reducing neuroinflammation. While another claimed CBD can reverse the cognitive decline caused by Alzheimer’s.
7. Improved Life-quality for Parkinson’s Disease Patients
Although research on the effectiveness of CBD for Parkinson’s disease is still at an early stage, one study suggests that patients can enjoy a higher quality of life with a daily regimen of CBD.
Note that this study was carried out in people who didn’t suffer from other psychiatric conditions.
8. Decreased Spasticity for Multiple Sclerosis (MS) Patients
A quarter of people diagnosed with MS live until they’re 65 or older. However, they experience a much-reduced quality of life.
9. Management of Cancer-related Symptoms
It’s common for cancer patients to live with anxiety, depression, pain, and sleep problems. Additionally, 60% of new cancer diagnoses and 70% of cancer deaths happen among seniors.
Firstly, CBD can replace the highly addictive opioid painkillers that are often prescribed or be the go-to painkiller for those that don’t respond to traditional therapies.
Secondly, CBD can alleviate other chemotherapy-related symptoms, like nausea and vomiting. These symptoms are so severe, at times, that they cause patients to give up the treatment altogether, drastically lowering their chances of survival.
10. Improved Cardiovascular Health
There’s proof of CBD’s ability to improve heart health in healthy people. Moreover, by lowering cholesterol levels, CBD can decrease the risk of cardiovascular disease. But it can also help those suffering from diabetes and cardiovascular diseases already.
11. Aid in Fighting Addiction
Seniors are at an increased risk of addiction, mainly due to prescription painkillers they’re advised to take. CBD, on the other hand, is non-addictive and rarely builds tolerance. Studies have proved its ability to treat both heroin and cigarette addiction.
What CBD Products Should Seniors Use?
Joy Organic’s CBD, sampled by Elder Guru.
There are plenty of ways to incorporate CBD into your daily life. There are also plenty of different manufacturers who sell quality CBD for seniors. Following are some companies that we recommend.
|CBD Company||About the Company|
|Avid Hemp||Avid Hemp has business relationships with hemp-farming associations in Florida and Colorado. They look for sustainable farming with strict quality-control.|
|Pur CBD||Based in Miami, Florida, Pur CBD‘s mission is to “be on the frontlines of natural health care, catering to those in search of new and improved ways to achieve an overall well-being and balanced lifestyle.”|
|Happy Garden CBD||Happy Garden began business in 2008 with leading scientists from Spain. They offer premium strains that contain minimal quantities of THC.|
|Joy Organics||Joy Organics is USDA certified organic full and broad spectrum CBD. They offer only premium CBD.|
|Prosper Wellness||Prosper Wellness is a Colorado-based company. The founder, Kriss Bergethon, suffered from a lot of pain and turned from prescription drugs, to which he knew he was getting addicted, to CBD alternatives.|
Choosing between the different options depends both on your preference and the problem you’re targeting. The most popular ones include CBD oil and capsules, edibles and drinkables, tinctures and sprays, concentrates, e-liquids, and different forms of topical CBD. Let’s look at each type a bit more closely.
CBD Oil and CBD Capsules
CBD oil is the most versatile option. You can ingest it alone or incorporate it into food or beverages. CBD capsules are an easy alternative if you don’t like the oil’s flavor or if you have a hard time dosing with the dropper.
CBD Edibles and Drinkables
The advantage of making your own edibles or drinkables over buying pre-made ones is that you can control the amount of CBD you’re taking more accurately. Pre-made edibles and drinkables are unreliable at times.
CBD Tinctures and Sprays
Tinctures and sprays are applied orally. You should put a tincture under your tongue for at least a minute before swallowing. With sprays, you simply spray them into your mouth.
Tinctures are but one of many ways to take CBD.
Tinctures and sprays have greater bioavailability than oils due to their composition, so you’ll feel the effects significantly faster.
CBD concentrates are meant to be added to food or drinks. Its greatest advantage is that you’ll know exactly how much CBD you’re taking.
All these options take a relatively long time to produce effects, but they also last longer. If you’re serious about starting a daily CBD regimen, you should pick one of the above routes and complement it with topicals and/or vaping for specific purposes.
CBD E-liquid for Vaping
Vaping offers the fastest results. Its effects spread through your whole body, just like the previous options but you can feel them right away – it’s perfect for emergency relief. Just beware that vaping can be quite harsh on your lungs and cause other health issues.
CBD Topicals, Like Balms, Lotions, and Salves
Finally, topicals are applied directly over the affected area – this is ideal for those dealing with skin conditions. However, if you have joint or muscular problems, transdermal products, like patches, are better since they can penetrate deeper than regular topicals.
Other Considerations When Choosing CBD Products
All these different CBD products can come in one of three forms:
- Isolate CBD: contains only CBD at a high purity level.
- Broad-spectrum CBD: contains all compounds in the cannabis plant, including other cannabinoids and terpenes, except THC.
- Full-spectrum CBD: contains all compounds in the cannabis plant, including THC. Depending on the concentration of THC, a full-spectrum CBD product may get you high.
The greatest advantage of isolate CBD is that you don’t risk getting an allergic reaction to any other component in the oil. Moreover, when using isolate or broad-spectrum CBD, you can be sure you’ll pass a drug test if you’re ever submitted to one.
However, with broad-spectrum and full-spectrum CBD you can benefit from the entourage effect.
The entourage effect is a scientific theory that defends that all the cannabinoids, terpenes, and flavonoids present in cannabis can work together synergistically and produce better and stronger effects than CBD on its own.
Dr. Danial Schecter, the co-founder of a network of cannabis-based medicine clinics and Director of Global Medical Services at Canopy Growth Corporate, defends this theory.
In an interview with Forbes, he recommended a combination of CBD and THC (in doses that can’t get you high) for those who need help with sleep, pain, appetite stimulation, nausea, and muscle spasms – and especially, for seniors.
How Much CBD Should Seniors Take?
Dosage-wise, while some people take as low as 5 to 10 mg per day, others are using as much as 1500 mg daily with no negative side effects. The most common doses range between 40 and 100 mg of CBD per day.
Notwithstanding, each person’s endocannabinoid system is different. You should always start with a low dose and progressively increase it until you find your perfect dosage.
Documenting how you feel while you experiment with different administration methods and doses can be helpful to figure out your ideal CBD regimen.
When targeting anxiety and pain, the most common dose ranges between 40 and 100 mg – again, start low and find out what works best for you.
Usually, the recommended starting dose is 5 mg. However, since seniors are often on other medication, they should start with 2.5 mg only and work their way up with 2.5 mg increments.
Know that CBD’s results arise faster for physical ailments than psychological ones – such as anxiety and depression. So, depending on what you’re targeting, those increments can be done every two days or weekly.
The Bottom-line – Is CBD Good for Seniors?
CBD can treat, manage, and/or prevent several different symptoms and diseases, including Alzheimer’s, Parkinson’s, type 2 diabetes, autoimmune diseases, like arthritis, sleep disturbances, anxiety, and chronic pain.
When asked “How does CBD make you feel?” Emily Heitman, co-founder, COO, and CMO of Leef Organics, said that:
CBD is used and repurposed by your body in the way you need it most, so the feeling by each individual tends to be a bit different. However, I think everyone feels relief and balance from the daily use of CBD.
Whether you don’t respond to traditional therapies, are looking for complementary treatment, or want to replace harmful prescribed medications, CBD is a great alternative.
Just remember to start with a low dose, building up from there, and always talk with your health provider before you start taking CBD – especially if you’re concurrently taking other medications.
On a final note, we’d like to highlight that CBD can be used as both a preventive and therapeutic measure. As long you do some proper research before starting your CBD journey, you’ll surely benefit from it in some way.
- CFAH: What Is CBD Oil? What Does Cannabidiol Stand For?
- WHO: Cannabidiol (CBD) – Critical Review Report
- Journal of Young Investigators: The Endocannabinoid System, Our Universal Regulator
- HealthCanal: 22 Benefits Of CBD Oil: Based On Academic Research
- Forbes: CBD Safety For Seniors
- US Pharmacist: Cannabidiol Use in Older Adults
- NCBI: BMJ – Management of chronic pain in older adults
- NCBI: Therapeutics and Clinical Risk Management – Cannabinoids in the management of difficult to treat pain
- PubMed: European Journal of Pharmacology – The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain
- PubMed: Rheumatology – Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis
- NCBI: Frontiers in Pharmacology – Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats
- PubMed: PLoS One – Distinct neurobehavioural effects of cannabidiol in transmembrane domain neuregulin 1 mutant mice
- NCBI: The Permanente Journal – Cannabidiol in Anxiety and Sleep: A Large Case Series
- PubMed: PLoS One – Endocannabinoid Signaling Regulates Sleep Stability
- PubMed: Current Psychiatry Reports – Cannabis, Cannabinoids, and Sleep: a Review of the Literature
- CBD News Today: What is CBD Oil Good for?
- Arthritis Foundation: CBD for Arthritis Pain: What You Should Know
- NCBI: Frontiers in Pharmacology – In vivo Evidence for Therapeutic Properties of Cannabidiol (CBD) for Alzheimer’s Disease
- PubMed: Journal of Alzheimer’s Disease – Long-term cannabidiol treatment prevents the development of social recognition memory deficits in Alzheimer’s disease transgenic mice
- PubMed: Journal of Psychopharmacology – Effects of cannabidiol in the treatment of patients with Parkinson’s disease: an exploratory double-blind trial
- PubMed: Neural Plasticity – Sativex in the management of multiple sclerosis-related spasticity: role of the corticospinal modulation
- NCBI: Transactions of the American Clinical and Climatological Association – Cancer in the Elderly
- PubMed: Journal of Pain and Symptom Management – Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain
- NCBI: British Journal of Clinical Pharmacology – Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting
- NCBI: JCI Insight – A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study
- NCBI: Journal of the American College of Cardiology – Cannabidiol attenuates cardiac dysfunction, oxidative stress, fibrosis, inflammatory and cell death signaling pathways in diabetic cardiomyopathy
- NCBI: Neurotherapeutics – Early Phase in the Development of Cannabidiol as a Treatment for Addiction: Opioid Relapse Takes Initial Center Stage
- PubMed: Addictive Behaviors – Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings
- HSOA Journal of Alternative, Complementary & Integrative Medicine: Cannabidiol and Contributions of Major Hemp Phytocompounds to the “Entourage Effect”; Possible Mechanisms
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
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 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
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