alzheimers

Continuing the Conversation: Medical Cannabis in Long-Term Care

I wanted to continue the conversation about cannabinoid therapy in long term care this week by sharing some insights from my colleague Kim Van Dam, Administrator at Steeves & Rozema’s Trillium Villa.

Here she talks about the outcomes we’ve seen in successfully reducing narcotic and antipsychotic use amongst residents living with chronic pain and dementia.

Trillium Villa is one of Ontario’s first LTC residences to introduce cannabinoid therapy and the first home that I worked in several years ago. I continue to work with Kim and the forward-thinking & dedicated S&R team to this day and have been excited by the number of like-minded long term care organizations and in-house physicians who have reached out to learn more about whether it could benefit their residents/patients.

New Warnings About Benzodiazepine Use and Dementia Risk

There have been several studies that have indicated that have linked benzodiazepine use to an increased risk for Alzheimer's disease (AD).

This is one out of Finland is one of the largest.

Lead author Vesa Tapiainen, MD, PhD, said: “These drugs are often used to treat sleep problems, but their efficacy for this indication diminishes over time, whereas the risks for adverse events remain.”

In addition to insomnia, benzodiazepines and other so-called "Z" drugs, such as zolpidem (multiple brands) and zopiclone (Lunesta, Sunovion), are used to treat other neuropsychiatric symptoms of dementia, such as anxiety.

Commenting on the study’s findings, David S. Knopman, MD (Mayo Clinic, Alzheimer's Association Medical and Scientific Advisory Council), noted that many studies have suggested that patients who are exposed to certain psychoactive drugs, such as those with cholinomimetic properties, are at increased risk for dementia.

"I therefore find it plausible that benzodiazepines and related drugs could carry the same risks," he said.

The "bottom line" for Knopman is that use of certain psychoactive drugs seems to increase the risk for dementia. However, it is unclear whether the drugs are temporarily worsening cognition or symptoms are being treated with these drugs, said Knopman.

"In other words, the direction of causality from drugs to dementia could go in either direction, and this study that used administrative data can't determine the direction of causality," he said.

Nevertheless, a take-home message is that benzodiazepines and related sleep medications should be avoided "if at all possible" in older individuals, said Knopman.

Similar to benzodiazepines and “Z” drugs, cannabinoid-based medicines have anxiolytic, anticonvulsive and relaxing effects. When dosed low and slow by an experienced healthcare practitioner, cannabinoids can be equally or more effective than these medications in managing symptoms, but with a far superior side-effect profile.

Read the full study here.

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