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An Interview About CBD in Nursing Homes

Cannabidiol Down the Hall: How One Nursing Home is Making it Work

Friday, June 14, 2019
 

Medical cannabis is becoming increasingly accepted as a treatment option for chronic conditions, including those in the older adult in nursing homes. Approved uses vary by state, but seizure disorders, pain, glaucoma, and severe nausea are among the conditions. As of this post, 33 states and the District of Columbia have legalized the use of medicinal marijuana, available in various forms including cannabidiol (CBD), in some capacity, and many states are very specific about how it can be purchased, by whom, and in what form.

Overcoming barriers and implementing a program in nursing homes can be challenging, and while these hurdles will vary from state to state, information can be gleaned from the success of the Hebrew Home at Riverdale in Bronx, NY. I was fortunate enough to meet with the medical director and innovator of their medical cannabis program, Zachary Palace, MD, FACP, CMD, at the recent annual conference of the Society for Post-Acute and Long-Term Care Medicine in Atlanta. The following Q&A may help clarify questions or concerns for those looking to implement a program at their facility.

Q. What are the regulatory hurdles associated with the use of medical marijuana in nursing home residents?
A. Ensuring that facilities do not do anything to prevent reimbursement from Medicare and Medicaid is the most important part. For our part, we made sure that any resident who was receiving CBD had a personal lock box with only themselves and/or their outside care provider having a key. No nursing home staff can administer or handle the product.

Q. If a facility were interested in pursuing the use of medical marijuana for their residents, where would they start?
A. The most important aspects of starting a program are knowing which diagnoses marijuana can be prescribed for in your state and following any other state regulations.

Q. Are there any challenges the residents face, either clinically or socially, after starting to use their medical marijuana?
A. Absolutely, a current hurdle within our facility is getting over the stigma of using medical marijuana. We are focused on education to get over that stigma, providing information to families, residents, and staff.

Q. What other challenges or concerns might a facility face when implementing a medical cannabis program?
A. Some of the concerns about using cannabidiol (CBD) is the lack of regulation and variability in quality. These concerns are addressed in our program by using a product from a registered NY supplier that has been rigorously tested for quality at multiple levels, with a consistently high percentage of CBD and minimal tetrahydrocannabinol (THC), the psychoactive ingredient in recreational marijuana. Finding a reliable supplier is important in ensuring consistent dosing and response.

Q. What results might residents and staff expect with the addition of CBD?
A. While responses will vary, we have one resident who was suffering from seizures two to three times per week. Without any other medication changes, the addition of CBD reduced seizures to around once per month.

As State and National regulations adjust to accommodate the changing marijuana landscape, there is no one-size-fits-all roadmap to guide nursing homes in developing a means to provide medical cannabis to their residents. Become comfortable with the laws and regulations in your state so you can anticipate the process and all that is involved in getting your staff on board before offering it to residents. As much as we’ve learned, the landscape will continue to evolve, and the recent approval of the first marijuana-derived CBD drug, Epidiolex, will also affect future regulations for these products. We are still early in our discovery of the benefits and risks of CBD-derived products, so as programs gain knowledge, we are hopeful they will share with the long-term care community so we can all gain understanding on the therapeutic benefits of cannabinoids in older adults.

Additional information can be found by following these links:

"What to Expect When Cannabis Comes to Your State" - Joanne Kaldy writes in Caring for The Ages: March 2019

"Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life" - Drs. Palace and Reingold published in JAMDA: January 2019

"When Retirement Comes with a Daily Dose of Cannabis" - Winnie Hu writes in The New York Times: February 2017

"FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy" Posted on FDA.gov: June 2018

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