A small group of nursing home residents in New York City has seen concrete improvements in pain management and other medical issues through the use of medical marijuana — and as the drug becomes legal in more jurisdictions, the SNF residents of the future may come to expect it as part of their care plans.
Writing in the January issue of JAMDA — The Journal of Post-Acute and Long-Term Care Medicine, medical director Zachary Palace of the Hebrew Home at Riverdale reported early results from its pioneering medical-marijuana program, in which nine of 10 participants saw some type of benefit.
“It is important that 20th-century social and political stigmata associated with cannabis use for recreational purposes not be attached to the application of cannabis use for medicinal purposes,” Palace and co-author Daniel Reingold, president and CEO of Hebrew Home operator RiverSpring Health, wrote. “The potential for therapeutic benefit associated with medical cannabis use should be viewed as an important additional tool in the clinician’s armamentarium of therapeutic options in the symptom management of many common nursing facility complaints.”
Diagnosis overlap
Hebrew Home at Riverdale, located in the Bronx, developed a formal medical marijuana policy in 2016, after New York State lawmakers legalized the use of cannabis by patients with a variety of conditions — including Parkinson’s disease, seizure disorders, and chronic pain.
Palace, a geriatrician, had been watching the growing legalization movement in other states, and noted that many of the approved uses for the drug overlapped with the cases he saw every day at the Hebrew Home. But federal law represents the biggest hurdle to promoting therapeutic marijuana use in SNFs, however: While more than 30 states have approved medical cannabis and 10 have legalized it for recreational use, it remains an illegal Schedule I drug on the federal level, and any SNF that actively dispenses marijuana products would thus risk losing Medicare and Medicaid reimbursements.
But in Palace’s view, residents’ ability to access the drug shouldn’t stop at the nursing home door.
“They’re not just residents of the nursing home, of the Hebrew Home. They’re residents of New York State as well,” Palace told SNN. “How do we enable them to exercise their rights as residents of New York State?”
And as public perceptions on marijuana shift, Palace said, the number of people using cannabis for medical purposes in the general community will only keep growing — and someday, those people will expect access to their medicine once they eventually require skilled nursing care.
“They’re looking for facilities that will have programs like what we’re doing here, that will welcome them, and enable them to use medical cannabis in a safe and legal manner,” Palace said.
Hebrew Home’s policy requires residents to clear multiple regulatory steps. After receiving a formal recommendation for medical marijuana from a doctor or nurse practitioner directly involved in the resident’s care, he or she must register with New York State’s official medical cannabis program, then self-administer the drug in a private space. The products themselves must be stored in a lockbox to which only the resident has a key, making them property of the resident, not the Hebrew Home.
Because the SNF bans smoking of all kinds, including e-cigarettes, the marijuana must take the form of capsules or oil drops, and residents who cannot physically consume the drugs without assistance must designate a third-party caregiver to assist; this way, Hebrew Home staff are never directly involved with the dispensing of a Schedule I drug.
Early promise
So far, 10 residents have gone through the process to become an approved consumer of medical marijuana at the facility — ranging in age from 62 to 100 — with nine seeing improvements. The 100-year-old female resident, for instance, reported improved appetite and reduced her use of opioids by 50%, while an 86-year-old woman with advanced dementia had a “significant reduction in seizures” as a result of marijuana use. Multiple other residents said the marijuana helped with pain, while a 62-year-old man began participating in more activities after taking the drug.
Some of the progress was slight, such as a 79-year-old woman with Parkinson’s reporting a “mild reduction in stiffness,” while an 82-year-old woman with the same disease saw “minimal effect.” In addition, the Hebrew Home team reported that pitching marijuana to nursing home residents came with its own set of preconceptions.
People generally fell into two camps, Palace said: Residents who enthusiastically embraced the concept and requested more information, or those who couldn’t get past the stigma of marijuana as an illegal, illicit drug. One resident with pancreatic cancer refused medical cannabis as wrong, while others came around after speaking with relatives or friends who convinced them of its potential efficacy.
“Like any decision to start a medication, you have to have buy-in from the resident as well,” Palace said.
Still, the results — combined with other research showing reductions in pain and quality-of-life improvements among elderly patients — were enough for Palace to strike an optimistic tone about the future of cannabis use in SNFs.
“These are historic times as the tides of cannabis acceptance are shifting,” he and Reingold wrote in the paper. “Clinicians should consider the wealth of historical experience as well as the results of more recent and contemporary research and appreciate the potential role of this novel, yet centuries old, alternative therapy.”
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