Taking a seat on the couch of her Laguna Woods apartment, 74-year-old Cynthia Rosenfeld reaches into a small white box, pulling out the contents one by one.
Here, she notes, is her pack of pre-rolled joints, followed by her vape pen, lozenges, dark chocolate edibles and an oil.
All of these medical cannabis products help her relax and sleep, but most importantly, they relieve the incessant pain that comes with age and far too many surgeries in the last dozen or so years: on her neck, shoulders, back, knees and foot. Not to mention a car accident and angioplasty.
“When I’m in pain I either have an edible or smoke. It relaxes my body and my back, and I’m not stiffening up and fighting the pain,” she explains.
She’s especially happy for a pain solution that reduces her opioid dependence.
Until she turned to cannabis about two years ago, she relied heavily on prescriptions of Vicodin, Tramadol and even at one point morphine, from which she weaned herself through Suboxone, a drug that mitigates opium addiction and withdrawal.
The meds severely constipated her, made her break out in hives and left her foggy-brained.
“The side effects are terrible,” she says of opioids, a medical staple in her retiree community – and a common topic of conversation. “Nobody wants to be on them.”
Abuse, Misuse and Addiction
Injury and death by overdose are among the consequences of opioid reliance in aging communities, as research shows.
A 2017 report from the county’s Health Care Agency highlighted these dangers of opioid abuse among seniors and older adults:
- The age group with the highest rate of opioid-related deaths from 2011-15 in Orange County was 45-54, followed by the 55-64 age group.
- In a breakdown by city, the average rate of opioid-related deaths in the county was highest in Laguna Beach and Laguna Woods, both older communities.
- The rates of opioid-related deaths in those two cities, 13.7 and 12.2, respectively, were almost twice the county average rate of 7.8 per 100,000.
“It catches your eye when you see the death rates in places where senior citizens are the primary residents like Laguna Woods,” said Dr. Bill Liu, a pharmacist for the OC Health Care Agency.
Liu gives presentations about medications to OC seniors at churches and senior centers, and while he runs into plenty of older patients who don’t misuse opioids, he said, the potential for abuse is constant.
For one, it’s easy to get confused about mixing numerous meds. One dangerous combination is opioids and benzodiazepines, which include sleeping pills and anxiety medicines. Mixing opioids with alcohol can lead to falling and breaking brittle bones, as well as fatal overdose in some cases, he said.
In addition, depression and isolation are common among seniors, Liu said, and they escalate the stakes of opioid use. About half the opioid overdose deaths to Orange County adults aged 65 and over were ruled intentional, according to researchers at the health care agency.
Even when nonlethal, the drugs take their toll.
“One of the misconceptions is that seniors can’t get addicted to drugs,” said Dr. Steven Ey, Chief of Service, Hoag Addiction Treatment Centers. “Addiction is more common in younger age groups but certainly we see addiction. I’m detoxing a 77-year-old woman from oxycodone in our unit today.”
Seniors come face to face with their addictions in unusual ways, he said. Some patients who are confronting dementia seek greater mental clarity, he said. In other cases, their adult children express concern about driving themselves or their grandchildren while under the influence of painkillers.
When it comes to older adults in the 45 and up bracket, he said, the problem usually starts with meds prescribed for pain, injury or surgery. Patients can become dependent in as few as three weeks, which is why doctors have been reducing their opioid prescriptions to foster short-term use.
Cutting Back
At Hoag, “We’re prescribing much less in the way of pain meds,” Ey said. “We can reduce the amount of opioids by 40 percent. I don’t need 60 Vicodins in my bathroom. I need 12 for three or four days.”
In Orange County, a group called SafeRX OC developed a program to let doctors in the county’s Cal Optima public insurance program for low income and senior residents know if their prescribing rates were higher than those of their fellow doctors. SafeRX OC also developed a video for hospital patients who are being discharged.
“Patients rarely hear enough about the types of meds they’re being discharged on. They hear a lot about the diagnosis: you have severe sciatic back pain so you’re being prescribed these medicines,” said Dr. Bharath Chakravarthy, an emergency room physician and a member of the group.
Both of SafeRX’s initiatives earned measurable results, he said, though neither was targeted specifically to older adults or seniors. In fact, targeted measures may be in short supply: Hoag doesn’t give community classes or talks about opioid abuse despite offerings on heart and thyroid health, diabetes, fitness and mindfulness. UCI Health offered a pain management class in April, though none are scheduled among the fall’s roster of classes on diabetes, weight and joint replacement.
Pain Options
There is no shortage of ways to learn about medical cannabis at Laguna Woods Village, where the average age is 76.
Santa Ana’s Bud and Bloom sponsors a monthly bus trip for residents, who can then shop at the dispensary and learn about the variety of medical cannabis products.
“For the past six months, our bus checks in full every month,” said Kandice Hawes, director of community outreach at Bud and Bloom.
There’s also the Laguna Woods Medical Cannabis Collective, which sells products to residents who have doctor notes. Collective director Lonnie Woods is a Laguna Woods resident as well as president of the community’s Cannabis Club, with at least 900 members over the years. A meeting in May drew 170 people.
Potential members of the club typically ask, “Will it help me with pain? Will I be able to get off opiates?” Painter said.
The jury is still out on this question, said Dr. Daniele Piomelli, who heads UC Irvine’s new Center for the Study of Cannabis.
Studies suggest that small amounts of cannabis can strengthen the efficacy of codeine or morphine, allowing lower doses of these highly addictive painkillers, Piomelli said. But the studies are on laboratory mice and more rigorous studies on humans outside labs are needed for more conclusive findings.
Further research on cannabis addiction is necessary, he said, as well as on the effects of cannabis on the brains of two groups in particular: young teens and the elderly.
Other treatments that could emerge as opioid alternatives include ketamine, acupuncture, pain injections and even cognitive behavioral therapy or exercise, according to Chakravarthy of SafeRX. These potential solutions require more time and serious study, he said.
But pain won’t wait for many of the residents of Laguna Woods Village.
Resident Kay Nelson, 76, eased off oxycodone upon discovering cannabis oils about four years ago. She was happy to make the change: the oils have no effect on her mentally, they aren’t constipating, and yet they have made it possible for her to cope with the chronic back pain that stems from a childhood injury and resulting stenosis.
Nelson has talked up the benefits of medical cannabis at her bible study meetings, and her kids know that she uses the oils and occasionally vapes on bad days. Her opioid use has dropped.
“I’m very thankful for cannabis,” says the 76-year-old, an avid painter, who is not worried about addiction. “I function very well.”