Some senior living residents use cannabis products in their communities, but as they do so operators have had to navigate a perilous and often confusing legal minefield.
Much of that has to do with the fact that marijuana is still a Schedule I drug on the federal level, a category also shared by heroin, LSD and MDMA. But there are signs the regulatory winds are shifting, if only in spirit for now.
Earlier this month, President Joe Biden directed the U.S. Department of Health and Human Services (HHS) and the attorney general to review marijuana’s Schedule I status, potentially opening the door to more flexibility in its use down the road.
Although senior living operators are still bound by federal law, 37 states have approved the use of medical cannabis and 19 others have legalized it for recreational use. That has given operators some the flexibility to experiment with cannabis on a limited basis, and set rules for residents who want to use it.
For example, Silverado CEO Loren Shook has not been shy about sharing the utility of marijuana gummies in memory care. And there are other operators that have developed smarter pot policies over the years in response to more residents wanting to use it.
While it remains unclear whether the federal government will ultimately reschedule marijuana, public opinion has shifted in favor of its use as a recreational drug.
The bottom line for senior living operators is that, if they haven’t thought about marijuana use in their communities already, they ought to start, according to Gabriela Sanchez, who co-chairs the senior living and long-term care team at law firm Lane Powell.
“With respect to senior living, what we are seeing is residents want to have the right, and the ability, to consume … marijuana products in their home,” Sanchez told SHN. “The challenge for the senior living sector is how to protect residents.”
Seniors are going to get high
Demand for cannabis is exploding in the U.S., with one report from New Frontier Data suggesting that annual sales for cannabis could grow to as high as $72 billion in the next seven years if more states legalize it for recreational use.
That demand is partly fueled by the baby boomer generation, who according to researchers are using marijuana in increasing amounts.
As many as 22% of participants in a 2021 study from the journal of Substance Abuse, Treatment, and Policy reported having used cannabis in the past 30 days. The percentage of baby boomers and non-baby boomers who reported having ever used cannabis was about the same, 56% versus 51%, respectively.
Given that shift in opinion, senior living communities should make sure they are keenly aware of both federal and local laws, Sanchez said. That is not always an easy process, and the two sometimes conflict.
For example, although medical marijuana is legal in Arizona, federal law has complicated some assisted living communities’ ability to regulate or manage its use among residents. Federally insured banks have historically not provided services for cannabis-related businesses — although other smaller banks are jumping on the trend in 2022.
Still, some communities don’t want cannabis on their campuses at all, or prefer to adopt a don’t-ask-don’t-tell policy for those and other reasons. They are likely not making a wise choice, according to Sanchez.
While banning it altogether on campus has its legal utilities, she said a widespread and total ban could run afoul of residents’ own sense of agency, and even potentially violate their rights in the process.
“I think the biggest hurdle for communities that want to ban cannabis is going to be around resident rights,” Sanchez said. “Are you violating the resident’s rights by banning them from using something that is legal under state law?”
Instead, Sanchez advises operators to have a marijuana disclosure policy that outlines where and how residents can use it; and one that clearly states the risks associated with marijuana use in older adults, such as impairment and addiction.
“I think that communities that want to stick their head in the sand and pretend it doesn’t happen in their community,” said Sanchez. “They’re not fooling anybody but themselves.”
Cannabis use in memory care
Like alcohol, cannabis use has been a tricky subject for memory care residents. But unlike alcohol, cannabis products do seem to have a practical use among older adults living with Alzheimer’s or dementia.
Silverado CEO Loren Shook recently hinted that the Irvine, California-based memory care operator had been dabbling in the use of THC for patients, and that the results have been encouraging.
“It’s amazing what a gummy bear will do with the behavior of a big burly guy in the afternoon that otherwise nothing else is touching,” Shook said in his September appearance on SHN+ Talks.
Kim Burtrum, senior VP of clinical services with Silverado, believes marijuana has its uses in memory care settings, and that it should be investigated for use among residents who struggle with anxiety or weight loss.
Some recent studies have shown medical cannabis may be effective for treating certain behaviors among memory care residents, including agitation and irritability. Indeed, that has been Silverado’s findings as it has done so in its own communities.
“We have anecdotal experience and it’s just been spectacular,” Butrum said.
According to Butrum, medical cannabis products may be more effective for residents with specific types of dementia.
“When the frontal part of your brain is affected in frontotemporal dementia or with traumatic brain injuries, [residents can experience] more difficulty with impulse control,” she said. “And cannabis, in our experience, has been excellent for that.”
Some residents at Silverado communities will take a marijuana edible every two hours to quell their chronic anxiety, as opposed to benzodiazepines, which carry risks such as cognitive decline and impairment.
Silverado also reports anecdotal success for memory care patients who have trouble gaining weight or maintaining a healthy weight.
“We had a resident in Arizona who paced all the time and had lost a significant amount of weight by pacing. A little cannabis for her was just magical,” Butrum said. “She could sit and enjoy engagements and interacting with her family and she gained a little weight from her increased appetite.”
Silverado’s 28 communities span coast-to-coast with locations in Arizona, California, Illinois and Virginia, where cannabis is legal. The operator also has locations in Missouri, Maryland, Wisconsin and Texas where cannabis is legal for only certain uses, and one location in Kansas where cannabis use is still outlawed.
For Silverado, the disparity between laws makes administering care difficult; but, Butrum believes it’s the laws — not Silverado — that are the issue.
“I think what we’ve done with cannabis is really a shame,” Butrum said. “It feels like if there was consistency in the federal regulation and allowance to really go forward with a deep dive… I think it would help a lot, especially with neurologic [ailments].”
First step on a long road
While the decision to reconsider marijuana’s Schedule 1 status is a notable first step, the industry will likely face a long road ahead, according to T.J. Griffin, senior vice president of LTC Operations and Chief Pharmacy Officer at PharMerica, a full-service pharmacy that serves the long-term care, senior living and behavioral health sectors.
“Since the DEA is a law enforcement agency, they have some very particular structures that they have to go through,” he told Senior Housing News. “I’m not sure this can be done by executive order, so I think it’ll have to be a process through which the Drug Enforcement Administration puts it through their rigors.”
He added: “I don’t see anything implementable within two years,” Griffin told SHN.
He said some pharmacies, healthcare providers and the general public are already more accepting of CBD products. Even so, marijuana is a tougher nut to crack.
“You’re seeing companies that are much more reputable putting out [CBD] products,” Griffin said. “I don’t have a universal answer for customers when they ask. Most of the time, they choose not to provide it in the skilled nursing setting or in the senior living setting.”
Rescheduling marijuana would open the floodgates to easier access for research, interstate commerce and higher involvement from those in the medical and pharmaceutical industries.
But Griffin sees years of research, public input, and congressional committee hearings in that event, to say nothing of supply chain and banking implications.
“If [cannabis] stays a scheduled item, then it’s got to come through the pharmacy. That’s going to be tricky for pharmacies to deal with because dispensaries are not pharmacies,” he said. “They’re not registered through the Board of Pharmacy, they’re registered through different business regulations by each state.”