Cannabis for Elders: A Precarious State
July 21, 2013
Liana Aghajanian, The Atlantic
Margo Bauer was desperate. Dealing with chronic nausea and frequent bouts of vomiting -- both attributed to her multiple sclerosis -- the retired nurse was constantly exhausted and in pain. That was, until she attended an informational meeting where she was introduced to medical marijuana.
Under California's Medical Marijuana Program, she received a medical marijuana card and now legally grows her own plant at a Southern California assisted living facility where she lives with her husband who suffers from Alzheimer's. She smokes a rolled joint occasionally, which she says keeps her nausea at bay, and her pain lifted to the point that she joined an all-female synchronized swimming team, the Aquadettes.
Bauer, now 75, has also become an outspoken advocate for medical marijuana use among seniors and was instrumental in starting a collective at her assisted living facility.
"I carry a little container with a rolled cigarette," she said, "and if I have nausea I know that it is because I haven't taken enough pot."
While California remains at the forefront of the country's tumultuous relationship with the marijuana industry, medical marijuana usage is on the rise amongst seniors like Bauer.
Ailments ranging from chemotherapy side effects, arthritis, glaucoma, chronic pain and even malnutrition are being treated with cannabis, a promising alternative for seniors who are increasingly susceptible to the dangerous side effects and growing dependency of multiple prescription medications. The fastest growing population in the U.S. also comprises a significant portion of medical marijuana users, amounting to as much as 50 percent, according to Kris Hermes of Americans for Safe Access, the nation's largest member-based medical marijuana advocate group.
But as many of these baby boomers move into assisted living facilities, questions arise on the use of medical marijuana behind their doors. Muddied by its illegal status at the federal level, social stigma, and often hesitant attitudes of administrators who in some cases fear losing funding for allowing a controlled substance on their property, medical marijuana presents a list of challenges for seniors and the people who care for them.
In a state that enacted the first medical marijuana voter initiative in the U.S., the group that stands to perhaps benefit the most from medical marijuana has the hardest time gaining access to it.
For the marijuana advocates working to change perceptions of a substance classified as a Schedule 1 Drug, reaching the seniors in assisted living facilities has been an ongoing, lengthy struggle.
Sue Taylor, the senior outreach coordinator for Harborside Health Center in Oakland, Calif., the largest marijuana dispensary in the country and subject of several federal lawsuits, had difficulties with assisted living facilities and nursing homes for years.
"They wouldn't let me in, because they were afraid of losing funding and getting put out of the building for even smoking," she said.
After several failed attempts, she changed her approach and teamed up with local organizations while meeting seniors at health fairs. She now arranges tours of Harborside for seniors and administrators, giving them a firsthand glimpse of the dispensary to answer questions and quell misconceptions.
She's starting to see a change in administrator's willingness to discuss medical marijuana for their residents, albeit slowly. The mother of three and former educator thinks a major part of why her message has been effective has to do with her approach.
"I'm harmless. I don't walk around with weed leaves on my shirt and weed earrings," she said. "I want cannabis to take its rightful place as a spiritual component and medicine."
Taylor's initial experience with administrators is echoed by other medical marijuana advocates.
According to a Los Angeles-based marijuana advocate who wished to remain anonymous, every administrator with whom she spoke several facilities was under the impression that cannabis is illegal and they would lose their state license if they allowed it as an alternative symptom relief for clients.
Most simply refused to discuss medical cannabis past this initial misconception, she said.
California's Compassionate Use Act, passed by voters in 1996 and its 2004 amendment, Senate Bill 420 was written in part specifically about seniors and their caretakers operating within the confines of the law, however.
The initiative included health care facilities, residential care facilities for elders, hospices or home health agencies on a list of primary caregivers allowed to administer medical marijuana without legal ramifications.
But the procedures on marijuana's medical usage in California care facilities still remain vague and vary from agency to agency -- assisted living facilities fall under state jurisdiction, at the Department of Social Services (DSS) Community Care Licensing Division. Specific guidelines on medical marijuana do not yet exist.
"There are no specific regulations to medical marijuana but there are specific regulations related to the use of prescription medicine and how medicine is distributed," said Michael Weston, spokesperson for the DSS.
Nursing homes and hospices on the other hand, are regulated at a federal level by the U.S. Department of Health and Human Services, leaving them at a precarious legal crossroad as many receive federal funding through the Centers for Medicare and Medicaid Services.
The vague and often nonexistent guidelines, as well as the perceived legal implications of a patient's desire to use medical marijuana have caused problems.
Molly Davies, the vice president of the Elder Abuse Prevention and Ombudsman Services Wise & Healthy Aging in Los Angeles says that as cases in L.A. involving medical marijuana in skilled nursing and assisted living facilities have increased, many residents who use it are subject to eviction, despite having medical marijuana cards.
This issue has been an evolving one, Davies said. Lack of regulatory oversight has left those interested in implementing medical marijuana in a trial by error phase, where figuring out dosage and potential harmful side effects is largely done without any established guidelines.
Administrators are also facing myriad questions: Where will it be stored? How do patients know how much to take, and who is going to administer it if they can't do it themselves? Since smoking isn't allowed in most assisted living facilities, how can medical marijuana be used, especially if it infringes on another patient's rights? Who will be able to get it for residents?
"We can't ask a facility staff member to go in and purchase on behalf of a resident, so what we recommend is finding a collective that will deliver if the individual is unable to purchase it on their own," Davies said. Stuck between maintaining the rights of residents and following regulatory guidelines, the non-profit agency faces a conflict and, Davies added, cannot instruct facilities to violate federal law.
Joel S. Goldman is an attorney who exclusively represents assisted living facilities in California. On average for the past 2 to 3 years, he has received a call a month from a client with a medical marijuana question. Goldman says that when it comes down to it, the facility is owned by his clients, which gives them the final say on what they allow on their premises.
There's also the fact that the unregulated nature of marijuana circumvents established protocol for handling medications in assisted living facilities.
"The rules for storing medication, with respect to labeling, dosage, destruction of expired meds -- none of these normal rules really work very well when the medication is marijuana," Goldman said.
He suggests that facilities looking to accommodate their residents can request exceptions from DSS and ultimately implement more individual care plans. According to Weston, DSS does consider any requests for regulatory exception, including those involving medical marijuana on a case by case basis, "if the intent can be met by a proposed alternative," he said.
Despite these workarounds, the topic is still a fearful one to broach. Even when facilities incorporate medical marijuana in their programs, they're often staying as low key as possible to not attract extra attention and minimize the possibility of facing criminal sanctions.
Several administrators running California facilities who had allowed residents to use medical marijuana, or at least considered it, declined being interviewed for this article, stating that they didn't want to draw attention from the federal government which could lead to possible charges.
But Liz McDuffie, founder of the Medical Cannabis Caregivers Directory in Pasadena, is ambitiously facilitating an educational endeavor familiarizing facility administrators with the benefits of medical marijuana, all within state law.
McDuffie, who has been a marijuana educator and advocate for decades, received approval from DSS in 2011 to teach a class under the department's continuing education program for Adult Residential Facility Administrator Licensing and Re-Certification.
The class, titled "California's Medical Marijuana Program As It Relates to Adult Residential Care Facility Access" provides four hours of credit toward the Continuing Education requirement for facility administrators and covers how Title 22 Regulations, which govern State Licensed Residential Care Facilities, support the ARF Client's participation in California's Medical Marijuana Program.
The class teaches administrators delivery, ingestion and storage options as well as how to recognize legal marijuana collectives and cooperatives within compliance of state and local law.
Though it is aimed at ARFs, whose residents range from 18 to 55 years of age, it's a first step towards progressing to reach seniors in assisted living facilities, nursing homes and hospice care.
But, according to McDuffie there's something bigger at play than just unwillingness of administrators: medical marijuana cannot reach seniors living in assisted living facilities until it's fully regulated.
"You got to give them something clean and safe," she said. "That's why we put in place agencies to protect the consumer. We don't have anything in our industry to address what we're giving to use as medicine. If no one is interested in how to regulate the product, it's not going in healthcare facilities."
Harborside's founder and marijuana trailblazer Steve DeAngelo, whose focus has been connecting medical marijuana with seniors for the last few years fielded refusals from every single laboratory he approached in the Bay Area to test cannabis. With two partners, he developed his own analytical lab, where every bud now passes through before being made available to patients to ensure quality.
Despite the limitations that the unfettered nature of marijuana presents, such as communicating its medicinal benefits with resistant administrators, DeAngelo remains positive about seniors taking the helm to address the challenges between them and medical marijuana. He's right. The Silver Tour, a first of its kind non-profit was founded by Robert Platshorn, one of the biggest marijuana smugglers of the 1970s who spent 30 years in federal prison. The cross-country platform is working to specifically educate seniors in the U.S. about the medicinal values of cannabis and has gained significant ground over the last three years.
"I think you're just beginning to see a realization in the senior community about how valuable cannabis is to seniors - they themselves over the course of the next few years will be vocal and effective advocates for changing cannabis laws," DeAngelo said.