Most Older Adults Don’t Tell Doctors About Their Cannabis Use

By Pat Anson, PNN Editor

A growing number of older adults have discovered the medical benefits of cannabis – everything from pain relief to lower blood pressure. But a new study found that most older Americans aren’t telling their doctors about their cannabis use.

In an analysis of over 17,000 Americans aged 50 and older who participated in the 2018 and 2019 National Surveys on Drug Use and Health, researchers at the University of Texas at Austin found that nearly nine percent had used cannabis in the past year. Of those, less than 40% had discussed their cannabis use with a healthcare provider.

Researchers say that’s an alarming figure because the cannabis users were significantly more likely to have substance abuse and mental health problems than nonusers.  

“Only a minority of older cannabis users discussed their drug use with a healthcare professional, although medical users were more likely than nonmedical users to have done so,” said lead author Namkee Choi, PhD, Professor of Gerontology at the University of Texas at Austin.

“Given little difference in cannabis and other substance use/use disorders between nonmedical and medical users, older cannabis users, regardless of use reasons, should consult healthcare professionals about their use, and healthcare professionals should screen for cannabis and other substance use as part of routine care.”

Compared to recreational users, medical users consumed cannabis more frequently, with nearly 40% using it everyday or a few times each week. Surprisingly, less than 20% of medical users bought their cannabis from a dispensary; most obtained it from friends, family or strangers. About 95% of medical users said obtaining cannabis was fairly easy or very easy.

“The finding that a significant proportion of medical and nonmedical users obtained cannabis via private/informal sources indicates that they are likely to use cannabis and cannabis products with unknown tetrahydrocannabinol (THC) potency,” said Choi. “Given the increase in THC potency, healthcare professionals should educate older cannabis users, especially high-frequency users, on potential safety issues and adverse health effects of cannabis and cannabis products obtained from unregulated sources.”

The study findings were published in The American Journal of Drug and Alcohol Abuse.

A 2018 survey by the American Association of Retired Persons (AARP) found that most older Americans think marijuana is effective for pain relief, anxiety and nausea. Seventy percent of those surveyed say they would consider asking their healthcare provider about medical marijuana if they had a serious condition that they thought might respond to it.

A recent study published in the journal Cannabis and Cannabinoid Research found that older adults are more likely to purchase sublingual formulations of cannabis, such as edibles and tinctures, as well as products low in THC and high in CBD.

‘Radical Shift’ Predicted in Fibromyalgia Diagnosis and Treatment

By Pat Anson, PNN Editor

New research has uncovered a previously unknown connection between fibromyalgia and the early stages of diabetes, which could dramatically change the way the chronic pain condition is diagnosed and treated.

In a small study of 23 fibromyalgia patients and two control groups, researchers at The University of Texas Medical Branch at Galveston (UTMB) were able to separate patients with fibromyalgia (FM) from healthy individuals using a common blood test for insulin resistance, or pre-diabetes. They then treated the fibromyalgia patients with a medication targeting insulin resistance (IR), which dramatically reduced their pain levels.

“Although preliminary, these findings suggest a pathogenetic relationship between FM and IR,  which may lead to a radical paradigm shift in the management of this disorder,” researchers reported in the online journal PlosOne.

Fibromyalgia is a poorly understood disorder that causes widespread body pain, fatigue, insomnia, headaches and mood swings. The cause is unknown, the symptoms are difficult to treat and there is no universally accepted way to diagnose it.

"Earlier studies discovered that insulin resistance causes dysfunction within the brain's small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder," said Miguel Pappolla, MD, a professor of neurology at UTMB.

Pappolla and his colleagues found that patients with fibromyalgia can be identified by their hemoglobin A1c levels, a protein in red blood cells that reflects blood sugar levels. A1c tests are widely used to diagnose type 2 diabetes and pre-diabetes, and are routinely used in diabetes management.

Researchers say pre-diabetics with slightly elevated A1c levels carry a higher risk of developing widespread body pain, a hallmark of fibromyalgia and other chronic pain conditions.

"Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection," said Pappolla. "The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range.

“However, this is the first study to analyze these levels normalized for the person's age, as optimal A1c levels do vary throughout life. Adjustment for the patients' age was critical in highlighting the differences between patients and control subjects."

After identifying the fibromyalgia patients with elevated A1c levels, researchers treated them with metformin, an oral medication that manages insulin resistance by restoring normal blood sugar levels. The patients showed dramatic reductions in their pain levels, with half (8 of 16 patients) having a complete resolution of pain.

“Our data provides preliminary evidence suggesting that IR may be a pathological substratum in FM and sets the stage for future studies to confirm these initial observations. If confirmed, our findings may translate not only into a radical paradigm shift for the management of FM but may also save billions of dollars to healthcare systems around the world,” researchers reported.

New Drug Discovered for Neuropathic Pain

By Pat Anson, Editor

Researchers at The University of Texas have discovered a potent non-opioid pain reliever that acts on a previously unknown pain pathway. They say the synthetic compound, known as UKH-1114, is as effective at relieving neuropathic pain in laboratory mice as gabapentin, but lasts much longer.

Now scientists need to find out if drug is safe, effective and nonaddictive in humans -- a process that could take years.

"This opens the door to having a new treatment for neuropathic pain that is not an opioid," said Stephen Martin, a chemistry professor at The University of Texas at Austin. "And that has huge implications."

UKH-1114 binds to a receptor on cells in the central nervous system called the sigma 2 receptor. Although it was discovered 25 years ago, scientists did not know what sigma 2 did until now.

Theodore Price, an associate professor of neuroscience at The University of Texas at Dallas, tested UKH-1114 on mice with nerve damage and found that it alleviated pain as well as gabapentin did, but was effective much longer -- lasting for a couple of days, compared to 4 to 6 hours. Price’s research was the first to demonstrate that the sigma 2 receptor may be a target for treating neuropathic pain.

"We started out just working on fundamental chemistry in the lab," said James Sahn, a research scientist at The University of Texas at Austin. "But now we see the possibility that our discoveries could improve the quality of people's lives. That is very satisfying."

Sahn and his colleagues have filed patent applications on the new compound. Their findings have been published in the journal ACS Chemical Neuroscience. An earlier paper on the sigma 2 receptor was published in the journal Proceedings of the National Academy of Sciences.

Chronic neuropathic pain is caused when nerves in the central nervous system are damaged by chemotherapy, shingles, diabetes or injuries to the brain or spinal cord. About 8% of adults worldwide suffer from some form of neuropathy.

Diabetic peripheral neuropathy causes nerves to send out abnormal signals. Patients can feel stinging or burning pain, as well as loss of feeling, in their toes, feet, legs, hands and arms. Nearly 26 million Americans have diabetes and about half have neuropathy, according to the American Diabetes Association. 

Many patients say drugs commonly used to treat neuropathic pain, such as gabapentin (Neurontin) and pregabalin (Lyrica), either don’t work or have unpleasant side effects such as dizziness, fatigue and diminished cognitive ability. Some doctors also feel the drugs are being overprescribed as alternatives to opioid pain medication.