By Dr. Melanie Bone
In April 2019, I was asked to direct a cannabinoid initiative at MorseLife Health System in West Palm Beach, Florida. MorseLife is an over-65 residential community with a teaching nursing home, memory care unit, hospice, and rehabilitation facility on site. CEO Keith Myers, partnered with Howard and Michele Kessler of Palm Beach, to fund this project as part of an overarching dedication to introducing cannabis medicine in the senior community.
The program began with surveying the residents, staff, and employees about attitudes toward cannabis and current use on campus, as well as interest in a physician-run cannabis program at MorseLife. The goal was adoption of cannabis for both management of ailments common to the residents and for improvement in quality of life. We found many people had no experience with cannabis but were curious about it. Anti-cannabis sentiment was also present, mainly due to the perception that cannabis is a dangerous and federally-illegal drug. Interest was robust among residents who had experience with cannabis years ago, or whose adult children (and grandchildren) encouraged them to participate.
There were obstacles to enrolling patients in the program. Probably the most common obstacle was the lack of either a valid driver’s license with a current address, or a Florida state photo identification card. Since many of the residents no longer drive, they have no reason to renew their license or update their address. Without an active license or a photo ID from the state, there is no way to apply for a medical marijuana card. No exceptions.
A second obstacle relates to a law that permits every patient in the Registry to have a caregiver. That designated caregiver is allowed to go to a dispensary and purchase product for the patient and then deliver it and administer it. The Office of Medical Marijuana Use has a course for prospective caregivers. Once they pass the test and pay the fee, they are sent a card similar to the medical card sent to the patient. During the 2019 legislative session, thanks to the diligent efforts of the Kessler team, a law was passed permitting a caregiver in a facility such as MorseLife to take care of multiple patients. This is critical to enable a successful program at a nursing home facility. The plan was to assign a set of patients to a caregiver. Unfortunately, we found that there is no pathway to implementing this law. The Registry does not allow for a person to be more than one person’s caregiver.
Not surprisingly, the cohort we have gathered at MorseLife is primarily made up of residents in the Independent Living setting and those on the Memory Care Unit. The former, because they are able to get their own cannabis and are able to follow up with office visits as needed. The latter because we use non-THC containing regimens to help with agitation and anxiety. Both of these groups are doing well.
A few significant observations have come out of the work at MorseLife. Residents report using fewer opiates, anti-depressants, anti-anxiety drugs, and sleep medications when using cannabis. We see at least a 70% positive outcome. On the Memory Care Unit, we have had spouses and children calling to say that they see a change in their loved one’s behavior and some are now asking about adding THC to the regimen. This is not to say that every patient has benefitted. About 30% take a break or stop using cannabis. The most cited reasons are because they do not feel it is working, it is too expensive, or other medications work better for them. Some have reverted to cannabis.
My team has been asked to produce protocols and algorithms for dosing around a variety of ailments and diagnoses. We use a planned introduction to cannabinoids and a stepwise increase in both dose and strength of cannabis. Additionally, we have investigated doing a traditional randomized controlled trial (RCT). These trials are challenging, especially because the marijuana that must be utilized for them is obtained from the federal government and it is inferior quality and arrives in smokable form. Additionally, cannabis medicine is unique. Every patient may need a different form factor, dose, and strength, and these can vary from day to day. At a recent meeting of Florida’s Medical Marijuana Physicians, the consensus among the leading doctors in the state was to utilize observational data to inform best practices.
As we move forward, we plan to reach out to a larger population of seniors who are housed in the community and are part of MorseLife outreach. Through grass roots adoption, we hope to engender interest in cannabis medicine for all who can benefit. Hopefully, we can use the knowledge and expertise garnered at MorseLife to guide utilization at senior care facilities and communities across the country.