Medical marijuana in Missouri was legalized in 2018 and medical marijuana cards have been approved for thousands of Missourians.
Now, some Missourians wonder whether that could help patients with dementia, including Alzheimer's Disease, particularly people who experience agitation and anxiety as the disease progresses.
Dementia is an umbrella term for a variety of conditions involving memory loss. The stress from these changes can make a dementia patient feel agitated, anxious, and in some cases angry.
Traditionally, those symptoms have been treated in a variety of ways, including with regular physical activity and sometimes medication.
But agitation of Alzheimer's Disease is among the chronic conditions listed by the state of Missouri as qualifying for medical marijuana, according to the Department of Health and Senior Services website.
Internal medicine specialist Dr. Mimi Vo of St. Louis runs her own medical practice and is a board member of MoCannTrade, an association helping to strengthen the medical marijuana industry. She recommends medical marijuana to help ease a patient’s anxiety and feels it can be used to help prevent memory loss.
“There are research studies that show that it can help to prevent progression of Alzheimer’s dementia by reducing the Acetylcholinesterase inhibitor function,” Vo said. “What that does is actually reduces the amount of plaque formation in the brain and helps prevent the continuing progression of Alzheimer’s dementia.
Vo said she lowers a patient’s other dosages when she starts them on medical marijuana.
“You may want to reduce the dosages of medicines you’re currently on or, as you start cannabis therapy, to slowly wean off some of the pharmaceuticals, which I see some patients being able to do,” Vo said. “The worry we have as clinicians is that starting a medication, it’s not that the cannabis is causing the side effects necessarily, it’s the other medications and pharmaceuticals that the patients are on.”
A double-blind, 14-week clinical trial at the University of Toronto tested a cannabinoid called nabilone on 39 patients and found that it improved the patient’s overall behavioral symptoms compared to placebo tests.
A Canadian health journal review also found limited evidence that medical marijuana may be effective for treating irritation and other side effects of dementia--but their review also said there aren't any evidence-based clinical guidelines for treating dementia patients with medical marijuana.
Vo agrees that more quality research needs to be done, but she thinks cannabis is a promising treatment for those with Alzheimer’s and other types of dementia.
Other doctors aren't so sure.
"You know, marijuana has been considered to be schedule one in the prescribing information from the federal government. Schedule one includes heroin, LSD and marijuana," said Dr. Curtis Schreiber, a neurologist at Citizens Memorial Hospital in Bolivar, Missouri.
Citizens Memorial Hospital is an underwriter for KSMU.
Schreiber runs a center dedicated to patients with memory problems, including Alzheimer’s and other types of dementia.
Schreiber is concerned about what happens when cannabis interacts with other drugs. And its long-term effects on dementia patients are unknown.
“You know, the hard part is this, there’s no clear studies that have been done to prove the claims,” Schreiber said. “A lot of the indications that are discussed are agitation and confusion and I don’t know yet if that is going to be an effective treatment for that.”
He's also concerned that clinicians haven't been trained on how to prescribe it to patients or what to watch for.
The FDA has not approved any medical marijuana treatments for Alzheimer’s and dementia patients.
Lyndall Fraker is the director of medical marijuana at Missouri Department of Health and Senior Services. He says psychological disorders are the number one reason patients request marijuana for medical treatment.
“We don’t advocate for or against using medical marijuana. That’s not our job to tell you it’s great for this or great for that. We leave that up to the doctors. This is a doctor-patient program. All we are doing at the department of health is providing it as an option for the doctors to be able to certify their patients,” Fraker said.
Medical marijuana cards for dementia patients also have the potential be abused, given the cognitive issues patients face. Most late-stage dementia patients with behavioral problems don’t have access to their own medications.
According to DHSS, patients can designate up to two caregivers, and both the patient and the caregivers must be licensed in coordination with Missouri's new law.