A century of “reefer madness” won’t be easily dispelled by the legalization of cannabis, even for medical uses.

“The stigma is alive and well,” even for medical cannabis, says professor Lynda Balneaves, the associate dean of research in the College of Nursing at the University of Manitoba. “Not all health-care professionals feel comfortable having that conversation, and it's often because this has been a stigmatized substance for 100 years. Most physicians, as well as nurse practitioners — those are the two groups who can authorize medical cannabis in Canada — have had little training or education about cannabis. We're starting to see that change, but it's a slow process.”

Now that cannabis is legal in Canada, some people — including the majority of people with no interest in smoking — are curious about the medical potential of edible, drinkable or topical cannabis products. But where to start?

Balneaves, who has researched medical and non-medical cannabis for more than 15 years, is a deputy director of the Canadian Consortium for the Investigation of Cannabinoids and is an expert in complementary and integrative medicine.

“I like working at the margins of health care,” she says. “I like working with stigmatized substances and trying to support people in making safe and informed decisions and ensuring they're treated in a respectful manner by our health-care system.”

It’s important, especially for older adults curious about medical cannabis, to first consult a physician, “who’s knowledgeable, and has some awareness of your current health condition and your medications [to ensure there are no] potential interactions with your medication, or with the health conditions you're living with.”

She knows that getting informed medical advice on cannabis can be challenging and stoutly advises that people not listen to “well-meaning family and friends, social media or the internet.” That, she says dryly, is “not necessarily the safest route.”

Those interested should start by asking their primary care provider or specialist if they're willing to discuss the use of medical cannabis in drinks, edibles, oils or topical products that contain THC or CBD, or both.

However, health-care professionals may be reticent. "They’re worried about risk. They're worried about safety, and they're worried about their own medical legal situations,” Balneaves says.

Medical professionals want to see “the gold standard of the clinical trial,” of which there are few, due to long stigmatization. What does exist are “hundreds of years of people using cannabis and having outcomes from it,” including much recent experience.

“We know that many older adults are using it for things like arthritis pain. They're using it for sleep issues. They're using it for anxiety. Some people find it helpful with depression as well.” It’s also being used to help with symptoms of dementia, Parkinson’s disease and by many veterans to help with symptoms of PTSD.

A 2021 study by Canadian researchers in neuropsychopharmacology, psychiatry, pharmacology and economics followed more than 4,600 seniors in Canada, most of whom used cannabis oil containing “only or mostly” CBD, which is a non-psychoactive element of cannabis. Most women in the study cited pain relief as their motivation, “whereas oncological and neurological conditions were more common in men,” the study’s authors wrote. “Users reported improved pain, sleep and mood symptoms at follow-up after cannabis use.”

The study’s authors said it highlighted, “the need for research to determine appropriate indications, precise doses of active ingredients and short- and long-term outcomes among older adults.”

Patients can speak to their doctor about medical cannabis, to see if this is something that could work for them, Balneaves says, though patients should understand that for their health issue, there may be “a pharmaceutical that's quite safe, and that it might be better to try that than to go down cannabinoid route.”

If a patient’s primary caregiver is not comfortable talking about medical cannabis, the patient can ask for a referral to a doctor, specialist or nurse-practitioner who is. If no referral is provided, the patient can search for a local, licensed medical cannabis clinic — while taking steps to ensure it’s qualified care.

First, Balneaves says, “if it's a medical cannabis clinic, they should not be selling cannabis in that setting. They're often attached to industry, so you have to have that awareness of potential conflict of interest.”

Ideally, she says, “a medical cannabis clinic should be run by a physician or a nurse practitioner, or, at the very least, a registered nurse who has advanced training in cannabis.”

A clinic should ask for a detailed medical history. The patient should ask whether the clinic is funded by a cannabis company, and whether it receives financial incentives to sell the products of any company. If a prescription is written, it should be a generic authorization that can be used with any Canadian supplier of medical cannabis.

Medical cannabis clinics can also be found online, and while Balneaves is “a bit hesitant” about online clinics, “most of them do online consultations. You want to make sure that they're grounded in Canada.”

Whoever is giving the advice, they should explain that while cannabis “has a really good safety profile compared to a lot of medications,” there are risks, especially for older adults.

A final tip: While cannabis is legal in Canada and in many U.S. states, it is still restricted federally in the U.S., and Canadians should not leave the country with any cannabis products in their possession.

Understanding THC versus CBD

There are more than 100 cannabinoids in cannabis, and most relevant are THC and CBD. They produce different effects when consumed.

THC: Psychoactive, causes a high and intoxication. “It has therapeutic effects and harmful effects,” says Health Canada, and “harmful effects may be greater when the strength of THC is higher.”

The amount of THC in dried cannabis has increased from an average of three per cent in the 1980s to as high as 30 per cent today.

CBD: Not psychoactive, does not produce a high. It’s being studied for therapeutic uses. While it could be ingested by smoking cannabis, most health sources advise the safest course for dosing CBD without ingesting trace elements of THC is through topical cannabis oil or edibles.

The Canadian Coalition for Seniors Mental Health cautions that the effects of cannabis can increase as you age and changes to fat and muscle mass slow your body’s ability to process cannabis. “This means that the effects can be more intense and last longer.”

The coalition also recommends bringing the following questions to your health adviser:

• Can cannabis help my condition?
• Will it interact with my medications?
• Are there risks or side effects?
• How much will it cost, and will my insurance cover it?
• Are there activities I should avoid while taking cannabis?
• What type and amount of cannabis would be best for me?

Product 101

Health Canada defines edibles as “a cannabis substance or mixture of substances that's intended to be consumed in the same manner as food.”

Edibles: These vary in the amount of THC or CBD they contain, and federal regulations require that all such information be included on packaging. Common types of edibles include solid foods — “gummies” is the word most often heard, though they can also include candy, chocolates bars or brownies, cookies, and sometimes dried fruit. Quebec, for example, doesn’t sell these products in gummy or chocolate form.

Drinks: Usually in cans or bottles. Some have added sweeteners.

Oils and concentrates: Extracted directly from cannabis and ingested orally in small amounts as prescribed, usually using a (needle-less) syringe.

Topicals for external use: Lotions or oils that are intended to be applied directly to joints, skin or other parts of the body.