When it comes to recreational marijuana use, Norman, 71, is one Virginia resident who has long been ahead of the curve.
Cannabis was legalized for medical use in the commonwealth as of July 2020, and recreational use by adults became legal as of July 1 this year, but Norman, whose last name is withheld at his request, says he’s been smoking every day since he was a 19-year-old high school senior. He adds that he is no hardcore pothead, consuming cannabis throughout the day. He’s never smoked at work, just as he would never drink on the job. “I’ve always tried to be responsible with my intake,” he says.
For him, marijuana is a tonic that makes life a bit brighter; he calls it Vitamin M, a substance that he says “puts me in a place mentally that I enjoy.” Consumption is a social ritual. “Smoking weed has always been communal and a kind of bonding with friends,” he says.
His many years of consistent toking also place Norman in the vanguard of a small but rapidly growing subgroup of recreational cannabis consumers, people age 65 and older. As restrictions have eased across the nation, recreational use of marijuana has increased. Recreational use is now legal in 18 states and the District of Columbia, and marijuana has been decriminalized in another 12. As for seniors, cannabis use increased from 2.4% of people age 65 and older in 2015 to 4.2% in 2018, according to a study cited in an April 2020 blog by Dr. Peter Grinspoon on the Harvard Health Publishing website. The blog speculates that the increased usage reflects a growing interest in medicinal marijuana by seniors who were comfortable using it in their youth, as well as a growing acceptance overall of medical use of cannabis.
Norman has been growing his own pot for nearly 45 years.
Nationally, recreational marijuana use increased the most in people age 50 and older, according to a June 2018 report in the journal Gerontology and Geriatric Medicine. Older users were generally unmarried men with several chronic diseases and psychological stresses. They also were reported to be using other substances such as alcohol, tobacco, and prescription or other drugs. Colorado, a state similar in population size to Virginia, legalized recreational use of cannabis in 2014 and tracks usage at marijuanahealthinfo.colorado.gov. In a Behavioral Risk Factor Survey, Colorado reports that from 2014 to 2019, the number of people age 65 and older who reported using marijuana in the past 30 days increased from 3% in 2014 to 9.3% in 2019. The survey notes that the age groups reporting the highest level of use were ages 18 to 25 years and ages 26 to 34. Usage was basically flat for the youngest group (27.5% in 2014 to 28.8% in 2019) and increased from 19.8% in 2014 to 29.4% in 2019 for ages 26 to 34.
The demand is there, but even as legal access to cannabis products for medicinal and recreation uses has increased, there are still many questions. Medical research has been limited for years because cannabis was illegal and still is, under federal law, and many of the studies that are available are limited and often anecdotal.
“There’s a lot that we don’t know about marijuana, for a long time we haven’t been able to study it,” says Dr. Michael Weissberger, a geriatric services physician at the Center for Advanced Health Management at VCU Health and an assistant professor in geriatric medicine at the VCU School of Medicine.
Evidence is strongest, he says, that cannabis may alleviate some kinds of pain, such as neuropathic pain in diabetes; lead to improvement in conditions such as spasticity in multiple sclerosis; and lessen nausea and vomiting in chemotherapy. Evidence is weaker when it comes to other medicinal uses. “It doesn’t mean that it doesn’t work, it means we don’t have good studies,” Weissberger says.
Senior Health and Cannabis
Seniors are more susceptible to adverse side effects of medication, especially those who have other health conditions such as diabetes, high blood pressure or cancer. Drug interactions may compound problems. Weissberger notes that many medications are metabolized in the liver, and that there may be hundreds of drug interactions whose interplay may be unknown, but significant.
Another factor to consider is that seniors often are regularly taking five or more medications, even nine or more, he says. That places them at greater risk for interactions. Weissberger also says that chronic marijuana users may require higher doses of anesthesia. Marijuana may also affect anticoagulants, seizure and heart medications, and statins.
Otherwise, cannabis products are relatively safe, especially if they are replacing narcotics, in which case they are mitigating harm, Weissberger says.
Norman downplays his health risks.
He says he doesn’t consume marijuana like some heavy users do, almost like a cigarette smoking habit, firing up multiple joints a day. Norman notes that such a habit would lead to health problems that you find in heavy, regular consumption of cigarettes. He says the amount of cannabis he smokes is not much of concern for him, health-wise, noting that he worked construction for years, and the stuff he inhaled on work sites was far worse.
Norman is acclimated to its use, but some of his peers who haven’t consumed cannabis since before the first Bush administration may be in for some surprises, ranging from sticker shock to the potency packed into today’s pot.
“There's a lot we don't know about marijuana.” —Dr. Michael Weissberger
Norman notes that in his youth, marijuana cost $15 an ounce, later $25 an ounce. Now, it’s reportedly $40 for an eighth of an ounce on the street, and Norman says seeds sell for $10 each. He also says that much of what’s available now has been hybridized extensively for high THC content. “A lot of the stuff you purchase is way too strong,” he says. “You smoke too much of that, you get sick.”
Potency also may be exacerbated in seniors because age and health changes impact how you metabolize a substance and how you experience it, Weissberger says. Some side effects are more of a nuisance, such as dry mouth and nausea. There’s also the potential for dizziness, which can be more of a problem for older users who are more likely to sustain a broken bone or other injury if they fall.
The usual cautions apply: Don’t drive or use machinery after using THC products; be aware that it can acutely impair judgement and motor skills in the short term. Weissberger also notes that cannabis use can cause problems with thinking and motor functions, liver function, and cardiopulmonary problems, especially if smoked. There’s also a risk of psychosis and other issues for some users.
Weissberger recommends talking with your doctor before you consume cannabis products for recreational or medicinal use. Instead of smoking, consider a tincture or an edible.
Homegrown and the Law
Norman worked in construction before he retired, but he also became a farmer of sorts along the way. As the cost of marijuana kept rising, he thought he could save some cash if he grew his own. It was a weed, after all, he reasoned, so he got to work. He’s been growing it for 45 years.
If you want to consume pot legally, that’s the way to go in Virginia, at least for now. While marijuana use is legal, the state has yet to legalize the sale of cannabis for recreational purposes, with a timetable calling for sales to be legal in 2024. But as of July 1, you can grow your own, if you follow the rules.
You can’t buy cannabis in any form, including seeds, but seeds may be given to you. The law allows you to grow up to four plants in your primary residence, according to Virginia NORML. If you grow your own, each plant must be tagged with your name and driver’s license number or other state identification. You can grow plants inside or outside your primary residence, but they must be in a place that can’t be seen from a public road or sidewalk.
Virginia currently allows adults 21 and older to possess up to 1 ounce of cannabis. You may share up to an ounce privately, as long as you are not in some way paid for the cannabis. Other rules regarding consumption include a ban on consuming cannabis in a public place or while in a car that’s being driven, and you can’t have an open container of cannabis in a car.
Realtor Eric Morehouse recently started a business, The Key RVA, that helps people get set up to grow marijuana at home.
Recreational use and growing your own is legal in Virginia, but some of the social stigma remains. Eric Morehouse, creator of The Key RVA, a cannabis cultivation consulting startup, notes that “people are mostly laying low and keeping quiet.”
The Richmond native’s day job is as a Realtor. The Key RVA supplies a range of services, from house calls to inspect setups and advise customers to complete indoor grow packages and equipment delivery and setup.
Morehouse had expected his business to attract “a bunch of 21-year-olds trying to make money,” but two months in, he’s had many older people seeking his services. Most either used cannabis recreationally in their youth or are now seeking to grow marijuana to allay conditions such as back pain, he says.
As of early September, about a dozen people have used the service. People 55 and older have predominated in network sessions so far, and about 60% are women, according to Morehouse.
It’s a new business model that has its practitioners learning their way. For now, it’s mostly about networking and answering questions. “We’re kind of taking it one day at a time,” Morehouse says.
Expect the laws governing recreational marijuana to continue to evolve. The General Assembly’s Joint Commission on Cannabis Oversight held its first meeting in August, and legislators are discussing ways to move up the date when recreational marijuana may be sold.
Medical Marijuana
Amy Whitehurst battled depression for years, getting treated with antidepressants for two decades, but she says it was marijuana that provided relief. She has a card for medical cannabis, and now she’s growing her own.
She says there’s a perception of marijuana users as lazy stoners, but the reality is “quite the opposite.” She notes that you can microdose with cannabis medicinally to gain benefit without getting high and says she had to figure out the effects of various strains, what worked for her and what didn’t. Whitehurst says she had spent too much time dealing with lethargy stemming from depression, so she wanted something to make her “feel stimulated and happier.”
Using the sativa strain of cannabis helps with her depression and also helps her get energized and motivated. “It’s not just where you lay on the couch and go to sleep,” she says.
The Glen Allen resident says she’s always been a gardener, but there’s been a bit of a learning curve in cultivating cannabis indoors. She’s passionate about pot and is encouraging other women to take up cannabis cultivation. “It has so much potential to help people,” she says.
She worked for a time with a Richmond cultivation shop and noticed that most of the people who were grow-your-own enthusiasts were men. “I wanted to encourage women that they can grow also,” she says.
Orthopedic surgeon Dr. Steven Fiore of CannabisMD TeleMed is registered with Virginia to treat patients with cannabis products. Here, he speaks with his receptionist with the same setup he uses to consult with patients.
Recreational users of marijuana have long been used to a grow-your-own ethos, but people who use cannabis products for medicinal purposes in areas where that’s legal tend to stick with commercially produced products, out of concern for standardized dosing, according to Dr. Steven Fiore, an orthopedic surgeon who is registered with Virginia to treat patients with cannabis products.
“I don’t see a lot of elderly people starting to grow their own marijuana for medicinal use,” he says.
Fiore and his son, Scott, started a business, CannabisMD TeleMed. Consultations are mostly done remotely, with Fiore and several physician assistants. There’s also an office in Midlothian for some consultations in person.
Medical marijuana has uses across the age spectrum. Fiore's caseload as of mid-August ranged from a 3 1/2-year-old to a person in their 80s. The toddler had not responded to traditional treatments to control seizures, and cannabis was a grasp at finding something that could work.
Most patients seeking treatment are in their 30s to 50s, with the range skewing to the older end of that spectrum. Of Fiore’s last 100 patients, about 10 were in their 60s, and one was 70. One caller wanted to see if her 87-year-old mother would be helped by cannabis to treat anxiety, but her mother had fallen and had difficulty walking, so she was not a good candidate for treatment. Gait instability is one of several conditions that may be contraindicated for medicinal cannabis use. Others include heart failure, arrhythmia, infarctions, and severe personality disorders or psychosis.
Fiore notes that many younger people seek help for sleep disorders after trying over-the-counter products or treatment with prescription sleep aids. The patient mix also includes many people seeking relief from pain for conditions including rheumatoid arthritis, previous back injuries, or nerve injuries and neuropathic injuries. Many are referred to Fiore by their doctors.
Some of the drugs prescribed for sleep interfere with REM sleep, according to Fiore; cannabis does not and “may actually help you sleep and get the kind of sleep you need.”
Cannabis can also help people who are dealing with addictions, relieving some of the craving for substances such as heroin or fentanyl. People with chronic pain may be referred for cannabis to decrease reliance on oral opioids, says Fiore. “It’s a huge variety,” he says.
Marijuana products may impair certain brain functions, but some older people may see improved cognitive function as cannabis products help them with sleep or pain. It’s also a viable choice in dealing with pain for some seniors who can’t use products such as acetaminophen or NSAIDs, because of issues such as kidney or heart disease and bleeding.
There is poor evidence for marijuana treatment in dementia, according to Weissberger. Evidence is mixed in its use in treating anxiety or depression, and there are no studies showing it helps with cognition. Studies of cannabis use in treating sleep and insomnia disorders have been small, with mixed results and methodological drawbacks, he says.
Medical cannabis is new, and not regularly recommended, says Weissberger. Its use hasn’t made its way into the education system, and the knowledge base is limited. “We generally try many different interventions first,” Weissberger says.
Virginia currently allows adults 21 and older to possess up to 1 ounce of cannabis.
Medicinal cannabis use is started slowly and methodically. In the elderly, a sublingual application, a tincture placed under the tongue absorbed directly into the bloodstream, is generally recommended. Fiore generally recommends that older patients first try CBD products, cannabis derivatives that don’t produce the “high” associated with THC products. If that doesn’t work, they can go to a THC product. If they use an edible, they may be told to cut it up and try an eighth at first, then progress upward until they begin to receive relief. Starting with a too-potent dosage may lead to side effects such as dizziness, fatigue and sleepiness. Cardiovascular conditions also are a concern because cannabis products can increase your heart rate.
“If you start elderly patients slow and let them increase the dose until they feel the effect, they won’t go too high,” Fiore says.
Medicinal cannabis is generally not covered by health insurance. The state assesses a $50 fee for a card that’s good for a year and says you’re authorized to use marijuana medically, purchased from a state-approved dispensary. An appointment with the doctor is about $100. Medicinal marijuana costs about $50 to $100 a month.
The initial impact of the easing of restrictions on recreational use of marijuana coincided with an increase in the medicinal marijuana business, according to Fiore. He says that legal recreational use may eventually impact the medical marijuana business as dispensaries open, and that some patients who are middle-aged and younger may opt for recreational cannabis instead.
The biggest difference between a medicinal product and homegrown cannabis is standardization. Fiore notes that producers of the medical product get the THC and CBD content standardized down to the milligram. “That’s the beauty of it,” he says. “You know what you’re getting.”
It’s the Law
Cannabis consumption is legal for recreational and medicinal use in Virginia, with stipulations.
Among them:
- You must be 21 or older.
- You may share up to an ounce of marijuana with others in private.
- You can have no more than an ounce in public — there is no stipulation on how much you can have in private for personal use — but you can’t consume cannabis in public, nor offer it to another person.
- You cannot order seeds, nor can you order cannabis from another state where it’s legal.
- You can buy cannabis from a licensed, state dispensary only if you’re certified and registered for medicinal marijuana use.
- You can grow your own in your primary residence with stipulations.
- Residents 21 and older in their primary home can grow up to four marijuana plants per household, which must be tagged with information that includes your name and Virginia driver’s license number or other state identification, as well as a note saying they’re being grown for personal use according to state law.
- Plants can be grown inside or outside your home, but they can’t be in a place visible from public view (sidewalk, street, etc.).
- It is still illegal to sell cannabis for recreational use in Virginia. The state law currently reads that it will not be legal to sell marijuana until Jan. 1, 2024.
Sources: cannabis.virginia.gov, Virginia NORML
