medical marijuana

People with Alzheimer’s disease frequently become distressed and agitated. Nursing homes may try to control this behavior with antipsychotic drugs such as aripiprazole (Abilify), haloperidol (Haldol), olanzapine (Zyprexa) or risperidone (Risperdal). Such medications can cause serious complications, including death. What can clinicians and families do when patients are agitated? Could the synthetic cannabinoid (Nabilone) offer an alternative for agitated or aggressive Alzheimer’s patients?

A Black Box Warning Is Scary:

The FDA requires a black box warning with antipsychotic drugs:


“Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. This drug is not approved for the treatment of patients with dementia-related psychosis.”

Human Rights Watch Issues Scathing Report:

On February 5, 2018 Human Rights Watch issued a damning report.

They Want Docile
How Nursing Homes in the United States Overmedicate People with Dementia”

Here are just a few tidbits from the article:

“In an average week, nursing facilities in the United States administer antipsychotic drugs to over 179,000 people who do not have diagnoses for which the drugs are approved. The drugs are often given without free and informed consent, which requires a decision based on a discussion of the purpose, risks, benefits, and alternatives to the medical intervention as well as the absence of pressure or coercion in making the decision. Most of these individuals—like most people in nursing homes—have Alzheimer’s disease or another form of dementia.”

“Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others. They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there. In many facilities, inadequate staff numbers and training make it nearly impossible to take an individualized, comprehensive approach to care.”

Updated Data from McKnight’s Long-Term Care News:

An article by Beverly Marselas (June 7, 2018) paints a bleak picture of current practices in nursing homes.

She writes:

“Approximately 20% of nursing home residents — more than 250,000 nationwide — are still receiving antipsychotic drugs as part of their long-term care treatment, according to an analysis of federal data released this week by a consumer advocacy group.”

So, despite the FDA black box warnings and admonitions not to prescribe antipsychotic drugs to patients with Alzheimer’s disease or other dementias, the practice continues.

Understaffed facilities and poor training mean that this practice will continue. Agitated and aggressive patients with Alzheimer’s disease are hard to handle. That’s why the new research is exciting.

Synthetic cannabinoid (Nabilone) vs. Agitation and Aggression:

We started hearing about the synthetic cannabinoid (Nabilone) a couple of years ago.

A Canadian researcher wrote in CNS Drugs (Aug. 2015):

“Alzheimer’s disease (AD) is frequently associated with neuropsychiatric symptoms (NPS) such as agitation and aggression, especially in the moderate to severe stages of the illness. The limited efficacy and high-risk profiles of current pharmacotherapies for the management of agitation and aggression in AD have driven the search for safer pharmacological alternatives. Over the past few years, there has been a growing interest in the therapeutic potential of medications that target the endocannabinoid system (ECS)…While findings from six studies showed significant benefits from synthetic cannabinoids—dronabinol or nabilone—on agitation and aggression, definitive conclusions were limited by small sample sizes, short trial duration, and lack of placebo control in some of these studies. Given the relevance and findings to date, methodologically rigorous prospective clinical trials are recommended to determine the safety and efficacy of cannabinoids for the treatment of agitation and aggression in dementia and AD.”

New Data to Support Nabilone vs. Agitation of Alzheimer’s

Now, a small study from Canada suggests that a synthetic cannabinoid called nabilone (Cesamet) may ease agitation more safely than most other drug treatments. It is approved by the FDA to control the nausea associated with chemotherapy. This preliminary research suggests that the synthetic cannabinoid may offer some benefit against the agitation of Alzheimer’s disease.

This was a placebo-controlled 14-week trial presented at the Alzheimer’s Association International Conference July 25, 2018.

MEDPAGE TODAY reported the results:

“The oral agent [nabilone] offered clinically and statistically significant improvements in agitation compared with placebo…”

One of the authors, Krista Lanctôt, PhD, is quoted by MedPage Today:

“We know that cannabis and related synthetic medications can have calming effects, increase appetite, and decrease pain — all of which might be helpful in those with Alzheimer’s disease suffering from agitation,” she added. “However, we did not know if these medications would be helpful in this group of patients. For those reasons, the [current study] results are both predictable, and surprising.”

“Benefits of the treatment went beyond the individual, with caregiver distress also showing a meaningful reduction, Lanctôt stated.”

Synthetic Marijuana: Pros and Cons:

The upside of a synthetic cannabinoid (nabilone) appears to be less agitation and aggression. It also improved overall behavioral symptoms.

The downside of this drug: there was a drowsiness effect and possibly even some euphoria. Let’s face it, this is synthetic THC, the active ingredient in marijuana.

Some health professionals get upset at the idea that an Alzheimer’s patient might experience some euphoria from THC. We leave it to you, dear reader, to determine if that is a negative or a positive.

One caution: drowsiness could lead to accidents or falls. Anyone taking nabilone would need to be very cautious about this potential adverse consequence.

To learn more about other possible therapeutic uses of marijuana you may wish to read our article on medical marijuana:

Will Medical Marijuana Ease Pain and Prevent Dementia?

You can also listen to the free podcast of our interview with Dr. David Casarett: “How One Doctor Changed His Mind About Medical Marijuana.” It says the CD is $9.99 but the mp3 download is FREE!

Show 1027: How One Doctor Changed His Mind About Medical Marijuana (Archive)


We would like to get your perspective on the use of the synthetic cannabinoid (nabilone). Is this a good idea or a scary proposition? Share your thoughts in the comment section below.

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  1. Mark

    Psychosis, paranoia and schizophrenia are potential side effects of marijuana, synthetic or natural. There is plenty of information on this!

    While I don’t doubt the money-making potential of synthetics, the biggest reason for them is that at least there are drug trials and dosage limits set for synthetic or “big pharma” drugs. No such thing yet exists for weed, or probably ever will, given the “just legalize it” mentality. I have first-hand knowledge of this. An elderly family member recently overdosed on natural, concentrated THC given for cancer side effects in Canada. The doctors and paramedics alike thought no, not possible, but it was ultimately found to be the cause of his near-death experience.

    Another point is that there are different types of marijuana effects: strains with higher CBD are thought to be less likely to cause psychosis, paranoia, or schizophrenia. Again, this is highly unregulated and untested, so it’s a crapshoot.

    Seriously? You want you give someone already in a psychotic state marijuana/THC without knowing the best dosage? Some will probably be helped. But what about those that will be harmed. Do they matter?

  2. Lynn
    Campbell, CA 95008

    I think they should do more larger scale trials on patients to determine if cannabis is better than the strong medications. I feel for the families and caretakers who try to deal with these patients. I know and have seen the effects of this horrible disease. My 3 Sisters have had it, and 2 are deceased, with one living and getting worse. I wonder if the blood test for Alzheimer’s is worth getting to see if I have the gene.

  3. Laura

    I am never sure what exactly people mean when they say ‘medical marijuana’. I have been told by someone who researched marijuana for medical reasons, that the plant marijuana contains two active ingredients. One is the THC that causes a high and is why it is used as a street drug. The other is cannabinoid, which has medicinal properties. It helps calm people who have anxiety issues, among other things.

    In Texas you can buy cannabinoid products that contain no THC. I was told it was the way they process the marjiuana plant to remove the cannabinoid. If it is done right, you only get cannabinoid, not THC. I have no problem with people using cannabinoid for medical reasons as long as there is no THC in it.

    I didn’t know there was a synthetic cannabinoid. If it is synthetic, shouldn’t it be THC free?

    I wish people would stop using the term ‘medical marijuana’ and be specific. For too many years when someone used the term marijuana, you were talking about a street drug that makes you high. So if they are meaning cannabinoid when they say medical marijuana, they should say so.

  4. Mary M

    Why is People’s Pharmacy standing with an artificial product like Marinol which has extremely limited success (and why Canada is going towards legalization of cannabis, in general, moving away from GW pharmaceuticals that never got their synthetic ‘brand’ right. No buffers to protect the user has a potential high 30 times that of cannabis, none of the CBD which is what is responsible for anti-anxiety in the first place, not THC. Please consider taking some time to look at Dr.Raphael Mechoulam (biochemist who specializes in the cannabis plant) to understand why more patients ranging from cancer to epilepsy finding better success. Even Salk which did a think tank on Alzheimers and Cannabis found that full plant extract was a smarter concept than Marinol.

  5. barbara

    Euphoric elders with dementia?? How horrible!!They must suffer!! They are being punished for their sins, who are we to interfere with God’s will??

    Bad as concern for a terminally ill cancer patient getting addicted to Fentenyl.This reminds me of the history of using anesthesia to manage the pain of childbirth, and the meme’s of the new age fitness gurus..”no pain no gain”

  6. Beth

    I understand the concerns about antipsychotic use in the elderly, but sometimes the risk is worth the improvement in quality of life. My mother was diagnosed with Alzheimer’s in 2004. She lived with me for many years, but has been in a nursing home for 3 years now. She had become delusional and extremely anxious, sometimes running out of her room in the middle of the night, telling me that we had to get out of the house, because it was going to explode! We tried several medications, but nothing helped. We finally went to a neurologist who prescribed Seroquel ( an antipsychotic). It took a little time to get the dosage right, but we saw improvements very quickly. She is calm but not overly sedated. She participates in activities, especially those involving music. The medication has given her back some quality of life, which I would take any day over extending a life of total misery. By the way, she is 95.

  7. Lyn
    Seattle, WA

    Living in WA State where recreation marijuana is legal, although so far not on a Federal level, I think it’s egregious that medical canabanoids are not available to patients in pain, Alzheimer’s/Dementia and other patients with horrific medical issues. Pot store abound in our region, but they carry only minimal CBD products with .1% THC, dictated to them by law. I would like to have seen medical canabanoid products legalized, not recreational marijuana. Our roads are rife with people who are high on marijuana, along with other substances, illegal and otherwise, while patients will continue to suffer. My hope is that big pharma will not become involved in dispensing canabanoids, and that people who require relief for whatever reason, can eventually be seen by an MD, and both organic and synthetic canabanoids can be dispensed in a clinic or hospital, who can be watchful for patients needs.

    I read about cancer patients, patients with intractable pain, who are now denied pain medications, and who are about at the end of their ropes. Sadly, until a politician’s family is affected, little will be done to help these people or a campaign is launched for those who suffer needlessly.

  8. Alison

    This is so hopeful. Those psychic drugs are more frighting than marijuana. Now can we trust the caregivers in not taking it themselves?

  9. Jane

    “Synthetic” marijuana is not marijuana. And it is very dangerous. Why don’t they just use straight-up Cannabis?

  10. Sara

    Antipsychotics can cause euphoric feelings as well. That is why they are often abused as street drugs. Since we are on the subject of THC, we should also discuss the synergistic effects of CBD and THC. They have been found to be better when used together. For that matter, why are they making a synthetic version? Did they run out of pot?

  11. Sharon

    As an RN who worked with psychotic patients in crisis including those with dementia, I understand the concerns about “over” medication with anti-psychotic drugs. You must realize though, that many of these people become EXTREMELY agitated and aggressive to the point that they are a real danger to themselves and others. They are much more likely to get hurt in this state of mind and it would be cruel to perpetuate the psychotic decompensation without giving some kind of calming medication.

    My opinion is that any medication that can promote calmness and or a feeling of well-being in this population is good. We need to think about their QUALITY of life, as they ramble through their maze of psychotic thoughts and scrambled memories each day.

    I believe anyone who disagrees with medicating this population in some way should be introduced to a room full of these people in an unmedicated state for long enough to get a feel for what caring for them and trying to meet their needs entails! I assure you that you will be the first one to the med room!

  12. REAL
    duluth MN

    I must be stupid, but why aren’t they using synthetic marijuana instead of a hemp extract?

  13. Sarah L

    I think it sounds like a wonderful idea. Why pump all those unapproved drugs into patients when a little cannabis can make a person feel calm and happy! There’s nothing to lose here.

  14. D light

    Might increase appetite, increase forgetfulness and doesn’t pot cause depression/apathy as an after affect like alcohol does? All this better than aggression. so ask someone who used to work with the elderly I guess that’s the payoff because I used to get hit and scratched by people who were aggressive way back in the eighties before they even were aware of what was going on in the field of Alzheimer’s

  15. Karyn

    What is wrong with REAL cannabinoids? Have there been any studies with CBD? I take CBD derived from hemp for both anxiety and inflammation,which are two problems that many patients in facilities need to be treated for. This synthetic stuff is not good,and,in my opinion, just a way for the pharmaceutical companies to make more money!We have seen too many things go wrong with synthetics, let’s just stick with the real thing that Nature provides please!

  16. Deno
    Spartanburg SC

    The only downside of providing Alzheimers patients with a cannabinoid that produces euphoria is that the patient’s family members will steal it.

  17. Lillian

    So would ingesting marijuana have the same effect?

  18. William

    “Drowsiness” isn’t incapacitation, and people under the influence of cannabis in nursing homes probably aren’t going to be attempting much that’s going to get them hurt in a fall. And labeling “euphoria” as a bad thing in nursing home patients boggles the mind. People need to look at the proverbial big picture here instead of picking insignificant nits.

  19. Mary

    Do not condemn nursing homes for medicating alzheimers patients who are out of control. My husband has alzheimers and I use olanzapine and unless you walk in my shoes you have no clue how bad it gets. He suffers from fear and anxiety and wants to go home to a place that no longer exists.

  20. JIm

    Marijuana has multiple medicinal uses, glaucoma, pain, anxiety, seizures, and nausea. That is why Big Pharma wants to create different compounds for different symptoms. But instead of using the natural product they want to make a synthetic compound so they can patent each compound to charge an exorbitant price.

    Marijuana’s risk of drowsiness or falls is no worse than what is used today for agitation.. In my opinion is is safer. It is time to legalize marijuana. No reason for illegal drug cartels to make exorbitant profits and no reason Big Pharma should either.

    They will not find a drug to prevent, stabilize or reverse Alzheimer’s because in my opinion it is the high carb diet allowing the genes to act. The lack of saturated fats in our diets will make us all have mental disease if we live long enough.

    Marijuana is less addicting than nicotine and alcohol. It should not be classified a Schedule 1 drug like heroin or cocaine. We also need a quantitative blood test for marijuana like alcohol to determine if one is inhibited at a set time. Testing for marijuana today is only a qualitative meaning it is simply very small amounts, not inhibitory amounts, but they can stay in the blood up to 60 days in some people.

    The advantages of the marijuana plant today is it can have different varieties to change the ratio of THC to CBD (cannabidiol). It is the cannabidiol which has the main medicinal actions.

    It should not be used by anyone under age of 20 as it will affect brain developement. But then so does alcohol but little is published to the public on this because this also is big business. It is time for the myths and disinformation about marijuana to end.

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