Cannabis and Older Adults

Clinician Toolkit
THE L.I.V.E. ACRONYM IS HELPFUL FOR DOSING CANNABIS1
L Start at a low dose. For both pharmaceutical and non-pharmaceutical cannabinoids,
the approach to starting cannabis in older adults is to generally start low and go slow.

I Titrate incrementally over a period of time to find a safe, effective minimal dose.

V Be vigilant while monitoring adverse effects

Cannabis E Engage older adults and their caregivers in monitoring.

Dosing
ADDITIONAL CONSIDERATIONS
During the titration period, encourage older adults Duration of the treatment trial will vary depending
or their caregiver to keep a diary of positive and/or on the indication and cannabinoid content. It is
adverse effects including: recommended not to exceed a 3-month trial for
• Date and time of dose patients starting cannabis.
• Amount of dose in ml and/or mg (THC and/or CBD) Review dose every 4-6 weeks until desired effect is
• Time of onset of effects achieved. The daily amount in grams of dried cannabis
• Effects on symptom/health condition product can then be set for 1 year (required for Medical
• Type and duration of adverse effects Document).2

Initial dosing for novice cannabis patients should be Set a maximum dose when discussing cannabis with
at bedtime due to potential drowsiness/sedation and older patients, especially for THC. Revise treatment if
dizziness. there is no clinical improvement after stable dosing.

CANNABIS DOSING
Nabilone3,4 Nabiximols5
• Nabilone is a synthetic cannabinoid similar to THC. • Nabiximols is available as an oro-mucosal spray.
• Dosage: 0.25 mg, 0.5 mg, 1 mg capsules. • Dosage: Each spray (100 μL) contains 2.7 mg THC and 2.5 mg CBD
• Compounding pharmacies can prepare liquid • Guidance for titration in adults: increase dose gradually,
formulations. no more than 1 additional dose per day.
• Maximum dose used in studies involving older • Most adults respond to 4 to 8 sprays per day.
adults is 2 mg. • No specific dosing guidance is available for older adults.
• Start with a single evening dose to determine effectiveness and tolerability.

Dried Cannabis for Inhalation6 Edibles7

• Dose should not usually exceed 1.5-2.0 grams per • In Canada, edible cannabis products are legally limited to a maximum
day of a dried plant product. of 10 mg THC in order to reduce the likelihood of overdose.
• Inhalation is generally not recommended for • Many commercial products (e.g., chocolate, drinks) have clearly stated
older adults (e.g. smoking/vaping). amounts of active ingredients.

Cannabis Oil2
• Patients are advised to start at a very low volume of • For a non-experienced patient, starting with pure CBD or 1:1
cannabis oil at night e.g., 0.1 mL to 0.2 mL (THC:CBD) oils may be better tolerated. THC dominant oils are
• The dose in milligrams should be titrated up slowly (may generally avoided depending on treatment goals.
take a few weeks), based on the patient’s goals and their • It is easier to control dosage with cannabis oil compared to edibles.
tolerance to potential side effects.
CBD Dominant Oil CBD:THC Hybrid oils
• Start: 0.1 to 0.2 mL (around 2-5 mg/day of CBD depending • Start at 0.1 mL once daily (no more than 1.25 mg of THC) for the
on concentration) once daily for the first 3 days first 3 days
• Titrate in 0.1 mL intervals every 2-3 days based on effect • Titrate in 0.1 mL intervals every 3 days based on effect up to 0.4 mL
• Consider increasing to twice daily dosing with 6-8 hrs • Continue titrating in 0.1 mL amounts on a weekly basis.
between doses • Most patients achieve therapeutic benefit by 0.4 to 0.5 mL.
• Total daily dose to no higher than 0.8 mL before the • Maximum daily dose is 0.7 to 0.8 mL
first follow-up visit

1. LIVE Acronym – J. Chau, Developed for CCSMH Cannabis module, March 2021 5. GW Pharma Ltd. Product Monograph PrSATIVEX® delta-9-tetrahydrocannabinol (THC) and
2. Guidance in Authorizing Cannabis Products within Primary Care.; 2021. https://www. cannabidiol (CBD) Solution, 27 mg/mL / 25 mg/mL, Buccal spray. Histon, Cambriduge UK; 2005.
cfpc.ca/CFPC/media/PDF/CFPC-Guidance-in-Cannabis-Within-Primary-Care.pdf Date of Revision: December 11, 2019.
3. Valeant Canada limitée/Limited. Product Monograph N Cesamet® Nabilone Capsules; 1mg, 6. Canada H. For health care professionals: Cannabis and cannabinoids. www.canada.ca. Published
0.5 mg, 0.25 mg. Montreal, Quebec; 2009. October 12, 2018. Accessed September 15, 2021. https://www.canada.ca/en/health-canada/
4. Nabilone: Drug information. Access Lexicomp Online for additional drug information, services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-
tools, and databases. Hudson, OH: Lexicomp, 2021. https://www.uptodate.com/ professionals-cannabis-cannabinoids.html#a2.2.1.4
contents/nabilone-drug-information?search=nabilone&source=panel_search_ 7. McClements DJ. Enhancing Efficacy, Performance, and Reliability of Cannabis Edibles: Insights
result&selectedTitle=1~19&usage_type=panel&kp_tab=drug_general&display_rank=1 from Lipid Bioavailability Studies. Annual Review of Food Science and Technology. 2020;11(1):45-70.
.1146/annurev-food-032519-051834
To learn more or register for asynchronous, accredited Production of this publication has been made possible through a
eLearning modules on Cannabis and Older Adults visit financial contribution from Health Canada. The views expressed
https://ccsmh.ca/cannabis-and-older-adults-project/ herein do not necessarily represent the views of Health Canada.
*The term cannabis refers to all modes of cannabis including prescription cannabinoids. September 2022 vi