I never thought I would be taken through a dispensary.

Right.

By a 94 year old.

Who else would take you?

Sometimes my reporting takes me to places I truly never would have expected. Now, a few months ago, while working on a new documentary, I paid a visit to a medical cannabis dispensary in Palm Beach, Florida, a place packed with seniors. And that's where I met 94 year old Ken, nearly old enough to be my grandfather. At the dispensary, I kind of eavesdrop in on his conversation with the "Budtender."

So just check that. How much THC and CBD....

Oh yeah we have these the pomegranate CBN and THC.

Oh, it's the same strength as?

Yes, it's ten milligrams.

Okay. And how much is it?

Well, these are 30.

30. And the special price?

You'll get your wisdom discount.

Did you catch that? A wisdom discount. Not seeing savings, not retirement age benefit. A wisdom discount, which, by the way, is given to anyone there over the age of 55. I love that. And so did Ken.

The first time you ever walked into a dispensary, what was that like for you?

It seemed most of the dispensaries are the same. You come in, you see a receptionist, they put your card in, somebody comes out to escort you inside to a cash register and they have the stuff for you.

Was it was it confusing?

No it was simple.

So why is Ken here? Why is he had a cannabis dispensary? Well, it's because his doctor prescribed him cannabis to help him sleep. Just think about that simple thing and how much change that reflects a 94 year old being prescribed marijuana as a medicine for sleep. Now, to be clear, Ken, who lived through significant stigma around cannabis, wasn't totally sold on the idea.

At first I said, I really don't want to smoke it. You know, I, I didn't know what an awful lot I would become a junkie. But is there a downside? And I didn't want to do that.

But the thing is this. He had tried all sorts of medications and now Ken says cannabis is one of the only medications he's ever tried for sleep that actually works.

I don't know buy it for smoking. I don't buy it to get high. I just it helps me go to sleep.

As you may know, I've been reporting on cannabis as a medicine for more than a decade now, and it's fair to say I have learned a lot and my thinking has evolved, even changed on the topic. I just finished my seventh documentary. It's called Weed seven. A senior moment Now, no doubt. When I started filming the documentary, Ken, a man nearly 100 years old, wasn't the typical patient I thought of as using medical marijuana so often. I, like a lot of you probably thought of this as a younger person's drug. My parents, for example, were born a few decades after Ken, and I couldn't imagine them trying it. But the reality is, cannabis use is on the rise among older adults, both recreationally and medicinally. In fact, seniors now make up the fastest growing population of cannabis users in the United States. On today's episode, I'm going to ask an expert in geriatric psychiatry what exactly is behind this trend and how he hopes medical cannabis might be able to alleviate. What I have come to call the nuisances of aging, everything from insomnia and pain to depression and anxiety, even certain symptoms of dementia. We're going to talk about what we really know and what we really don't know about some of the risks and the rewards of using cannabis. And we're going to highlight some of the precautions folks of any age should take. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent. And this is Chasing Life.

Back in 2017, Dr. Aaron Greenstein was in residency training to become a psychiatrist when he noticed a trend that surprised him.

I noticed that a lot of the veterans who are seeking mental health care there were cannabis users. Many VA patients lean on the older and these are, you know, Vietnam era Korean War era people and they swear by cannabis. They swear by its positive impact on their day to day life.

Now, Aaron was training at Harvard in Boston, and medical cannabis was legal in the state of Massachusetts. But Dr. Greenstein says from a medical perspective, he ran into a familiar problem a lack of data, which meant most people were flying blind, even doctors themselves.

I had no information really to inform my discussions. Even so, it's not like I'm going to give them advice and tell them what strains to use. Like I didn't have anything to tell them clinically, like, Oh, this is bad for you, this is good for you. This is how much you should be using. You should not be using this formulation. Had none of that information.

And that is what inspired Dr. Greenstein to do his own research on medical cannabis in the elderly. And while he says there are still a lot of questions that remain unanswered, the bottom line is that he now believes the substance can be useful, and it's highly promising for some patients today. Aaron is a licensed geriatric psychiatrist in Denver, Colorado. That means he helps older patients navigate their mental health, which frankly, is something that is too often ignored. In fact, there simply aren't enough doctors like him out there. According to a 2018 study from the University of Michigan, there are around 1200 geriatric psychiatrists in the country. Meanwhile, our nation's senior population is about 55.7 million and growing.

I mean, there's just a huge shortage in geriatrics. So the need is there and partially because there's a huge shortage. The reason that this population really needs specialized care is because as people age, they become more frail, their metabolism slows, they tend to have more medical problems. And then, of course, for a another subset of the population, there's also changes to their brain. You look at an MRI of someone's brain and they're 28 versus when they're 80, you know, their brain is probably smaller. It probably has some chronic inflammation and those things certainly contribute to mental health. So we look at people's mental health through a completely different lens. And it's also looking at treating mental health in the setting of medical complexity.

And increasingly, one of the options to help people who need it is cannabis. For Ken, who I introduced you to earlier, it was his specific lack of sleep that was really driving his poor mental health. And cannabis, as it turns out, helped him with both.

The lack of another word. I don't run out of gas. I get a decent night's sleep and we could be 6 hours, 7 hours day. That's fine for me.

I really wanted to dig into this with him to understand, like, does it help you go to sleep? Does it help you stay asleep? Like, what is it about cannabis and sleep for you? Why is it something that you find useful and attractive and helpful? And he said something interesting, which is that when he wasn't taking cannabis, sometimes he would wake up in the middle of the night. And when you're a senior, someone in his nineties in this case, where does the mind go when you start to wake up in the middle of the night? And where it went for him? Super nice guy, successful guy in his life but the mind went to could have, would have, should have. Here's what I could have done with my life. Here's what I should have done with my life. Here's what I would have done with my life. And it was anxiety provoking.

A lot of coulda, woulda, shoulda. I would get up. I should have done that when I was 40. Why didn't I go to a better school? Why did I do this? So in not sleeping, you really do a lot of damage to yourself.

That was how the cannabis was helping him. It was giving him sleep. It was also taking him away from the could of would have shutters of life, which I just found really interesting.

I love that anecdote, though. That's really fascinating. And this is also, by the way, why like clinically, it's really important to take a really good history, right? Because if somebody just came to me and said, Oh, I use cannabis daily for sleep and I didn't get into why they're actually using it and all of the benefits that it has for them, you know, I'm just as a physician, I'm like, Oh, is this doing more harm? Is this doing harm or is this doing benefit? And how should I counsel them and how should I do motivational interviewing to get them to stop using it? So, you know, that's somebody who is getting far more benefit from cannabis than from any pharmaceutical product. I mean, every pharmaceutical sleep aid comes with a whole set of downsides, and none of them come with an indication that it can help relieve existential distress of aging at 4 a.m..

Right. I know I had the same reaction to that. Like, I just needed to sit back and reflect on what he said. It was powerful to me because. The existential questions. Maybe they, by their very nature of the age of the people we're talking about, they experience existential questions more the time that they have to to address some of the things in their life they wish they addressed. That time is running out and they're aware of that. So how not to lapse into what can become an existential crisis or even just an existential anxiety I thought was super interesting.

Yeah, that's really powerful too. I mean, I just imagine the level of distress from that is massive because you have this short window of time. You probably have some physical limitations, maybe cognitive limitations, and looking back with regret. So, you know, if if there's a way to alleviate that and, you know, help people pass through that without having to go through that struggle like power to them, I would say a lot of when I found out that a lot of people were using cannabis, I really was more interested in why they were using it instead of giving them the hand, the slap on the hand that I probably should have given them based on training and at that point in time. So I was just really interested. I would do these detailed histories just to learn more about why they're actually doing it and when they're using it and what formulations and what it's doing for them and why they're spending so much of their Social Security check on it. You know, to me, when somebody is investing so much effort and time and money into something, there's a good reason for it. It's not usually just that it's a fun hobby.

Why is it that your training would have sort of, you know, made you want to slap them on the hands? Is there a concern about addiction? I mean, I think the gateway sort of hypothesis has been pretty adequately addressed. I mean, what is it what would your professor say to you? Maybe you've talked to your professors about this. What would they say about this work that you've done on cannabis and seniors?

Well, first of all, I think there's a paradigm shift. I don't blame my attendings and professors for preaching against cannabis. I mean, this is a schedule one substance, highly stigmatized for many decades. And we really never had a good population sample of, you know, what this stuff actually does to people when it's used. And we also don't have good information on like how it impacts different age subsets. Like I would say that like in younger people, I heavily discourage cannabis use because we know that persistent cannabis use in younger people for recreational purposes will lower IQ for many people. And you know, is is deeply impactful, especially on teenagers. I mean, it's very well established that it is not a safe substance for younger people. Now, as people age, it's a different story, right. If they're using this primarily for medical reasons to deal with insomnia, to deal with chronic pain, to deal with muscle spasms, even to deal with mental health issues like that, that's a different conversation because these people are more likely to use it responsibly. They're less likely to, you know, abuse it, frankly, and they're using it for something that is not being addressed by our health care system. So I think we you know, I'm trying not to I try not to look at this as a black and white issue. And I'd say that, yes, there are some people who do. But I think a more nuanced view of this has formed over time, especially since I started thinking about it.

If if someone is thinking, look, I, I think there might be some some virtue in me trying cannabis as a senior for some of the things you've talked about, the nuisances of aging, call them sleep, pain, mood. How would they even begin? Because again, it's a schedule one substance. They don't know anything like what strains to take, how much to take, how to take it. Is there a way for for people to do this in a responsible way?

I think that's that's a really challenging question is probably the question. And at this point, you know, responsibility is on that person, frankly, because we don't have dosing guidelines, we don't have formulation guidelines, we don't have FDA approved indications. We really don't have that much information. So, I mean, just personally, what do I say when somebody comes in and says, I want to try cannabis, you know, for my sleep, I have not been able to sleep. I've been on every hypnotic drug and every other pharmaceutical. I'm sick of it. So, I mean, I'll first of all, talk to them about, you know, you're on these medications for your AFib and your other problems. Like let's first of all, make sure that you're not going to have a drug interaction that will end up causing you more harm than benefit. Like, let's talk about your mobility. Do you have mobility problems? Is using cannabis going to impact your mobility further? Are you driving still? You know, let's talk about how this fits into the bigger picture of your life. And then, you know, once all those boxes have been checked, if if the person has taken all the risks and still thinks there's a potential benefit, I still don't have an answer for them at that point. I mean, at that point I say to them, like, you know. Do what you do with pharmaceuticals. We go low and slow with the elderly, low doses, low titration, and don't take any big risks and talk to somebody who knows what they're talking about, which is typically somebody who works at a medical dispensary, because I don't have a nuanced, nuanced enough knowledge. And frankly, we actually don't even know what's in a lot of these compounds. Like, you know, when when you say that that guy in Florida had these incredible benefits, you know, he helped them sleep, that helped him deal existential distress. Okay. We can assume that, you know, it's THC and maybe some CBD that's doing that. But the reality is there's 150 over 100 cannabinoids in this stuff and there's another 500 compounds that we don't know anything about. And it's possible that it's one of those compounds that's actually, you know, modulating the part of his brain that's driving this existential distress and alleviating that. So, you know, it's hard for me to make any recommendations without us actually understanding what this stuff is and what it's made of and what the different chemicals are actually doing. We just don't know at this point.

I thought a lot about my own parents throughout this discussion. If they had asked me what I recommend cannabis for their so-called nuisances of aging. Yeah, probably. Especially compared to the things they are too often prescribed pain pills, sleeping meds, antidepressants. In fact, after the break, Dr. Greenstein is going to reveal how his own family has, in fact, grappled with this issue.

And as I told my mom, like, the biggest risk here is that we give her too much and she is stoned for a few hours.

We'll be right back.

And now back to Chasing Life.

I don't know where I've landed. Aaron, on whether or not if my parents came to me and said, Hey, okay, you've done seven documentaries on this and you know, we're reading all this stuff about cannabis and and we have these nuisances of aging, should we try it? But I got to tell you, you know, at this point in my life, I think I'd be a lot less reluctant to go ahead and say, try it, which is not something I would have said ten years ago. But what should they take away from this, though? I mean, they are people are ambulatory. They're getting around. They go to the gym every day. But as I mentioned, they deal with some of these, I guess what we call the nuisances of aging has as they've sort of alluded to them. What about them with everything that, you know, if you were their grandson, what would you tell them?

You know, the first thing that I'd want to know is how much are these things actually bothering them? Are these things actually impacting their quality of life and are they preventing them from doing the things they enjoy doing and seeing the people they enjoy seeing? That to me is the biggest question. If the answer to that question is like, you know, I get together with my friends and all we talk about is our arthritis and we have a great time joking around about it, then like that doesn't seem like it's that big of a deal to them. In fact, it actually allows them to bond with other people about their changes. But if they say, you know, my you know, my insomnia is so bad, you know, the hypnotics don't work or they make me confused. None of the other medications, the market do anything for me and I can't function. I'm staying home all day. I'm tired. I'm like, not myself. I need something desperately. Then at that point, you know, I'm not going to argue. What am I going to say? If that's if you think that may help you, like, go figure out what formulation can help with sleep and test it out. You know, at this point, that's safer. This is a safer option than a lot of the hypnotics that a low dose in a controlled environment, you know, as long as I'm on a medications that interact with it.

But you'd still say do they hypnotics first? Could it be a first line or do you think you have to exhaust everything else?

I will try the pharmaceuticals first just because, again, I can predictable. I know the side effect profile. I know how to dose them. You know, all those things are there. And you know, if they don't do well in pharmaceuticals, I'll do pretty quick trials of them then, you know, if they say I want to go test out cannabis and see if that helps me with sleep, I I'm not going to discourage that. I actually will use it as a learning experience myself, frankly, to see if it is effective for them and what they're actually taking as long as, again, the safety parameters are there. I'm not going to tell them not to do it as a first line treatment. My issue with prescribing this stuff at this point is that, again, no guidelines. It's not predictable. I don't know what's in the formulations. I don't know how it's interacting with the pharmaceuticals they're on. I just can't responsibly prescribe it as a physician trying to practice with integrity at this point.

These issues aren't just abstract ones. For Doctor Greenstein. He talks to his patients about these issues regularly, and it's also something he has experienced firsthand with someone he was really close to, his late grandmother, Marion.

Backing up a little bit. Just a funny story is when I told my grandmother that I was going into geriatric psychiatry, she asked why I didn't just become a real doctor. Hey.

Just so you know, that happens, I think, for all of parent, child, grandparent, grandchild, relationships.

So she asked me that many times, you know, why why don't you just become a family doctor? Why don't you just become a real doctor? Why are you going into this crazy field? And I would say the interesting piece is a big part of why I went into psych geriatric psychiatry is because I grew up around my grandparents. My mom's parents are both Holocaust survivors. And, you know, with people who have gone through such deep trauma, a big coping strategy is just narrative. It's just talking and talking about their experiences in their stories, talking, talking, talking. And I grew up around that. And when I rotated in geriatric psychiatry and I realized that a huge part of this job is just the life narrative and, you know, learning about people's lives, I was like, Sign me up. This is like I was basically trained for this my whole life, being around my grandparents. So even though she was, you know, upset that I didn't become a real doctor, she was a big part of why I became a geriatric psychiatrist. That's right. Yeah. And then ultimately, as she, you know, went through the really difficult end of her life, I was one of the few people who actually was able to come up with ways to help her with this unimaginable the strategy was going through.

Can you describe what was happening?

So at about two years ago, she had a fall and then like a month later, couldn't get up from her chair. The fall was, you know, bad, but she got picked up and was able to walk after that. And months later she can get up on her chair, said she got back pain. My mom took her to the emergency room and they found, incidentally, that she had a spinal fracture and said that she needed to have surgery on it. So from the time she went into the emergency room, she became confused, which in our lingo is encephalopathy or delirium. And the content of her confusion was all Holocaust related.

I want to give you a little warning here. What Dr. Greenstein is about to describe can be difficult to hear. It might even be triggering to some.

Starting from that point through a hospital admission, through a rehab admission. The traumatic memories just came back and just went on day and night. She was confusing medical staff with Nazis. I mean, she she accused me of murdering her family multiple times. She just was in this confused state where she was reliving all of this unimaginable trauma she went through. There's one really distinctive moment when a phlebotomist came to take her blood and she said to this phlebotomist, you know, why are you taking my blood? What about all of the other girls here? And what she was alluding to was that the doctor Mengele, who was the Nazi physician, actually drew her blood when she was in Auschwitz. And she in that moment with this phlebotomist coming in to draw her blood, was reliving that moment. And, yes, she had spoken about it, but she had never relived it from what I'd seen. So that that phlebotomist was shaken. He's like, you know, I don't you know, he didn't know what to do with that information. So this sort of thing went on and it really deeply impacted her care. I mean, and when you see comments like that to a phlebotomist, it impacts the ability for that person to do their job.

This all happened while Dr. Greenstein was still in residency, so he tried to help his grandmother as much as he could, along with her primary care doctors. But nothing really worked to calm her down. So Dr. Greenstein said he was actually shocked when his own mother recommended going to a dispensary as a last ditch effort. They decided to give it a try.

We gave her, like, you know, two and a half milligrams first, not effective, five milligrams, and her screaming and agitation and recalled traumatic memories from the Holocaust, like stopped like within minutes and nothing else worked. Anti-psychotics didn't work. Mood stabilizers didn't work. Nothing worked for more than maybe a few hours. And she basically dosed it, you know, ongoing. And I think she lived maybe a few weeks after we started doing that or a month. But, you know, it was this one substance that was really able to relieve her of, you know, reliving these memories that, you know, nobody needs to relive. And, you know, going through this whole experience again, that, you know, that it had happened 80 years earlier. Yeah. It was this unbelievable treatment that actually helped her maintain this quality of life. And then, you know, she ultimately passed away peacefully and, you know, thankfully had an end, really abrupt end to this reliving of the Holocaust that she had gone through.

You didn't know for sure whether it was going to work. I mean, you'd read the read the trials, you read the results of this, the smaller studies. What about the risks?

Yeah. So, I mean, the risks were not that high at that point in life. Again, this is towards the end of life. She was not really ambulate ing much, you know, she wasn't really walking around much. She wasn't taking many other medications at that point. And her cognition was pretty poor. So a lot of the things that I worry about with older adults really didn't pertain to her. And as I told my mom, like, the biggest risk here is that we give her too much and she is stoned for a few hours. That's the biggest risk at this point in time. And frankly, that's a probably a better state to be in than her current state of distress. So I think that narrow you know, if this is an indication, it's a very narrow one of like, you know, end of life, you know, distress or terminal delirium, whatever you want to call it. But if you can relieve that without causing over sedation like that seems like a really great use of a of a compound, because at that point, you're not as worried about the risk profile of it. This is a time where it's, you know, the risks are so minimal. This is a person who is going to live, you know, weeks, months longer.

Dr. Greenstein says this is fundamentally a story about the way cannabis can be used to treat some of the trauma and post-traumatic stress that can surface later in life. But it's also about much more than that. He believes it helped his grandmother die with dignity. For other folks like Ken, who I met at the dispensary at the beginning of the episode. It can even help someone age with integrity. That's a concept that came up during my conversation with Dr. Greenstein, and I found it really fascinating.

The psychologist Erick Erickson, you know, defines that the emotional development milestones of that last period of life as integrity versus despair. Right. So those people who age with integrity or they end up in despair. And again, it's very much a reflection of their lifelong emotional development. A lot of the people that I see are people who actually age with despair, and they struggle in their last decades of life. And again, it's very much based on I would say a lot of it's actually based on childhood, frankly, and like how they developed emotionally at that point in time, but also like what their life trajectory looked like. You know, if they're actually able to look back and be proud of their accomplishments and proud of their life and, you know, proud of their kids and grandkids, I mean, those are people who are able to age with integrity. And then, you know, there are people who age with despair. So, again, I have this biased perspective because I just you know, I see the despair, you know, on a day to day basis. I am inspired, though, by people who age with integrity. And that's really why I went to this line of work. And it's really what I preach to my patients a lot is, you know, finding ways to find meaning and purpose in late life so that they can have the integrity.

I was incredibly moved by Dr. Greenstein story and the lessons he's learned along the way with his own grandmother. I think it's safe to say, based on the new studies and the old stories, cannabis can help with the many nuisances of aging. Look, it's not a miracle drug. It's not a cure. But man, the impact it seemed to have on Marion and Ken, helping with their most existential fears and worries that could come with their aging. That was really something. That's what I think we all want for the older folks in our lives, even ourselves, to stay sharp, to stay healthy, and to age with integrity. Next week on Chasing Life. Do you want to live to 100?

I don't know how old I feel. I've never felt this old, but I am going to be 99 in August. And I have to say I'm grateful that I feel as well as I do at this age.

That's next Tuesday on the season finale of Chasing Life. Thanks for listening.

Chasing Life is a production of CNN Audio. Our podcast is produced by David Rind, Xavier Lopez and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer and Tommy Bazarian is our engineer. Dan Dzula is our technical director and the executive producer of CNN Audio is Steve Lickteig. Also, a special thanks to Ben Tinker, Amanda Sealy and Nadia Kounang of CNN Health.