Nearly a quarter of medical marijuana licenses in Arizona are owned by individuals over the age of 60. Yet the right to administer marijuana and marijuana-derived drugs in Arizona residential care facilities is still misunderstood.
Veronica Santarelli is the CEO of Grassp Health which provides cannabis, where an estimated 30 to 40 percent of the company’s clientele are seniors, spread across hundreds of facilities throughout Arizona.
“There is a huge misconception about the use of cannabis in long-term care,” said Santarelli. “I’d see families smuggling gummies into assisted living facilities, and I’d say, ‘You know, you don’t have to.’”
Santarelli firmly believes that marijuana should be a normalized health care option. The relevant Arizona law, ARS 36-2805, permits the administration of medical marijuana and marijuana-derived drugs to registered and qualified patients in licensed assisted living facilities. As with any medication, this requires a doctor’s prescription.
But it can be difficult to find a doctor willing to give the order, both in Arizona and across the country. Santarelli said many doctors are not fully embracing medical marijuana for fear of federal or Drug Enforcement Agency (DEA) repercussions.
dr. Elaine Burns, a naturopath and medical director of the Southwest Medical Marijuana Physicians Group, isn’t afraid. In the industry since 2011, Burns is a licensed physician with additional expertise including homeopathy, acupuncture and botanical medicine, including cannabis. An estimated 75 percent of her patients are seniors.
“A lot of mainstream doctors refer their patients to me,” Burns said of marijuana prescribing. “My goal is to help people get better with the drug, not just get a card.”
Burns works with individual patients to prescribe the correct dosage and type. One of the first things she asks new patients is if they live in a facility that allows marijuana. When it comes to such communities, there is no general plan.
“It depends on the facility,” Burns said. “Some may be willing to allow CBD because it’s legal at the federal level, rather than actually having a full map.”
Arizona law outlines four ways assisted living facilities may “reasonably limit” medical marijuana consumption. The law states that they will not store or maintain patient stock of marijuana and are not responsible for providing the marijuana to eligible patients. The law further states that marijuana must be consumed other than smoking and only in a place specified by the facility.
While this allows patients to still consume, the need for a non-facility caregiver to store and administer doses is often prohibitive.
For one woman, medical marijuana is a desperate option to ease her mother’s extreme pain and anxiety. She refused to be identified for fear that this would lead to hostility towards her mother who lived there. Despite much back and forth with the facility, regulators and doctors, the facility refuses to store and administer marijuana to the woman’s mother. As a result, the only options left are to hire outside caregivers, move closer to the parent to administer it directly themselves, or opt for a more traditional prescription such as opiates.
“Their policy is that someone, not one of their employees, is responsible for bringing the marijuana to the patient, watching them take it, and removing anything that isn’t consumed,” she said. “The doctor recommended medical marijuana three to four times a day. That’s almost impossible.”
She added that despite many pleas to give her parents marijuana for debilitating anxiety and pain, the institution only reiterated that they are “just not comfortable with it.”
“Their arguments indicated to me that they just didn’t understand,” she said. “I think part of the problem is there’s a lot of vagueness in this statute.”
Shane Pennington, a New York-based attorney who deals with federal appeals and regulatory issues related to cannabis, also finds ARS 36-2805 confusingly vague.
“You can’t do anything unreasonable” unless it jeopardizes funding under federal law or regulation?’ said Pennington. “Then I think you can impose unreasonable restrictions.”
Arizona law does not require assisted living facilities to administer medical marijuana if doing so would be harmful to the facility under federal law. And while such damage is highly unlikely, the conflict between state and federal marijuana laws creates confusion and uncertainty.
For example, Pennington noted that assisted living facilities are federally required to register with the DEA to dispense legally controlled substances, such as opioid pain relievers.
Medical marijuana — although legal in Arizona, 38 other states, and Washington DC — is classified as an illegal Schedule I drug by the federal government. These substances are defined as “no medical use,” and so their distribution could put a facility at odds with the DEA.
Pennington noted that the Justice Department would not be able to spend funds to disrupt the state’s implementation of medical marijuana laws.
“If what you’re doing is in compliance with the state’s medical marijuana regimes, the DOJ — including DEA — can’t enforce it,” Pennington said. “This is a deep problem, how confusing it gets.”
The Arizona Department of Health Services reported that it is not aware of any retirement home that embraces the use of medical marijuana. phoenix New times contacted several assisted living facilities in Phoenix and got a response from one.
“Hospice of the Valley fully respects the wishes of all patients wishing to use cannabis medications and is working with their physicians to coordinate a safe and effective plan of care,” was the response.
Hospice of the Valley declined to comment on whether staff would administer the cannabis medication.
The popularity and acceptance of marijuana-derived treatments for the effects of aging is increasing as more seniors question the merits of traditional drugs, with their sometimes serious side effects. Research promises relief for seniors when it comes to ailments such as pain, poor sleep and Alzheimer’s disease.
“For 12 years I have seen people come off opioids, fentanyl, morphine and sleeping pills. They basically take their medicine cabinets full of amber plastic prescription bottles and put their one or two cannabis drugs on the shelf,” Burns said.
For glaucoma patients, Burns finds that supplementing traditional medications with marijuana improves pressure levels. Cancer patients can tolerate chemotherapy and radiation better. Migraine patients report massive reductions in both frequency and intensity. And all of them have a better quality of life.
The Arizona Department of Health Services, which issues medical use permits but does not keep records of how many assisted living facilities are licensed, outlines the legally approved terms for medical use of marijuana. While this includes glaucoma, cancer, and “Alzheimer’s disease agitation,” it does not explicitly include migraines or insomnia. These are symptoms common in the elderly, and Burns notices that marijuana diminishes.
Santarelli and Burns cite particularly good benefits for Alzheimer’s patients in residential facilities, including a sedative effect that replaces sedatives that would otherwise make patients nearly comatose. In one instance, Santarelli recalls a woman who suffered from Alzheimer’s disease and was so agitated that she could not be contained. She was evicted from several residential facilities before incorporating medical marijuana into her routine. This calmed her and allowed her to live in one house for the rest of her life.
“These are people in hospitals and nursing homes, in many cases they are veterans,” Pennington said. “There’s a federal ban, and the lack of Congress to clarify all of this is what everyone is suspecting. It’s having a real impact on people.”