By David Downs
March 18, 2017
Before it even began, the monthly meeting of the People of Parkside Sunset had devolved into an angry crowd of seniors shouting in Cantonese.
“No invaders! No invaders! No invaders!” yelled out 100 or so Sunset District residents crammed into a humid room inside the Taraval Police Station earlier this month.
Their target? Floyd Huen, a Bay Area geriatrician who once led Oakland’s Highland Hospital. Huen, 70, has made it his late-in-life mission to spread awareness of the benefits of medical marijuana among the group he has found most hostile to it: elderly Asian Americans.
For more than 20 years, Huen has counseled thousands of arthritis and insomnia patients to try marijuana. On this night, though, Huen worked to persuade the Sunset group of the benefits of what would be the neighborhood’s first licensed pot shop — one he and his wife, former Oakland mayor Jean Quan, would co-own.
When Huen took the microphone and began trying to speak, the shouting increased. Liar. Child endangerer. Huen was escorted out. The room cheered.
The raucous evening demonstrates the challenge Huen and other doctors who advocate for medical marijuana face in trying to convince not just the general public, but especially older patients they believe can benefit the most.
Twenty-one years after Californians legalized medical marijuana for the seriously ill, experts say the elderly are still the least likely to seek out the botanical or be able to access it. Just 2.2 percent of Californians age 65 and over had ever used medical cannabis, according to the most recent state survey, in 2014, from the California Behavioral Risk Factor Surveillance System.
Huen and other medical professionals maintain seniors are exactly the population that could most benefit from cannabis treatment. Data support this: In January, the National Academy of Sciences released the most comprehensive and authoritative review of medical marijuana studies to date. It found “conclusive and substantial” evidence that cannabis and its derivatives work on chronic pain, nausea, muscle spasms and a host of other conditions.
Statistics from the Centers for Disease Control, meanwhile, indicate that half of the country’s seniors have chronic pain, half have arthritis, half have insomnia, and 17 percent get migraine headaches, and that many seniors have more than one of these conditions. All are conditions cannabis has been proved to address. Other conditions it has been used to treat include neuropathy, muscle spasms, diabetes and insomnia.
State survey data show that patients who use cannabis use it primarily for those conditions, as well as to ease side effects of cancer treatment. Of the 3,789 Californians surveyed who tried medical marijuana for a serious condition, 91 percent said it helped.
Still, many seniors are unlikely to try medical marijuana, according to Huen and many other leading physicians, nurse practitioners and therapists in the field. The Taraval meeting was a stark illustration of the stigma pot carries among the elderly, many of whom have long believed the drug was like heroin or LSD.
“The No. 1 problem is simply ignorance,” Huen said.
Many doctors also remain skeptical of marijuana. Fundamentally, pot remains a federally illegal Schedule 1 drug — defined as medically useless and highly prone to abuse. The U.S. government has systematically blocked research into cannabis’ benefits.
Other data also give some doctors pause. On March 9, the American College of Cardiology linked marijuana use with a 26 percent increase in the risk of stroke and a 10 percent increase in the risk of developing heart failure.
“More research will be needed to understand the pathophysiology behind this effect,” said Dr. Aditi Kalla, a cardiologist at the Einstein Medical Center in Philadelphia and the study’s lead author.
Alameda County Commissioner on Aging Sue Taylor said official information and discussion of medical marijuana directed toward seniors is almost nonexistent in the state. AARP’s 2016 policy book, for instance, does not mention the word “marijuana” once.
Geriatricians aren’t getting any national guidance on medical marijuana, either. “We have not developed any clinical practices guidelines for medical marijuana,” said Dan Trucil, assistant director of communications with the American Geriatric Society.
Health insurance almost never covers medical cannabis, which can cost $3,000 per year on average — prohibitive for a person on a fixed income. Medical facilities generally lack written policies approving the use of medical marijuana, so seniors who do use it often do so covertly.
And even in a region historically tolerant toward marijuana, much of the Bay Area is blanketed in bans on medical pot dispensaries, making it difficult for anyone to safely locate and buy the drug.
As a result, many seniors who could benefit from cannabis use may be suffering serious consequences, advocates say. In states where medical cannabis is legal, there are 25 percent fewer opioid overdoses, the journal JAMA Internal Medicine reported in 2016. States with legal medical cannabis also saved $176 million in Medicare prescription drug costs per year, the journal Health Affairs found in 2016.
“People are beginning to understand … marijuana is very helpful for some of the problems that come with old age,” said San Francisco medical sociologist Sheigla Murphy, who researched Baby Boomer pot use in a 2015 study paid for by the National Institute on Drug Abuse. “Frankly, this could be a relatively inexpensive drug and its safety has been tested for 1,000 years.”
Huen, who is the paid medical director of the Apothecarium dispensary in the Castro District, points out that cannabis cannot cause a fatal overdose. Also, patients can use marijuana to get relief without smoking it or even getting high.
Dr. Donald Abrams, chief of oncology and hematology at San Francisco General Hospital, treats cancer patients at the UCSF Osher Center for Integrative Medicine. He said “not a day goes by” that he does not see seniors with nausea, vomiting, loss of appetite, pain, depression or anxiety. And he often recommends cannabis therapy.
“When I see those people, I’m able to offer them one medicine instead of writing them prescriptions for five or six, all of which might interact with each other or the chemotherapy or targeted therapy that the patients are taking,” Abrams said. “I think a lot of people are totally unaware of cannabis’ potential health benefits.”
There are many seniors who are aware and supportive of medical marijuana. In the retirement community of Rossmoor in Walnut Creek, for example, monthly meetings of its Medical Marijuana Education and Support Group regularly attract 150 attendees; about 500 seniors are on its email list.
Its executive committee, led by Renee Lee, met recently in the home of group member Dr. Paul Holland and talked about the hurdles seniors face learning about and safely using cannabis.
For Holland, a retired physician, the biggest barrier was finding good information.
After he suffered a massive stroke that left him with tremors, loss of appetite and insomnia, he said, “I’d wake up at 1 or 2 in the morning and I could not go back to sleep for the rest of the night. It was very wearying.”
He decided to try his adult son’s bong. But smoking marijuana just made him dizzy, and he gave it up. It wasn’t until several years later that a nurse practitioner recommended a precision-formulated liquid extract of cannabis called a tincture that he takes under the tongue before bed. “I get no high effects from it, but it really helps you sleep until 5 or 6 in the morning, which is good for me,” he said.
Holland, a researcher at the National Institutes of Health for 20 years, calls the government’s Schedule 1 designation for marijuana “ridiculous.” That classification prevents the kind of placebo-controlled human trials doctors would trust, he said.
And without enough doctor buy-in, most seniors will stay in the dark, said another Rossmoor resident, Lois Langer, 87. “For older people, the doctor was like a god,” she said. “You didn’t question them or their judgment.”
Even if seniors find a good doctor and information, they may be denied cannabis as they age, said Lee, a licensed psychotherapist. A senior living alone has freedom to choose what works for them, but that freedom may diminish if they enter an institution, many of which don’t have written policies about medical cannabis use, she said.
“Once you get into more constricted places, it’s very difficult. It’s not very accepted,” Lee said. “There’s an underground of people who use it, but it’s very small and not done well.”
Dr. Cheryl Phillips, senior vice president for public policy and health services for LeadingAge, a nonprofit network representing more than 2,000 nursing homes in the country, agrees. “This is an important issue. Really the concern is twofold: One is regulatory — the federal government does not recognize this. Secondly, staff who might be administering it are concerned about criminal charges.”
An hour north of the Sunset dispensary battleground, Huen makes a house call in another place lacking any medical pot shops, Marin County.
Huen drove out to check on a longtime patient, 63-year-old Dieter Schien, a former bus driver with multiple medical problems. He has kidney failure and goes to dialysis four times every week. He’s also an amputee who lost his right leg below the knee.
Every other week, Schien takes mass transit to San Francisco to resupply at the Apothecarium, because Marin County continues to ban dispensaries. “It’s a shame,” he said. “I deal with 25 hours of health care a week already. Every week. Having something closer would be much, much easier.”
Huen checks on Schien’s heart and asks him about his medical marijuana use. Cannabis helps him control his diabetes, treats the nerve pain in his limbs, helps him sleep and keeps him calm during dialysis, he said.
“The fact that’s he able to have a good quality of life without taking any opiates is just remarkable,” said Huen.
“I make it look easy,” Schien laughs. “Ninety percent of the people around me (at dialysis) don’t want to get up in the morning. Me, I’m up every day having fun and lighting a fire.”
As their visit comes to an end, Huen has one more question for his enthusiastic patient.
“Do you have any Chinese friends that use cannabis?” he asks.
Chronicle intern Spencer Silva contributed to this report.
David Downs is The San Francisco Chronicle’s cannabis editor. Subscribe to The Chronicle’s enhanced cannabis coverage by emailing firstname.lastname@example.org