Category Archives: News and Articles

Benzos, Depression & Alzheimer’s During Pandemic Isolation

Nerd Land: Benzos, Depression & Alzheimer’s During Pandemic Isolation

Benzodiazepines are frequently prescribed to ease anxiety, insomnia and agitation. Anxiety and insomnia are risk factors for developing dementia. 

As one who’s mom, paternal grandmother and aunt all died with complications related to dementia, and one who knows they all suffered with anxiety and insomnia, I am particularly interested in these kinds of stories. Additionally, anxiety has been my ongoing medical issue since I was a kid, really. I sucked my thumb til I was 12 and only stopped after my best friend blabbed it to her boyfriend. 

For a long time, doctors recommended benzodiazepines to treat my anxiety, along with recommending exercise and mindfulness practices. After reading that the FDA-approved, prescription meds I was on could cause sudden seizures, I swore to never take them again and leaned into plant medicine, despite the societal stigma in the early 1990’s. 

Anxiety and isolation related depression are having a devastating impact on our seniors and the people who love them.

Below are some recent stories and research that I found particularly interesting:

Benzodiazepine Use and the Risk of Dementia

[FTA] “…Concluding Thoughts

Available evidence indicates a positive association between the use of benzodiazepines and the development of dementia, although causality cannot be inferred from this data. Despite the lack of evidence proving causality, the association between benzodiazepine use and the development of dementia is a major cause for concern given the prevalence of benzodiazepine use among older adults. The prescription of benzodiazepines to older adults must be carefully reviewed given the lack of data regarding their long-term efficacy and their significant adverse effects including the risk for developing dementia.”

Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders

Preliminary clinical trials also support the efficacy of CBD as an anxiolytic, antipsychotic, and antidepressant, and more importantly, a positive risk-benefit profile. These promising results support the development of large-scale studies to further evaluate CBD as a potential new drug for the treatment of these psychiatric disorders.

Alzheimer’s deaths skyrocket as patients’ lives ‘upended’ by pandemic

[FTA] “…In September, Bettie Pitchford, 76, who had been an accomplished quilter, occasional clown for children’s parties, active member of her church and the NAACP and director of special education for the Pontiac School District outside Detroit, became one of thousands of Americans with dementia to die unexpectedly, succumbing not to the infection of COVID-19 but to the way it upended their already off-kilter lives.

Nationally, about 259,250 people with Alzheimer’s or other forms of dementia were expected to die last year, according to the Alzheimer’s Association. Federal data analyzed by the association shows that the number of dementia deaths, at least through the end of November, was 16% higher. More than 38,000 people died unexpectedly…”

Study Finds Older Adults Using Cannabis to Treat Common Health Conditions

“Pain, insomnia and anxiety were the most common reasons for cannabis use and, for the most part, patients reported that cannabis was helping to address these issues, especially with insomnia and pain,” said Christopher Kaufmann, PhD, co-first author of the study and assistant professor in the Division of Geriatrics and Gerontology in the Department of Medicine at UC San Diego.

Pandemic isolation has killed thousands of Alzheimer’s patients while families watch from afar

[fta] “…Overlooked amid America’s war against the coronavirus is this reality: People with dementia are dying not just from the virus but from the very strategy of isolation that’s supposed to protect them. In recent months, doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years…”

GW Pharma Hopes to Bring Its Second Cannabis-Based Drug to Market in the U.S.

As big pharmaceutical companies vie to enter the medical cannabis space and establish a foothold with overpriced and inaccessible cannabis based drugs…

GW Pharma Hopes to Bring Its Second Cannabis-Based Drug to Market in the U.S.

“In June 2018, the FDA approved a cannabidiol (CBD) prescription medication for the first time. Called Epidiolex, it is approved specifically to treat seizures in two rare, severe forms of child-onset epilepsy in patients who are 2 and older.

This approval precipitated the removal of Epidiloex specifically from the Controlled Substances Act, allowing its sale and transport, with a doctor’s prescription, in every state in the US.

Now GW Pharma is trying to bring a second cannabis formulation to the United States, with Phase 3 trials now beginning for Sativex for for the treatment of MS spasticity. The cannabis based drug is also being studied by Kings College London for use by people living with dementia, specifically Alzheimer’s Disease.

Sativex known Nabiximols in the US, is a 1:1 formulation of CBD and THC:

“Nabiximols is a complex botanical medicine formulated from extracts of the cannabis plant that contains the principal cannabinoids THC and CBD and also contains minor constituents, including other cannabinoid and non-cannabinoid plant components, such as terpenes, sterols and triglycerides, according to company data. The product is administered as an oral spray.”

Since 2011, Farmacann has established itself as the leader in research and development of cannabis therapeutics based on evidence of efficacy in real world environments in Northern California Residential Care Facilities and in the homes of patients throughout the area.

And as California’s legal and regulatory environment has changed, so has Farmacann, by developing products and packaging that always meet or exceed the manufacturing, testing and regulatory requirements of the State of California, Medical Professionals and Licensed Care Facilities.

While the rest of the country waits for Big Pharma to enter the medical cannabis space, Farmacann is delivering relief to 7 counties in the Bay Area with the same ratio and established efficacy:

THRIVE Caps 1:1 CBD:THCTHRIVE – Monthly

Ratio CBD:THC: 1:1
Dosage: 5mg CBD and 5mg THC (each capsule)
Packaging: Pill Cards of 30 capsules, each that contain a total of 300mg of combined cannabinoids.

Ideal for: Patients seeking a balance between physical comfort and mental relaxation.

And with a monthly subscription at $81, inclusive of state and local taxes and delivery, this is cannabis medicine that is accessible now in Northern California, and soon the entire state and beyond.

Farmacann – Providing seniors & medical professionals with a technology platform that simplifies access to effective & affordable alternative cannabis choices

DC

Nursing Homes Oust Unwanted Patients With Claims of Psychosis

Nursing Homes Oust Unwanted Patients With Claims of Psychosis

By Jessica Silver-Greenberg and Rachel Abrams

New York Times Sept. 20, 2020

They are finding what families say are pretexts to send patients to hospitals for psychiatric care — and then refusing to let them return.

In a New York nursing home, a resident hurled a bingo chip. At a home in Georgia, a 46-year-old woman, paralyzed from the waist down, repeatedly complained that no one had changed her diaper. In a California facility, a patient threw tableware.

In all three cases, the nursing homes cited the incidents as a reason to send the residents to hospitals for psychiatric evaluations — and then to bar them from returning.

Across the United States, nursing homes are looking to get rid of unprofitable patients — primarily those who are poor and require extra care — and pouncing on minor outbursts to justify evicting them to emergency rooms or psychiatric hospitals. After the hospitals discharge the patients, often in a matter of hours, the nursing homes refuse them re-entry, according to court filings, government-funded watchdogs in 16 states, and more than 60 lawyers, nursing home employees and doctors.

The practice at times violates federal laws that restrict nursing homes from abruptly evicting patients.

“Even before the pandemic, there was tremendous pressure to get rid of Medicaid patients, especially those that need high levels of staffing,” said Mike Wasserman, a former chief executive of Rockport Healthcare Services, which manages California’s largest chain of for-profit nursing homes. “The pandemic has basically supercharged that.” He said homes often take advantage of fits of anger to oust patients, claiming they need psychiatric care.

About 70 percent of American nursing homes are for profit. The most lucrative patients are those on short-term rehabilitation stints paid for by private insurers or Medicare, the federal program that insures seniors and people with disabilities. Poor people on longer-term stays are covered by Medicaid, which reimburses nursing homes at a much lower rate than Medicare.

The financial incentive to have more Medicare or privately insured patients, and fewer on Medicaid, becomes more pronounced when the Medicaid patients have illnesses, like dementia, that require extra care from staff.

Nursing homes have faced acute staff shortages as the coronavirus has left employees sick or afraid to go in to work. Workers said they faced increased pressure from their employers during the pandemic to get rid of the most expensive, least lucrative patients

Invoking psychiatric problems is a popular tool. Nursing homes routinely admit patients with dementia, Alzheimer’s or similar illnesses, and angry outbursts are common.

In March, the Rehabilitation Center of Santa Monica, Calif., sent Joan Rivers, who suffered from dementia and was on Medicaid, to the emergency room at USC Verdugo Hills Hospital. The nursing home’s staff said Ms. Rivers, 87, had tossed aside her chair, scaring other residents, according to her daughter, Evon Smith, and a government-funded watchdog.

Ms. Smith said that she had repeatedly asked the Rehabilitation Center to take her mother back, but that it had refused. A social worker at Verdugo Hills said she, too, had tried unsuccessfully to get the nursing home to readmit Ms. Rivers.

Linda Taetz, the chief compliance officer at Mariner Health Care, which operates the Rehabilitation Center and 19 other nursing homes in California, said the center hadn’t known that Ms. Rivers wanted to return.

Ms. Rivers eventually was admitted to the Colonial Care Center nursing home in Long Beach, Calif. There, she contracted Covid-19. She died on July 20.

Federal law requires nursing homes to follow strict guidelines when they intend to evict someone: They must give 30 days’ notice and come up with a plan to transfer the resident to a facility that can meet his or her needs. If a resident goes to a hospital, the facility must hold the bed for a week.

But nursing homes frequently flout these rules, according to employees and state-funded ombudsmen who help oversee the industry. The New York Times reported in July that nursing homes were evicting an increasing number of low-income — and therefore low-profitability — residents into homeless shelters and run-down motels, apparently in violation of federal law.

There is no national data on nursing home evictions. The Times contacted ombudsmen in all 50 states. Some said they had not seen nursing homes dumping patients in hospitals during the pandemic. But in 16 states, including California, Texas and New York, ombudsmen said the problem was continuing. Some said they believed it was getting worse.

“We have been seeing these kinds of illegal discharges all the time, because nursing homes seem to have figured out that they will rarely, if ever, be penalized,” said Alison Hirschel, senior legal counsel to the Michigan ombudsman program. “It’s devastating for residents and their families all the time, but especially horrible and dangerous during a pandemic.”

Medicaid patients who require lots of staff attention “have a target on their back,” she said.

The problem predates the pandemic.

Gloria Single was a resident of the Pioneer House nursing home in Sacramento. She had dementia and pulmonary disease and was on California’s version of Medicaid. Pioneer House was receiving about $400 a day for her care.

In 2017, Ms. Single got upset and threw utensils, according to a lawsuit against Pioneer House filed in state court by Ms. Single’s lawyer. The nursing home called 911, and Ms. Single was taken to a hospital for an involuntary psychiatric hold, in which patients are held until they are determined not to be a danger to themselves or others. The hospital determined later that day that there was nothing wrong with Ms. Single aside from her pre-existing dementia.

But Pioneer House would not let her return. The California Department of Health Care Services concluded that Pioneer House had violated the law and ordered it to let her go back. The home still refused. After about five months at the hospital, Ms. Single was moved to another nursing home. She died last year.

“You can get $1,000 extra a day by getting rid of the Gloria Singles of the world and replacing them with someone on Medicare,” said Matthew Borden, Ms. Single’s lawyer.

John Supple, a lawyer for the Retirement Housing Foundation, which operates Pioneer House, said that its medical director had deemed the home unsuitable for Ms. Single’s medical needs and that Pioneer House had never received the medical records it needed to readmit her. (Ms. Single’s lawyer disputes that. The lawsuit is ongoing.) Mr. Supple said Pioneer House had held Ms. Single’s bed for months and had not replaced her with a Medicare patient.

During the pandemic, nursing homes in Illinois and Michigan have repeatedly sent elderly and disabled Medicaid patients to NeuroBehavioral Hospital in Crown Point, Ind., said Kimberly Jackson, a discharge planner at the psychiatric hospital. In one case, a resident who yelled at a staff member was branded as being violent and having a psychoticbreak.

“The homes seem to be purposely taking symptoms of dementia as evidence of psychosis,” Ms. Jackson said. (Christy Gilbert, the chief operating officer of the hospital’s parent company, said instances when nursing homes dumped patients in her company’s hospitals were “very few and far between.”)

In June, Life Care Center of Plainwell, Mich., sent Nicki Safapour, a Medicaid patient who needs a wheelchair, to NeuroBehavioral Hospital. Because of a developmental disability, Mr. Safapour, 55, has the mental capacity of a 5-year-old, according to his brother John, who is his legal guardian. He said Life Care had told him that Mr. Safapour assaulted an employee and another resident.

A state health inspector later determined that the discharge was illegal, according to a copy of the inspector’s report reviewed by The Times.

“It seemed like they were just trying to get rid of Nicki,” John Safapour said. “He took up a lot of staff time.”

A spokesman for Life Care, Davis Lundy, said that privacy rules prohibited him from discussing Mr. Safapour’s case, but that Life Care had a significant number of residents on Medicaid and that “we never discharge patients based on their payer source.”

The families of some evicted patients have had to take them into their homes, although they lack the training or equipment to care for them.

In June, Connie Rodina got a phone call from the Richmond Healthcare and Rehabilitation Center in Richmond, Kan. Her 63-year-old brother, Jon Fowler, who suffers from mental illness and dementia, had hit another resident. Ms. Rodina, her brother’s guardian, was told that she needed to pick him up immediately.

By the time Ms. Rodina arrived, Mr. Fowler was already being transported to an emergency room. The hospital was ready to discharge him a couple of days later, after treating him for a urinary tract infection. Ms. Rodina said Richmond Healthcare wouldn’t take him back.

“You can’t just put somebody out like that,” said Camille Russell, a regional ombudsman who filed a complaint against the facility with the Kansas Department for Aging and Disability Services. The complaint is pending, she said.

Ms. Rodina couldn’t find another nursing home that would admit Mr. Fowler, who needs near-constant care. After her brother had been in the hospital for weeks, she reluctantly moved him into her home.

“It’s basically taken my life away from me,” Ms. Rodina said. “It’s impossible for me to care for him.”

Representatives of Richmond Healthcare didn’t respond to requests for comment.

In some cases, nursing homes have ignored orders from regulators to take back patients they sent to emergency rooms or psychiatric hospitals.

Charles Borden, a stroke victim with dementia, had been staying at the skilled nursing facility at Tahoe Forest Hospital in Truckee, Calif. Medicaid was covering his long-term stay. But in April, after Mr. Borden elbowed a nursing assistant and cursed at her, the nursing home sent him to the hospital’s emergency room for a psychiatric evaluation.

Within hours, the emergency room cleared Mr. Borden to return to the nursing home. But it wouldn’t take him back, according to court records. (While the nursing home and the main Tahoe Forest hospital share a campus and are owned by the same organization, the nursing home is financially independent from the hospital.)

Later that day, the nursing home dropped off all of Mr. Borden’s possessions at the E.R. and moved another resident into the room that Mr. Borden had shared with his wife, Beverly.

Two days later, on April 22, Mr. Borden’s son appealed the decision to California’s health care agency. It determined that the nursing home was legally required to take Mr. Borden back. The nursing home refused.

The state agency said it had no authority to force the nursing home to let Mr. Borden return, aside from fining it $50 for every day it refused.

Matt Mushet, a lawyer for the nursing home, said it “is committed to the optimal safety of all patients and team members.” He said that he couldn’t comment on Mr. Borden’s case but that “it’s important for the public to understand there is more than one side to this story.”

Mr. Borden has spent the past five months marooned in the hospital. His dementia makes it hard for him to understand what is going on, his son said, but Mr. Borden asks every day to see his wife.

Jessica Silver-Greenberg is an investigative reporter on the business desk. She was previously a finance reporter at the Wall Street Journal. @jbsgreenberg • Facebook

Rachel Abrams joined The Times as a business reporter in 2013. She was part of the award-winning teams that covered sexual harassment and misconduct and General Motors’ crisis involving fatal ignition switches. She previously worked for Variety. @rachelabramsny

Medical Cannabis and Cognitive Performance in Middle to Old Adults Treated for Chronic Pain

Sharon R Sznitman 1Simon Vulfsons 2 3David Meiri 4Galit Weinstein 1

Abstract

Introduction and aims: Cannabis exposure is becoming more common in older age but little is known about how it is associated with brain health in this population. This study assesses the relationship between long-term medical cannabis (MC) use and cognitive function in a sample of middle-aged and old chronic pain patients.

Design and methods: A cross-sectional study was conducted among chronic pain patients aged 50+ years who had MC licenses (n = 63) and a comparison group who did not have MC licenses (n = 62). CogState computerised brief battery was used to assess cognitive performance of psychomotor reaction, attention, working memory and new learning. Regression models and Bayesian t-tests examined differences in cognitive performance in the two groups. Furthermore, the associations between MC use patterns (dosage, cannabinoid concentrations, length and frequency of use and hours since last use) with cognition were assessed among MC licensed patients.

Results: Mean age was 63 ± 6 and 60 ± 5 years in the non-exposed and MC patients, respectively. Groups did not significantly differ in terms of cognitive performance measures. Furthermore, none of the MC use patterns were associated with cognitive performance.

Discussion and conclusions: These results suggest that use of whole plant MC does not have a widespread impact on cognition in older chronic pain patients. Considering the increasing use of MC in older populations, this study could be a first step towards a better risk-benefit assessment of MC treatment in this population. Future studies are urgently needed to further clarify the implications of late-life cannabis use for brain health.

Keywords: chronic pain; cognitive decline; medical cannabis; older population.

© 2020 Australasian Professional Society on Alcohol and other Drugs.