Cannabinoids for dementia treatment
Photo illustration by Jeffrey C. Chase | Photo by Evan Krape May 04, 2026
UD epidemiologist leads nursing home study on prescription cannabinoid use
Dr. Jennifer Rhodes-Kropf, a palliative care physician and geriatrician in Boston, was always searching for alternatives to antipsychotics for her patients with dementia.
“We really worry about the sedation component of antipsychotics creating a vegetative state and increasing their fall risk,” she said.
When medical marijuana became legal in Massachusetts, she encouraged caregivers to try it in dementia patients with agitation.
“For patients with dementia, we can address pain and agitation simultaneously with cannabinoids,” Rhodes-Kropf said.
She saw some encouraging results and pointed to a patient, Barbara, 85, with moderate dementia and extreme anxiety.
“It helped her appetite and was definitely calming for her, allowing her to enjoy her day more,” Rhodes-Kropf said.
The positive effects of cannabinoids used in tandem or in place of antipsychotics in patients with dementia piqued the interest of Daniel Harris, assistant professor of epidemiology at the University of Delaware College of Health Sciences. Harris was awarded more than $260,000 from Delaware INBRE, sponsored by the NIH IDeA Program and the State of Delaware, to conduct a first-of-its-kind pilot study, examining the use of prescription cannabinoids in nursing homes nationwide.
“Use of drugs like dronabinol, nabilone and cannabidiol has increased over time, but overall utilization remains low,” Harris said. “We know from clinicians that these medications are being used for dementia symptoms when other therapies haven’t worked well.”
Harris and Kareem Khairy, a doctoral student in epidemiology, will use electronic health record data from 2017 to 2023 to study not only cannabinoid use but also its safety and effectiveness. Khairy, an international student from Egypt, hopes to draw on his clinical pharmacy background to study drug interactions and help older adults make informed decisions.
“I want to examine cannabinoids’ cardiovascular safety and effectiveness and whether they’re a safer alternative to opioids for pain management,” Khairy said. “We need to learn more about the risk-to-benefit ratio so that clinicians can feel more comfortable prescribing cannabinoids.”
Harris also wants to study whether cannabinoids increase the risk of falls differently from Trazodone and antipsychotics.
“That data will provide more evidence that can help prescribers make decisions around which drugs may be preferred in certain populations,” Harris said.
A study like this would not be possible without Delaware INBRE.
“Delaware, being an IDeA state, is a huge advantage, because it gives us boutique access to research funding to generate pilot data needed for larger National Institutes of Health studies,” Harris said.
From pilot study to population impact
More than 7 million Americans over 65 live with dementia, and most experience behavioral and psychological symptoms that severely impact quality of life. While antipsychotics can help, Harris said, they’re often overprescribed in nursing home settings.
“Psychotropic medications still hold an important place for treating behavioral symptoms of dementia, particularly when those behaviors pose a risk to the person or those around them,” Harris said. “But we also know that antipsychotics carry substantial health risks for older adults with dementia.”
Jim Ellison, a geriatric psychiatrist and co-director of the Comprehensive Alzheimer's Disease Center at Thomas Jefferson University, said nonpharmacologic strategies like reassurance, occupational therapy and music or pet therapy are recommended, but can be ineffective and resource-intensive.
“Evidence supporting cannabinoid usage for anxiety, pain management and insomnia is somewhat limited and controversial,” Ellison said. “When we have treatment-resistant cases of agitation and dementia, where we’ve ruled out remediable medical causes, there’s no psychosis, and they’re not a fall risk — that’s an ideal place to use cannabinoids.”
For now, Harris is not studying recreational marijuana, which remains illegal on the federal level; however, a sub-aim of his research will examine how prescription use varies by state cannabis policy.
But curiosity about cannabis products is rising, as they’re used off-label for pain, sleep and anxiety. Harris hopes this research will lead to an expanded R01 proposal on the safety and effectiveness of prescription cannabinoids for dementia treatment.
Ellison said Harris’s research could help pave the way for broader use of cannabinoids in nursing homes.
“Nursing homes are where so many people with dementia stay until the end of their lives, and to have a well-tolerated, safe, effective treatment for the main disruptive symptom of agitation would be very valuable,” Ellison said.
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