By Liz Seegert
Cannabis use is on the rise among older adults, thanks in part to an aging baby boomer population who have more relaxed attitudes about the drug than do their parents’ generation. The increase in consumption — for medical and recreational reasons — has some researchers concerned, since there are few U.S. studies on long-term effects. Marijuana remains a Schedule 1 drug at the federal level, despite more states legalizing its use.
There’s still a lot we don’t know about cannabis or its major components, CBD and THC, and their effects on older adults. Look around any dispensary (or the Internet) and you’ll find varying concentrations in products ranging from gummies to tea, salves to oils, along with the more traditional buds. The FDA says some companies are marketing cannabis-derived products in ways that violate the federal Food, Drug and Cosmetics Act and may be putting consumers at risk.
A study published in the February 24 issue of JAMA Internal Medicine found a 75% relative increase in use by older adults, from 0.4% in 2006-07 to 2.9% 2015-16. While that may seem like a small proportion of older cannabis users, it does indicate an upward trend. According to the research, women, racial/ethnic minorities, those with higher family incomes, and those with mental health problems were among the subgroups experiencing a “marked increase” in use. Interestingly, this increase did not appear driven by people with multiple chronic conditions.
“It’s a big unknown. We just don’t have studies that support the use,” Gretchen Orosz, M.D., a geriatrician at University of Colorado Health said in this article. “We know that THC (tetrahydrocannabinol) is psychoactive and the aging brain is more vulnerable to psychoactive drugs. So we tell our patients that they have to be very careful when using THC.”
To date, 33 states, the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands have legalized cannabis for medical or recreational use or both. Other states, such as New York, are strongly considering doing so. Former Democratic presidential candidate Bernie Sanders promised to decriminalize it in all states, and many other people — users and physicians alike — see cannabis as a less harmful alternative to opioids and other risky pharmaceuticals, as this NPR story describes. Yet, as Paula Span reported in this 2018 New York Times story, physicians are concerned that marijuana’s expanding popularity among this demographic is growing faster than scientific evidence to support its use, especially for pain management.
A 2017 report from the National Academies of Sciences, Engineering and Medicine found conclusive or substantial evidence that cannabis or cannabinoids are effective for:
- Treatment of chronic pain in adults,
- Certain treatment side effects, such as nausea after chemotherapy,
- Improving spasticity in people with multiple sclerosis.
They found moderate evidence that cannabis or cannabinoids are effective for:
- Improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome,
- Fibromyalgia,
- Chronic pain,
- Multiple sclerosis
Evidence was limited for the efficacy of cannabis or cannabinoids in:
- Increasing appetite and decreasing weight loss associated with HIV/AIDS (when using cannabis and oral cannabinoids),
- Improving clinician-measured multiple sclerosis spasticity symptoms (oral cannabinoids),
- Improving symptoms of Tourette syndrome (THC capsules),
- Improving anxiety symptoms in individuals with social anxiety disorders (cannabidiol),
- Improving symptoms of post-traumatic stress disorder (nabilone; a single, small fair-quality trial).
Evidence is limited on the efficacy of cannabis to improve symptoms associated with:
- Dementia,
- Glaucoma,
- Mitigating depression in individuals with chronic pain.
Another challenge is how and from whom users obtain the product. Dispensaries may or may not be highly regulated, depending on state or local laws. And training for the “bud tenders,” as well as provider education, varies widely.
Older adults want more information so they can make informed decisions, according to a 2019 study from the University of Colorado. Researchers found “many report barriers to getting medical marijuana, a lack of communication with their doctors and a lingering stigma attached to the drug, according to researchers.”
There are plenty of health questions about the long-term use of cannabis, including possible side effects or interactions with other drugs and risks such as balance problems or falls among the older population. The use of marijuana among older adults for recreational or medical purposes also raises some intriguing public policy questions, Brian Kaskie, Ph.D., writes in The Gerontologist.
There are tons of story ideas if you’re interested in reporting on cannabis use among older adults. For example:
If cannabis is legal in your state for medical use:
- For which ailments?
- How comfortable are physicians or other experts discussing this issue with older patients?
- What kinds of feedback are they receiving when the subject comes up?
- Are there resources or patient education information available?
- What training, if any, do providers receive?
- Do dispensary employees receive any sort of training in managing health conditions or even know to ask about other medications an older person may be taking?
- Are physicians writing fewer opioid prescriptions? Do they think this is a good trade-off?
If cannabis also is legal for recreational use:
- Try to get a handle on whether older adults are using it merely for pleasure, as a sleep aid, or to help manage chronic pain.
- Has there been an uptick in ED visits among older adults for psychosis or drug-drug interactions, or perhaps falls?
- What are ED physicians or law enforcement encountering when it comes to other issues, like impaired driving?
If it’s not legal in your state, what are the chances of a law passing? What are the concerns? What does the medical community think? What is the consensus among older adults? Would they use it?
Facilities that receive federal funding, like nursing homes, often deny their residents access to cannabis even when legal in that state, due to fear of running afoul of federal law. But according to this Forbes article, one facility in New York is pushing back.
Further reading
- Article on the potential harms of marijuana use among older adults.
- Study on the oral health implications of increased cannabis use among older adults.
- Article by David Levine, reflecting on his experiences in the mile-high city at Health Journalism 2014.
Sources
- American Cannabis Nurses Association.
- James D’Olimpio, M.D., oncology palliative care specialist, Northwell Health, New York.
- Namkee Choi, Ph.D., professor and chair in Gerontology, School of Social Work, University of Texas at Austin, who has published several studies on marijuana use and older adults.
- Benjamin Han, M.D., MPH, assistant professor, division of geriatric medicine and palliative care, New York University School of Medicine, who has published widely on the subject.
- Karen Boxx, professor, University of Washington School of Law, who is an expert on marijuana legalization. She is part of the UW Cannabis Law and Policy Project, which provides thought leadership on the responsible development of recreational and medical marijuana industries in her state and across the country.
