Senior cannabis use: Increasing substance abuse disorders among Medicare beneficiaries

A team of researchers led by FDA epidemiologist Silvia Perez-Vilar, PharmD, PhD, analyzed the data of nearly 56 million Medicare beneficiaries ages 65 and older. Nursing home residents and patients receiving dialysis were excluded. More than three dozen cannabis disorders were included, from abuse with withdrawal, to dependence with intoxication delirium. 

Rates of such medical encounters increased during the six-year period—regardless of a state or territory’s cannabis laws. However, rates were highest in locations where cannabis is legal for both medical and adult recreational use, about 45 encounters per 10,000 beneficiaries in 2022. The findings were published last week in the journal JAMA Network Open. 

The rate was 42 per capita in states or territories where only medical cannabis is legal and 28 in places where cannabis is illegal. Across all legalization categories, researchers saw the greatest increases in nonemergency outpatient settings. In addition, beneficiaries enrolled in Medicare Advantage plans had higher average annual increases in cannabis-related disorder encounters than fee-for-service enrollees.

“Data suggest that increasing rates of health care encounters documenting cannabis-related disorders among older adults might be associated with the type of cannabis legalization,” Perez-Vilar and her colleagues wrote. “However, differences in cannabis use patterns and perception of risk may influence policy changes and present challenges to causal inference.”

Strengthening the connection between cannabis and health care may help ensure that older adults are consuming the drug safely, says Dr. Brooke Worster, an associate professor in the MS in Medical Cannabis Science and Business program at Thomas Jefferson University, who wasn’t involved in the research. 

“While this study documents an increase in encounters for cannabis use disorder (CUD), it’s likely simply more of an increase in awareness and conversation between clinician and patient that medical documentation is increasing,” she tells Fortune via email. “For so long, use and overuse existed, but there was little in the way of open, nonjudgemental conversation around this because many feared legal repercussions.”

Worster, who’s also director of the Division of Supportive Oncology at TJU’s Sidney Kimmel Cancer Center, adds, “Policy and rescheduling can reduce this fear and improve how we discuss and document as well as ultimately try to help treat and support those patients who do develop CUD or risky use.” 

Why are older adults increasingly consuming cannabis?

Marijuana use is on the rise. While teens and young adults ages 18–25 use marijuana the most, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), its use is climbing among all adult age groups and sexes—even among pregnant people.

Approximately 12.1% of U.S. adults ages 50–80 reported consuming cannabis within the past year, according to a University of Michigan survey conducted in January 2021 and published in February 2024 in the journal Cannabis and Cannabinoid Research. By comparison, 9.5% of adults 50 and older said they used cannabis in 2019, per the National Survey on Drug Use and Health.

“Many older adults are turning to cannabis for help with increased pain syndromes—osteoarthritis, degenerative joint diseases, as well as insomnia,” Worster tells Fortune. “As we are living longer and often healthier, more active lifestyles, older adults are looking for help with these symptoms that impact quality of life. And very often, they have little other safe choices for pain or sleep.“

Given the heightened awareness of opioid abuse, as well as the health risks older adults may face from NSAIDs and benzodiazepines, cannabis is an appealing choice, Worster says.

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Is cannabis safe for older adults?

Cannabis products, particularly marijuana, have long been stereotyped as harmless and nonaddictive. And the psychoactive, botanical drug isn’t without health benefits.

Cannabis sativa was first used as a medicinal plant more than two thousand years ago, and today is legalized for medical use in 42 U.S. states and territories. Cannabis is a popular chronic pain reliever, and research suggests it may do everything from relieve nausea to lower risk of cognitive decline. Last month, the Justice Department moved to reclassify marijuana from a schedule I to a less dangerous schedule III drug.

However, cannabis use still comes with plenty of health risks, particularly for older adults. The American Medical Association highlights these potential dangers:

• Elevated heart rate and blood pressure
• Impaired thinking and coordination
• Increased risk of anxiety, paranoia, and other types of psychosis
• Interaction with medications
• Lung injury
• Poisoning

People who have abused other substances in the past are at higher risk for developing CUD, Worster says. She also recommends older adults avoid products with high-potency THC, the psychoactive component of cannabis.

“The line between recreational or adult use and medical is often much more of a legislative line than a practical one—most older adults seek cannabis for some perceived benefits in health and wellness,” Worster says. “However, the barriers to access in a strict ‘medical state’ are sometimes hard to navigate and can create additional financial burdens for older adults who may be on a fixed income.”

She adds, “The question really is, how do we recognize and avoid abuse or CUD, which is important and only now being recognized and discussed in the medical community more regularly.” 

If you or a loved one are struggling with cannabis use, help is available 24/7. Visit FindTreatment.gov, text your ZIP code to HELP4U (435748), or call the SAMHSA National Helpline at 800-662-HELP (4357) or TTY: 800-487-4889.

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