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Cannabis use in older adults is up, according to researchers who used a national survey database to study emergent patterns in older adult use of the substance.

Their results were published online in JAMA Internal Medicine.

After noting an upward trend in seniors using cannabis — from 1.0% in 2005 to 4.2% in 2018 — a group of investigators led by Benjamin H. Han, MD, from the University of California San Diego School of Medicine, conducted a cross-sectional analysis of the 2021-2023 cohorts from the National Survey on Drug Use and Health.

Their sample included 15,689 adults aged 65 years or older. More than half of the sample (54%) were women. Han and colleagues found that when compared with prior years, past-month cannabis use increased significantly across the cohorts, from 4.8% (95% CI, 3.9%-5.9%) in 2021 to 7.0% (95% CI, 6.2%-8.0%) in 2023.

In a subanalysis, the investigators found that increased prevalence in past month cannabis use was associated with multiple demographic factors. Both women and men showed increased trends, with an odds ratio (OR) of 1.32 (1.10-1.59) in women and an OR of 1.18 (0.97-1.43) in men.

Increased past month cannabis use was also observed in older adults with a minimum $75,000 annual income, those with college or postgraduate degrees, those who were married, and those living in a state with legalized medical cannabis.

Further subanalysis of the survey respondents by race showed that persons who identified as “other” sustained the highest OR of increased use, OR = 2.26 (1.12-4.59).

Older adults with the highest incomes previously were found to have the lowest prevalence of cannabis use compared with other income levels, but by 2023, they had the highest usage increase. The study authors suggested this could be due to their ability to afford medical cannabis.

Although an increase in past-month cannabis use was associated with a number of medical conditions, the researchers wrote that they were unable to cleanly sort recreational from medical use. People with chronic diseases, especially those with multiple conditions, saw a spike in cannabis use. The most common medical condition recorded was chronic obstructive pulmonary disease with heart conditions, diabetes, hypertension, cancer, and two or more chronic conditions also noted to have increased prevalence (6.4%-13.5%).

“The substantial increased prevalence in states with legalized medical cannabis highlights the importance of structural educational support for patients and clinicians in those states,” Han and colleagues wrote. “The use of cannabis products, especially with psychoactive properties, may complicate chronic disease management among older adults.”

A cannabis researcher not involved in Han and colleagues’ study agreed.

“One of the most important findings was that those in residence in a state where medical cannabis is legal at the time of interview also showed greater increases in cannabis use,” said Elise Weerts, PhD, a professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins Medical School, in Baltimore, in an interview with Medscape Medical News. Weerts is also a researcher at the Cannabis Science Laboratory at Johns Hopkins.

Meanwhile, in an accompanying editorial, experts pointed to how, despite a lack of consistent data on cannabis use in older age, its use is growing as it is increasingly legalized.

“Existing therapeutic evidence for medical cannabis in older adults has been inconsistent across several conditions, with many studies suggesting possible benefits, while others finding limited benefit,” the authors of the editorial wrote.

“The potential harms of cannabis use in older adults are apparent, with increased risks of cardiovascular, respiratory, and gastrointestinal conditions, stroke, sedation, cognitive impairment, falls, motor vehicle injuries, drug-drug interactions, and psychiatric disorders,” they wrote.

The editorial authors stated concerns about scant evidence and a lack of standards around administering cannabis in this patient population.

“Existing therapeutic evidence for medical cannabis in older adults has been inconsistent across several conditions, with many studies suggesting possible benefits, while others finding limited benefit,” they wrote. “Much of the evidence for benefit derives from a single or a small number of studies with nonrandomized designs, and very few studies evaluated harms, making the benefit to risk ratio unclear.”

The editorialists also pointed to the frustration older adult users of cannabis feel around “the lack of awareness and education about age-related issues” at cannabis dispensaries and even in healthcare workers.

The study’s findings did not surprise Weerts, who said she has been tracking similar data elsewhere. She said she agreed with the editorial writers that the gap between cannabis use and the understanding of its potential adverse effects or contraindications is widening.

“I am concerned that older adults using cannabis may not be aware of the risks, and that data supporting its efficacy for medical purposes are still not available,” Weerts said. “We need randomized placebo-controlled trials to demonstrate any potential benefits and also track any adverse effects and potential harms.”

Weerts disclosed she had received funds from MyMD Pharmaceuticals and MIRA Pharmaceuticals for contracted preclinical research and from Cultivate Biologics LLC, and Canopy Growth Corp for clinical research projects on cannabis products. Editorial author Lona Mody, MD, MSc, reported receiving grants from the National Institute on Aging, Centers for Disease Control and Prevention, Veterans Affairs, and NanoVibronix; and Kenneth E. Covinsky, MD, MPH, reported receiving grants from the National Institute on Aging. No other disclosures were reported.