Benjamin Han, a geriatrician and addiction medicine specialist at the University of California-San Diego, tells his students a cautionary tale about a 76-year-old patient who, like many older people, struggled with insomnia.<\/p>\n
\u201cShe had problems falling asleep, and she\u2019d wake up in the middle of the night,\u201d he said. \u201cSo her daughter brought her some sleep gummies\u201d \u2014 edible cannabis candies.<\/p>\n
\u201cShe tried a gummy after dinner and waited half an hour,\u201d Han said.<\/p>\n
Feeling no effects, she took another gummy, then one more \u2014 a total of four over several hours.<\/p>\n
Han advises patients who are trying cannabis to \u201cstart low; go slow,\u201d beginning with products that contain just 1 or 2.5 milligrams of tetrahydrocannabinol, or THC, the psychoactive ingredient that many cannabis products contain. Each of the four gummies this patient took, however, contained 10 milligrams.<\/p>\n
The woman started experiencing intense anxiety and heart palpitations. A young person might have shrugged off such symptoms, but this patient had high blood pressure and atrial fibrillation, a heart arrhythmia. Frightened, she went to an emergency room.<\/p>\n
Lab tests and a cardiac work-up determined the woman wasn\u2019t having a heart attack, and the staff sent her home. Her only lingering symptom was embarrassment, Han said. But what if she\u2019d grown dizzy or lightheaded and was hurt in a fall? He said he has had patients injured in falls or while driving after using cannabis. What if the cannabis had interacted with the prescription drugs she took?<\/p>\n
\u201cAs a geriatrician, it gives me pause,\u201d Han said. \u201cOur brains are more sensitive to psychoactive substances as we age.\u201d<\/p>\n
Thirty-nine states and the District of Columbia now allow cannabis use<\/a> for medical reasons, and in 24 of those states, as well as the district, recreational use<\/a> is also legal. As older adults\u2019 use climbs, \u201cthe benefits are still unclear,\u201d Han said. \u201cBut we\u2019re seeing more evidence of potential harms.\u201d<\/p>\n A wave of recent research points to reasons for concern for older users, with cannabis-related emergency room visits and hospitalizations rising, and a Canadian study finding an association between such acute care and subsequent dementia. Older people are more apt than younger ones to try cannabis for therapeutic reasons: to relieve chronic pain, insomnia, or mental health issues, though evidence of its effectiveness in addressing those conditions remains thin, experts said.<\/p>\n In an analysis of national survey data<\/a> published June 2 in the medical journal JAMA, Han and his colleagues reported that \u201ccurrent\u201d cannabis use (defined as use within the previous month) had jumped among adults age 65 or older to 7% of respondents in 2023, from 4.8% in 2021. In 2005, he pointed out, fewer than 1% of older adults reported using cannabis in the previous year.<\/p>\n What\u2019s driving the increase? Experts cite the steady march of state legalization \u2014 use by older people is highest in those states \u2014 while surveys show that the perceived risk<\/a> of cannabis use has declined. One national survey found that a growing proportion of American adults \u2014 44% in 2021 \u2014 erroneously thought<\/a> it safer to smoke cannabis daily than cigarettes. The authors of the study, in JAMA Network Open, noted that \u201cthese views do not reflect the existing science on cannabis and tobacco smoke.\u201d<\/p>\n The cannabis industry also markets its products to older adults. The Trulieve chain gives a 10% discount, both in stores and online, to those it calls \u201cwisdom\u201d customers, 55 or older. Rise Dispensaries ran a yearlong cannabis education and empowerment program for two senior centers in Paterson, New Jersey, including field trips to its dispensary.<\/p>\n The industry has many satisfied older customers. Liz Logan, 67, a freelance writer in Bronxville, New York, had grappled with sleep problems and anxiety for years, but the conditions grew particularly debilitating two years ago, as her husband was dying of Parkinson\u2019s disease. \u201cI\u2019d frequently be awake until 5 or 6 in the morning,\u201d she said. \u201cIt makes you crazy.\u201d<\/p>\n Looking online for edible cannabis products, Logan found that gummies containing cannabidiol, known as CBD, alone didn\u2019t help, but those with 10 milligrams of THC did the trick without noticeable side effects. \u201cI don\u2019t worry about sleep anymore,\u201d she said. \u201cI\u2019ve solved a lifelong problem.\u201d<\/p>\n But studies in the United States and Canada, which legalized nonmedical cannabis<\/a> use for adults nationally in 2018, show climbing rates of cannabis-related health care use among older people, both in outpatient settings<\/a> and in hospitals.<\/p>\n In California, for instance, cannabis-related emergency room visits<\/a> by those 65 or older rose, to 395 per 100,000 visits in 2019 from about 21 in 2005. In Ontario, acute care (meaning emergency visits or hospital admissions) resulting from cannabis use increased fivefold in middle-aged adults from 2008 to 2021, and more than 26 times among those 65 and up<\/a>.<\/p>\n \u201cIt\u2019s not reflective of everyone who\u2019s using cannabis,\u201d cautioned Daniel Myran, an investigator at the Bruy\u00e8re Health Research Institute in Ottawa and lead author of the Ontario study. \u201cIt\u2019s capturing people with more severe patterns.\u201d<\/p>\n But since other studies have shown increased cardiac risk<\/a> among some cannabis users with heart disease or diabetes, \u201cthere\u2019s a number of warning signals,\u201d he said.<\/p>\n For example, a disturbing proportion of older veterans who currently use cannabis screen positive for cannabis use disorder<\/a>, a recent JAMA Network Open study found.<\/p>\n As with other substance use disorders, such patients \u201ccan tolerate high amounts,\u201d said the lead author, Vira Pravosud, a cannabis researcher at the Northern California Institute for Research and Education. \u201cThey continue using even if it interferes with their social or work or family obligations\u201d and may experience withdrawal if they stop.<\/p>\n Among 4,500 older veterans (with an average age of 73) seeking care at Department of Veterans Affairs health facilities, researchers found<\/a> that more than 10% had reported cannabis use within the previous 30 days. Of those, 36% fit the criteria for mild, moderate, or severe cannabis use disorder<\/a>, as established in the Diagnostic and Statistical Manual of Mental Disorders.<\/p>\n VA patients differ from the general population, Pravosud noted. They are much more likely to report substance misuse and have \u201chigher rates of chronic diseases and disabilities, and mental health conditions like PTSD\u201d that could lead to self-medication, she said.<\/p>\n Current VA policies don\u2019t require clinicians to ask patients about cannabis use. Pravosud thinks that they should.<\/p>\n Moreover, \u201cthere\u2019s increasing evidence of a potential effect on memory and cognition,\u201d said Myran, citing his team\u2019s study of Ontario patients with cannabis-related conditions going to emergency departments or being admitted to hospitals.<\/p>\n Compared with others of the same age and sex who were seeking care for other reasons, research shows<\/a> these patients (ages 45 to 105) had 1.5 times the risk of a dementia diagnosis within five years, and 3.9 times the risk of that for the general population.<\/p>\n Even after adjusting for chronic health conditions and sociodemographic factors, those seeking acute care resulting from cannabis use had a 23% higher dementia risk<\/a> than patients with noncannabis-related ailments, and a 72% higher risk than the general population.<\/p>\n None of these studies were randomized clinical trials, the researchers pointed out; they were observational and could not ascertain causality. Some cannabis research doesn\u2019t specify whether users are smoking, vaping, ingesting or rubbing topical cannabis on aching joints; other studies lack relevant demographic information.<\/p>\n \u201cIt\u2019s very frustrating that we\u2019re not able to provide more individual guidance on safer modes of consumption, and on amounts of use that seem lower-risk,\u201d Myran said. \u201cIt just highlights that the rapid expansion of regular cannabis use in North America is outpacing our knowledge.\u201d<\/p>\n Still, given the health vulnerabilities of older people, and the far greater potency of current cannabis products compared with the weed of their youth, he and other researchers urge caution.<\/p>\n \u201cIf you view cannabis as a medicine, you should be open to the idea that there are groups who probably shouldn\u2019t use it and that there are potential adverse effects from it,\u201d he said. \u201cBecause that is true of all medicines.\u201d<\/p>\n The New Old Age is produced through a partnership with\u00a0The New York Times<\/a>.<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n