Fewer than 1 in 5 older adults who reported past-year cannabis use said they had discussed cannabis or other drug use with a clinician, according to a nationally representative survey study published in the American Journal of Preventive Medicine.
Cannabis use has increased among older adults, with prior data showing that 7% of adults aged 65 years and older reported past-month use and 9.5% reported past-year use in 2023. The trend may partly reflect the aging of the Baby Boomer cohort, as well as growing interest in cannabis for chronic symptoms and medical conditions.
Researchers analyzed 2021 to 2023 data from the National Survey on Drug Use and Health, including 14,387 community-dwelling US adults aged 65 years and older who reported at least 1 health care visit in the previous year. Among them, 1,194 reported past-year cannabis use.
Overall, 37% of older adults reported that a physician or other health care professional had asked them, either in person or on a form, whether they used marijuana or other illegal drugs. Screening was more commonly reported among respondents with 2 or more chronic conditions, moderate or serious mental illness, past-year alcohol use, past-year cannabis use, and annual household income of at least $75,000. Hispanic/Latine older adults were less likely than White older adults to report screening.
Among respondents who reported past-year cannabis use, 19% reported discussing cannabis or other drug use with a clinician, 37% reported screening without discussion, and 44% reported neither screening nor discussion. Discussions were more likely among respondents with 2 or more chronic conditions and those with mild mental illness. They were less likely among Hispanic/Latine respondents and respondents in other racial groups compared with White respondents.
Female respondents who used cannabis were also less likely than male respondents to report a discussion compared with screening alone. The researchers noted this disparity alongside lower discussion rates among Hispanic/Latine adults and other racialized groups as areas where clinician training and support may be needed.
Past-year alcohol use was positively associated with screening overall but negatively associated with discussions among older adults who used cannabis. The researchers described this as an unexpected finding that may point to a need for additional support for older adults reporting polysubstance use.
Structural characteristics, including urbanicity, survey year, and residence in a state with a medical cannabis law, were not associated with screening or discussion. The lack of association with medical cannabis law status was notable, the researchers wrote, given the expanding availability of cannabis.
The findings suggest missed opportunities for clinicians to discuss cannabis use with older adults, particularly given the higher prevalence of chronic disease, medication use, and physiologic vulnerability in this population. Cannabis use in older age may be associated with adverse events, including acute toxic effects, injury, poorer mental health, and exacerbation of chronic disease.
The researchers noted several potential strategies to improve screening and discussion, including validated single-item drug screening questions for short visits, 2-step tools such as the Tobacco, Alcohol, Prescription Medication, and Other Substance Use tool, electronic health record screening prompts, and screening measures that separate cannabis from other illegal drugs. They also cited prior research suggesting that clinician knowledge gaps and discomfort may contribute to missed discussions about recreational and medical cannabis use.
Several limitations should be considered. The screening question combined cannabis with other illegal drugs, so the researchers could not isolate cannabis-specific screening. Discussion measures also included other illegal drugs when applicable, although sensitivity analyses excluding respondents who used other illegal drugs were consistent with the main findings. Screening and discussion were self-reported and were not validated against medical records. The cross-sectional design also could not determine why screening and discussion rates differed across groups.
In addition, response rates were low, and the survey excluded institutionalized adults and unhoused adults not living in shelters, limiting generalizability to some older populations. Public survey data also included medical cannabis law status but not state identifiers or recreational cannabis law status.
Together, the findings underscore the need to strengthen cannabis-related screening and discussions among older adults who use cannabis, with particular attention to Hispanic/Latine adults, other racialized groups, and women, the researchers concluded.
Disclosures: The study was supported by grants from the National Institute on Drug Abuse. The researchers reported no conflicts of interest.
