A new study released Monday finds that more than one in nine people age 65 and older who use cannabis meet the criteria for cannabis use disorder.
In the study, published by the University of California San Diego School of Medicine, researchers analyzed data from the 2021-2024 National Survey on Drug Use and Health, which included surveys of 21,189 older adults. That survey found that an estimated 8.9% of senior citizens surveyed used cannabis in the past year.
Among those adults, 11.4% showed indications of cannabis use disorder. Roughly 74% of older adults reported spending time obtaining, using and recovering from the drug’s effects while 67.5% said they craved cannabis.
“That’s really alarming,” said Dr. Scott Hadland, an addiction physician at Mass General Brigham. “Cannabis, especially if it’s ingested … can potentially interact with medications that an individual might be on and may contribute to falls or to dizziness, particularly if somebody’s on other sedating medications.”
According to the survey, smoking remains the most common method of marijuana use among those aged 65 and older, followed by eating or drinking cannabis and vaping.
The study comes roughly one month before Massachusetts voters are expected to vote on Ballot Question 8, which seeks to repeal the 2016 legalization of recreational marijuana sales and limit possession.
But Dr. Peter Grinspoon, an addiction specialist at Massachusetts General Hospital, said while rates of cannabis use disorder are rising, he doesn’t feel it warrants the repeal of legal recreational cannabis.
“Arrests of minorities are down. The products are safer if they’re bought in a dispensary instead of in the illicit market, it gives people a legal way to obtain the drug,” he said. “Also, if it’s legal, there’s less stigma and people are better able to get help if they’re having problems with addiction or dependency.”
Hadland said he’s unsure whether the passage of ballot Question 8 would improve rates of cannabis use disorder. He said the prevalence of older adults using cannabis for medical reasons “really highlights the need for potential access to medical cannabis through legal routes, which we have here in Massachusetts, and which will stay in place regardless of the outcome of Ballot Question 8.”
“I think a separate question is whether or not legalization of cannabis is contributing to problems with more adults using cannabis or more adults having addiction to cannabis,” he said.
Grinspoon said he believes rates of cannabis use disorder are increasing among senior citizens simply because more people are using cannabis.
“A lot of seniors are using cannabis really helpfully with great benefit for disorders such as pain, anxiety, insomnia, weight loss,” he said. “A lot of them are using cannabis instead of more traditional pharmaceuticals, which they find cannabis more helpful and with fewer side effects.”
Just under 20% of older adults who used cannabis in the last 12 months said a doctor had recommended some or all their marijuana use, according to the study.
But Grinspoon said he thinks cannabis use disorder is overdiagnosed. He said that a patient needs to meet two out of 11 criteria to be diagnosed with any substance use disorder.
“With opiates, for example, they say if you just have tolerance and withdrawal, you don’t have an addiction because everybody that uses medicinal opiates has tolerance and withdrawal,” he said. “They’re just effects of the medication, and there’s something called the opiate exclusion.”
But there’s no cannabis exclusion, Grinspoon adds.
“If these medical patients have tolerance and withdrawal — that is two out of the 11. That’s enough to give them a diagnosis of cannabis use disorder,” he said. “It’s only because the medical field hasn’t decided definitively … that cannabis is a medicine.”
Hadland said he agrees with Grinspoon to some extent, but that some symptoms exhibited by older adults in the study “can still be problematic.”
“About two-thirds had strong cravings to use cannabis, and that in and of itself can be problematic because cravings can actually be really disruptive and unsettling for many people,” he said.
Hadland said of all the people in the U.S. that use cannabis, one in three will develop cannabis use disorder.
“This one in nine number is actually lower than for the general population,” he said. “But I think very concerning nonetheless because I think that this is a group that often goes overlooked and whose cannabis use might not necessarily be addressed by clinicians who think, ‘This is someone who’s older and let’s let them make their choices towards the end of their lifespan.’”
Previous research has associated cannabis use among senior citizens with chronic disease, cognitive impairment, falls, cannabis poisoning and cannabis-related emergency room visits.
Hadland said thoughtful counseling about cannabis could help prevent cannabis use disorder among older adults.
“Helping older adults understand not just what are the potential harms of cannabis, but how are those harms in relation to the benefits that they perceive that they’re getting from it,” he said. “A thoughtful clinician could help an older adult patient understand, are there ways that they can get that benefit without exposing themselves to as much harm.”
