Cannabis is “one of the most widely used and controversial substances worldwide.”1 Although it is federally prohibited in the United States, 30 states and the District of Columbia have legalized some form of medical marijuana, and 8 states and DC have also legalized recreational marijuana for adults.2 According to the National Institute on Drug Abuse (NIDA), cannabis use in the United States has increased dramatically in the last decade from 14.5 million people (5.8% of people > 12 years of age) to 19.8 million (about 7.5%) in 2013.3

Marijuana use by older adults is also rising. A study by the National Survey of Drug Use and Health (NSDUH) found that from 2002-2014 the proportion of adults aged 50 to 64 who reported cannabis use in the past year more than tripled from 2.9% to 9.0%.4 Among adults age 65 or older, there was more than a ten-fold increase (from 0.2% to 2.1%).5  Data from a Substance Abuse and Mental Health Services Administration (SAMSHA) report reveal that as many as 132,000 older US adults use marijuana on a given day.6 Another study suggested that cannabis use among adults age 50 and above increased by 250% from 2006 to 2013.7

Compared with nonmedical use only, medical use has been found to be directly associated with older age, older marijuana initiation age, disability, Medicaid status, stroke diagnosis, poor self-rated health, anxiety disorder, daily or near daily marijuana use, residing in a medical marijuana legalization state, and perceived state legalization of medical marijuana.8 Interestingly, it was inversely associated with heavy alcohol use and nonmedical use of prescription stimulants and analgesics.8

“There are many reasons for the current increase in cannabis use among older adults,” said Walter Prozialeck, PhD, Professor of Pharmacology, Department of Pharmacology, Chicago College of Osteopathic Medicine, Midwestern University, Glendale, Illinois. “The needs of older adults are complex and it is important for clinicians to know what their patients are using,” he told MPR.

“Safer” Pain Relief

According to Dr Prozialeck, one of the most common reasons that older adults turn to marijuana is for pain relief, and as an alternative to opioids. “The need for more effective pain relief is important in today’s prescribing climate, in which prescribers are cutting back on opioid prescriptions in general, and particularly for older adults. Older people were one of the populations in which opioids were most widely used and now, since advanced age and sleep apnea are known to increase overdose problems, doctors are reluctant to prescribe –but older adults are a population with an increasing number of underlying pain conditions that they want relief from.” 

Dr Prozialeck noted that, while some older adults of the “aging hippie generation” might have used marijuana before during the 1960s and 1970s, a fair number are new users.

Thorsten Rudroff, PhD, assistant professor Department of Health & Human Physiology, University of Iowa, Iowa City, agreed, noting that many people age 50 and above first started using medical marijuana, primarily for pain relief.

Data on 138 older adult cannabis users presented at the 2018 annual meeting of the American Geriatric Society showed that most were able to partially or fully curb their use of prescription analgesic by using medical marijuana and 91% of respondents would recommend it to others.9 Another study found that Medicare Part D prescriptions filled for all opioids decreased in states with medical marijuana laws.10 A study of Medicaid prescription data concluded that medical marijuana laws and adult-use marijuana laws were associated with lower opioid prescribing rates.11