US study finds rise in cannabis-related hospital visits among older people

New findings highlighting a rise in cannabis-related hospital visits among older consumers have led to calls for more patient-doctor communication around its use in medical care. 

As a growing number of older adults are experimenting with cannabis to help alleviate chronic symptoms, a new study has identified an increase in cannabis-related emergency department visits among the elderly.

The study, published this month in the Journal of the American Geriatrics Society, identified a 1,808% relative increase in the rate of cannabis-related trips to the emergency department among California adults ages 65 and older from 2005 to 2019. 

Researchers at the University of California San Diego School of Medicine, used a trend analysis of data from the Department of Healthcare Access and Information and found that cannabis-related emergency department visits went from a total of 366 in 2005 to 12,167 in 2019.

The significant increase is particularly troublesome to geriatricians, say the authors, given that older adults are at a higher risk for adverse health effects associated with psychoactive substances, including cannabis.

Benjamin Han, MD, MPH, the study’s first author and a geriatrician in the Division of Geriatrics, Gerontology, and Palliative Care in the Department of Medicine at UC San Diego School of Medicine, said: “Many patients assume they aren’t going to have adverse side effects from cannabis because they often don’t view it as seriously as they would a prescription drug.

“I do see a lot of older adults who are overly confident, saying they know how to handle it — yet as they have gotten older, their bodies are more sensitive, and the concentrations are very different from what they may have tried when they were younger.”

The use of cannabis by older adults has increased sharply over the past two decades in the United States with the legalisation for medical and recreational purposes in many states. A study from 2021 found that 26% of cannabis consumers in the US (nearly 17 million people) were aged 50 or older. 

California legalised medical marijuana in 1996 and recreational cannabis in 2016. But the availability of recreational cannabis does not appear to correlate with a higher rate of cannabis-related emergency department visits among older adults, according to the paper. 

While emergency department visits increased sharply between 2013 and 2017, they levelled off in 2017 after the implementation of Proposition 64, which saw the legalisation of adult-use cannabis in California.

Many older adults turning to cannabis for health conditions

Older adults are increasingly using the plant to treat a wide range of symptoms, despite the need for more scientific evidence.

Early studies indicate that cannabis may be a helpful tool for managing chronic pain, anxiety and poor sleep, which can be prevalent among older generations, as well as the symptoms of conditions such as Parkinson’s and Alzheimer’s disease.

Meanwhile previous research has found medical cannabis to be safe, effective and well-tolerated in adults aged 65 and older.

However, the study highlights that cannabis use among older adults can lead to unintended consequences that require emergency care for a variety of reasons.

Cannabis can slow reaction time and impair attention, which may lead to injuries and falls; increase the risk for psychosis, delirium and paranoia; exacerbate cardiovascular and pulmonary diseases and interact with other prescription medications.

Alison Moore, MD, MPH, co-author of the study and chief of the Division of Geriatrics, Gerontology, and Palliative Care in the Department of Medicine at UC San Diego School of Medicine, commented: “We know from work in alcohol that older adults are more likely to make a change in substance use if they see that it is linked to an undesirable medical symptom or outcome — so linking cannabis use similarly could help with behavioural change.

“We truly have much to learn about cannabis, given all the new forms of it and combinations of THC (tetrahydrocannabinol) and CBD (cannabidiol), and this will inform our understanding of risks and possible benefits, too.”

The need for open discussion with patients 

The study highlights the need for more education and discussions with older adults about how cannabis should be included in routine medical care. Yet, according to Moore, current substance uses screening questionnaires typically lump cannabis/marijuana with non-legal drugs, such as cocaine and methamphetamine, which can lead to patients being hesitant to answer.

“Instead, asking a question like, ‘Have you used cannabis — also known as marijuana — for any reason in the last 12 months?’ would encourage older adults to answer more frankly,” Dr Moore said.

“Providers can then ask how frequently cannabis is used, for what purpose — such as medically for pain, sleep, or anxiety or recreationally to relax — in what form (smoked, eaten, applied topically) and if they know how much THC and CBD it contains. Once the provider has this type of information, they can then educate the patient about potential risks of use.”

Dr Han added: “Although cannabis may be helpful for some chronic symptoms, it is important to weigh that potential benefit with the risk, including ending up in an emergency department.”

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