Cannabis use more than doubled over the past decade among Americans of 50 years and over, with nearly one in 10 now reporting usage over the past year, an analysis of the National Survey on Drug Use and Health has found, reports MedPage Today. Increasing medical cannabis use among older adults is raising concern about self-treatment risks.
Of the 8.9% who reported using cannabis in the past year; roughly one in five (18.5%) reported using it for medical purposes such as treatment of chronic pain or depression, or for diseases like arthritis, reported Dr Namkee Choi and Dr Diana DiNitto, both from University of Texas at Austin.
Compared to recreational users, those using cannabis for medical purposes were more likely to discuss drug use with a healthcare professional (adjusted OR 4.18, 95% CI 2.53-6.89), to purchase from a medical cannabis dispensary (aOR 4.38, 95% CI 2.47-7.76), and to report more frequent use (aOR 2.56, 95% CI 1.35-4.86), according to the research published in the American Journal of Drug and Alcohol Abuse.
"The findings suggest that some medical users may be self-treating without healthcare professional consultation," Choi said. "As part of routine care, healthcare professionals should screen for cannabis and other substance use, and for mental health problems, and recommend treatment when necessary."
Kate Kneisel wrote in the MedPage Today story on 2 May 2021 that for their study, the researchers examined 2018 and 2019 data from the National Survey on Drug Use and Health (NSDUH) involving 17,685 individuals ages 50 and up, 55% of whom were women.
Of self-described medical cannabis users – which by NSDUH definition implies physician-recommended use – less than 40% reported discussing cannabis use with a healthcare provider, which the authors noted suggests that some reported medical use without a doctor's recommendation, possibly because they believed it to be necessary for relieving their symptoms.
Indeed, Choi and DiNitto cited another large survey performed in the US in 2017 that found the most common medical reasons for marijuana use were anxiety (49%), insomnia (47%), chronic pain (42%), and depression (39%).
Among those using marijuana for medical purposes, 21% did not have a doctor. Among those with doctors, 33% did not inform them, 28% reported their doctor was neutral on their use, 32% reported their doctor was supportive, and 8% reported their doctor was not supportive.
MedPage Today writes that in the current study, while medical users reported using cannabis more frequently, with 40% using it roughly four to seven days per week, they were less likely to have alcohol use disorder compared with non-medical cannabis users (aOR 0.39, 95% CI 0.20-0.76).
Otherwise, medical and non-medical users did not differ on physical and most behavioural health indicators, although cannabis users in general had significantly higher rates of alcohol use disorder, nicotine dependence, other illicit drug use, and mental illness compared with non-users.
Most were experienced users rather than new to cannabis use; most obtained cannabis from private or informal sources, reportedly with little difficulty. Of self-reported medical users, 71% reported exclusive medical use; the rest reported both medical and nonmedical use.
It is important that patients be made aware of the risks of obtaining cannabis and cannabis products from unregulated sources, the authors noted in the MedPage Today story.
"Given the increase in THC [tetrahydrocannabinol] potency, healthcare professionals should educate older cannabis users, especially high-frequency users, on potential safety issues and adverse effects.”
In addition to urging doctors to do more to screen and educate their patients, the study authors say the NSDUH needs updating to "reflect changing cannabis product commercialisation," with cannabidiol, topical solutions, and edibles often available now.
In fact, there has been a push in recent years to help familiarise healthcare providers with the health effects of cannabis, MedPage Today concludes.
Last year, citing a 2015 survey of healthcare providers, Dr Nora Volkow, director of the National Institute on Drug Abuse, concluded that providers "perceive a knowledge gap related to cannabis dosing, treatment plans, and different areas related to cannabis products, so providers themselves realise the need for research and expertise to be developed in this area."
Study details
Comparing older nonmedical and medical cannabis users: health-related characteristics, cannabis use patterns, and cannabis sources
Namkee G Choi and Diana M DiNitto
Affiliations: University of Texas
Published in The American Journal of Drug and Alcohol Abuse on 29 April 2021.
Abstract
US epidemiologic data show that nearly one in 10 individuals aged 50+ report past-year cannabis use, and nearly one in five users report medical use. However, research on older cannabis users, especially medical cannabis users, is scant.
Objectives
We examined medical and nonmedical cannabis users aged 50+ on health-related characteristics, cannabis use patterns, and cannabis sources.
Hypotheses were that compared to nonmedical users, medical users are more likely to have physical and mental health problems, use healthcare services, discuss their drug use with a healthcare professional, use cannabis more frequently, and purchase cannabis from a medical dispensary and other sources rather than obtain it as a gift, share someone else’s, or use other means.
Methods
We used 2018 and 2019 National Survey on Drug Use and Health data (N = 17,685 aged 50+; male = 8,030; female = 9,655). Hypotheses were tested using logistic regression analysis.
Results: The past-year cannabis use rate was 8.9%. Of past-year users, 18.5% reported medical use.
Compared to nonmedical use, medical use was associated with lower odds of alcohol use disorder but higher odds of discussing drug use with a healthcare professional (AOR = 4.18, 95% CI = 2.53–6.89), high-frequency use (e.g., AOR = 2.56, 95% CI = 1.35–4.86 for 200–365 days), and purchase at a medical cannabis dispensary (AOR = 4.38, 95% CI = 2.47–7.76).
Conclusion
Medical and nonmedical users did not differ on physical and most behavioral health indicators. Most obtained cannabis from private/informal sources. Some medical users are likely to self-treat without healthcare professional consultation.
Healthcare professionals should engage older adults in discussions of cannabis use and behavioural health needs.
MedPage Today story – Time to Screen for Older Patients' Cannabis Use? (Open access)
SEE ALSO FROM THE MEDICALBRIEF ARCHIVES
Cannabis reduces blood pressure in older adults – Israeli research
15% of older adults use cannabis to treat common health conditions – US study
Doctors still reluctant to prescribe medical cannabis – Canadian study