Cannabis Use Among Older Adults

Abstract

Importance: Little is known about patterns (forms, frequency, and reasons) and factors associated with cannabis use in older veterans (aged ≥65 years).

Objective: To examine factors associated with past 30-day cannabis use and cannabis use disorder (CUD) in older veterans.

Design, setting, and participants: In this cross-sectional study, community-dwelling adults aged 65 to 84 years who used Veterans Health Administration care were interviewed between February 5, 2020, and August 29, 2023.

Exposure: Sociodemographic, behavioral, and health-related characteristics.

Main outcomes and measures: Past 30-day cannabis use (smoking, vaping, dabbing, or edibles) and any CUD (≥2 criteria based on Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) were assessed using weighted multivariable logistic regressions.

Results: Of the 4503 participants (weighted mean age, 73.3 years [95% CI, 73.0-73.5 years]; 85.4% [95% CI, 83.6%-87.2%] men), 58.2% (95% CI, 55.3%-61.0%) had ever used cannabis, 28.9% (95% CI, 26.0%-31.8%) of whom reported using cannabis for medical reasons, most commonly for pain (56.4%; 95% CI, 50.9%-61.9%), mood or mental health (18.4%; 95% CI, 14.7%-22.1%), and sleep (16.0%; 95% CI, 11.9%-20.0%). More than 1 in 10 reported past 30-day cannabis use (10.3%; 95% CI, 8.9%-11.7%), with 52.4% (95% CI, 45.4%-59.4%) of these using cannabis for 20 days or more; smoking (72.4%; 95% CI, 65.4%-79.3%) and edibles (36.9%; 95% CI, 29.8%-43.9%) were the most common forms of use. Characteristics associated with past 30-day use included younger age (65-75 years), economic hardship, tobacco and illicit drug use, and residing in a state with recreationally legal cannabis. Among those with past 30-day cannabis use, 36.3% (95% CI, 30.1%-42.6%) screened positive for CUD, with higher odds among younger respondents, those reporting anxiety, those with 1 or more deficits in activities of daily living, those with illicit drug use, those with frequent cannabis use, and those using cannabis recreationally. Past 30-day inhaled cannabis use, compared with edibles only, was associated with increased odds of any CUD (adjusted odds ratio, 3.56; 95% CI, 1.12-11.26).

Conclusions and relevance: In this cross-sectional study of cannabis use in older veterans, use was common, and more than one-third who used in the past 30 days had any CUD. The prevalence of past 30-day cannabis use was close to tobacco use prevalence, and risk factors for cannabis use were similar to those observed in other populations. Frequent and inhaled cannabis use was associated with higher odds of any CUD. Routine health screening for cannabis use in Veterans Health Administration clinical settings is necessary to identify older adults with cannabis use.

Figure 1.. Study Flow Diagram for the Participants

VHA indicates Veterans Health Administration.

Figure 2.. Forms of Past 30-Day Cannabis Use Among US Veterans 65 Years and Older, 2020-2023

Results shown are weighted percentages for any and exclusive use of cannabis by modes of use (smoking, vaping, dabbing, or edibles) among those who used cannabis in the past 30 days (n = 1193 [10.3% of the total sample of 4503]). Any use indicates those who reported any cannabis use in the past 30 days by the forms shown (eg, any use of inhaled cannabis includes 78.3% of those who reported any smoking, vaping, and/or dabbing regardless of the use of edibles). Exclusive use indicates those who reported cannabis use exclusively by the forms shown (eg, exclusive use of inhaled cannabis includes 63.1% of those who reported any inhaled use [smoking, vaping, or dabbing] and no edibles). In contrast, 21.7% of respondents with past 30-day cannabis use reported the use of edible cannabis only. Multiple forms includes reporting any 2 or more forms of use (smoking, vaping, dabbing, and/or edibles).