Cannabis Use in Senior Patients

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COMMENTARY

Given the societal shift and cultural acceptance of cannabis, its use has become all too common in my practice amongst all age groups. But the nonchalant use and experimentation with cannabis by my senior patients took me by surprise.

Even more surprising was the relative quiet by the psychiatric and general medical professions to the widespread use of cannabis by older patients. (I was glad to learn that the American Psychiatry Association has a new textbook on the potential dangers of cannabis).

Psychiatrists have focused on the adverse effects from prescribed sleep aids for older patients, encouraging behavioral interventions instead of medication use as first line treatment. Notices from insurance RX plans are sent daily to clinicians to alert them of the dangers inherent in the use of anxiety, sleep, and long-term antidepressant use; but relative quiet on the cannabis front. Some of my patients have been frightened by the media blitz that benzodiazepines can cause cognitive decline and lead to dementia but have no qualms about a few hits of “weed” at bedtime or edibles to calm their nighttime anxieties and promote sleep. Some have been given cannabis and edibles to try by their family members or friends.

Despite the perception that dispensaries are similar to pharmacies for “natural herbal” remedies, cannabis is not without risk for older patients. Harvard Health Publishing reported an increase in emergency care visits in California with cannabis use among older adults, a jump from 366 in 2005 to 12,169 in 2019.¹

Alison Moore, MD, MPH, professor and chief of geriatrics, gerontology, and palliative care at the University of California points out that geriatric patients primarily use cannabis to treat pain and insomnia and she states that medications for insomnia can be dangerous and are not recommended. “So many older adults are really with these conditions suffering and they feel stuck. So older adults are also turning to cannabis to treat mental health concerns, such as anxiety and depression, and for caretakers of those with dementia, to treat some of the negative behavioral complications of dementia, such as agitation.”²

This leads me to contemplate that our concern and fear of adverse effects from the use of anxiety and sleep medications by older patients has led us to inadequately treat geriatric patients who are suffering from anxiety and insomnia and, as a result, increases their need to turn to alternative sources such as cannabis for relief. A question that I have decided to ask my patients: What am I not addressing in my treatment of your symptoms that has led you to turn to cannabis for relief?

Psychiatrists can only benefit from increased curiosity as to what symptoms their patients are seeking to alleviate through the use of cannabis and edibles.³ Hopefully, well-controlled randomized trials of known sleep and anxiety medications vs different forms of cannabis, looking at both efficacy and safety, as well as cognitive adverse effects, will provide more concise guidelines for psychiatrists and mental health clinicians.

Dr Varas is a psychiatrist in Westwood, New Jersey.

References

1. Salamon M. Emergency care visits after cannabis use rising among older adults. Harvard Health Publishing. May 1, 2023. Accessed February 24, 2025. https://www.health.harvard.edu/staying-healthy/emergency-care-visits-after-cannabis-use-rising-among-older-adults

2. Cannabis side effects for senior and older adult patients with Alison Moore, MD, MPH. American Medical Association. June 1, 2023. Accessed February 24, 2025. https://www.ama-assn.org/delivering-care/public-health/cannabis-side-effects-senior-and-older-adult-patients-alison-moore-md

3. Agronin ME. The age of cannabis has arrived: issues for older adults. Psychiatric Times. 2023;38(3).