As medical and recreational cannabis becomes increasingly accessible across the United States and beyond, a growing number of older adults are turning to marijuana for relief from chronic pain, insomnia, and anxiety. However, medical experts are raising urgent concerns about the unique health risks cannabis poses to those over 65.

Recent data reveals a significant uptick in cannabis use amongst older populations. In 2023, 7% of Americans over 65 reported recent cannabis use, up from less than 5% in 2021. Whilst some seek it for legitimate medical reasons, many may not fully understand the potential dangers, particularly given how drastically different today’s cannabis products are from those of decades past.

Stanford Medicine experts specialising in geriatrics, psychiatry, and cardiovascular health have identified five crucial facts that older adults must understand before using cannabis.

Today’s Cannabis Is Far Stronger Than You Remember

For those who experimented with marijuana in their youth, today’s products bear little resemblance to the cannabis of the 1970s and 1980s. Back then, street marijuana typically contained between 1% and 4% tetrahydrocannabinol (THC), the psychoactive component responsible for the “high.”

Modern legal cannabis flower averages 20% THC content, with some strains reaching as high as 35%. Even more concerning are concentrated products such as oils, edibles, and extracts, which can contain THC concentrations up to 90%. This dramatic increase in potency means that accidental overconsumption has become a genuine risk, particularly for older adults unfamiliar with these stronger formulations.

Cannabis use in older adults has led to a troubling rise in emergency room visits. A Canadian study examining the period before and after nationwide legalisation found that emergency room visits due to cannabis poisoning in those over 65 nearly tripled. Symptoms of cannabis overconsumption can include severe confusion, rapid heart rate, extreme anxiety, and dangerous falls.

The variety of available products adds another layer of complexity. Cannabis now comes in countless forms including edibles like gummies and chocolates, vape cartridges, tinctures, topical creams, and traditional flower. Each delivery method affects the body differently, with varying onset times and duration of effects.

“There are so many different formulations and so many different strengths,” notes addiction psychiatry specialist Dr Smita Das. “This is really not the cannabis of the ’70s.”

Serious Heart Disease and Cancer Risks

Perhaps the most alarming finding from recent research involves the cardiovascular risks associated with cannabis use in older adults. Heart disease remains the leading cause of death in the United States, with rates particularly high amongst those over 65.

Studies have demonstrated that THC causes blood vessel inflammation, and epidemiological research has uncovered concerning correlations. Regular cannabis use is associated with a 29% increase in heart attacks and a 20% increase in stroke risk. For a demographic already at elevated risk for cardiovascular events, these statistics are particularly worrying.

Dr Joseph Wu, director of the Stanford Cardiovascular Institute, emphasises that whilst these effects are lower than those associated with regular tobacco or excessive alcohol consumption, many cannabis users also consume tobacco, alcohol, or both. The combination appears to create a synergistic effect, significantly amplifying heart disease risk.

“There is no safe amount of cannabis,” Dr Wu cautions. “Low doses and occasional use are still associated with vascular inflammation. Abstinence is the safest option for heart health.”

Beyond cardiovascular concerns, smoking or vaping cannabis is linked to increased risk of lung cancer and head and neck cancers. Whilst edibles avoid the direct lung exposure of smoking, they are not without their own risks and can still contribute to systemic inflammation.

For older adults with existing heart conditions, the risks are even more pronounced. Those considering cannabis use should consult their cardiologist before beginning, as the substance may dangerously interact with their condition or medications.

Cognitive Effects and Dangerous Drug Interactions

Older adults face unique vulnerabilities when it comes to cannabis use in older adults due to age-related physiological changes. Metabolism naturally slows with age, meaning cannabis compounds remain in the body longer. This extended presence increases both the duration of impairment and the likelihood of drug interactions.

The cognitive effects of cannabis can be particularly problematic for older individuals. Cannabis use can cause confusion, impaired judgement, and dizziness, all of which significantly increase fall risk. For older adults, falls represent a major health hazard, often resulting in serious injuries like hip fractures that can dramatically impact quality of life and independence.

Moreover, cannabis may exacerbate age-related cognitive decline. For those already experiencing mild cognitive impairment or early dementia, cannabis use could accelerate deterioration or mask symptoms that should prompt medical evaluation.

Drug interactions present another serious concern. Cannabidiol (CBD), a non-intoxicating compound found in cannabis, interferes with enzymes responsible for breaking down various medications. This interaction is particularly dangerous with blood thinners. When CBD raises blood thinner levels in the body, even a minor fall or injury could result in excessive bleeding.

Cannabis can also reduce the effectiveness of certain medications or create unpredictable interactions with the multiple prescriptions many older adults take daily. Without proper medical guidance, these interactions can lead to treatment failures or dangerous side effects.

The Addiction Myth: Cannabis Use Disorder Is Real

One of the most persistent and dangerous misconceptions about cannabis is that it is not addictive. This belief is demonstrably false. Research indicates that approximately 30% of regular cannabis users develop cannabis use disorder, a genuine addiction characterised by specific diagnostic criteria.

Cannabis use disorder manifests through several warning signs. Users may experience physical withdrawal symptoms when attempting to stop, including irritability, insomnia, decreased appetite, anxiety, and restlessness. They may find themselves needing progressively higher doses to achieve the same effects, a phenomenon known as tolerance. The substance may begin to interfere with daily responsibilities, relationships, and quality of life.

Whilst rates of cannabis use disorder are lower than those for alcohol use disorder, the problem is likely underdiagnosed in older adults. Healthcare providers may not routinely ask older patients about cannabis use, and older adults may not volunteer this information, particularly if they feel embarrassed or believe it is irrelevant to their care.

For those struggling to reduce or stop their cannabis use, professional help is available and effective. Cognitive behavioural therapy has proven successful in treating cannabis addiction, helping individuals understand their patterns of use and develop healthier coping strategies.

“Empowering individuals by helping them understand the criteria of a substance use disorder can then help them decide if this is something they want to address,” Dr Das explains. Healthcare providers can offer crucial support throughout the difficult process of reducing or stopping cannabis use.

Limited Evidence for Medical Benefits

Despite widespread marketing claims, scientific evidence supporting medical cannabis use remains surprisingly limited. The US Food and Drug Administration has not approved cannabis itself for any medical condition. Only two specific cannabinoid compounds have received FDA approval: CBD for certain forms of childhood epilepsy, and dronabinol (a synthetic cannabis compound) for nausea and appetite loss in cancer and HIV/AIDS patients.

Many older adults turn to cannabis hoping for relief from chronic pain, one of the most commonly cited reasons for use. However, research on cannabis for pain management has produced mixed and inconclusive results. Some studies show modest pain reduction, but these same studies often demonstrate large placebo effects, making it difficult to determine cannabis’s true efficacy.

For conditions like insomnia and anxiety, which frequently drive cannabis use in older adults, there is no medical consensus that cannabis provides effective treatment. The American Psychiatric Association has issued statements opposing the use of cannabis as medicine for psychiatric disorders due to insufficient evidence of effectiveness.

That said, some medical professionals working in palliative care settings report that certain patients find cannabis helpful, particularly those with life-limiting illnesses. These patients may use cannabis for cancer-related side effects and often appreciate avoiding highly addictive opioid medications. In this specific context, where quality of life in remaining time is paramount, some providers view cannabis as a reasonable option.

Geriatric nurse practitioner Eloise Theisen, who specialises in cannabis therapy for palliative care patients, notes that very small doses of THC can sometimes be therapeutic for this population. “There’s also a lot of stigma around its effects of euphoria,” she observes. “In our patients who may have months to a few years to live, still being able to experience joy is really important.”

The Importance of Medical Guidance

Regardless of differing professional opinions on cannabis’s medical utility, experts universally agree on one point: older adults who are using or considering cannabis must discuss it openly with their healthcare providers.

Many early cannabis users made critical mistakes due to lack of proper guidance. Without clear instructions on dosing, some consumed excessive amounts of THC in edible form, leading to frightening experiences that sometimes required emergency medical care. These negative experiences often discouraged patients from finding potentially helpful lower doses or alternative products.

Primary care physicians offer invaluable insight into how cannabis might interact with a patient’s specific constellation of medical conditions and medications. They can also help assess whether other, better-studied treatment options might address the underlying concern more effectively and safely.

For older adults determined to use cannabis, medical supervision enables harm reduction. Providers can recommend safer consumption methods (edibles rather than smoking, for instance), suggest appropriate starting doses, monitor for side effects and interactions, and adjust treatment plans accordingly.

Finding trustworthy information about cannabis can be challenging. Dispensary staff, whilst often well-intentioned, are not medical professionals and may not understand the unique risks facing older adults. Online sources vary wildly in quality and scientific rigour. Healthcare providers remain the most reliable source of personalised, evidence-based guidance.

“Talking to your doctor and letting them know not only what you’re prescribed, but what you’re using recreationally, will help formulate a way to do it in as safe a manner as possible,” advises psychiatry professor Dr Claudia Padula.

Making Informed Decisions

The rising popularity of cannabis amongst older adults reflects both increasing legalisation and persistent health challenges in this demographic. Chronic pain, poor sleep, and anxiety are genuine problems that significantly impact quality of life. The desire to find relief is entirely understandable.

However, cannabis is not the harmless, natural remedy it is often portrayed to be, particularly for older adults. The cardiovascular risks, potential for cognitive impairment and falls, numerous drug interactions, real addiction potential, and lack of robust evidence for many claimed benefits all warrant serious consideration.

For older adults weighing cannabis use, the key is making informed decisions based on facts rather than marketing claims or outdated assumptions about the drug’s safety. Today’s cannabis products are dramatically more potent than those of previous decades, and older bodies respond differently than younger ones.

Those with existing heart conditions, cognitive issues, or who take multiple medications face elevated risks. The safest approach for heart health is complete abstinence from cannabis. For those who choose to use it despite the risks, medical supervision is essential to minimise potential harm.

As research continues to evolve, our understanding of cannabis’s effects on older adults will hopefully become clearer. Until then, caution and medical guidance should be the watchwords for anyone in this demographic considering cannabis use.

Source: Stanford Medicine