Four in every five older adults who used cannabis in the past year never discussed it with their doctor. That finding, from a new national study in the United States, raises serious questions about whether general practice is keeping pace with a fast-growing pattern of substance use among people aged 65 and over. Clinical cannabis screening in this age group is not where it needs to be, and the consequences are becoming harder to ignore.

The research appeared in the American Journal of Preventive Medicine. Researchers drew on data collected between 2021 and 2023 through the National Survey on Drug Use and Health. The study covered 14,387 community-dwelling adults aged 65 and older who had attended at least one health care appointment in the preceding year. Of that group, 1,194 reported past-year cannabis use.

Older Adults Are Using Cannabis More Than Ever

Cannabis use has climbed steadily in this age group. In 2023, around 7% of adults aged 65 and older reported past-month use, with past-year figures sitting at 9.5%. Researchers point partly to the ageing Baby Boomer cohort, a generation with higher historical exposure to cannabis. Growing interest in the drug for chronic pain, sleep problems, and other age-related conditions also appears to be pushing the numbers higher.

That increase makes the gaps in clinical engagement all the more notable. Across the full sample, only 37% of older adults said a doctor had asked them about cannabis or other illegal drug use. Rates of clinical cannabis screening were higher among those managing two or more chronic conditions, those experiencing moderate or serious mental illness, and those in higher income brackets.

Who the Cannabis Use in Older Adults Screening Gap Leaves Behind

The disparities in who gets screened are not evenly spread. Just 19% of past-year cannabis users said the topic came up in conversation with a clinician. More than four in ten (44%) experienced neither screening nor any discussion at all.

Women who used cannabis were less likely than men to report a clinical discussion. Hispanic and Latine older adults were less likely than White older adults to receive screening, and other racialised groups followed the same pattern. The researchers point to these gaps as areas where clinician training is most urgently needed.

An unexpected pattern also emerged around alcohol. Past-year alcohol use linked to a higher chance of drug screening overall. Among those who also used cannabis, however, alcohol use connected negatively with having a cannabis-specific discussion. Those managing multiple substances may therefore be the least well served by current clinical practice.

Why Clinical Cannabis Screening Matters More in Older Age

The physical realities of ageing make this silence in clinical settings significant. Older adults typically manage multiple chronic conditions and take several prescribed medications simultaneously. The risks tied to cannabis use therefore run higher in this population than in younger age groups. Research connects the drug in this cohort to acute toxic effects, heightened injury and fall risk, poorer mental health outcomes, and worsening of existing chronic disease.

These risks do not diminish because cannabis laws have been relaxing. The study found no link between living in a state with a medical cannabis law and whether a person received screening or had a clinical discussion. The legal landscape, it seems, is not translating into better clinical conversations.

Practical Steps for Clinicians

Researchers outlined several approaches to improving screening and discussion rates for cannabis use in older adults. Validated single-question drug screening tools designed for brief appointments offer one practical starting point. Two-step instruments such as the Tobacco, Alcohol, Prescription Medication, and Other Substance Use tool may also suit busier clinical settings. The team pointed to electronic health record prompts as a low-cost structural fix for flagging cannabis with older patients.

The researchers also highlighted the value of separating cannabis from broader illegal drug screening, arguing this approach reduces stigma and encourages honest disclosure. Prior research the team cited suggests clinician knowledge gaps and personal discomfort contribute directly to how often these conversations fail to happen.

Limitations

Several limitations shape how the findings should be read. The screening question combined cannabis with other illegal drugs, so cannabis-specific rates remain hard to isolate. Screening and discussion figures came from self-report rather than clinical records. The survey excluded institutionalised adults and those without stable housing, and response rates were low.

Despite these constraints, the pattern is consistent and clear. Cannabis use among older adults is rising. Clinical engagement with that use remains limited. The gaps fall unevenly across gender, ethnicity, and race. That is a challenge health systems cannot afford to ignore.

Source: conexiant