- Design
- Cross-sectional intercept survey with multivariable logistic regression
- Population
- 315 adults aged 65 and over approached in public parks and outside older adult centres in New York City
- Primary outcome
- Past-year cannabis use, reasons, adverse effects and cannabis use disorder
- Effect
- 22.2% used in the past year; of users, 32.9% met criteria for cannabis use disorder and 5.7% for severe disorder; current smokers aOR 3.73 (95% CI 1.65-8.48)
Cannabis use in people over 65 has been measured almost entirely through national household surveys, which reach older adults poorly. This study went and asked them: an intercept survey of 315 New Yorkers aged 65 and over, approached in public parks and outside older adult centres.
Twenty-two per cent reported cannabis use in the past year, and of those, 11.1% had used within the previous 24 hours. Reasons given were to get high (60.0%), to relieve tension (55.7%), for sleep (52.9%) and for chronic pain (30.0%) — note that recreational and medicinal motives ran together in the same people rather than separating into two populations. Reported adverse effects were dry mouth (41.4%) and drowsiness (18.6%). Current cigarette smokers had over three times the odds of use (adjusted OR 3.73, 95% CI 1.65 to 8.48), and the odds fell with each year of age (aOR 0.90, 0.84 to 0.95) and were lower in women (aOR 0.35, 0.17 to 0.73).
The finding that should change the consultation is the last one: 32.9% of those using met criteria for cannabis use disorder, and 5.7% for severe disorder. That is not incidental use. Yet in an older adult the features that would prompt the question in a younger one — falls, confusion, somnolence, poor concentration, dry mouth, low appetite — are all routinely attributed to ageing, to medication, or to early dementia, and the question goes unasked.
So ask it, of everyone, as part of the medication and substance history rather than as a suspicion. The prevalence here is specific to New York and does not transfer to India, where the legal position and the forms used are different; what does transfer is that older patients are not asked, that bhang and other traditional preparations are socially normalised and rarely volunteered, and that the interaction risk with sedatives, anticholinergics and antihypertensives is exactly the same.
- Add cannabis to the routine substance history in every older patient, not selectively.
- Ask about form and frequency — edibles, smoked, traditional preparations — not just yes or no.
- Screen for use disorder when use is daily or used for sleep, tension or pain.
- Reconsider cannabis before attributing new falls, somnolence or confusion to age or dementia.
- Check for additive sedation with benzodiazepines, opioids, antihistamines and antipsychotics.
Why it matters
The symptoms that would trigger the question in a younger patient are the ones we attribute to ageing in an older one.
Don't overread it
A 315-person street survey in one city gives a prevalence for that sample, not for older adults generally.
The statistics, in plain English
An intercept survey stops people in public places, so it reaches older adults who are out and about and misses the housebound and the institutionalised — the 22.2% prevalence therefore describes this sample rather than the population, and should not be quoted as a rate for older adults generally. The 32.9% figure is a proportion of the 70 people who reported use, so it rests on a small denominator and its confidence interval is wide. What survives those limitations is the direction: use disorder among older users is common enough that not asking is no longer defensible.
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