Unveiling the Hidden Dangers: Cannabis Use Among Older Adults
The legalization of cannabis has sparked a growing trend among older adults, who are turning to cannabinoid-infused products to manage pain, sleep issues, and other chronic ailments. However, a recent study published in the Journal of General Internal Medicine reveals a concerning trend: many of these users are ending up in hospital emergency departments due to severe adverse effects.
Led by Dr. Jerry H. Gurwitz, the study analyzed emergency department visits among U.S. adults aged 50 and older linked to the medical use of cannabinoid-containing products, including medical marijuana, CBD, and hemp-derived items, from 2016 to 2023. The findings are alarming, with the estimated number of emergency department visits for adverse events attributed to these products rising from 4,408 during 2020-2021 to 7,490 during 2022-2023.
Dr. Gurwitz emphasizes that this is just the tip of the iceberg, as the study only captured emergency department visits. It did not include urgent care visits, doctor's office calls, or cases where individuals never sought medical attention. So, why is this trend on the rise?
Access plays a significant role. Medical cannabis is legally available in most states, while recreational use is accessible in nearly half of all states plus the District of Columbia. However, Dr. Gurwitz warns that greater availability doesn't necessarily equate to safety. Many of these products contain multiple active compounds, and their contents are often unknown due to inadequate FDA evaluation.
The complexity of cannabis further complicates matters. Dr. Gurwitz explains that the presence of multiple active compounds makes it challenging to determine what's in these products. His interest in the issue was sparked by a relative in her 90s who experienced side effects from a cannabis product for back pain, prompting him to realize that many of his patients might have been using cannabis without his knowledge.
What are the real risks? The study uncovered a troubling spectrum of adverse effects, including confusion, psychiatric symptoms (anxiety, paranoia), syncope (fainting), gastrointestinal symptoms, falls, and injuries. Dr. Gurwitz emphasizes that these are not trivial issues and are precisely the types of potentially preventable events that geriatricians focus on when caring for older patients.
He also highlights that older adults are often more sensitive to the effects of medications, increasing the risk of adverse events. The study strongly suggests that older patients need to be warned about the potential risks of cannabis use.
Who is using it, and why? According to Dr. Gurwitz, recent national survey data indicates that about 12% of U.S. adults between ages 50 and 80 report using cannabis. Many of these older users are seeking alternatives to prescription medications, such as painkillers or sedatives. However, this may place them at risk.
The study focused only on legal, medically used products, and not recreational cannabis. Dr. Gurwitz warns that recreational cannabis use, especially when combined with alcohol, may pose even greater risks for adverse events. So, what should you ask your doctor, and how can you stay safer?
Dr. Gurwitz recommends having an open and honest conversation with your doctor if you're over 50 or caring for someone who is. He suggests asking the following questions:
"Is this the best choice for me?" Sometimes, the risks may outweigh the benefits.
"What alternatives exist?" There may be non-pharmacological options for pain, such as physical therapy, or behavioral strategies for insomnia, which carry fewer risks.
"What are the potential side effects specifically more likely to occur in older adults?" Dr. Gurwitz recommends asking about the risk of confusion, falls, fainting, and gastrointestinal side effects.
As a geriatrician, Dr. Gurwitz emphasizes the importance of prescribing medications only when they are efficacious and the benefits outweigh the risks. He urges clinicians to ask about cannabis use with their patients, especially for older adults with chronic pain, sleep disturbances, or other conditions. If an older person develops new symptoms, their physicians should inquire about cannabis use to avoid preventable morbidity.
Furthermore, the research highlights the need for further evaluation of these products by the FDA, more accurate product labeling, and improved patient and healthcare provider education. Dr. Gurwitz concludes, "Until we have a better understanding of what's in these products and how they affect older adults, we need to approach their use with great caution."
