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Han BH, Palamar JJ. Trends in Cannabis Use Among Older Adults in the United States, 2015-2018. JAMA Intern Med. 2020;180(4):609–611. doi:10.1001/jamainternmed.2019.7517
With the legalization of cannabis in many states for medical and/or recreational purposes, there is increasing interest in using cannabis to treat a variety of long-term health conditions and symptoms common among older adults. The use of cannabis in the past year by adults 65 years and older in the United States increased sharply from 0.4% in 2006 and 2007 to 2.9% in 2015 and 2016.1,2 This study examines the most recent national trends in cannabis use to determine whether cannabis use has continued to increase among older adults and to further examine trends in use among subgroups of older adults.
We performed secondary analysis of adults 65 years and older from the most recent 4 cohorts (2015-2018) of the National Survey on Drug Use and Health, a cross-sectional nationally representative survey of noninstitutionalized individuals in the United States.3 We estimated the prevalence of past-year cannabis use across cohorts and estimated prevalence stratified by each level of sex, race/ethnicity, educational attainment, household income, marital status, chronic disease, tobacco and alcohol use, mental health treatment, and all-cause emergency department use. Cannabis use was ascertained by asking about marijuana, hashish, pot, grass, and hash oil use either smoked or ingested.3 We calculated the absolute and relative change in prevalence between 2015 and 2018. Using logistic regression, we estimated whether there was a log-linear association between cannabis use and time, and interactions were examined to determine changes across subgroups. Statistical significance was defined as a 2-sided P value less than .05. We used sample weights (provided by National Survey on Drug Use and Health) to account for the complex survey design, selection probability, nonresponse, and population distribution. This secondary analysis was exempt from review by the New York University’s institutional review board. Analyses were conducted using Stata/SE version 13 (StataCorp).
Of 14 896 respondents 65 years and older, 55.2% were men and 77.1% were white. The prevalence of past-year cannabis use among adults 65 years and older increased significantly from 2.4% to 4.2% (P = .001), a 75% relative increase (Figure). The Table presents prevalence trends stratified by participant characteristics. There were significant increases among women, individuals of white and nonwhite races/ethnicities, individuals with a college education, individuals with incomes of $20 000 to $49 000 and $75 000 or greater, and married individuals. In terms of chronic disease, among adults with diabetes, there was a 180% relative increase (1.0% [95% CI, 0.5-2.1] in 2015 vs 2.8% [95% CI, 1.7-4.7] in 2018; P = .02) in cannabis use. Individuals reporting 1 or less chronic diseases had a significant relative increase in cannabis use of 95.8% (2.4% [95% CI, 1.8-3.2] in 2015 vs 4.7% [95% CI, 3.6-6.2] in 2018; P < .001). Those who received mental health treatment also had a significant increase in cannabis use (2.8% [95% CI, 1.3-5.9] in 2015 vs 7.2% [95% CI, 4.8-10.5] in 2018; 157.1% relative increase; P = .02) as well as those reporting past-year alcohol use (2.9% [95% CI, 2.2-4.0] in 2015 vs 6.3% [95% CI, 5.0-8.0] in 2018; 117.2% relative increase; P < .001).
The use of cannabis continues to increase among older adults nationally. We determined that a number of key subgroups experienced marked increases in cannabis use, including women, racial/ethnic minorities, those with higher family incomes, and those with mental health problems. While we also found an increase in cannabis use among older people with diabetes, in general, it appears that the increase in cannabis use is driven largely by those who do not have multiple chronic medical conditions.
We also detected an increase in cannabis use among older adults who use alcohol. The risk associated with co-use is higher than the risk of using either alone, and a 2019 study of trends in alcohol and cannabis co-use following legalization in Washington state4 found significant increases in simultaneous cannabis and alcohol use among adults 50 years and older. Future research is needed to monitor and educate older patients regarding co-use to minimize potential harms.
Limitations of this study include possible limited recall and social desirability bias. While more older adults use cannabis, the current clinical evidence to support its use in this population is limited.5 Older adults are especially vulnerable to potential adverse effects from cannabis,6 and with their increase in cannabis use, there is an urgent need to better understand both the benefits and risks of cannabis use in this population.
Accepted for Publication: December 28, 2019.
Corresponding Author: Benjamin H. Han, MD, MPH, Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 550 First Ave, BCD 615, New York, NY 10016 (firstname.lastname@example.org).
Published Online: February 24, 2020. doi:10.1001/jamainternmed.2019.7517
Author Contributions: Drs Han and Palamar had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Both authors.
Acquisition, analysis, or interpretation of data: Both authors.
Drafting of the manuscript: Both authors.
Critical revision of the manuscript for important intellectual content: Both authors.
Statistical analysis: Palamar.
Obtained funding: Both authors.
Conflict of Interest Disclosures: None reported.
Funding/Support: This research was supported by grants K23DA043651 (Dr Han), K01DA038800 (Dr Palamar), and P30DA011041 (Holly Hagan, PhD, NYU School of Global Public Health, New York, New York) from the National Institute on Drug Abuse.
Role of the Funder/Sponsor: The National Institute on Drug Abuse helped in the preparation of the manuscript but had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; review or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Charles M. Cleland, PhD (Center for Drug Use and HIV/HCV Research, New York University College of Global Public Health, New York), for his mentorship regarding these data analyses. No compensation was provided for his guidance.
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