Abstract
Introduction:
Legal access to and attitudes toward cannabis are changing rapidly. Most of the United States and territories allow adults to use medical and/or recreational cannabis. Recent trends demonstrate increasing cannabis use among older U.S. adults. However, little research has examined cannabis use among older adults since 2019, when the COVID-19 pandemic caused major changes in patterns of substance use.
Methods:
The National Poll on Healthy Aging is a nationally cross-sectional survey that asked U.S. adults ages 50–80 in January 2021 about their cannabis use in the past year. Multivariable logistic regression was used to identify demographic and health characteristics associated with cannabis use.
Results:
Among 2023 participants aged 50–80 (52.7% female), 12.1% reported cannabis use in the past year. Among those who reported cannabis use, 34.2% reported using cannabis products 4 or more days per week. In multivariable logistic regression, cannabis use was less likely among people who identified as Hispanic ethnicity or as “other” races compared with non-Hispanic white respondents. Cannabis use was more likely among unmarried/unpartnered and unemployed respondents. Those who consumed alcohol were more likely to use cannabis.
Conclusions:
More than one in 10 U.S. adults aged 50–80 used cannabis in the 1st year of the COVID-19 pandemic, and many used cannabis frequently. As access to and use of cannabis continue to increase nationally, clinicians and policymakers should monitor and address the potential risks among older adults.
Keywords: aging, alcohol, cannabis, coronavirus, middle aged, older adult
Introduction
Access to cannabis products is increasing rapidly across the United States as states legalize medical and recreational cannabis use.1 Amid these legislative changes, rates of cannabis use and attitudes are also changing, particularly among older adults.2 Between 2006 and 2019, the prevalence of past-year cannabis use increased from 2.8% to 9.5% among U.S. adults aged 50 and older.2,3 These shifting trends have been attributed, in part, to the aging “Baby Boomer” generation, which includes individuals born between 1946 and 1964 who reached 57–75 years in 2021. This generation is characterized by more accepting attitudes about drug use and greater support for legalization of cannabis than the previous generation.4
In early 2020, another seismic event took place, the World Health Organization declared COVID-19 a global pandemic.5 The pandemic, and the subsequent emergency declarations and lockdowns, changed people's lives, introducing new and unique stressors and lifestyle patterns, which increased substance use for many.6 The pandemic also negatively impacted the mental health of older adults,7 and older adults are at particular risk of cannabis-related neuropsychiatric problems, mental health problems, injuries (e.g., falls), polysubstance use, and driving under the influence of cannabis.8–10 Older adults are also more likely to use medications that can interact with cannabis in harmful ways.11 Such cannabis-related harms are more likely with regular cannabis use.10,12 However, the postpandemic prevalence and frequency of cannabis use among older adults are unknown.
To fill this gap in research, this study reports national estimates of the prevalence and frequency of cannabis use among older U.S. adults in the 1st year of the COVID-19 pandemic. In addition, this study evaluates demographic and health factors associated with cannabis use during this time period.
Materials and Methods
Design and participants
Data from this study came from the January 2021 University of Michigan National Poll on Healthy Aging (NPHA), a recurring national survey of adults aged 50–80. Data were collected January 14–28, 2021. Respondents are selected from the Ipsos web-enabled KnowledgePanel®, in which panel participants are randomly recruited through address-based sampling. The addressed-based sampling methodology uses a database from the U.S. Postal Service with full coverage of all delivery points in the nation.13 Households without internet connection are provided with a web-enabled device and free internet service to ensure unbiased recruitment. After data collection, the sample was weighted to reflect population figures from the U.S. Census Bureau. The study data and more information on the survey are available at National Poll on Healthy Aging. The University of Michigan Institutional Review Board deemed this study exempt from human subjects review.
Measures
Cannabis use was assessed with the question: “In the past year, how often did you use cannabis products that contain THC (e.g., cannabis, pot, hash, edibles)?” Response options included the following: never, monthly or less, 2–4 times a month, 2–3 times a week, or 4 or more times a week.
The survey collected demographic, health, and substance-use information using brief items across multiple domains. Past-year alcohol use was assessed using the Alcohol Use Disorder Identification Test, Consumption (AUDIT-C). Each of the 3-items in the AUDIT-C is scored on a 0–4 scale and summed resulting in an overall score that ranges from 0 to 12.14 Other health questions used Yes/No or Likert-type responses. See Table 1 for additional details on items and response options.
Table 1.
Associations Between Cannabis Use, Responder Characteristics, and Health Variables
| No past-year cannabis use (n=1777), n (%) | Any past-year cannabis use (n=241), n (%) | OR (95% CI) | p * | aOR (95% CI)a | p | |
|---|---|---|---|---|---|---|
| Sex | ||||||
| Male (n=947) | 821 (86.7) | 126 (13.3) | Reference | NA | Reference | NA |
| Female (n=1071) | 956 (89.0) | 115 (11.0) | 0.80 (0.60–1.07) | 0.14 | 0.76 (0.55–1.03) | 0.08 |
| Race/ethnicity | ||||||
| White, non-Hispanic (n=1527) | 1333 (86.8) | 194 (13.2) | Reference | NA | Reference | NA |
| Black, non-Hispanic (n=186) | 162 (86.3 | 24 (13.7) | 1.05 (0.65–1.68) | 0.85 | 0.89 (0.51–1.55) | 0.67 |
| Other, non-Hispanic (n=125) | 116 (95.3) | 9 (4.7) | 0.32 (0.13–0.78) | 0.01 | 0.39 (0.16–0.96) | 0.04 |
| Hispanic (n=180) | 166 (92.0) | 14 (8.0) | 0.57 (.31–1.04) | 0.07 | 0.42 (0.22–0.80) | 0.01 |
| Age | ||||||
| 50–64 (n=1002) | 865 (86.2) | 137 (13.8) | Reference | NA | Reference | NA |
| 65–80 (n=1016) | 912 (90.5) | 104 (9.5) | 0.67 (0.50–0.88) | 0.00 | 0.77 (0.50–1.16) | 0.21 |
| Education | ||||||
| High school or less (n=667) | 581 (87.1) | 86 (12.9) | Reference | NA | Reference | NA |
| Some college (n=667) | 582 (86.8) | 85 (13.2) | 1.02 (0.72–1.44) | 0.90 | 0.94 (0.65–1.37) | 0.75 |
| Bachelor's or higher (n=684) | 614 (90.1) | 70 (9.9) | 0.74 (0.52–1.06) | 0.10 | 0.68 (0.44–1.04) | 0.08 |
| Total annual household income | ||||||
| <$30,000 (n=242) | 207 (85.7) | 35 (14.3) | Reference | NA | Reference | NA |
| $30,000–$59,999 (n=433) | 378 (87.1) | 55 (12.9) | 0.89 (0.55–1.44) | 0.63 | 1.33 (0.77–2.23) | 0.30 |
| $60,000–$99,999 (n=511) | 460 (89.7) | 51 (10.3) | 0.69 (0.42–1.13) | 0.14 | 1.13 (0.63–2.01) | 0.68 |
| $100,000 or more (n=832) | 732 (88.3) | 100 (11.7) | 0.79 (0.51–1.23) | 0.30 | 1.42 (0.81–2.50) | 0.23 |
| Marital status | ||||||
| Married or partnered (n=1435) | 1294 (90.6) | 141 (9.4) | Reference | NA | Reference | NA |
| Not married or partnered (n=583) | 483 (82.0) | 100 (18.0) | 2.11 (1.57–2.84) | 0.00 | 2.32 (1.66–3.25) | 0.00 |
| Current employment status | ||||||
| Employed (n=811) | 714 (88.5) | 97 (11.5) | Reference | NA | Reference | NA |
| Retired (n=937) | 842 (89.9) | 95 (10.1) | 0.87 (0.63–1.20) | 0.39 | 1.17 (0.75–1.83) | 0.50 |
| Unemployed (n=169) | 142 (83.5) | 27 (16.5) | 1.52 (0.93–2.49) | 0.10 | 1.87 (1.12–3.11) | 0.02 |
| On disability (n=98) | 76 (79.2) | 22 (20.8) | 2.02 (1.16–3.53) | 0.01 | 1.72 (0.85–3.46) | 0.13 |
| Alcohol useb | ||||||
| No alcohol use (n=615) | 580 (94.6) | 35 (5.5) | Reference | NA | Reference | NA |
| Low-risk alcohol use (n=835) | 744 (89.1) | 91 (10.9) | 2.13 (1.37–3.31) | 0.00 | 2.48 (1.56–3.94) | 0.00 |
| Hazardous alcohol use (n=375) | 317 (84.0) | 58 (16.1) | 3.32 (2.05–5.37) | 0.00 | 4.14 (2.46–6.96) | 0.00 |
| Harmful alcohol use (n=193) | 136 (68.5) | 57 (31.5) | 7.98 (4.84–13.16) | 0.00 | 8.83 (5.14–15.17) | 0.00 |
| In general, how would you rate your mental health? | ||||||
| Excellent/very good (n=1352) | 1212 (89.6) | 140 (10.4) | Reference | NA | Reference | NA |
| Good (n=508) | 434 (85.5) | 74 (14.5) | 1.46 (1.06–2.03) | 0.02 | 1.23 (0.84–1.78) | 0.29 |
| Fair or poor (n=153) | 127 (83.2) | 26 (16.8) | 1.74 (1.06–2.89) | 0.03 | 1.21 (0.64–2.23) | 0.56 |
| In general, how would you rate your physical health? | ||||||
| Excellent/very good (n=912) | 816 (89.4) | 96 (10.6) | Reference | NA | Reference | NA |
| Good (n=815) | 716 (87.9) | 99 (12.1) | 1.16 (0.84–1.60) | 0.36 | 1.06 (0.73–1.52) | 0.77 |
| Fair or poor (n=290) | 244 (83.9) | 46 (16.1) | 1.61 (1.07–2.43) | 0.02 | 1.31 (0.76–2.26) | 0.33 |
A logistic regression model (0=no cannabis use; 1=any past-year cannabis use) was adjusted for all other variables.
Alcohol-use categories are based on AUDIT-C scores. No alcohol use=0; low-risk=1–2 for females, 1–3 for males; hazardous=3–4 for females and 4–5 for males; harmful=5+ for females and 6+ for males.
A two-tailed p<0.05 was considered statistically significant.
aOR, adjusted odds ratio; AUDIT-C, Alcohol Use Disorder Identification Test, Consumption; CI, confidence interval; NA, not applicable; OR, odds ratio.
Analysis
Analyses were conducted using survey weights provided by Ipsos, developed based on U.S. population estimates from the 2020 March Supplement of the Current Population Survey, and adjusted for poststratification to account for differential nonresponse. Participants were classified into two cannabis-use groups based on whether they reported any cannabis use in the past year or reported “never” using cannabis in the past year. We created clinically meaningful alcohol-use categories based on AUDIT-C scores and participant sex (no alcohol use=0; low risk=1–2 for females, 1–3 for males; hazardous=3–4 for females and 4–5 for males; harmful=5+ for females and 6+ for males). The association of past-year cannabis use (yes, no) with respondent characteristics and health variables was evaluated using logistic regression in unadjusted and multivariable analyses using Stata version 15.1 (StataCorp LLC). Models were adjusted for all variables listed in Table 1.
Results
The survey completion rate was 78% (n=2023/2583). Among 2023 participants aged 50–80 (52.7% female), 12.1% reported past-year cannabis use in the past year (Table 1). This included 13.8% of adults ages 50–64 and 9.5% of adults ages 65–80. Among those who used cannabis, 34.2% reported daily or near daily use in the past year (4.1% of the total sample) (Fig. 1). In adjusted analysis, cannabis use was less likely among those of Hispanic ethnicity (adjusted odds ratio [aOR]=0.42 [95% confidence interval [CI], 0.22–0.80]; p=0.008) and “other” races (aOR=0.39 [95% CI, 0.16–0.96]; p=0.04) relative to white non-Hispanic respondents. Those who were unmarried/unpartnered (aOR=2.32 [95% CI, 1.66–3.35]; p<0.001) and unemployed (aOR=1.87 [95% CI, 1.12–3.11]; p=0.017) were more likely to report cannabis use.
FIG. 1.
Frequency of cannabis use among adults ages 50–80.
Compared with respondents who did not drink alcohol in the past year, those who drank any amount of alcohol were more likely to report cannabis use (low risk alcohol use: aOR=2.48 [95% CI, 1.56–3.94]; p<0.001, hazardous alcohol use: aOR=4.14 [95% CI, 2.46–6.96]; p<0.001). Those drinking at harmful levels, defined as alcohol consumption that causes physical or psychological harm, had the highest likelihood of cannabis use (aOR=8.83 [95% CI, 5.14–15.17]; p<0.001) compared with those who did not drink alcohol.
Compared with those who reported excellent mental health, those with “good” or “fair/poor” mental health were more likely to report cannabis use in unadjusted models only (good: odds ratio [OR]=1.46 [95% CI, 1.06–2.03]; p=0.02; fair/poor: OR=1.74 [95% CI, 1.06–2.89] p=0.03). Compared with those who reported excellent physical health, those with poor/fair physical health were more likely to report cannabis use in unadjusted models only (OR=1.61 [95% CI, 1.07–2.43]; p=0.02).
Discussion
In this national study, 12.1% of U.S. adults aged 50–80 reported cannabis use in the past year as of January 2021, including 13.8% of middle-aged adults (ages 50–64) and 9.5% of older adults (ages 65–80). Among those who use cannabis, one in three reported using cannabis four or more times per week. These prevalence rates are higher than those reported in the 2020 National Survey of Drug Use and Health, which found that 10.3% of adults older than 50 used cannabis in the past year, including 6.0% of those older than 65 years.15 Individuals who were unmarried and unemployed were more likely to use cannabis, which is consistent with other research and likely reflects higher levels of socioeconomic stressors in these groups.16,17 Hispanic ethnicity and non-white/non-black race were protective factors against cannabis use. These demographic findings are consistent with other studies of cannabis use in the United States.2,15
Research highlights protective cultural factors in the Hispanic community, including higher disapproval of cannabis and higher religiosity, with recent immigrants and those reporting lower acculturation generally reporting lower cannabis involvement.4,18–20
A person's frequency of cannabis use is critical information needed to assess cannabis-related health risks. Frequent (i.e., daily or near-daily) cannabis use is linked to increased harms in older adults, including mental health problems, and is a positive predictor of respiratory symptoms, social problems, and cannabis-use disorder.9,21,22 In our study, a sizable proportion of those who use cannabis reported doing so multiple times each week, consistent with other studies conducted in this age group.22 Thus, our findings add additional evidence to the literature indicating a large proportion of older adults, aged 50–80, who use cannabis do so at levels linked to harmful and costly clinical outcomes. Older adults should receive health guidance regarding cannabis use, recommending abstinence from cannabis as the safest choice, with additional recommendations for low-potency and low-frequency cannabis use among those who chose to use cannabis.23
This study also found increased odds of cannabis use across all alcohol-use categories when compared with those who do not drink any alcohol. In the heaviest drinking group, the odds of cannabis were nearly eightfold higher that in the nondrinking group. This finding is consistent with prior national studies that report significantly higher odds of alcohol-use disorders among adults 50 and older who use cannabis relative to those who do not.24 The overlap between cannabis and alcohol use represents a high-risk behavior, particularly in older adults. Couse of alcohol and cannabis is associated with an increased likelihood of a constellation of negative consequences, including comorbid substance-use and mental health disorders, increased likelihood of driving when impaired, greater quantity and frequency of substance use, and greater physical impairment.25
In addition, research indicates that the majority of adults 50 and older who use cannabis and alcohol use the substances simultaneously (i.e., at the same time),26 further potentiating risks to physical and mental health.26,27 Clinicians and policymakers should take steps to identify and address cannabis use and couse among older adults. These steps could include additional recommendations and support for regular cannabis-use screening, risk education, and counseling in this age group when screening for alcohol and other drug use.
Conclusion
More than one in 10 U.S. adults aged 50 and older used cannabis in the past year. Among those who used cannabis, one in three used cannabis at least four times per week. This warrants the attention of clinicians, families, and communities given the risk of cannabis use to older adults and the increasing accessibility and potency of cannabis products. Although this study did not evaluate medical versus recreational cannabis use, additional research should evaluate older adults' reasons for using cannabis, quantity, potency, and methods of use, as well as motives for use of both cannabis and alcohol, and the long-term effects on physical and mental health.
Abbreviations Used
- aOR
adjusted odds ratio
- AUDIT-C
Alcohol Use Disorder Identification Test, Consumption
- CI
confidence interval
- NPHA
National Poll on Healthy Aging
- OR
odds ratio
Author Disclosure Statement
J.T.K. has received consulting fees from SeeChange Health, HealthMine, the Kaiser Permanente Washington Health Research Institute, and the Washington State Office of the Attorney General; and honoraria from the Robert Wood Johnson Foundation, AbilTo, Inc., the Kansas City Area Life Sciences Institute, the American Diabetes Association, the Luxembourg National Research Fund, the Donaghue Foundation, the National Science Foundation, the University of California-Los Angeles, and the University of Pennsylvania. No other authors have conflicts of interest to declare.
Funding Information
The University of Michigan NPHA is supported by AARP and Michigan Medicine. A.C.F. effort was partially supported by a career development award from the National Institute of Alcohol Abuse and Alcoholism (K23 AA023869). Support for J.T.K. was also provided by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.
Cite this article as: Fernandez AC, Coughlin L, Solway ES, Singer DC, Kullgren JT, Kirch M, Malani PN (2024) Prevalence and frequency of cannabis use among adults ages 50–80 in the United States, Cannabis and Cannabinoid Research 9:1, 59–64, DOI: 10.1089/can.2023.0056.
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