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. Author manuscript; available in PMC: 2025 Nov 22.
Published in final edited form as: Clin Gerontol. 2024 Nov 22;48(5):1255–1267. doi: 10.1080/07317115.2024.2429595

Cannabidiol Use Among Older Adults: Associations with Cannabis Use, Physical and Mental Health, and Other Substance Use

Namkee G Choi 1,*, C Nathan Marti 2, Bryan Y Choi 3
PMCID: PMC12095604  NIHMSID: NIHMS2037168  PMID: 39575982

Abstract

Objectives:

To examine older adults’ cannabidiol (CBD) use and its associations with cannabis use and physical/mental health and other substance use problems.

Methods:

Using the 2022 National Survey on Drug Use and Health (N=10,516 respondents age 50+), we fitted generalized linear models (GLM) with Poisson and log link using CBD as the dependent variable in the 50–64 and the 65+ age groups.

Results:

In the 50–64 age group, 18.3% and 18.0% reported past-year CBD and cannabis, respectively, use. In the 65+ age group, the percentages were 14.3% and 8.0%. GLM results showed significant positive associations with both medical and non-medical cannabis use in both age groups. CBD use was positively associated with physical/mental health and illicit drug use problems in the 50–64 age group and with disordered psychotherapeutic drug use in the 65+ age group. Minoritized older adults had a lower likelihood of CBD use.

Conclusions:

CBD use is common, more so than cannabis especially in the 65+ age group and positively correlated with both medical and nonmedical cannabis use.

Keywords: Cannabidiol, CBD, THC, Cannabis, Chronic illness, Mental illness, Substance use problems

Introduction

Federal and state laws regulating the use of cannabinoid products containing Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have changed substantially over the past decade. A number of states have legalized medical and non-medical use of THC-containing products, i.e., cannabis, and the 2018 Farm Bill broadly legalized the production and sales of CBD products, i.e., the hemp-derived products that contain no more than 0.3% THC, by removing them from Schedule I status under the Controlled Substances Act (Hudak, 2018). In the increasingly permissive environment for cannabinoid use, commercial markets for and sales of THC and CBD products, including oils/tinctures, topical preparations/serums, edibles/drinks, capsules/pills, and concentrates, have proliferated for their purported therapeutic benefits and as dietary supplements (Spindle et al., 2019; Skodzinski, 2024; Wagoner et al., 2021).

Systematic reviews of the therapeutic benefits of THC-dominant cannabinoid products showed low to moderate evidence for small improvements in chronic and neuropathic pain but increased risk for dizziness and sedation (Chou et al., 2023; McDonagh et al., 2022; Seffah et al., 2023). Medicinal cannabis does not yet have an established evidence base for its benefits for mental illnesses (Crichton et al., 2024; Seffah et al., 2023; Stanciu et al., 2021) and dementia (Bosnjak Kuharic et al., 2021). Moreover, systematic reviews found that cannabis use is associated with the development and worsened course and prognosis of major depressive and bipolar disorders (Sorkhou et al., 2024; Tourjman et al., 2023). Although dronabinol (whose trade names include Marinol and Syndros) was approved by the U.S. Food and Drug Administration (FDA) in 1985 for treatment of nausea and vomiting associated with cancer chemotherapy and low appetite among people diagnosed with AIDS, a systematic review found THC not to have positive effects on appetite-related symptoms in cancer patients (National Cancer Institute, 2023; Razmovski-Naumovski et al., 2022).

Despite its purported health and wellness benefits, scientific evidence for CBD is also slim except for its efficacy and safety in pediatric patients with Lennox-Gastaut syndrome or Dravet syndrome: rare and severe forms of epilepsy with onset in early childhood (Aderinto et al., 2024; Lattanzi et al., 2019; Laux et al., 2019). Epidiolex for Lennox-Gastaut and Dravet syndromes is the only FDA-approved CBD-based prescription medicine. Research on CBD’s other therapeutic benefits is in its incipient stage, and the outcomes of limited clinical trials showed little or no positive medicinal effects for different types of pain (Filippini et al., 2022; Häuser et al., 2023; Mücke et al., 2018) or mental health problems (Dammann et al., 2024; Khan et al., 2020; Kirkland et al., 2022). However, unlike psychoactive THC, CBD has been shown to be safe except for short-term sedation, drowsiness, or some cognitive delays as side effects in some individuals (Lo et al., 2024; Manning et al., 2024; MacNair et al., 2022).

The lack of scientific evidence of positive health effects and the FDA’s clear warnings about unproven health claims made by manufacturers selling CBD products over the counter did not stop the rapid uptake of CBD (Soleymanpour et al., 2021; Wagoner et al., 2021). In 2019, 14% of U.S. adults tried CBD (Sideris & Doan, 2024). In the 2022 National Survey on Drug Use and Health (NSDUH), 23% and 20% of the adult (age ≥ 18 years) population self-reported past-year use of cannabis and CBD, respectively; more than half of cannabis users co-used CBD and close to two-thirds of CBD users co-used cannabis (Choi et al., 2024). The high prevalence of CBD-cannabis co-use is likely because users of either product tend to have more positive perceptions leading to higher inclination to use the other (Spinella et al., 2023). In their study of Canadian adults, Spinella et al. found that both prior cannabis users and nonusers rated CBD higher than THC in therapeutic effects on sleep, stress, pain, anxiety, attention, and nausea. Compared to nonusers, prior cannabis users also rated all cannabinoids higher for many non-therapeutic positive effects including enhanced mood, creativity, and social and sexual facilitation, and were less likely to endorse negative effects including the risks for impaired cognition, addiction, and psychosis. CBD users mostly report high perceived positive health and wellness effects (Binkowska et al., 2024; Corroon & Phillips, 2018; Fedorova et al., 2021; Geppert et al., 2023; Goodman et al., 2022; Kaufman et al., 2023; Leas et al., 2020; Moltke & Hindocha, 2021).

Cannabinoid use has been increasing among adults of all ages (Caulkins, 2024; Wilson-Poe et al., 2023); however, the increases were fastest among those age 50 and older (Han & Palamar, 2020). Individuals age 50 and older also compose the largest share of state medical cannabis registrants, with chronic pain, musculoskeletal disorders and spasms, cancer, Parkinson’s disease, and sleep disorders being the primary conditions for medicinal use (Brown et al., 2020; Kaufmann et al., 2022; Porter et al., 2021). These studies showed that a majority of medical users, especially those age 65 and older, used CBD-only or CBD-dominant (i.e., high CBD to THC ratio) products. Given its purported health and wellness benefits and higher safety evidence than THC, it is not surprising that older adults (age 65+) who tend to have more health-related problems are attracted to using CBD. They may be especially inclined to use CBD only or CBD+THC as opposed to THC-only products to reduce potential harms associated with THC-only use. A systematic review found that CBD may reduce intense experiences of anxiety or psychosis-like effects, but not subjective intoxication or psychomotor effects, of THC (Freeman et al., 2019). A study also found that regular cannabis users who consumed a THC+CBD product reported similar levels of positive and psychotomimetic effects relative to those who consumed a THC-only product, despite consuming less THC and displaying lower plasma THC concentrations (Gibson et al., 2024).

Older adults may also want to substitute CBD for opioids and other pain medications (Boehnke et al., 2021). A survey of medical cannabis dispensary members (ages 18–84) showed that three quarters reduced their use of opioids and two thirds reduced anti-anxiety, migraine, and sleep medications and more than one-third reduced anti-depressant use (Piper et al., 2017). A 4-week observational study of CBD users (ages 18–75) also found that among those who took CBD for chronic pain, 42% and 24% decreased or stopped over-the-counter and prescription drugs, respectively, during the study period (Kaufmann et al., 2023). Those who used CBD for sleep disorders, mental health problems, and other conditions also reduced or stopped over-the-counter (25–33%) and prescription (8–23%) drugs (Kaufmann et al., 2023).

To date, however, little epidemiologic research has been done on CBD use among those age 50 years and older. In the present study, we used the 2022 NSDUH (that included the questions about past-year and past-month use of “CBD or hemp products made from hemp plants” (referred to as CBD hereafter for brevity) for the first time in the annual NSDUH history) and examined the prevalence of past-year CBD and cannabis use among individuals age 50 and older and the associations of CBD use with medical or non-medical cannabis use, physical and mental health statuses, and other substance use, controlling for sociodemographic factors.

Given the significant differences in physical and mental health and substance use statuses between the 50–64 age group and the 65+ age group, especially among cannabis users (Yang et al., 2024), we examined these two age groups separately. Yang et al. found that of the two age groups of cannabis users, the 65+ age group had a higher prevalence of more cardiovascular and musculoskeletal diseases, but the 50–64 age group had a higher prevalence of mood and anxiety disorders and alcohol and tobacco use disorders. Thus, CBD use may be associated with both physical and mental health problems in the 50–64 age group and with physical health problems in the 65+ age group. The study hypotheses were that: (H1) in both age groups, both medical and non-medical cannabis use would be significantly positively associated with CBD use; (H2a) moderate/severe mental illness and other substance use, as well as physical health problems, would be significantly positively associated with CBD use in the 50–64 age group; and (H2b) physical health problems will be significantly positively associated with CBD use in the 65+ age group. The findings will provide valuable insight into the associations between cannabis and CBD use and the physical and mental health and other substance use characteristics of individuals age 50 and older who used CBD as well as any potential differences between the 50–64 and the 65+ age groups.

Methods

Data source

The NSDUH is an annual epidemiologic survey, funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), of the civilian, non-institutionalized, age 12+ population to measure the prevalence of substance use, mental and substance use disorders, behavioral health treatment, and physical/functional health and healthcare use. Because of the ongoing COVID-19 pandemic, data collection in 2022 was done using both in-person and online modes. However, starting February 3, 2022, in-person data collection was available in all states and counties, and in-person data collection commenced after potential respondents were first given the opportunity to complete the survey online. The overall percentage of interviews completed online was 40.7% for 2022 (Center for Behavioral Statistics and Quality, 2023). The 2022 NSDUH public use data set includes responses from 59,069 individuals who completed an in-person or web-based NSDUH survey. Of these, 11,969 were age 12–17, and 47,100 were age 18 years or older (adults). In this study, we focused on 10,560 respondents, representing nearly 119 million U.S. adults, who were age 50 and older. Analysis of these de-identified public-use data was exempt from the authors’ institutional review boards’ review.

Measures

CBD and cannabis use: In the 2022 NSDUH, respondents were asked two questions about “CBD or hemp products made from hemp plants”: (1) Ever use, even once, of any CBD or hemp products (yes or no); and (2) time since the last use of any form of CBD or hemp product (within the past 30 days, more than 30 days ago but within the past 12 months, and more than 12 months ago). Respondents were also asked about use and time since the last use of “marijuana or any cannabis product, sometimes called pot, weed, hashish, or concentrates, excluding CBD or hemp products.” Based on the responses to these questions, we created the past-year CBD and cannabis use variables (nonuse of CBD or cannabis, CBD use only, cannabis use only, both CBD and cannabis use). Cannabis users were also asked about medical use (no vs. any medical use), frequency of use (in number of days), and the questions pertaining to the 11 criteria for DSM-5 cannabis use disorder (CUD). The NSDUH data set provided the summary variables for CUD (yes or no) and CUD severity (mild [2–3 symptoms], moderate [4–5 symptoms], or severe [6–11 symptoms]) (American Psychiatric Association, 2013).

Physical and mental health and other substance use: Physical health status was measured with the number (0–10) of diagnosed chronic illnesses, including asthma, cancer, chronic obstructive pulmonary disease, diabetes, heart disease, hepatitis, HIV/AIDS, hypertension, kidney disease, and liver disease. Mental health status was measured with any past-year mental illness (none, mild, moderate, serious). Serious mental illness refers to any mental, behavioral, or emotional disorder--excluding developmental and substance use disorders--that substantially interfered with or limited one or more major life activities (SAMHSA, 2023). Past-year other substance use problems included in the study were nicotine dependence (Heatherton, et al., 1991), DSM-5 alcohol use disorder, any prescription opioid, tranquillizer, and/or sedative medication use disorder (referred to as disordered psychotherapeutic drug use hereafter), and the use of any illicit drugs excluding cannabis.

Sociodemographic factors were age (50–64 and 65+ years); gender; race/ethnicity; marital status (married vs. not married); education (college degree vs. no college degree); income (<poverty line, up to 2X poverty line, >2X poverty line); and the residence in a medical cannabis legal state (yes vs. no).

Analysis

We used Stata/MP 18’s svy function (College Station, TX) and subpop command in all analyses to account for NSDUH’s multi-stage, stratified sampling estimates to ensure that variance estimates incorporate the full sampling design. All estimates presented in this study are weighted except sample sizes. First, we calculated the prevalence, with 95% confidence intervals (CI), of past-year CBD and cannabis use in the 50–64 and the 65+ age groups. Second, we used Pearson’s χ2 and t tests to compare CBD users with nonusers in the 50–64 and the 65+ age groups regarding cannabis use, sociodemographic, physical and mental health, and other substance use characteristics. Third, we fitted three generalized linear models (GLMs) for a Poisson distribution with a log link function to test the study hypotheses (associations of CBD use with cannabis use [medical and non-medical uses vs. no cannabis use), physical and mental health statues, and other substance use) for the combined age group (i.e., all those age 50 and older, to examine age group effect) and separately for the 50–64 age and 65+ age groups. We further examined possible differences between medical versus nonmedical uses of cannabis in their associations with CBD use by fitting two additional GLMs (one for each age group) with non-medical use as the reference category (i.e., medical cannabis use and nonuse of cannabis vs. non-medical use of cannabis). The GLM results are presented as incidence rate ratios (IRR) with 95% CI. We used the Poisson distribution with a log link rather than logistic regression models because odds ratios exaggerate the true relative risk to some degree when the event (i.e., CBD use) is a common (i.e., >10%) occurrence (Grimes & Schulz, 2008). As a preliminary diagnostic, variance inflation factor (VIF), using a cut-off of 2.50 (Allison, 2012), from linear regression models was used to assess multicollinearity among covariates. VIF diagnostics indicated that multicollinearity was not a concern. Significance was set at p<.05.

Results

Prevalence of past-year CBD and cannabis use in the 50–64 and 65+ age groups

Table 1 shows that 18.3% and 14.3% of the 50–64 and 65+ age groups, respectively, reported using CBD in the preceding 12 months. The corresponding percentages for cannabis use were 18.0% and 8.0%, showing that CBD use was more prevalent than cannabis use in the 65+ age group. Table 1 also shows that 8.9% and 9.9% of the 50–64 and the 65+ age groups, respectively, reported using CBD alone; 8.6% and 3.6%, respectively, reported using cannabis alone; and 9.4% and 4.4%, respectively, reported using both CBD and cannabis.

Table 1.

Prevalence of past-year CBD and cannabis use in U.S. individuals age 50 and older

Age 50 and older Age 50–64 Age 65 and older
Sample N 10,560 5,369 5,191
Population size 118,705,224 61,928,903 56,776,322
Non-use of CBD or cannabis (%) 77.4 (75.7–79.0) 73.1 (71.0–75.1) 82.1 (80.0–84.0)
Any CBD use (%) 16.4 (15.0–17.8) 18.3 (16.4–20.3) 14.3 (12.9–15.9)
Any cannabis use (%) 13.3 (12.1–14.4) 18.0 (16.5–19.7) 8.0 (6.7–9.6)
Use of CBD only, cannabis only, or both (%)
 CBD only 9.4 (8.4–10.5) 8.9 (7.6–10.4) 9.9 (8.7–11.3)
 Cannabis only 6.3 (5.5–7.1) 8.6 (7.5–10.1) 3.6 (2.8–4.6)
 Both CBD and cannabis 7.0 (6.2–7.9) 9.4 (8.1–10.9) 4.4 (3.5– 5.4)
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(): 95% confidence intervals

Note: Prevalence data were calculated based on the 2022 National Survey on Health and Drug Use public use data file.

Characteristics of CBD users compared to nonusers

Table 2 shows that in the 50–64 age group, 51.3% of CBD users, compared to 10.6% of nonusers of CBD, used cannabis. In the 65+ age group, 30.7% of CBD users, compared to 4.3% of nonusers of CBD used cannabis. Of the CBD-cannabis co-users, 22.4% and 29.0% in the 50–64 and 65+ age groups, respectively, were medical cannabis users. In both age groups, CBD users also had higher proportions of non-Hispanic whites. In the 50–64 age group, CBD users had a higher proportion of females than non-users. In the 65+ age group, CBD users included higher proportions of college graduates and the residents of medical cannabis legal states.

Table 2.

Characteristics of past-year CBD users compared to nonusers

Age 50–64 Age 65 and older
No CBD use CBD use p No CBD use CBD use p
N (%) 4,408 (81.7%) 961
(18.3)		 4,391
(85.7%)		 800
(14.3%)
Past-year cannabis use status (%) <.001 <.001
 Nonuse 89.4 48.7 95.7 69.3
 Any medical use 1.3 11.5 0.8 8.9
 Nonmedical use only 9.3 39.8 3.5 21.8
Cannabis use disorder (%) <.001 .002
 None 98.1 89.2 99.7 97.5
 Mild disorder 1.4 7.6 0.2 1.6
 Moderate disorder 0.4 1.9 0.1 0.9
 Severe disorder 0.1 1.3 0 0
Female (%) 49.8 55.8 .046 54.6 55.8 .689
Race/ethnicity (%) <.001 .043
 Non-Hispanic white 62.8 79.5 73.2 81.6
 Non-Hispanic Black 12.7 8.1 9.8 7.0
 Hispanic 16.6 6.3 10.3 5.4
 All other 7.9 6.1 6.7 6.0
Married (%) 60.5 61.0 .835 57.4 61.1 .238
College degree (%) 32.2 31.1 .619 31.1 37.3 .022
Income (%) .731 .185
 Below poverty line 13.1 11.5 9.6 7.8
 Up to 2X poverty line 17.0 17.1 20.5 16.6
 More than 2X poverty line 69.9 71.3 69.9 75.6
Residence in medical cannabis legal state (%) 72.3 76.1 .214 74.0 82.3 .003
No. of chronic illnesses (M, SE) 0.81 (0.02) 1.09 (0.07) <.001 1.26 (0.03) 1.34 (0.06) .180
Past-year any mental illness (%) <.001 <.001
 None 85.4 72.5 90.0 85.4
 Mild 7.0 10.2 6.6 6.5
 Moderate 3.8 10.0 2.0 6.2
 Severe 3.7 7.3 1.4 1.9
Nicotine dependence (%) 9.7 12.6 .040 5.0 4.6 .747
Alcohol use disorder (%) 8.9 14.7 <.001 3.6 8.1 <.001
Disordered psychotherapeutic drug usea (%) 3.2 4.6 .142 2.0 4.6 .016
Illicit drug (other than cannabis) use (%) 5.3 14.6 <.001 2.3 6.7 <.001
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a

Any prescription opioid, tranquillizer, and/or sedative medication use disorder

Note: probability values were calculated based on Pearson’s χ2 and t tests.

Among CBD users, 10.8% of the 50–64 age group had CUD (7.6% mild, 1.9% moderate, and 1.3% severe CUDs); and 2.5% of the 65+ age group had CUD (1.6% mild and 0.9% moderate CUDs). Among nonusers of CBD, 1.9% and 0.3% of the 50–64 and 65+ age groups, respectively, had CUD. Additional analyses showed that among cannabis users age 50–64 (n=877), CBD users and nonusers did not differ on CUD rates (F[2.87, 143.68]=0.360, p=.773), although a larger proportion of CBD users (58.2% vs. 41.1%) used cannabis more frequently (i.e., 100+ days; F[3.76, 188.04]=2.857, p=.028). Among cannabis users age 65+ (n=429), CBD users and non-users did not differ on CUD rates (F[1.67, 80.21]=0.272, p=.723) and cannabis use frequency (42.5% vs. 43.5% used 100+ days; F[3.09, 148.41]=0.802, p=.498).

Table 2 also shows that CBD users in the age 50–64 age group had higher rates of chronic illnesses, any mental illnesses, alcohol use disorder, nicotine dependence, and illicit drugs. CBD users in the 65+ age group included higher rates of any mental illness, alcohol use disorder, disordered psychotherapeutic drug use, and illicit drug use.

Correlates of past-year CBD use: Results from GLMs

The second column of Table 3 shows that age group (65+ years vs. 50–64 years) was not a significant factor for CBD use when other variables were controlled for. The third and fourth columns of Table 3 shows that in both age groups, CBD use was significantly associated with both medical and non-medical cannabis use: IRR=5.17, 95% CI=4.07–6.57 for any medical use and IRR=4.42, 95% CI=3.65–5.37 for non-medical use in the 50–64 age group; and IRR=5.59, 95% CI=4.36–7.18 for any medical use and IRR=4.19, 95% CI=3.18–5.54 for nonmedical use in the 65+ age group. These findings support H1.

Table 3.

Associations of CBD use with cannabis use, physical and mental health, and other substance use problems: Results from generalized linear models for a Poisson distribution using a log link function

Both age groups
(Age 50+ years)		 Age 50–64 only Age 65+ only
IRR (95% CI) IRR (95% CI) IRR (95% CI)
Past-year cannabis use status: vs. No use
 Any medical use 5.38 (4.42–6.55)*** 5.17 (4.07–6.57)*** 5.59 (4.36–7.18)***
 Nonmedical use only 4.41 (3.82–5.09)*** 4.42 (3.65–5.37)*** 4.19 (3.18–5.54)***
No. of chronic medical conditions 1.10 (1.04–1.15)** 1.13 (1.05–1.12)* 1.05 (0.98–1.12)
Past-year mental illness: vs. None
 Mild mental illness 1.20 (0.99–1.44) 1.29 (1.02–1.62)* 1.00 (0.70–1.43)
 Moderate/severe mental illness 1.34 (1.07–1.68)* 1.35 (1.03–1.77)* 1.32 (0.97–1.81)
Nicotine dependence 0.84 (0.68–1.04) 0.84 (0.66–1.07) 0.78 (0.52–1.17)
Alcohol use disorder 1.08 (0.91–1.28) 1.05 (0.86–1.26) 1.23 (0.89–1.71)
Disordered psychotherapeutic drug usea 1.00 (0.78–1.28) 0.79 (0.54–1.15) 1.50 (1.05–2.14)*
Illicit drug (other than cannabis) use 1.27 (1.07–1.50)** 1.30 (1.07–1.57)* 1.32 (0.98–1.77)
Age 65+ vs. Age 50–64 0.96 (0.86–1.07)
Female vs. Male 1.30 (1.13–1.49)*** 1.39 (1.18–1.64)*** 1.18 (0.97–1.42)
Race/ethnicity: vs. Non-Hispanic white
 Non-Hispanic Black 0.70 (0.54–0.91)** 0.68 (0.52–0.91)** 0.72 (0.47–1.09)
 Hispanic 0.52 (0.41–0.66)*** 0.48 (0.37–0.63)*** 0.58 (0.35–0.95)*
 Other 0.76 (0.56–1.05) 0.70 (0.51–0.95)* 0.91 (0.52–1.62)
Married vs. Not married 1.19 (1.04–1.36)* 1.22 (1.05–1.42)** 1.12 (0.90–1.39)
College degree vs. No degree 1.11 (0.99–1.23) 1.05 (0.92–1.21) 1.12 (0.92–1.37)
Income: vs. Below poverty line
 Up to 2X poverty line 1.02 (0.77–1.36) 1.05 (0.75–1.47) 1.04 (0.59–1.83)
 More than 2X poverty line 1.09 (0.81–1.46) 1.09 (0.80–1.50) 1.15 (0.69–1.92)
Residence in medical cannabis legal state vs. illegal state 1.05 (0.86–1.29) 0.93 (0.73–1.18) 1.27 (1.00–1.62)*
N 10,560 5,369 5,191
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a

Any prescription opioid, tranquillizer, and/or sedative medication use disorder

Note: IRR: Incident rate ratios

*

p<.05;

**

p<.01;

***

p<.001

Figure 1 is the graphic illustration of the GLM results shown in Table 3 regarding the associations between CBD use and cannabis use after adjusting for all other covariates.

Figure 1.

Figure 1.

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Adjusted predicted probability of past-year CBD use by past-year cannabis use

Additional analyses (results not included in Table 3) showed that medical or non-medical use did not differ significantly in the 50–64 age group (IRR=1.17, 95% CI=0.94–1.45, p=.150); however, in the 65+ age group, the likelihood of CBD use was higher among medical cannabis users than among non-medical users (IRR=1.33, 95% CI=1.02–1.74, p=.033).

In the 50–64 age group, CBD use was also significantly associated with the number of chronic illnesses (IRR=1.13, 95% CI=1.05–1.22), any mental illness (IRR=1.29, 95% CI=1.02–1.62 for mild mental illness and IRR=1.35, 95% CI=1.03–1.77 for moderate/severe mental illness), and illicit drug use (IRR=1.30, 95% CI=1.07–1.57). In the 65+ age group, CBD use was significantly associated with disordered psychotherapeutic drug use (IRR=1.50, 95% CI=1.05–2.14). These findings support H2a but not H2b.

Of the sociodemographic factors, the likelihood of CBD use in the 50–64 age group was higher among females than males, married than non-married individuals, and non-Hispanic whites than Blacks, Hispanics, and other racial/ethnic groups. In the 65+ age group, the likelihood of CBD use was lower among Hispanics but higher among the residents of medical cannabis legal states.

Discussion

This study is the first examination of nationally representative, epidemiologic data on CBD use among U.S. individuals age 50 and older. The findings show that the prevalence of past-year CBD use in the 50–64 age group (18.3%) was similar to that of cannabis use (18.0%) in 2022. However, the prevalence of CBD use in the 65+ age group was significantly higher than that of cannabis use (14.3% vs. 8.0%), indicating that CBD uptake has even outpaced that of rapidly-increasing cannabis use in this age group. The data also show that in the 50–64 age group, a little less than one out of ten used CBD only, another one out of ten used both CBD and cannabis, and yet another one out of ten used cannabis alone. In the 65+ age group, one out of ten used CBD only and a little less than one out of 13 used cannabis with or without CBD.

Our multivariable findings show significant associations between CBD use and medical or non-medical cannabis use in both age groups, although medical cannabis use was more closely associated with CBD use than non-medical cannabis use in the 65+ age group. The significant associations between CBD use and non-medical cannabis use in both age groups suggest that in general, older adults who use cannabis are more inclined to use CBD and vice versa. As described earlier, non-medical cannabis users may use CBD to counteract THC’s negative effects (Freeman et al., 2019; Gibson et al., 2024) and promote general wellness (e.g., CBD oil as a dietary and nutritional supplement; Bartončíková et al., 2023). Studies of young and middle-aged CBD users found that beauty-related and recreational motives were popular (Bilaonova et al., 2021; Kudrich et al., 2024).

Multivariable analysis also revealed some interesting findings pertaining to two age groups. Specifically, as hypothesized, both physical and mental health problems were significantly associated with CBD use in the 50–64 age group. However, in the 65+ age group, contrary to the study hypothesis, physical health problems were not significant correlates. Mental health problems were not a significant factor, either, for the 65+ age group. This suggests that CBD users age 50–64 are more likely than users age 65+ to use it for its purported therapeutic effects for physical and mental health conditions. Some users may have had an unmet healthcare need that other forms of treatment were not satisfying (Zenone et al., 2021). The lack of significant associations between CBD use and physical health in both bivariate and multivariable analyses in the 65+ age group is puzzling given the significant association between CBD and medical cannabis use. One reason may be the prevalence of chronic health conditions in this age group regardless of CBD use or nonuse.

The finding that illicit drug use in the 50–64 age group and disordered psychotherapeutic drug use in the 65+ age group were associated with higher likelihood of CBD use may be interpreted in two different ways. First, it suggests that older CBD users include a significant share of poly-drug users. Second, these poly-drug users may also have used CBD to alleviate the negative effects of illicit drugs (in the 50–64 age group) and to reduce harms associated with opioid and other psychotherapeutic drug use disorders (in the 65+ age group). A systematic review found that CBD may reduce drug cravings and other addiction-related symptoms and may have utility as an adjunct harm reduction strategy for people who use drugs (Lo et al., 2023). Other studies have also shown that CBD might be efficacious as a treatment for CUD (Bhardwaj et al., 2024) and nicotine, opioid, and psychostimulant use disorders (Karimi-Haghighi et al., 2022; Navarrete et al., 2021; Paulus et al., 2022). A recent study of individuals receiving opioid use treatment found that 23% had a history of using CBD; among CBD users (mean age 43.8±12.4 years), 17% reported using it to control their addiction and 42% to ease opioid withdrawal symptoms (Kudrich et al., 2024). Older adults with opioid or other psychotherapeutics (e.g., benzodiazepines) use problems may also be trying to substitute these medications with CBD as a safer alternative (Boehnke et al., 2021; Piper et al., 2017).

Of the demographic correlates, female gender was significantly associated with CBD use in the 50–64 age group, which is consistent with previous research findings. Kalaba and Ware (2022) found that among medical cannabis users, women more frequently consumed CBD-dominant products (especially CBD oil), and men more frequently consumed THC-CBD-balanced products. Women may also be more attracted to CBD for its mental health-related benefits as well as for beauty/skin care purposes (Baswan et al., 2020; Bilaonova et al., 2021). The context of the association between CBD use and marital status is not clear. However, the association between CBD use and residence in medical cannabis legal states in the 65+ age group is understandable given the significant association between CBD use and medical cannabis use. A previous study of the U.S. CBD users age 16–65 found that CBD users were more likely to be women and white (Goodman et al., 2022).

In both age groups, Blacks and Hispanics were less likely to have reported past-year CBD use. The lower likelihood of CBD use among minoritized older adults may reflect economic disparities, marketing of CBD, and cultural factors. CBD products can be expensive, thus a barrier for many older adults with fixed income, especially among minoritized older adults. An analysis of CBD marketing strategies of three large companies also found that nearly 85% of advertising occurrences and expenditures in the U.S. were via online display (Berg et al., 2023). Given the persisting digital divide among low-income, minoritized older adults (Tappen et al., 2022), they are less likely to be exposed to information and advertising about CBD than their non-Hispanic white peers. Historical context, stigma, and perceptions about legality and morality could also influence the acceptance and usage of CBD products.

This study has some limitations. First, the NSDUH did not collect any data on frequency and dosage of CBD use, types of CBD products, and reasons for use, limiting the study scope. Second, the NSDUH did not distinguish CBD from other hemp-derived products containing Δ8- or Δ10-THC that are widely available in the market (Geci et al., 2023). Δ8- or Δ10-THC are usually made synthetically from CBD and added to edible and inhaled products that are marketed as legal hemp products (Babalonis et al., 2021). With increasing CBD and other hemp product use in the population, the NSDUH needs to collect more detailed data on CBD use for more epidemiologic research. Third, since NSDUH is based on self-report data, the validity of respondents’ self-reported CBD, cannabis, and other substance use may have been affected by social desirability and recall bias. Fourth, given the low degree of consumer knowledge of THC and CBD levels (Hammond & Goodman, 2022), the reliability and validity of CBD use report is also a suspect.

Despite these limitations, our findings show that self-reported CBD use is common, more so than cannabis among older adults age 65 and older, and expand the knowledge base about CBD users and their characteristics. Along with its assumed health and wellness benefits, the non-psychoactive and other safety-related qualities and easy access to CBD products (e.g., at grocery and convenience stores) appear to have contributed to CBD’s rapid uptake. CBD’s popularity will likely rise given the public’s positive attitude towards its safety and efficacy as a natural product (Bhamra et al., 2021). While CBD use is exploding, studies have shown that most commercially available CBD products did not meet the definition of the product type claimed on the packaging and deviated from their label claim of CBD potency, contained THC, and showed lot-to-lot variability, making dosing unpredictable (Gidal et al., 2024; Miller et al., 2022; Spindle et al., 2022). With rapid increase in CBD use, more clinical research is needed to provide empirical evidence on CBD’s efficacy on physical and mental health especially among growing numbers of older-adult CBD users. The FDA needs to develop and enforce more effective rules and regulations to ensure safety of CBD and THC consumer products to protect older adults who are drawn to CBD for its therapeutic and general health effects. Research is also needed to better understand older adults’ motivation for and patterns of CBD use, associations between specific physical and mental health problems and CBD use, and demographic differences.

Clinical Implications:

Research is needed to examine therapeutic benefits and negative effects of CBD use in late life. Public health education is needed for growing numbers of older-adult CBD users.

Clinical Implications.

  • Public health education on CBD and other hemp products will be helpful for older adults who want to use them for its therapeutic effects.

  • Healthcare providers need to ask older adults about their CBD or hemp product use and discuss potential benefits and negative effects of CBD/hemp-cannabis co-use and other poly drug use.

Funding Source:

This study was supported by grant, P30AG066614, awarded to the Center on Aging and Population Sciences at The University of Texas at Austin by the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Declaration of Conflict of Interest: The authors declare that there is no conflict of interest.

Research Ethics: This study based on de-identified public-domain data was exempt by the University of Texas at Austin’s Institutional Review Board.

Contributor Information

Namkee G. Choi, Steve Hicks School of Social Work, University of Texas at Austin.

C. Nathan Marti, Steve Hicks School of Social Work, University of Texas at Austin.

Bryan Y. Choi, Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth.

Data Availability Statement:

This study is based on de-identified public-domain data (The National Survey on Drug Use and Health).

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

This study is based on de-identified public-domain data (The National Survey on Drug Use and Health).

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