Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Feb 21.
Published in final edited form as: Am J Prev Med. 2025 Oct 14;70(3):108149. doi: 10.1016/j.amepre.2025.108149

Epidemiology of Cannabis Use Among Middle-Aged and Older Adults in the U.S.

Ofir Livne 1,2, Malka Stohl 2, Jodi Gilman 3, Terry E Goldberg 1,2, Melanie M Wall 1,2, Deborah S Hasin 1,2,4
PMCID: PMC12922627  NIHMSID: NIHMS2134450  PMID: 41101401

Abstract

Introduction:

The prevalence of medical cannabis use, consumption methods, other key cannabis behaviors, and attitudes toward use is understudied, and associations with any cannabis use among U.S. middle-age and older adults is of particular interest because they are especially vulnerable to the adverse effects of cannabis.

Methods:

Health and Retirement Study data (N=1,324) were analyzed, calculating weighted prevalence for cannabis measures, including past-year use, consumption methods, medical use, health conditions for which cannabis was used, healthcare provider recommendations, attitudes toward acceptability, risks, and legalization, by primary age groups (50–64 and ≥65 years) and specified older age groups (65–74 and ≥75 years) and sex. Associations with any cannabis use were evaluated using multivariable logistic regression, adjusting for sex, race/ethnicity, household income, and employment.

Results:

Past-year cannabis use in the U.S. was reported by 18.5% and 5.9% of middle-age and older adults, respectively. Smoking was the primary consumption method in both groups. Approximately 25% of middle-aged adults and 20% of older adults who used cannabis consumed it for medical purposes, with ~20% of those receiving a prescription or recommendation. Over 75% of individuals in both age groups viewed medical use as acceptable, and older adults were more likely to view cannabis as a gateway drug and to support restrictions of cannabis laws.

Conclusions:

Cannabis use among both middle-aged and older U.S. adults is higher than previously reported in state- and national-level studies, with many engaging in cannabis behaviors associated with increased harm. Greater public health and clinical efforts are needed for tailored prevention and intervention strategies.

INTRODUCTION

Since 2006, cannabis use has increased disproportionately among middle-aged (ages 50–64 years) and older (ages ≥65 years) U.S. adults,1–6 with past-year use in adults aged ≥50 years increasing more than threefold5,7 and more pronounced among individuals with underlying physical and mental health conditions.8–12 Although some studies suggest that age-related brain changes may lower sensitivity to pharmacologic effects of cannabinoids in older adults,13–15 a large body of clinical and epidemiologic research indicates that adults aged ≥50 years are more vulnerable than younger adults to numerous adverse effects of cannabis use,16 for example, falls,17 motor vehicle crashes,18 injuries, emergency department visits,19 and declines in health.20–22 These findings underscore the need for further research to better understand cannabis use behaviors and consequences in this growing population and to address key public health challenges.

Several factors have contributed to the increased prevalence of cannabis use among adults aged ≥50 years. One is the aging of the Baby Boomer cohort, who had higher adolescent rates of drug use and more tolerant attitudes toward cannabis than previous cohorts.23–28 Other contributors include decreasing perceptions of cannabis as risky29 and growing beliefs in its benefits30,31 despite limited efficacy.16,32 U.S. cannabis legalization and the creation of commercial markets may also contribute to this trend; ~50% of adults aged ≥50 years support medical cannabis laws (CLs) and recreational CLs.33 As more states enact CLs and the U.S. population ages,34 the number of middle-aged and older adults consuming cannabis is expected to increase further.5,35 However, existing epidemiologic studies of these age groups have not addressed key cannabis behaviors and related measures.36

Extant knowledge about cannabis use in middle-aged and older adults often relies on data from small, nonrepresentative samples37–39 or from the National Survey on Drug Use and Health (NSDUH),1–3,40 which surveys basic cannabis use measures but fails to capture key predictors of harms such as methods of consumption and motivations for use. In addition, previous studies assessing sociodemographic characteristics of adults aged ≥50 years who use cannabis are either outdated or are based on nonrepresentative samples.41 Consequently, many questions about cannabis use among middle-aged and older adults remain unanswered: (1) What are the preferred cannabis products and consumption methods in these age groups? 37–39 (2) What are attitudes toward medical cannabis use, the prevalence of medical use, and specific health conditions for which medical cannabis is being used? In addition, to what extent was medical cannabis use prescribed or recommended by a healthcare provider? These questions are particularly important to answer given the risk of interactions between medication and cannabis,42 especially among older populations who frequently engage in polypharmacy.43 (3) What are key sociodemographic characteristics of middle-aged and older adults who are at increased risk of cannabis use? Considering the broader societal acceptance of cannabis that may differentially impact sociodemographic subgroups over time,3 research aimed at addressing this question is crucial for developing targeted approaches for risk assessment and intervention strategies.

The Health and Retirement Study (HRS),44 supported by the National Institute on Aging, conducts national surveys of U.S. adults aged ≥50 years. In 2018, HRS conducted a comprehensive assessment of cannabis use behaviors, offering extensive nationally representative data on cannabis use among middle-aged and older adults in the U.S. This, together with careful sampling of these specific age groups and assessments of key sociodemographic factors relevant to middle-aged and older adults, such as employment and retirement status, and receipt of social security benefits, also make HRS a uniquely informative source of epidemiologic data on cannabis use in these understudied age groups. A recent HRS brief report45 noted associations of cannabis use measures with health conditions, opioid use, and service utilization in adults aged ≥50 years. However, although a useful start on addressing the epidemiology of cannabis use in this age group, it lacks key details on cannabis use measures, such as methods of consumption and medical use. In addition, it does not explore cannabis behaviors among more specific age groups within middle-aged and older adult or examine associations with age-specific sociodemographic measures, such as retirement status. Such information is critical to provide a better understanding of the cannabis landscape as it pertains to middle-aged and older adults.

Therefore, using 2018 HRS data, this study investigated (1) national prevalence of key cannabis behaviors never reported for adults aged ≥50 years, including methods of consumption, medical cannabis use and specific conditions for which cannabis was used, healthcare provider prescription or recommendation for medical cannabis use, and perceptions and attitudes toward cannabis use; (2) whether these cannabis behaviors differed by age groups that had been combined in previous studies and by sex; and (3) whether key sociodemographic characteristics are associated with increased risk of past-year cannabis use.

METHODS

Study Population

The HRS is a longitudinal, biannual nationally representative health survey of ~20,000 U.S. adults aged ≥50 years. It employs a multistage area probability design with geographic stratification and clustering, oversampling specific demographic groups,46 successfully recruiting and retaining minority participants.47 Core interviews are conducted in person or by phone. The HRS includes experimental modules, including 1 on attitudes toward and use of cannabis (2018). This module was administered to a randomly selected subset (~10%) of the HRS core self-respondents. As the module was randomly assigned, this analytic sample is representative of the broader HRS cohort, itself designed to reflect the U.S. population aged ≥50 years.48

Study participants provided written informed consent, and protocols were approved by the University of Michigan IRB. This study utilized data from deidentified public files, creating an analytic sample of core survey respondents who participated in the 2018 experimental module (N=1,324). Response rates for the core survey were 74%,49 and sampling weights accounted for differential probability of selection and nonresponse.46

Measures

Participants were assessed for past-year and lifetime cannabis use. Nonresponse on these items was imputed to no use. Among those who reported lifetime use, several variables were assessed: (1) method of consumption (smoking, other than smoking); (2) cannabis use for the treatment of health problems (medical cannabis use); and (3) healthcare provider recommendation for medical cannabis (healthcare provider involvement). Participants reporting medical cannabis use were asked about health conditions/symptoms for which they used cannabis; these were categorized into 4 groups: emotional and psychological conditions, neurologic and sensory conditions, physical conditions, and miscellaneous and other health conditions.

Participants of the 2018 cannabis module, regardless of whether they reported lifetime or past-year cannabis use, were asked binary questions about whether they (1) currently believe that cannabis use for medical reasons is acceptable; (2) believed that at age 18 years, cannabis use for medical reasons is acceptable; (3) believe that cannabis use leads to the use of harder drugs (i.e., gateway drug); and (4) believe that enforcement of CLs should be restricted.

Sociodemographic characteristics included sex (male, female); age (2-level variable representing middle-aged and older adults [aged 50–64 years, ≥65 years] and more detailed 3-level variable [50–64 years, 65–74 years, ≥75 years]); race (White, Black or African American, other); ethnicity (Hispanic, non-Hispanic), marital status (married, annulled/separated/divorced, widowed, never married); veteran status (veteran, nonveteran); educational level (less than high school, high school, some college or higher); employment and retirement status (employed, unemployed, retired); annual household income ($0–$19,999; $20,000–$34,999; $35,000–$59,999; ≥$60,000); poverty level (below, above), defined according to yearly U.S. Census poverty thresholds; and receipt of social security benefits.

Statistical Analysis

Weighted cross-tabulations were used to produce estimated means, prevalence, and SEs for all cannabis behavior measures within 2 primary age groups (50–64 years, ≥65 years) as well as in 2 specified older age groups (65–74 years, ≥75 years), overall and by sex. Differences in means and prevalence between age groups and between sexes within each age group were evaluated using Wald chi-square tests. Associations between sociodemographic variables and past-year cannabis use were estimated using ORs obtained from multivariable logistic regressions that controlled for sex, continuous age, race, and educational level. Analyses were performed using SAS 9.4 and SUDAAN (Version 11.0) to account for the HRS complex sample design.50

RESULTS

Among participants of the 2018 cannabis use behaviors module, 54.6% (SE=2.07) were aged 50–64 years, and 45.4% (SE=2.07) were aged ≥65 years. Appendix Table 1 (available online) presents the sociodemographic characteristics of the analytic sample, overall and by age group

The prevalence of past-year cannabis use was 18.50% among middle-aged adults and 5.87% among older adults (p<0.0001) (Table 1). Prevalence was higher in those aged 65–74 years (8.84%) than in those aged ≥75 years (1.78%) (p<0.0001) (Appendix Table 2, available online). Among individuals reporting lifetime cannabis use, 26.10% of middle-aged adults and 32.87% of older adults consumed cannabis through nonsmoking methods (p=0.23).

Table 1.

Prevalence of Cannabis Use Measures by Age (50–64 Years, ≥65 Years) and by Sex

All
 Males
 Females
Cannabis use patterns Age group, years % (SE) n p-valuea % (SE) n % (SE) n Wald chi-square p-valueb
Past-year cannabis usec
50–64 18.50 (2.17) 102 <0.0001 27.60 (4.11) 62 10.05 (2.21) 40 0.0016
≥65 5.87 (1.19) 34 7.89 (2.29) 16 4.46 (1.27) 18 0.2049
Cannabis use other than smokingd
50–64 26.10 (3.12) 72 0.2267 28.02 (4.41) 38 23.59 (4.15) 34 0.4569
≥65 32.87 (5.03) 40 22.45 (5.37) 15 45.26 (7.02) 25 0.0126
Medical cannabis used
50–64 25.03 (3.20) 80 0.3256 26.98 (5.00) 42 22.48 (3.92) 38 0.5044
≥65 20.45 (4.08) 29 22.12 (6.69) 15 18.45 (4.68) 14 0.6656
Health conditions/symptoms treatede
Emotional and psychological conditions
50–64 25.97 (3.00) 19 0.1828 26.33 (4.26) 10 25.40 (4.75) 9 0.8906
≥65 16.31 (5.89) 4 27.75 (8.26) 4 0 0
Neurologic and sensory conditions
50–64 9.12 (4.37) 6 0.8087 6.88 (4.80) 3 12.62 (8.60) 3 0.5694
≥65 10.66 (4.13) 4 9.82 (6.95) 2 11.86 (3.22) 2 0.7880
Physical conditionsf
50–64 20.44 (4.97) 22 0.0024 21.67 (7.02) 9 18.50 (5.03) 13 0.6938
≥65 54.14 (10.03) 13 46.46 (12.38) 5 65.10 (11.17) 8 0.3001
Miscellaneous/other symptomsg
50–64 39.29 (6.43) 29 0.1126 44.43 (8.84) 18 31.26 (5.30) 11 0.2201
≥65 18.88 (7.13) 8 15.97 (8.78) 4 23.04 (10.07) 4 0.5717
Recommendation of cannabis use by healthcare providere
50–64 21.98 (4.93) 21 0.8284 21.93 (5.57) 10 22.06 (5.88) 11 0.9816
≥65 20.54 (4.36) 9 18.45 (6.17) 4 23.53 (6.39) 5 0.5765
Open in a new tab

Note: Boldface indicates statistical significance (p<0.05).

a

Test between age groups.

b

Test between sex within age groups.

c

Assessed among participants in the overall sample.

d

Assessed among participants who reported lifetime use.

e

Assessed among participants who reported lifetime use for medical purposes.

f

Including cancers/tumors; skin conditions; musculoskeletal system/connective tissue conditions; cardiovascular/blood conditions; allergies; sinusitis/tonsillitis; endocrine conditions, metabolic and nutritional conditions; gastrointestinal conditions; reproductive system conditions.

g

Including a wide array of conditions such as dementia; dental conditions; acute infectious diseases; injuries; and trauma, including broken bones, fractures, pulled muscles, strains, and tendon damage.

Among individuals reporting lifetime cannabis use, 25.03% of middle-aged adults and 20.45% of older adults reported lifetime medical cannabis use (p=0.33). Among middle-aged adults, miscellaneous and other conditions (39.29%) were the most commonly reported reasons for medical cannabis use, followed by emotional and psychological conditions (25.97%), physical conditions (20.44%), and neurologic and sensory conditions (9.12%). Older adults most commonly reported physical conditions (54.14%) as their reason for medical cannabis use, followed by miscellaneous and other conditions (18.88%), emotional and psychological conditions (16.31%), and neurologic and sensory conditions (10.66%). Among medical cannabis users, similar proportions of middle-aged and older adult users received a healthcare provider’s recommendation for medical cannabis (21.98% and 20.54%, respectively; p=0.82).

Among middle-aged adults, the prevalence of past-year cannabis use was nearly 3 times higher in males (27.60%) than in females (10.05%, p<0.01). Among older adults, the prevalence of cannabis consumption through nonsmoking methods was twice as high in females (45.26%) as in males (22.45%, p<0.05).

In 2018, 89.12% of middle-aged adults and 77.19% of older adults viewed medical cannabis use as acceptable (p<0.0001) (Table 2). Older adults were significantly more likely than middle-aged adults to view cannabis as a gateway drug (50–64 years: 41.59%; ≥65 years: 71.18%, p<0.0001). Appendix Table 3 (available online) shows additional information about attitudes toward cannabis among those aged 65–74 years and ≥75 years. With few exceptions, no significant sex differences were observed in attitudes toward cannabis in either age group. No sociodemographic differences were found in past-year cannabis use in either age group, except for sex differences in past-year cannabis use among middle-aged adults (Table 3).

Table 2.

Attitudes Toward Cannabis Use by Age (50–64 Years, ≥65 Years) and by Sex

All
 Males
 Females
Attitudes toward cannabis use Age group, years % (SE) n p-valuea % (SE) n % (SE) n Wald chi-square p-valueb
Current belief that medical cannabis use is acceptable
50–64 89.12 (1.76) 511 <0.0001 91.69 (1.92) 230 86.70 (2.66) 281 0.1185
≥65 77.19 (2.44) 515 75.98 (3.82) 208 78.04 (2.57) 307 0.6114
Past (at age 18 years) beliefs that medical cannabis use is acceptable
50–64 39.74 (2.68) 216 <0.0001 44.04 (3.83) 111 35.72 (3.42) 105 0.0967
≥65 13.84 (1.86) 79 19.62 (3.21) 46 9.67 (2.23) 33 0.0191
Current belief that cannabis is a gateway drug
50–64 41.59 (3.00) 293 <0.0001 39.81 (4.51) 120 43.29 (4.00) 173 0.5640
≥65 71.18 (2.12) 490 67.50 (3.34) 192 73.76 (2.75) 298 0.1706
Current belief in need to restrict enforcement of cannabis laws
50–64 37.62 (2.99) 273 <0.0001 34.26 (4.04) 111 40.78 (3.87) 162 0.2142
≥65 55.75 (2.89) 393 53.09 (4.36) 156 57.65 (3.66) 237 0.4176
Open in a new tab

Note: All questions on attitudes toward cannabis use were assessed in the overall 2018 HRS sample.

Boldface indicates statistical significance (p<0.05).

a

Test between age groups.

b

Test between sex within age groups.

HRS, Health and Retirement Study.

Table 3.

Associations Between Sociodemographic Variables and Past-Year Cannabis Use Among Adults Aged 50–64 Years and ≥65 Years

Sociodemographic variables 50–64 years
OR (95% CI)		 ≥65 years
OR (95% CI)
Sex
 Females versus males 0.30 (0.15, 0.61) 0.60 (0.24, 1.48)
Race
 Black versus White 0.65 (0.34, 1.25) 0.65 (0.22, 1.91)
 Other race versus White 0.54 (0.22, 1.33) –
Ethnicity
 Hispanic versus non-Hispanic 0.67 (0.24, 1.83) 0.12 (0.01, 1.21)
Marital status
 Annulled/separated/divorced versus married 1.23 (0.61, 2.48) 2.16 (0.56, 8.32)
 Widowed versus married 1.80 (0.37, 8.77) 2.26 (0.57, 8.97)
 Never married versus married 1.43 (0.56, 3.69) 5.49 (0.97, 31.12)
Veteran status
 Yes versus no 0.88 (0.33, 2.31) 0.24 (0.05, 1.16)
Educational level
 Highschool versus less than high school 0.58 (0.21, 1.57) 5.05 (0.53, 47.82)
 Some college or higher versus less than high school 0.79 (0.30, 2.06) 7.51 (0.88, 63.85)
Employment and retirement status
 Unemployed versus employed 1.21 (0.60, 2.45) 0.64 (0.15, 2.84)
 Retired versus employed 1.20 (0.49, 2.94) 1.07 (0.41, 2.83)
Annual household income
 $0–$19,999 versus ≥$60,000 1.23 (0.57, 2.63) 1.06 (0.28, 4.03)
 $20,000–$34,999 versus ≥$60,000 1.46 (0.49, 4.37) 1.35 (0.35, 5.24)
 $35,000–$59,999 versus ≥$60,000 0.95 (0.37, 2.44) 0.39 (0.11, 1.45)
Poverty level
 Below poverty level versus above 0.95 (0.36, 2.49) 0.41 (0.09, 1.89)
Social security benefits
 Yes versus no 1.78 (0.88, 3.60) 1.19 (0.14, 10.44)
Open in a new tab

Note: Boldface indicates statistical significance (p<0.05).

All ORs are adjusted for sex, age, education, and race.

DISCUSSION

In 2018, 18.5% of U.S. adults aged 50–64 years and 5.9% of U.S. adults aged ≥65 years used cannabis, representing over 11.5 million and 3 million individuals, respectively.51 In addition to revealing higher numbers of middle-aged and older adults with past-year cannabis than previously reported, this is the first nationally representative epidemiologic study to report the prevalence of key cannabis use behaviors in these age groups.

The prevalence of cannabis use among U.S. middle-aged and older adult HRS participants is higher than that reported by NSDUH participants.52,53 Although both surveys employ a multistage area probability sample design, HRS oversamples adults aged ≥65 years from minority groups and selected geographic areas, whereas NSDUH focuses on broad national and state-level representation. Furthermore, HRS uses clustering and stratification to account for the geographic clustering of its sample, which is less emphasized in NSDUH.47,54 Consequently, HRS’s probability sampling method likely offers considerable accuracy in representing middle-aged and older adults nationally. This study separated older adults into 2 groups (those aged 65–74 years and those aged ≥75 years), which were combined in previous reports, potentially overlooking cannabis behaviors and sociodemographics unique to each group. Past-year cannabis use was nearly 5 times higher in adults aged 65–74 years than in those aged ≥75 years. With growing acceptance, cannabis use among adults aged ≥75 years is expected to rise, emphasizing the need for clinician awareness of aging-related physiologic changes, such as altered drug metabolism and neurotransmitter sensitivity, which heighten vulnerability to adverse effects.55–57

In 2018, middle-aged males were nearly 3 times more likely to use cannabis than females, aligning with other national- and state-level reports.58–62 No sex differences were observed in the older adult age group, suggesting that the previously reported sex gap in cannabis use among older adults41 may be narrowing, possibly owing to disproportionate increases in cannabis use among women,3 particularly for medical purposes.63–67

Approximately one quarter of middle-aged and one third of older adults reported consuming cannabis through methods other than smoking. This finding contrasts with data from Washington State, which indicate a broader variety of consumption methods within these populations.67,68 Such differences may be attributable to easier access to diverse products in states that were early to legislate medical CLs and recreational CLs, such as Washington. The high rates of cannabis consumption exclusively through smoking among middle-aged and older adults, particularly those aged ≥75 years—despite smoking not being the recommended method for medical use—highlight their resistance to changing established habits and their ongoing exposure to smoking-related harms. Notably, the finding that older adult women were twice as likely as men to consume cannabis through methods other than smoking suggests that older women may be more responsive to public health messaging promoting the use of less harmful methods of cannabis consumption, such as edibles and tinctures. Physicians prescribing cannabis should be aware of such age- and sex-specific cannabis use behaviors, educate patients about the potential harms of smoking, and promote safer consumption methods.

The findings provide valuable insights into attitudes toward medical cannabis use, its prevalence, and healthcare provider involvement among middle-aged and older U.S. adults—populations increasingly using cannabis to manage chronic conditions.69–72 Approximately 25% of middle-aged adults and 20% of older adults who reported lifetime cannabis use have used it for medical purposes, aligning with findings of smaller studies.73 However, unlike those studies, no sex differences in medical cannabis use were observed in this study. Unlike NSDUH surveys, which focus on healthcare provider recommendations as a proxy for medical cannabis use, HRS directly assessed it by asking participants about cannabis use for the treatment of physical and mental health problems, including specific conditions, thus providing more accurate estimates of medical use prevalence in the U.S. Among older adults, the prevalence of medical cannabis use decreased with increasing age, mirroring the overall age-related differences in both medical and nonmedical cannabis use.

This study reveals widespread acceptance of medical cannabis across both age groups, consistent with findings of Pew Research and smaller studies.74,75 This acceptance has grown substantially from age 18 years to the present, reflecting increasing beliefs in cannabis’s therapeutic benefits, possibly influenced by industry marketing efforts,76,77 and suggesting an expected rise in medical cannabis use among these age groups in the future. These high rates of medical cannabis use among middle-aged and older adults are concerning, given the associated risks, including a 20%–25% prevalence of cannabis use disorder (CUD) among medical cannabis users, surpassing that of recreational users.78,79

Furthermore, the high rates of cannabis use to treat a wide range of physical conditions, emotional and psychological conditions, and other issues (e.g., injuries and trauma) are concerning given a growing body of evidence questioning its therapeutic efficacy80–82 and indicating that cannabis use may be associated with numerous negative health outcomes.83–85 Older adults with chronic conditions, such as chronic pain, are particularly at risk of CUD.86,87 Notably, only ~20% of individuals with medical cannabis use in both age groups received a recommendation from a healthcare provider for cannabis to treat health conditions, indicating widespread self-medication. This practice poses risks of incorrect dosing and dangerous drug interactions,88 such as increased risk of bleeding when delta-9-tetrahydrocannabinol is combined with blood thinners.89 These results may reflect the growing reliance on internet and social media for information about medical cannabis use.90 Stigma or legal concerns may also contribute to this. Although healthcare providers generally support medical cannabis use, their knowledge of its administration and legal frameworks varies, leading to mixed views on effectiveness.91,92 In the absence of clear, evidence-based guidelines, it is vital to improve education for both patients and physicians, ensure access to knowledgeable providers, and engage policymakers in addressing this gap. Key strategies include enhancing routine screening for cannabis use among older adults, increasing education on potential drug–cannabis interactions and age-related risks, and promoting nonjudgmental communication to encourage open dialog about cannabis use. Healthcare systems and professional organizations can also help by developing targeted training and practical tools to support informed decision making and risk reduction in this growing population.

Older adults are more likely than middle-aged adults to view cannabis as a gateway drug, with nearly three quarters believing that it leads to the use of harder substances. This contrasts with NSDUH data, where less than half of older adults perceive cannabis as a risky.29 Differences in methodology, such as NSDUH’s broader questions on perceived harm than HRS’s focus on progression to harder substances, may account for this variation. Nonetheless, older Americans perceive cannabis as more harmful than middle-aged adults. In addition, most older adults support restrictions on cannabis legalization, consistent with Gallup polls.93 Further research is needed to explore whether the risk of cannabis use among older adults varies by legalization status.

Limitations

Study limitations include the single administration of the 2018 cannabis use module, which prevents analysis of trends over time. The cross-sectional design also limits causal inference. Self-reported data may be subject to social desirability and recall biases, particularly for less recent or nonspecific timeframes. HRS did not assess certain cannabis use measures, such as amount used, product type, or outcomes such as CUD, nor did it specifically evaluate medical use for chronic pain, a common reason for use. In addition, although past-year use was assessed, questions about reasons and methods of use referred only to lifetime use, limiting capture of current consumption patterns that may have shifted in recent years. Future studies should assess more granular use patterns. Small sample sizes in some subgroups—especially adults aged ≥75 years—may have produced unstable estimates; larger samples are needed to clarify patterns in these older age groups. Despite these limitations, HRS has notable strengths,48 including a large, nationally representative sample of U.S. adults aged ≥50 years, which enables accurate estimates of cannabis use in understudied groups. Its oversampling and targeted recruitment yield strong response rates across racial groups and a high overall panel retention rate. In addition, it captures a broader range of cannabis measures than other national studies.

CONCLUSIONS

Amid growing belief in the health benefits of cannabis, diminishing risk perceptions, and evolving legislation, middle-aged and older adults emerge as distinct groups warranting special attention. Epidemiologic studies such as this one are vital for informing targeted prevention, treatment, and policy initiatives tailored to these rapidly growing and vulnerable populations.

Supplementary Material

Supplementary Material

Supplemental materials associated with this article can be found in the online version at https://doi.org/10.1016/j.amepre.2025.108149.

ACKNOWLEDGMENTS

This manuscript was published as a preprint on MedRxiv (https://www.medrxiv.org/content/10.1101/2024.10.11.24315329v1).

Funding:

This study was funded by the National Institute on Drug Abuse (K23DA057417)

Footnotes

Declaration of interest: None.

CREDIT AUTHOR STATEMENT

Ofir Livne: Funding acquisition, Project administration, Conceptualization, Investigation, Methodology, Data curation, Writing - original draft. Malka Stohl: Methodology, Formal analysis, Software, Validation. Jodi Gilman: Investigation, Methodology, Writing - review & editing. Terry E. Goldberg: Methodology, Writing - review & editing. Melanie M. Wall: Conceptualization, Formal analysis, Validation, Writing - review & editing. Deborah S. Hasin: Conceptualization, Writing - review & editing, Resources, Supervision.

REFERENCES

  • 1.Salas-Wright CP, Vaughn MG, Cummings-Vaughn LA, et al. Trends and correlates of marijuana use among late middle-aged and older adults in the United States, 2002–2014. Drug Alcohol Depend. 2017;171:97–106. 10.1016/j.drugalcdep.2016.11.031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Azofeifa A, Mattson ME, Schauer G, McAfee T, Grant A, Lyerla R. National estimates of marijuana use and related indicators - National Survey on Drug Use and Health, United States, 2002–2014. MMWR Surveill Summ. 2016;65(11):1–28. 10.15585/mmwr.ss6511a1. [DOI] [PubMed] [Google Scholar]
  • 3.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. 10.1001/jamainternmed.2019.7517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Maxwell CJ, Jesdale BM, Lapane KL. Recent trends in cannabis use in older Americans. Ann Intern Med. 2021;174(1):133–135. 10.7326/M20-0863. [DOI] [PubMed] [Google Scholar]
  • 5.Han BH, Sherman S, Mauro PM, Martins SS, Rotenberg J, Palamar JJ. Demographic trends among older cannabis users in the United States, 2006–13. Addiction. 2017;112(3):516–525. 10.1111/add.13670. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Han BH, Yang KH, Cleland CM, Palamar JJ. Trends in past-month cannabis use among older adults. JAMA Intern Med. 2025;185(7):881–883. 10.1001/jamainternmed.2025.1156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.NSDUH detailed tables, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health, 2020, [Last Accessed: January 21, 2024].
  • 8.Kim Y, Oh S, Fadel PJ, Salas-Wright CP, Vaughn MG. Trends of substance use among individuals with cardiovascular disease in the United States, 2015–2019. Int J Environ Res Public Health. 2022;19(1):577. 10.3390/ijerph19010577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Sexton TR, Alshaarawy O. Cannabis use prevalence among individuals with diabetes: the National Survey on Drug Use and Health, 2005–2018. Drug Alcohol Depend. 2020;212:108035. 10.1016/j.drugalcdep.2020.108035. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Yang KH, Tam RM, Satybaldiyeva N, et al. Trends in past-month cannabis use among U.S. adults across a range of disabilities and health conditions, 2015–2019. Prev Med. 2023;177:107768. 10.1016/j.ypmed.2023.107768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Gorfinkel LR, Stohl M, Hasin D. Association of depression with past-month cannabis use among U.S. adults aged 20 to 59 years, 2005 to 2016. JAMA Netw Open. 2020;3(8):e2013802. 10.1001/jamanetworkopen.2020.13802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Pacek LR, Weinberger AH, Zhu J, Goodwin RD. Rapid increase in the prevalence of cannabis use among people with depression in the United States, 2005–17: the role of differentially changing risk perceptions. Addiction. 2020;115(5):935–943. 10.1111/add.14883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Mueller RL, Ellingson JM, Bidwell LC, Bryan AD, Hutchison KE. Are the acute effects of THC different in aging adults? Brain Sci. 2021;11(5):590. 10.3390/brainsci11050590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Piyanova A, Lomazzo E, Bindila L, et al. Age-related changes in the endocannabinoid system in the mouse hippocampus. Mech Ageing Dev. 2015;150:55–64. 10.1016/j.mad.2015.08.005. [DOI] [PubMed] [Google Scholar]
  • 15.Ginsburg BC, Hensler JG. Age-related changes in CB1 receptor expression and function and the behavioral effects of cannabinoid receptor ligands. Pharmacol Biochem Behav. 2022;213:173339. 10.1016/j.pbb.2022.173339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Minerbi A, Häuser W, Fitzcharles MA. Medical cannabis for older patients. Drugs Aging. 2019;36(1):39–51. 10.1007/s40266-018-0616-5. [DOI] [PubMed] [Google Scholar]
  • 17.Workman CD, Fietsam AC, Sosnoff J, Rudroff T. Increased likelihood of falling in older cannabis users vs. non-users. Brain Sci. 2021;11(2):134. 10.3390/brainsci11020134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Johnson MB, Mechtler L, Ali B, Swedler D, Kelley-Baker T. Cannabis and crash risk among older drivers. Accid Anal Prev. 2021;152:105987. 10.1016/j.aap.2021.105987. [DOI] [PubMed] [Google Scholar]
  • 19.Choi NG, Marti CN, DiNitto DM, Choi BY. Older adults’ marijuana use, injuries, and emergency department visits. Am J Drug Alcohol Abuse. 2018;44(2):215–223. 10.1080/00952990.2017.1318891. [DOI] [PubMed] [Google Scholar]
  • 20.Grant I, Gonzalez R, Carey CL, Natarajan L, Wolfson T. Non-acute (residual) neurocognitive effects of cannabis use: a meta-analytic study. J Int Neuropsychol Soc. 2003;9(5):679–689. 10.1017/S1355617703950016. [DOI] [PubMed] [Google Scholar]
  • 21.Schreiner AM, Dunn ME. Residual effects of cannabis use on neurocognitive performance after prolonged abstinence: a meta-analysis. Exp Clin Psychopharmacol. 2012;20(5):420–429. 10.1037/a0029117. [DOI] [PubMed] [Google Scholar]
  • 22.Kurtzman ET, Dowling NM, Beebe SL. Marijuana use and older adults’ self-reported difficulty concentrating, remembering, or making decisions. J Stud Alcohol Drugs. 2022;83(6):893–900. 10.15288/jsad.21-00318. [DOI] [PubMed] [Google Scholar]
  • 23.Johnson RA, Gerstein DR. Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in U.S. birth cohorts since 1919. Am J Public Health. 1998;88(1):27–33. 10.2105/ajph.88.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Wu LT, Blazer DG. Substance use disorders and psychiatric comorbidity in mid and later life: a review. Int J Epidemiol. 2014;43(2):304–317. 10.1093/ije/dyt173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Lau N, Sales P, Averill S, Murphy F, Sato SO, Murphy S. A safer alternative: cannabis substitution as harm reduction. Drug Alcohol Rev. 2015;34(6):654–659. 10.1111/dar.12275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Black P, Joseph LJ. Still dazed and confused: midlife marijuana use by the baby boom generation. Deviant Behav. 2014;35(10):822–841. 10.1080/01639625.2014.889994. [DOI] [Google Scholar]
  • 27.Lloyd SL, Striley CW. Marijuana use among adults 50 years or older in the 21st century. Gerontol Geriatr Med. 10.1177/2333721418781668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Johnston LD, Miech RA, O’malley PM, Bachman JG, Schulenberg JE, Patrick ME. Sponsored by The National Institute on Drug Abuse at The National Institutes of Health; 1975. (accessed Jul 23 2023). [Google Scholar]
  • 29.Han BH, Funk-White M, Ko R, Al-Rousan T, Palamar JJ. Decreasing perceived risk associated with regular cannabis use among older adults in the United States from 2015 to 2019. J Am Geriatr Soc. 2021;69(9):2591–2597. 10.1111/jgs.17213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Walsh Z, Callaway R, Belle-Isle L, et al. Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. Int J Drug Policy. 2013;24(6):511–516. 10.1016/j.drugpo.2013.08.010. [DOI] [PubMed] [Google Scholar]
  • 31.MO Bonn-Miller Babson KA, Vandrey R. Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug Alcohol Depend. 2014;136:162–165. 10.1016/j.drugalcdep.2013.12.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Solomon HV, Greenstein AP, Delisi LE. Cannabis use in older adults: a perspective. Harv Rev Psychiatry. 2021;29(3):225–233. 10.1097/HRP.0000000000000289. [DOI] [PubMed] [Google Scholar]
  • 33.Green TV. Overwhelming support for legal recreational or medical marijuana in U.S. Washington, DC: Pew Research Center; 2022. https://www.pewresearch.org/short-reads/2022/11/22/americans-overwhelmingly-say-marijuana-should-be-legal-for-medical-or-recreational-use/. [Google Scholar]
  • 34.U.S. Census Bureau. Population Projections. https://www.census.gov/programs-surveys/popproj.html. [Google Scholar]
  • 35.Colliver JD, Compton WM, Gfroerer JC, Condon T. Projecting drug use among aging baby boomers in 2020. Ann Epidemiol. 2006;16 (4):257–265. 10.1016/j.annepidem.2005.08.003. [DOI] [PubMed] [Google Scholar]
  • 36.Wolfe D, Corace K, Butler C, et al. Impacts of medical and non-medical cannabis on the health of older adults: findings from a scoping review of the literature. PLoS One. 2023;18(2):e0281826. 10.1371/journal.pone.0281826. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Ueno LF, Mian MN, Altman BR, Giandelone E, Luce M, Earleywine M. Age-related differences in cannabis product use. J Psychoactive Drugs. 2021;53(4):312–318. 10.1080/02791072.2020.1870778. [DOI] [PubMed] [Google Scholar]
  • 38.Levy J Which cannabis products are popular among different age groups? https://www.vcstar.com/story/sponsor-story/hpc-port-hueneme/2020/09/22/which-cannabis-products-popular-among-different-age-groups/5825462002/. Accessed January 14, 2022 2020. [Google Scholar]
  • 39.Kaufmann CN, Kim A, Miyoshi M, Han BH. Patterns of medical cannabis use among older adults from a cannabis dispensary in New York State. Cannabis Cannabinoid Res. 2022;7(2):224–230. 10.1089/can.2020.0064. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Han BH, Palamar JJ. Marijuana use by middle-aged and older adults in the United States, 2015–2016. Drug Alcohol Depend. 2018;191:374–381. 10.1016/j.drugalcdep.2018.07.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Yang KH, Satybaldiyeva N, Bergstrom J, et al. Sociodemographic and health correlates of cannabis use among middle-aged and older adults: findings from NESARC-III. J Am Geriatr Soc. 2024;72(6):1903–1908. 10.1111/jgs.18800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Qian Y, Gurley BJ, Markowitz JS. The potential for pharmacokinetic interactions between cannabis products and conventional medications. J Clin Psychopharmacol. 2019;39(5):462–471. 10.1097/JCP.0000000000001089. [DOI] [PubMed] [Google Scholar]
  • 43.Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016;176(4):473–482. 10.1001/jamainternmed.2015.8581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Health and Retirement Study, Public Use Dataset University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740), 2020, Ann Arbor M. https://hrsdata.isr.umich.edu/data-products/public-survey-data [Google Scholar]
  • 45.Kaskie B, Bhagianadh D, Bobitt J, Martinos F, Milavetz G, Arora K. Unrelenting growth and diversification: using the health and retirement study to illuminate cannabis use among aging Americans. Gerontologist. 2024;64(6):gnae016. 10.1093/geront/gnae016. [DOI] [PubMed] [Google Scholar]
  • 46.Heeringa SG, Connor JH. Technical Description of the Health and Retirement Survey Sample Design Technical Descriptions Health and Retirement Study Sample Design; 1995. https://deepblue.lib.umich.edu/items/5ef97e7f-deee-428d-b075-e473633ea1b9 [Google Scholar]
  • 47.Ofstedal MB, Weir DR. Recruitment and retention of minority participants in the health and retirement study. Gerontologist. 2011;51(suppl 1):S8–20. 10.1093/geront/gnq100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Sonnega A, Faul JD, Ofstedal MB, Langa KM, Phillips JWR, Weir DR. Cohort profile: the Health and Retirement Study (HRS). Int J Epidemiol. 2014;43(2):576–585. 10.1093/ije/dyu067. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Staff HRS. HRS core interview sample sizes and response rates. Ann Arbor, MI: Survey Research Center, Institute for Social Research, University of Michigan; 2023. https://hrs.isr.umich.edu/documentation/survey-design/response-rates. [Google Scholar]
  • 50.SUDAAN® Statistical Software for Analyzing Correlated Data. Research Triangle Institute. https://www.rti.org/impact/sudaan-statistical-software-analyzing-correlated-data. (n.d). Accessed September 4, 2023. [Google Scholar]
  • 51.2018 population age - Census Bureau Tables. United States Census Bureau. https://data.census.gov/table?q=2018%20population%20age. Updated July 19, 2023 Accessed September 13, 2024. [Google Scholar]
  • 52.NSDUH detailed tables. CBHSQ data https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables. Accessed July 8, 2024 2018. [Google Scholar]
  • 53.PE tables – results from the 2020 national survey on drug use and health: detailed tables, SAMHSA, CBHSQ – Section 1. https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020v25/NSDUHDetailedTabs2020v25/NSDUHDetTabsSect1pe2020.htm. Accessed July 7, 2024.
  • 54.Ofstedal B, Kuang-Tsung DW, Chen James Wagner MR. HRS Documentation Report Updates to HRS Sample Weights. Survey Research Center: University of Michigan Ann Arbor, MI, 2011. Accessed July 7, 2024. [Google Scholar]
  • 55.Ahmed AIA, van den Elsen GAH, Colbers A, et al. Safety and pharmacokinetics of oral delta-9-tetrahydrocannabinol in healthy older subjects: a randomized controlled trial. Eur Neuropsychopharmacol. 2014;24(9):1475–1482. 10.1016/j.euroneuro.2014.06.007. [DOI] [PubMed] [Google Scholar]
  • 56.Dowling GJ, Weiss SRB, Condon TP. Drugs of abuse and the aging brain. Neuropsychopharmacology. 2008;33(2):209–218. 10.1038/sj.npp.1301412. [DOI] [PubMed] [Google Scholar]
  • 57.Anderson GD, Chan LN. Pharmacokinetic drug interactions with tobacco, cannabinoids and Smoking Cessation products. Clin Pharmacokinet. 2016;55(11):1353–1368. 10.1007/s40262-016-0400-9. [DOI] [PubMed] [Google Scholar]
  • 58.Mattingly DT, Richardson MK, Hart JL. Prevalence of and trends in current cannabis use among U.S. youth and adults, 2013–2022. Drug Alcohol Depend Rep. 2024;12:100253. 10.1016/j.dadr.2024.100253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59.Khan SS, Secades-Villa R, Okuda M, et al. Gender differences in cannabis use disorders: results from the national epidemiologic survey of alcohol and related conditions. Drug Alcohol Depend. 2013;130(1–3):101–108. 10.1016/j.drugalcdep.2012.10.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Greaves L, Hemsing N. Sex and gender interactions on the use and impact of recreational cannabis. Int J Environ Res Public Health. 2020;17(2):509. 10.3390/ijerph17020509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Cuttler C, Mischley LK, Sexton M. Sex differences in cannabis use and effects: a cross-sectional survey of cannabis users. Cannabis Cannabinoid Res. 2016;1(1):166–175. 10.1089/can.2016.0010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Schepis TS, Desai RA, Cavallo DA, et al. Gender differences in adolescent marijuana use and associated psychosocial characteristics. J Addict Med. 2011;5(1):65–73. 10.1097/ADM.0b013e3181d8dc62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63.Ryan-Ibarra S, Induni M, Ewing D. Prevalence of medical marijuana use in California, 2012. Drug Alcohol Rev. 2015;34(2):141–146. 10.1111/dar.12207. [DOI] [PubMed] [Google Scholar]
  • 64.Aggarwal SK, Carter GT, Sullivan MD, ZumBrunnen C, Morrill R, Mayer JD. Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State. J Opioid Manag. 2009;5(5):257–286. 10.5055/jom.2009.0028. [DOI] [PubMed] [Google Scholar]
  • 65.Cooper ZD, Craft RM. Sex-dependent effects of cannabis and cannabinoids: a translational perspective. Neuropsychopharmacology. 2018;43(1):34–51. 10.1038/npp.2017.140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66.Bruce D, Grove TJ, Foster E, Shattell M. Gender differences in medical cannabis use: symptoms treated, physician support for use, and prescription medication discontinuation. J Womens Health (Larchmt). 2021;30(6):857–863. 10.1089/jwh.2020.8437. [DOI] [PubMed] [Google Scholar]
  • 67.Cuttler C, Mischley LK, Sexton M. Sex differences in cannabis use and effects: a cross-sectional survey of cannabis users. Cannabis Cannabinoid Res. 2016;1(1):166–175. 10.1089/can.2016.0010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Subbaraman MS, Kerr WC. Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state. J Cannabis Res. 2021;3(1):17. 10.1186/s42238-021-00071-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 69.Briscoe J, Casarett D. Medical marijuana use in older adults. J Am Geriatr Soc. 2018;66(5):859–863. 10.1111/jgs.15346. [DOI] [PubMed] [Google Scholar]
  • 70.Minerbi A, Häuser W, Fitzcharles MA. Medical cannabis for older patients. Drugs Aging. 2019;36(1):39–51. 10.1007/s40266-018-0616-5. [DOI] [PubMed] [Google Scholar]
  • 71.MacNair L, Kalaba M, Peters EN, et al. Medical cannabis authorization patterns, safety, and associated effects in older adults. J Cannabis Res. 2022;4(1):50. 10.1186/s42238-022-00158-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Yang KH, Kaufmann CN, Nafsu R, et al. Cannabis: an emerging treatment for common symptoms in older adults. J Am Geriatr Soc. 2021;69(1):91–97. 10.1111/jgs.16833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73.Livne O, Potter KW, Schuster RM, Gilman JM. Longitudinal associations between cannabis use and cognitive impairment in a clinical sample of middle-aged adults using cannabis for medical symptoms. Cannabis Cannabinoid Res. 2024;9(3):e933–e938. 10.1089/can.2022.0310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 74.Leinen ZJ, Mohan R, Premadasa LS, Acharya A, Mohan M, Byrareddy SN. Therapeutic potential of cannabis: a comprehensive review of current and future applications. Biomedicines. 2023;11(10):2630. 10.3390/biomedicines11102630. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 75.Pew Research Center. Public support for legalizing medical marijuana. Washington, DC: Pew Research Center; 2010. https://www.pewresearch.org/politics/2010/04/01/public-support-for-legalizing-medical-marijuana/. [Google Scholar]
  • 76.Hall W Minimizing the adverse public health effects of cannabis legalization. CMAJ. 2018;190(35):E1031–E1032. 10.1503/cmaj.181035. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 77.Haney M Perspectives on cannabis research-barriers and recommendations. JAMA Psychiatry. 2020;77(10):994–995. 10.1001/jamapsychiatry.2020.1032. [DOI] [PubMed] [Google Scholar]
  • 78.Dawson D, Stjepanović D, Lorenzetti V, Cheung C, Hall W, Leung J. The prevalence of cannabis use disorders in people who use medicinal cannabis: a systematic review and meta-analysis. Drug Alcohol Depend. 2024;257:111263. 10.1016/j.drugalcdep.2024.111263. [DOI] [PubMed] [Google Scholar]
  • 79.Gilman JM, Schuster RM, Potter KW, et al. Effect of medical marijuana card ownership on pain, insomnia, and affective disorder symptoms in adults: a randomized clinical trial. JAMA Netw Open. 2022;5(3):e222106. 10.1001/jamanetworkopen.2022.2106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 80.Walsh Z, Callaway R, Belle-Isle L, et al. Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. Int J Drug Policy. 2013;24(6):511–516. 10.1016/j.drugpo.2013.08.010. [DOI] [PubMed] [Google Scholar]
  • 81.Scherma M, Muntoni AL, Riedel G, Fratta W, Fadda P. Cannabinoids and their therapeutic applications in mental disorders. Dialogues Clin Neurosci. 2020;22(3):271–279. 10.31887/DCNS.2020.22.3/pfadda. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 82.National Academies of Sciences, Engineering, and Medicine. Health and Medicine Division. Board on Population Health and Public Health Practice. Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. Therapeutic effects of cannabis and cannabinoids. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda, eds. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: National Academies Press; (U.S.); 2017.https://www.ncbi.nlm.nih.gov/books/NBK425767/. [Google Scholar]
  • 83.Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219–2227. 10.1056/NEJMra1402309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 84.Volkow ND, Swanson JM, Evins AE, et al. Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry. 2016;73(3):292–297. 10.1001/jamapsychiatry.2015.3278. [DOI] [PubMed] [Google Scholar]
  • 85.National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. 10.17226/24625 [DOI] [PubMed] [Google Scholar]
  • 86.Hasin DS, Wall MM, Alschuler DM, et al. Chronic pain, cannabis legalisation, and cannabis use disorder among patients in the U.S. Veterans Health Administration system, 2005 to 2019: a repeated, cross-sectional study. Lancet Psychiatry. 2023;10(11):877–886. 10.1016/S2215-0366(23)00268-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 87.Gilman J A potential downside of cannabis legalisation for older adults with pain. Lancet Psychiatry. 2023;10(11):823–824. 10.1016/S2215-0366(23)00304-8. [DOI] [PubMed] [Google Scholar]
  • 88.Antoniou T, Bodkin J, Ho JMW. Drug interactions with cannabinoids. CMAJ. 2020;192(9):E206. 10.1503/cmaj.191097. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 89.Cox EJ, Maharao N, Patilea-Vrana G, et al. A marijuana-drug interaction primer: precipitants, pharmacology, and pharmacokinetics. Pharmacol Ther. 2019;201:25–38. 10.1016/j.pharmthera.2019.05.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 90.Boehnke KF, Litinas E, Worthing B, Conine L, Kruger DJ. Communication between healthcare providers and medical cannabis patients regarding referral and medication substitution. J Cannabis Res. 2021;3(1) :2. 10.1186/s42238-021-00058-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 91.Sideris A, Khan F, Boltunova A, Cuff G, Gharibo C, Doan LV. New York physicians’ perspectives and knowledge of the state medical marijuana program. Cannabis Cannabinoid Res. 2018;3(1):74–84. 10.1089/can.2017.0046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 92.Gardiner KM, Singleton JA, Sheridan J, Kyle GJ, Nissen LM. Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis - A systematic review. PLoS One. 2019;14(5):e0216556. 10.1371/journal.pone.0216556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 93.For first time. Americans favor legalizing marijuana. Gallup October, 22; 2013. Accessed July 4, 2024 https://news.gallup.com/poll/165539/first-time-americans-favor-legalizing-marijuana.aspx. [Google Scholar]

Associated Data

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

Supplementary Materials

Supplementary Material
NIHMS2134450-supplement-Supplementary_Material.docx (42.3KB, docx)

RESOURCES