Agitation in Alzheimer’s Disease as a Qualifying Condition for Medical Cannabis in the United States: A Brief Report on Current Trends

Abstract

Objectives:

We assessed state-level access to medical cannabis with Alzheimer’s Disease and related agitation (AD) as a qualifying condition.

Methods:

In 2024-2025, we examined regulatory agencies’ publicly available online reports regarding medical cannabis, including use specifically for AD.

Results:

Of 38 states that allow medical cannabis, 19 (50%) allow medical cannabis for AD. AD accounts for <1% of medical cannabis certifications. Some data suggest that AD as a qualifying condition is declining in states that have legalized recreational cannabis use.

Conclusions:

Despite limited evidence of efficacy supporting medical cannabis for AD, this remains a qualifying condition in 19 states, though it is invoked for a small minority of the population. With increasing medical and recreational cannabis access, there is a need for geriatric clinicians to assess and monitor cannabis use among the growing population of patients with AD across states with varied policies, particularly given decreases in medical program involvement.

Introduction

Cannabis is the third most commonly consumed addictive substance in the United States (following alcohol and tobacco). In 2013, 4.7% of adults ages 60-64 and 1.4% of those ages 65+ reported past-year cannabis use which increased to 17.5% and 9.5%, respectively, in 2023 (1) (2). Considering older adults’ cannabis use within an age-period-cohort framework (3), this acceleration coincided with increased access to cannabis via state-level medical and recreational legalization, stronger-than-ever delta-9 tetrahydrocannabinol (THC) cannabis product potency (4), increasing rates of cannabis use disorders (5), and lower-than-ever cannabis-related risk perceptions (1). The National Academies of Science and Medicine (6) identify older adults as a vulnerable population that require critical monitoring in the changing cannabis policy landscape to prevent negative health impacts.

Cannabis has attracted consumer interest and research given potential therapeutic benefits across conditions (7). Most US states allow possession and consumption of cannabis for medical reasons. States vary in medical cannabis regulations (6): many require a medical professional’s recommendation to use cannabis that is limited to the presence of one or more “qualifying conditions,” with required medical provider documentation varying across states (e.g., choosing ≥1 diagnosis from a checklist, or selecting a “primary serious condition”). Some conditions, such as Alzheimer’s Disease and associated agitation from behavioral and psychological symptoms (“AD” hereafter), have little or no scientific evidence demonstrating cannabis as an effective treatment. Specifically, a recent Cochrane Review (8) found no strong evidence for the efficacy of cannabis on behavioral and psychological symptoms of dementia broadly (most participants studied had AD).

Given the growing population of US older adults living with AD (9), public interest in potential therapeutic benefits, including among older adults (10), the increased prevalence of cannabis consumption among older adults, and the changing policy context (6), monitoring trends in medical cannabis use as related to AD is important. A 2016 report (11) found that 9 of 23 states allowing medical cannabis allowed it for AD-related reasons (among others), yet data were limited about how frequently AD was the basis for medical cannabis consumption. Now, 38 states allow medical cannabis and 22 have legalized recreational cannabis. The purpose of this brief report is to provide a snapshot, detailing the states allowing for medical cannabis and the proportions of patients reported as receiving medical cannabis for AD over time, with examination of trends post-recreational legalization. Although this descriptive analysis precludes formal hypothesis testing, we expected to see increases in appearance of AD as a qualifying condition, but we did not have an a priori hypothesis about fluctuations in AD as a qualifying condition based on state-level recreational cannabis policy.

Methods

We executed a comprehensive search of state cannabis regulatory websites in July 2024, with updated searches between January and March 2025 (data sources available from authors). In May 2025, we reviewed these websites for information about caregiver and provider certification. Two researchers (EEB, CYT) reviewed available online reports and extracted the most recent data on the number and/or proportion of patients receiving medical certification for AD as a qualifying condition. For states with legalized recreational cannabis, we reviewed and extracted data from reports one year prior to local recreational legalization. We also extracted data from the 2016 report (11). Trends in AD-related qualifying conditions are summarized descriptively given states’ variation in reporting timeframes and methods.

Results

Table 1 summarizes all data. As of March 2025, 19 states allowed medical cannabis for AD (38% of US states, 50% of those allowing medical cannabis [N=38]), approximately double the number reported in 2016. Specifically, AD (without mention of agitation/behavioral symptoms) was listed for 9 states (AK, LA, MN, MS, NH, NM, NY, OH, UT) whereas Agitation of AD was listed for 8 (AZ, DE, IL, ME, MI, MO, ND, RI). For Pennsylvania and Oregon qualifying conditions can include AD, but were broadly listed as “Neurodegenerative Diseases” and “Degenerative or Pervasive Neurological Conditions,” respectively. Eighteen states require a medical provider (types vary across states) to “diagnose” and/or “certify” that patients have a qualifying condition, though Louisiana uses the terminology that a provider must “recommend” cannabis (e.g., per medical records) and transmit that recommendation to a medical cannabis pharmacy. Currently, 18 states allow registered caregivers to obtain cannabis for registered patients; Louisiana does not.

Table 1.

Summary of states’ medical cannabis data pertaining to Alzheimer’s Disease

1	2	3	4
State / Medical Cannabis Legalization Year /Recreational Cannabis Legalization Year	Patients with AD-Related Qualifying Condition Reported in Maust et al., 2016 N (%)	Patients with AD-Related Qualifying Condition in Year Prior to Recreational Legalization N (%)	Patients with AD- Related Qualifying Condition Most Recently Reporteda N (%)
States with Medical Cannabis Only
Arkansas / 2016			131 (0.1%)
Louisiana / 1978	Data by condition not available for LA and NH. All other states listed allowed medical cannabis in 2016 orlater.	No recreational cannabis in these states.	N/A
Mississippi / 2022			N/Ab
New Hampshire /2013			18 (0.1%)
North Dakota / 2016			<10 (N/Ac)
Pennsylvania / 2016			781 (N/Ac)
Utah / 2018			49 (0.05%)
States with Medical and Recreational Cannabis
Arizona / 2010 / 2020	33 (0.1%)	93 (0.04%)	4 (0.05%)
Delaware / 2011 / 2023	0 (0.0%)	31 (0.1%)	32 (0.1%)
Illinois / 2013 / 2019	7 (0.2%)	67 (0.2%)	38 (0.07%)
Maine / 1999 / 2016	N/A	N/A	N/A
Michigan / 2008 / 2018	48 (0.5%)	0.05% (no N reported)	0 (0.0%)
Minnesota / 2014 /2023	N/Ad	N/A	46 (0.01%)
Missouri / 2018 /2022	N/Ad	4 (<.01%)	N/A
New Mexico / 2007 /2021	N/Ad	52 (0.05%)	30 (0.04%)
New York / 2014 /2021	N/Ad	N/A	91 (0.09%)
Ohio / 2016 / 2023	N/Ad	N/A	N/A
Oregon / 1998 / 2014	N/A	N/A	N/A
Rhode Island / 2006 / 2022	24 (0.1%)	5 (0.09%)	0 (0.0%)

Notes. Unless described in more detail in a footnote, N/A denotes that data by AD-related qualifying condition were not reported online. In addition, we note some specific details about states here: North Dakota lists AD as a qualifying diagnosis with the requirement of agitation as a qualifying symptom. Oklahoma and Virginia do not specify qualifying conditions, but do require a physician recommendation for use and Maryland allows “another chronic medical condition which is severe and for which other treatments have been ineffective.” thus no data are reported on AD, but it is possible in these states that patients are using cannabis for AD.

^aThe most recently reported years (state) were from: 2020 (ND), 2021 (MO), 2022 (NH), 2023 (DE, RI), and 2024 (AR, PA, UT, AZ, IL, MI, MN, NM, NY)

^bOnly data on the 10 most common qualifying conditions were reported for Mississippi.

^cDenominator or percentage not available in relevant report. Note that Pennsylvania’s qualifying condition is “Neurodegenerative Diseases” not otherwise specified.

^dAD was added as a qualifying condition after 2016 for MN (2018), NM (2019), and NY (2021, same year as recreational legalization); medical cannabis was not legalized until 2018 in MO and 2016 in OH.

In the most recent years for which state-level data were available (N=13 states, data reported anywhere from 2020 to 2025), 12 states reported fewer than 1% of patients (range: 0 to 131 patients across states) had an AD-related qualifying condition. In Pennsylvania, there were 781 individuals reported with a neurodegenerative disease-based qualifying condition, but there was no information specific to AD nor was there a denominator allowing calculation of the proportion of these individuals among all seeking medical cannabis. Rhode Island (in 2023) and Michigan (in 2025) both reported 0 patients seeking AD-related medical cannabis.

Of the states with available data at the time of the 2016 evaluation (11), AZ, DE, IL, MI, and RI have all since legalized recreational cannabis. DE showed an increase in AD-related qualifying conditions from the 2016 report to the year prior to local recreational cannabis legalization from 0.0% to 0.1% in 2022. AZ decreased from 0.1% to 0.04% in 2019, and RI slightly decreased from 0.1% to 0.09% in 2021. IL remained stable at 0.2% in 2018 and MI

decreased from 0.5% to 0.05% in 2017. There are 6 states (AZ, DE, IL, MI, NM, RI) with information available on AD-related rates from the year prior to recreational cannabis legalization vs. the most recent period for which data are available post-recreational legalization. Of those, a slight increase occurred for AZ (from 0.04% in 2019 to 0.05% in 2024). Decreases occurred for IL (0.2% in 2018 to 0.07% in 2024), MI (0.05% in 2017 to 0.0% in 2024), and RI (0.09% in 2021 to 0.0% in 2023) with a slight decrease for NM (0.05% in 2020 to 0.04% in 2024). DE remained stable at 0.1% (from 2022 to 2023).

Discussion

Half of states that allow medical cannabis include AD or AD-related agitation as a qualifying condition, a proportion that has increased over time. Considering the variation in reporting across states with diverse policy contexts, the interpretation of available data on AD-related medical cannabis consumption is muddied and generalizations are limited. Thus, more research, especially individual-level data, is needed to understand how policies shape cannabis consumption in relation to different medical conditions, and specifically AD among older adults.

As the broader US cannabis policy shifts toward recreational access and legalization, these early data suggest the need to evaluate how recreational access changes utilization of medical cannabis programs for obtaining cannabis for AD-related symptoms. Recreational access may reduce AD patients’ touchpoints with clinicians regarding cannabis use while perhaps decreasing the burden of obtaining cannabis for medical purposes (e.g., obtaining a doctor’s recommendation, applying for certification, associated fees). Understanding the potential reasons why some patients may forgo participation in medical cannabis programs in the context of recreational availability is a recommended avenue for inquiry. It may be that those patients who previously obtained medical cannabis certification found the products ineffective, or they may not have perceived value from medical cannabis programs specifically when balanced against the less restrictive access offered by recreational programs. Nuances regarding affordability in light of market supply-demand dynamics as well as geographic access to medical vs. recreational cannabis outlets may also help explain these changes.

Next, we note that individuals (or perhaps their caregivers (12)) who seek medical cannabis for AD comprise a very small proportion of adults obtaining medical cannabis. However, the Baby Boomer generation comprises roughly 20% of the US population (per the US Census), and the absolute number who will encounter an AD diagnosis and may seek symptomatic relief through cannabis is non-trivial. It is possible that individuals with AD are obtaining medical cannabis for other common qualifying conditions (e.g., chronic pain, glaucoma, cancer) or that their caregivers involved in medical decision-making could obtain cannabis for them through recreational or illegal sources in an attempt to ameliorate behavioral and psychological symptoms or other co-occurring conditions. As about half of older adults who use cannabis have not discussed cannabis consumption with their healthcare provider (13), there remains an onus on clinicians to, at minimum, assess cannabis use among older adult patients living with AD. In the absence of consensus guidelines, we recommend that clinicians monitor cannabis consumption for potential therapeutic benefits, dependence (e.g., onset of cannabis use disorder), and/or adverse effects (e.g., hyperemesis, falls, impaired cognition). Further, addressing harm reduction strategies (e.g., choosing low-potency products) with patients and caregivers may help to limit the potential for such adverse effects for this population.

As described previously (11), patients living with AD are a vulnerable population, and some have limited ability to weigh the medical risks and benefits of cannabis consumption, which have been under-studied. Thus, efforts are needed from clinicians, regulators, clinical consensus groups, and researchers to better monitor and understand this topic to inform appropriate education and recommendations for patients and their families/caregivers who desire such help (12) to reduce suffering.

Highlights.

• What is the primary question addressed by this study? How prevalent is certification for medical cannabis for the treatment of Alzheimer’s Disease and related agitation (AD) in US states that allow medical cannabis?

• What is the main finding of this study? Despite limited evidence supporting efficacy, AD is a qualifying condition for medical cannabis in 19 US states, though it is invoked for a small minority of the population. There some evidence of a trend toward decreasing medical cannabis access for AD after states legalize recreational cannabis.

• What is the meaning of the finding? While relatively few individuals seek medical cannabis for an indication related to AD, the size of the older adult population suggests that the absolute number who will encounter an AD diagnosis and potentially seek symptomatic relief through cannabis is not trivial.

Data Statement:

The data have not been previously presented orally or by poster at scientific meetings.