Abstract

Cannabis use among older Americans is increasing. Although much of this growth has been attributed to the entry of a more tolerant baby boom cohort into older age, recent evidence suggests the pathways to cannabis are more complex. Some older persons have responded to changing social and legal environments and are increasingly likely to take cannabis recreationally. Other older persons are experiencing age-related health care needs, and some take cannabis for symptom management, as recommended by a medical doctor. Whether these pathways to recreational and medical cannabis are separate or somewhat tangled remains largely unknown. There have been few studies examining cannabis use among the growing population of Americans aged 65 and older. In this essay, we illuminate what is known about the intersection between cannabis and the aging American population. We review trends concerning cannabis use and apply the age–period–cohort paradigm to explicate varied pathways and outcomes. Then, after considering the public health problems posed by those who misuse or abuse cannabis, we turn our attention to how cannabis may be a viable policy alternative in terms of supporting the health and well-being of a substantial number of aging Americans. On the one hand, cannabis may be an effective substitute for prescription opioids and other misused medications; on the other hand, cannabis has emerged as an alternative for the undertreatment of pain at the end of life. As intriguing as these alternatives may be, policy makers must first address the need for empirically driven, representative research to advance the discourse.
Alternative and complementary medicine/care/therapy, Health care policy, Medications/prescriptions/OTC drugs/pharmacology, Pain management, Public policy
Topic:
Cannabis use among persons older than 50 years has increased significantly, exceeding projections and outpacing the recent growth observed across all other age groups (Substance Abuse and Mental Health Services Administration, 2014). In 2000, past-year cannabis use among all persons older than 50 years was estimated as 1.0%, with rates reaching 2.0% among those aged between 50 and 59 years (i.e., the baby boomers). Projecting to the year 2020, use rates among those older than 50 years were expected to climb to 2.9%, largely as a function of the continued aging of a baby boom cohort with historically higher rates of lifetime use (Colliver, Compton, Gfroerer, & Condon, 2006). However, when analyzing the 2008 National Survey of Drug Use and Health (NSDUH), DiNitto and Choi (2011) found past-year cannabis use for all persons older than 50 years already had reached 2.8%. When NSDUH data from 2008 through 2012 were pooled, Choi, DiNitto, Marti, and Choi (2015) found past-year cannabis use climbed to 3.9%.
Using another nationally representative survey, the 2014 Summer Styles Consumer Panel Survey, Schauer, King, Bunnell, Promoff, and McAfee (2016) found that 5.1% of persons older than 50 years reported taking cannabis in the past month, suggesting use rates might be higher than indicated by the NSDUH data. Schauer and colleagues (2016) also reported that among all current cannabis users (including those older than 50 years), 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. In comparison to the NSDUH, these estimates were generated from a small subpopulation of older adults who were not recruited from a population-based probability sample. Schauer and colleagues also did not stratify reasons for use by age (Figure 1).
Figure 1.
Past-year cannabis use by age group.
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Past-year cannabis use by age group.
Although this prior work has been illuminating, policy makers have only been offered glimpses into this imminent public health challenge. Several substantive gaps exist in what is currently known about cannabis and older persons. What are the self-reported antecedents of taking cannabis? Does cannabis use lead to substance misuse or prescription substitution? As the United States is about to enter a period when the older adult population is projected to double (Ortman, Velkoff, & Hogan, 2014) and the cannabis economy may grow fivefold (Caulkins, Kilmer, Reuter, & Midgette, 2015), such critical questions need to be asked. Yet, at this time, there have been few directions charted for conducting the kind of research that would be most useful in providing empirically based answers.
In this analytic essay, we apply the age–period–cohort paradigm to explore the intersection between cannabis and older persons. We consider how cannabis use among older adults is being shaped variably by social attitudes, state laws, and individual characteristics, such as health needs and prescription drug use, and rely on previous data analyses as well as original data collected from eight state medical cannabis programs to chart the different paths older adults are taking. We consider undesirable outcomes such as the misuse and abuse of cannabis. We then direct our attention to two other prominent public health issues, one concerning the increasing misuse of prescription medications (e.g., opioids) and the other focusing on the undertreatment of pain at the end of life, and consider how cannabis substitution may be a viable policy alternative to these more prominent public health problems.

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