Colleen Maxwell and Bill Jesdale

Study by professors Colleen Maxwell and Bill Jesdale show increased cannabis use in 65+ population

In Canada, cannabis became legal to produce, distribute, purchase and use non-medicinally for adults on October 17, 2018. Though Canada is only the second country in the world to adopt this legalization, other countries have also implemented more lax cannabis laws in recent years.

As cannabis becomes more socially accepted and easily accessible, researchers like Colleen Maxwell and Bill Jesdale are examining how reported usage changes. They are epidemiologists – Maxwell from the University of Waterloo in Canada and Jesdale from the University of Massachusetts in the United States – and as such, they work with large datasets to observe population trends.

Jesdale and Maxwell have conducted research focused on older adults – those aged 65 years and older. This is a population that is often overlooked when it comes to cannabis use, and in their study, Recent Trends in Cannabis Use in Older Americans, they examined how frequently this group used cannabis.

“Many tend to look at the 65+ population as homogeneous, but there’s often considerable variation across age ranges in this older population group,” Maxwell says. “We know that habits change as we age, and this population is a cohort that has lived through more experimental times, so we suspected they might in fact be more comfortable with cannabis use.”

Older adults are at particular risk for medication interactions with cannabis use as they are more likely to have multiple chronic conditions and to use multiple medications. They are also more likely to be frail, making the risk of falls while using more significant.

To understand how many older adults are using, Maxwell partnered with Jesdale to examine data from the U.S. Behavioral Risk Factor Surveillance System (BRFSS), a state-issued survey. They analyzed results from 19 states and 2 territories who surveyed their populations about cannabis. This amounted to 171,507 participants from 2016-2018.

“The BRFSS was an ideal source of data for our study because it is the only U.S. dataset that links responses to the legal regime where people are living,” Jesdale says. “Using this data enabled us to examine responses about cannabis usage while also understanding the legal state of cannabis use in each location.”

The BRFSS asks users ‘During the past 30 days, on how many days did you use marijuana or hashish?’ 4.9% of respondents aged 55+ years, and 2.9% of those 65+, across all years reported that they had used cannabis and men were more likely to report any use and daily use. The prevalence was nearly double in men versus women. As the population got older, the prevalence decreased. However, prevalence of cannabis use increased over time for all age groups, including among respondents aged 65 years and older. By 2018, 8.2% of men and 3.8% of women aged 65-69 reported use in the past month.

“The increase in reported usage is quite substantial compared to other trends in health behaviours,” Jesdale says. “With laxer laws, this increase may be in part due to increased comfort reporting. It’s hard to project if this will continue, especially with the impact of COVID where we’ve seen an increased use of substances to manage stress, but we won’t have the data to study for another two years.”

Because it’s administered at the state level, the BRFSS results allowed the researchers to study if there’s a link between cannabis legal status – for medicinal or non-medicinal use – and reported usage. The states in the study had a variety of legal regimes for cannabis, from complete illegalization to legal use for both recreational and medical purposes.

“We saw that cannabis use increased both in states with no legal provisions for use and in states that had legalized it completely,” says Maxwell. “We didn’t find consistent evidence of large differences in frequency of use with respect to legalization status.”

In Canada, it has been more challenging to draw conclusions about cannabis use. Though there are robust health surveys and clinical databases capturing older populations, they are not tied to the cannabis-related data gathered in Statistics Canada’s National Cannabis Survey. And though qualitative studies have examined older adult use, including work by Professor Jennifer Baumbusch at the University of British Columbia, there are still many questions the researchers would like answered.

“We also want to know about the benefits and risks of cannabis use in nursing homes, including the association between use and falls and other health outcomes, about whether or not older adults are talking to their health-care provider before starting use,” Maxwell says. “We know from smaller studies that older adults tend to say they are using cannabis for medical reasons but that most of the information they have about it comes from the media, friends or the employees at cannabis stores and not their family doctor.”

Other studies have indicated that in some cases, health-care providers simply didn’t have the information to provide adequate counselling to patients.

“Our findings demonstrate that older adults are increasingly using cannabis,” Maxwell says. “It’s important for health-care providers to take this into account – to not dismiss the older adult population based on assumptions, and to be prepared to initiate a conversation about cannabis use and provide counselling.”

The study, Recent Trends in Cannabis Use in Older Americans, appeared in the Annals of Internal Medicine in January 2021.