Cannabis use has increased steadily among older adults, and they are a significant proportion of medical cannabis users. Using 2015–2019 National Survey on Drug Use and Health data (n = 44,007 age 50+), we examined whether the numbers of emergency department (ED) visits and nights hospitalized are associated with cannabis use status, use reason (nonmedical-only, medical-only, and medical and nonmedical), and use characteristics. Past-year users had higher rates of any ED visit (30.0%) and hospitalization (14.7%) than prior-to-past-year users and never users. However, negative binomial regression models showed that past-year users did not differ from never users on numbers of ED visits and nights hospitalized, although they had more ED visits than prior-to-past-year users (IRR = 1.21, 95% CI = 1.10–1.34). Medical-only users had more ED visits (IRR = 1.38, 95% CI = 1.02–1.88) than nonmedical-only users. Cannabis use and use characteristics were not associated with nights hospitalized. The study findings provide insights into older cannabis users’ healthcare utilization.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. 4th ed. American Psychiatric Association.
2.
AndersenR.NewmanJ. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund QuarterlyHealth and Society, 51(1), 95–124. https://doi.org/10.2307/3349613.
3.
AndersenR. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter?Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284.
4.
AroraK.QuallsS. H.BobittJ.MilavetzG.KaskieB. (2021). Older cannabis users are not all alike: Lifespan cannabis use patterns. Journal of Applied Gerontology, 40(1), 87–94. https://doi.org/10.1177/0733464819894922.
5.
BabitschB.GohlD.&von LengerkeT. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services Use: A systematic review of studies from 1998-2011. Psychosocial Medicine, 9, Doc11. https://doi.org/10.3205/psm000089.
6.
BahorikA. L.CampbellC.I.SterlingS. A.LeibowitzA.TravisA.WeisnerC. M.SatreD. D. (2018). Adverse impact of marijuana use on clinical outcomes among psychiatry patients with depression and alcohol use disorder. Psychiatry Research, 259, 316-322. https://doi.org/10.1016/j.psychres.2017.10.026.
7.
BalachandranP.ElsohlyM.HillK. P. (2021). Cannabidiol interactions with medications, illicit substances, and alcohol: A comprehensive review. Journal of General Internal Medicine, 36(7), 2074–2084. https://doi.org/10.1007/s11606-020-06504-8.
8.
BanerjeeA.GandhiA. B.AntonyI.AlexanderJ.HisbullaM.KannichamyV.KaleemI.MishraV.KhanS. (2020). Role of cannabis in the incidence of myocardial infarction: A review. Cureus, 12(10), e11097. https://doi.org/10.7759/cureus.11097.
9.
BonomoY.NormanA.BiondoS.BrunoR.DaglishM,DaweS.Egerton-WarburtonD.KarroJ.KimC.LentonS.LubmanD. I.PastorA.RundleJ.RyanJ.GordonP.SharryP.NuttD.CastleD. (2019). The Australian drug harms ranking study. Journal of Psychopharmacology, 33(7), 759–768. https://doi.org/10.1177/0269881119841569.
10.
BradfordA. C.BradfordW. D.AbrahamA.Bagwell AdamsG. (2018). Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population. JAMA Internal Medicine, 178(5), 667–672. https://doi.org/10.1001/jamainternmed.2018.0266.
11.
BrownJ. D.CostalesB.Van Boemmel-WegmannS.GoodinA.J.SegalR.WintersteinA.G. (2020). Characteristics of older adults who were early adopters of medical cannabis in the Florida medical marijuana use registry. Journal of Clinical Medicine, 9(4), 1166. https://doi.org/10.3390/jcm9041166.
12.
BroydS. J.van HellH. H.BealeC.YücelM.SolowijN. (2016). Acute and chronic effects of cannabinoids on human cognition-a systematic review. Biological Psychiatry, 79(7), 557–567. https://doi.org/10.1016/j.biopsych.2015.12.002.
13.
CampenyE.López-PelayoH.NuttD.BlithikiotiC.OliverasC.NuñoL.MaldonadoR.FlorezG.AriasF.Fernández-ArtamendiS.VillalbíJ. R.SellarèsJ.BallbèM.RehmJ.Balcells-OliveroM. M.GualA. (2020). The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms. European Neuropsychopharmacology, 33, 1-35. https://doi.org/10.1016/j.euroneuro.2020.02.003.
14.
Center for Behavioral Health Statistics and Quality. (2019). National Survey on Drug Use and Health Public Use File Codebook. Substance Abuse and Mental Health Services Administration.
15.
ChoiN. G.DiNittoD. M.ChoiB. Y. (2021). Prescription pain reliever use and misuse among cannabis users aged 50+ years. Clinial Gerontologist, 44(1), 53–65. https://doi.org/10.1080/07317115.2020.175754.
16.
ChoiN. G.MartiC. N.DiNittoD. M.ChoiB. Y. (2018). Older adults’ marijuana use, injuries, and emergency department visits. American Journal of Drug and Alcohol Abuse, 44(2):215–223. https://doi.org/10.1080/00952990.2017.1318891.
17.
DamkierP.LassenD.ChristensenM. M. H.MadsenK. G.HellfritzschM.PottegårdA. (2019). Interaction between warfarin and cannabis. Basic and Clinical Pharmacology and Toxicology, 124(1):28–31. https://doi.org/10.1111/bcpt.13152.
18.
DesaiR.PatelU.SharmaS.AminP.BhuvaR.PatelM. S.SharmaN.ShahM.PatelS.SavaniS.BatraN.KumarG. (2017). Nonmedical marijuana use and acute myocardial infarction: Insights from Nationwide Inpatient Sample in the United States. Cureus, 9(11), e1816. https://doi.org/10.7759/cureus.1816.
19.
ElSohlyM. A.MehmedicZ.FosterS.GonC.ChandraS.ChurchJ. C. (2016). Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the United States. Biological Psychiatry, 79(7), 613–619. https://doi.org/10.1016/j.biopsych.2016.01.004.
20.
FairmanB. J. (2016). Trends in registered medical marijuana participation across 13 US states and District of Columbia. Drug and Alcohol Dependence, 159, 72–79. https://doi.org/10.1016/j.drugalcdep.2015.11.015.
21.
FusterD.ChengD. M.Allensworth-DaviesD.PalfaiT. P.SametJ. H.SaitzR. (2014). No detectable association between frequency of marijuana use and health or healthcare utilization among primary care patients who screen positive for drug use. Journal of General Internal Medicine, 29(1), 133–139. https://doi.org/10.1007/s11606-013-2605-z.
22.
GelmanA.HillJ. (2007). Data analysis using regression and multilevel/hierarchical models. Cambridge University Press.
23.
HallW.LynskeyM. (2020). Assessing the public health impacts of legalizing nonmedical cannabis use: The US experience. World Psychiatry, 19(2), 179–186. https://doi.org/10.1002/wps.20735.
24.
HallK. E.MonteA. A.ChangT.FoxJ.BrevikC.VigilD. I.Van DykeM.JamesK. A. (2018). Mental health-related emergency department visits associated with cannabis in Colorado. Academic Emergency Medicine, 25(5), 526–537. https://doi.org/10.1111/acem.13393.
25.
HasinD.WalshC. (2020). Cannabis use, CUD, and comorbid psychiatric illness: A narrative review. Journal of Clinical Medicine, 10(1), 15. https://doi.org/10.3390/jcm10010015.
26.
HeathertonT. F.KozlowskiL. T.FreckerR. C.FagerströmK. O. (1991). The fagerström test for nicotine dependence: A revision of the fagerström tolerance questionnaire. British Journal on Addiction, 86(9), 1119–1127. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x.
27.
JohalH.DevjiT.ChangY.SimoneJ.VannabouathongC.BhandariM. (2020). Cannabinoids in chronic non-cancer pain: A systematic review and meta-analysis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 13, 1179544120906461. https://doi.org/10.1177/1179544120906461.
28.
KaskieB.AyyagariP.MilavetzG.ShaneD.AroraK. (2017). The increasing use of cannabis among older Americans: A public health crisis or viable policy alternative?The Gerontologist, 57(6), 1166–1172. https://doi.org/10.1093/geront/gnw166.
29.
KesslerR. C.BarkerP. R.ColpeL. J.EpsteinJ. F.GfroererJ. C.HiripiE.HowesM. J.NormandS. L.ManderscheidR. W.WaltersE. E.ZaslavskyA. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. https://doi.org/10.1001/archpsyc.60.2.184.
30.
Lev-RanS.RoereckeM.Le FollB.GeorgeT. P.McKenzieK.RehmJ. (2014). The association between cannabis use and depression: A systematic review and meta-analysis of longitudinal studies. Psychological Medicine, 44(4), 797–810. https://doi.org/10.1017/S0033291713001438.
31.
LinL. A.IlgenM. A.JannauschM.BohnertK. M. (2016). Comparing adults who use cannabis medically with those who use nonmedically: Results from a national sample. Addictive Behaviors, 61, 99–103. https://doi.org/10.1016/j.addbeh.2016.05.015.
32.
LloydS. L.StrileyC. W. (2018). Marijuana use among adults 50 years or older in the 21st century. Gerontology & Geriatric Medicine, 4, 2333721418781668. https://doi.org/10.1177/2333721418781668.
33.
MathesonJ.Le FollB. (2020). Cannabis legalization and acute harm from high potency cannabis products: A narrative review and recommendations for public health. Frontiers in Psychiatry, 11, 591979. https://doi.org/10.3389/fpsyt.2020.591979.
34.
MoosR. H.BrennanP. L.SchutteK. K.MoosB. S. (2010). Older adults’ health and late-life drinking patterns: A 20-year perspective. Aging & Mental Health, 14(1), 33–43. https://doi.org/10.1080/13607860902918264.
35.
National Academies of Sciences. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies Press (US).Engineering, and Medicine
36.
NicholasL. H.MacleanJ. C. (2019). The effect of medical marijuana laws on the health and labor supply of older adults: Evidence from the Health and Retirement Study. Journal of Policy Analysis and Management, 38(2), 455–480.
37.
NovakS. P.ColpeL. J.BarkerP. R.GfroererJ. C. (2010). Development of a brief mental health impairment scale using a nationally representative sample in the USA. International Journal of Methods in Psychiatric Research, 19(Suppl 1), 49–60. https://doi.org/10.1002/mpr.313.
38.
ParkJ. Y.WuL. T. (2017). Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and nonmedical marijuana users: Results from a national adult sample. Drug and Alcohol Dependence, 180, 311-318. https://doi.org/10.1016/j.drugalcdep.2017.08.028.
39.
PerisettiA.GajendranM.DasariC. S.BansalP.AzizM.InamdarS.TharianB.GoyalH. (2020). Cannabis hyperemesis syndrome: An update on the pathophysiology and management. Annals of Gastroenterology, 33(6), 571–578. https://doi.org/10.20524/aog.2020.0528.
40.
PorrC. J.RiosP.BajajH. S.EganA. M.HuotC.BattenR.BishopL.RyanD.DavisE.DarveshN.RahmanA.AsghariS.AcheampongL.TriccoA. C. (2020). The effects of nonmedical cannabis use on glycemic outcomes and self-management behaviours in people with type 1 and type 2 diabetes: A rapid review. Systematic Reviews, 9(1), 187. https://doi.org/10.1186/s13643-020-01411-9.
41.
RabgayK.WaranuchN.ChaiyakunaprukN.SawangjitR.IngkaninanK.DilokthornsakulP. (2020). The effects of cannabis, cannabinoids, and their administration routes on pain control efficacy and safety: A systematic review and network meta-analysis. Journal of the American Pharmacists Association, 60(1), 225–234. https://doi.org/10.1016/j.japh.2019.07.015.
42.
RamadanM. M.BantaJ. E.BahjriK.MontgomeryS. B. (2021). Marijuana users are likely to report opioid misuse among adults over 50 years in representative sample of the United States (2002-2014). Journal of Addictive Disorders, 39(1), 66–73. https://doi.org/10.1080/10550887.2020.1816117.
43.
ReynoldsI. R.FixenD. R.ParnesB. L.LumH. D.ShanbhagP.ChurchS.LinneburS. A.OroszG. (2018). Characteristics and patterns of marijuana use in community-dwelling older adults. Journal of the American Geriatrics Society, 66(11), 2167–2171. https://doi.org/10.1111/jgs.15507.
44.
RobertsB. A. (2019). Legalized cannabis in Colorado emergency departments: A cautionary review of negative health and safety effects. Western Journal of Emergency Medicine, 20(4), 557–572. https://doi.org/10.5811/westjem.2019.4.39935.
45.
Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. HHS Publication No. PEP20-07-01-001, NSDUH Series H-55.
46.
VacaflorB. E.BeauchetO.JarvisG. E.SchaviettoA.RejS. (2020). Mental health and cognition in older cannabis users: A review. Canadian Geriatrics Journal, 23(3), 242–249. https://doi.org/10.5770/cgj.23.399.
47.
VolkowN. D.SwansonJ. M.EvinsA. E.DeLisiL .E.MeierM. H.GonzalezR.BloomfieldM. A.CurranH. V.BalerR. (2016). Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: A review. JAMA. Psychiatry, 73(3):292–297. https://doi.org/10.1001/jamapsychiatry.2015.3278.
48.
WangG. S.DaviesS. D.HalmoL. S.SassA.MistryR. D. (2018). Impact of marijuana legalization in Colorado on adolescent emergency and urgent care visits. Journal of Adolescent Health, 63(2), 239–241. https://doi.org/10.1016/j.jadohealth.2017.12.010.
49.
WuL-T.BlazerD. G. (2014). Substance use disorders and psychiatric comorbidity in mid and later life: A review. International Journal of Epidemiology, 43(2), 304–317. https://doi.org/10.1093/ije/dyt173.
50.
YangK. H.KaufmannC. N.NafsuR.LifsetE. T.NguyenK.SextonM.HanB. H.KimA.MooreA. A. (2021). Cannabis: An emerging treatment for common symptoms in older adults. Journal of the American Geriatrics Society, 69(1), 91–97. https://doi.org/10.1111/jgs.16833.
