A study looking at cannabis-related trips to the Emergency Department (ED) among Californians aged 65 and above has found a 1,808 percent increase from 2005 to 2019, as the drug became legal for medical and then recreational use in the state.
Using data on admissions to Californian emergency departments from the Department of Healthcare Access and Information, the team found that cannabis-related visits rose from 366 in 2005 to 12,167 in 2019 for those aged 65 and above. The biggest relative increase was in patients aged 75–84, who saw a 2,208 percent increase in weed-related visits. Older males accounted for more visits to the ED than older females, though females saw a bigger relative change between 2005 and 2019 at 2208 percent.
"Interestingly, the ED rate appeared to increase sharply between 2013 and 2017, but then the rate of increase levels off in 2017 after the implementation of Proposition 64 [which legalized personal use in the state]," the team wrote in their paper.
"Therefore, the availability of recreational cannabis does not appear to correlate with a higher rate of increase in cannabis-related ED visits among older people. However, high ED rates among older adults with higher comorbidity are concerning as cannabis has been associated with acute cardiac, respiratory, and psychiatric effects."
The use of cannabis by older sections of the population has increased over the past two decades, following the legalization of the drug in California in 1996. Evidence suggests that older adults are self-medicating as well as using it recreationally, in an attempt to treat pain and other conditions.
“Many patients assume they aren’t going to have adverse side effects from cannabis because they often don’t view it as seriously as they would a prescription drug,” first author Dr Benjamin Han said in a statement.
“I do see a lot of older adults who are overly confident, saying they know how to handle it — yet as they have gotten older, their bodies are more sensitive, and the concentrations are very different from what they may have tried when they were younger.”
The team explains that increases in trips to the ED included injuries resulting from reduced reactions and impaired attention, plus conditions such as cardiovascular and pulmonary diseases which can be exacerbated by the drug.
"Additionally, there are potential drug interactions that can lead to adverse effects and cannabinoid hyperemesis syndrome is related to cannabis use," the team writes. "Many of these complications have resulted in the need for acute clinical care in EDs."
According to the authors, current questionnaires designed to assess cannabis use may be off-putting to older patients, as they lump in cannabis with non-legal drugs such as cocaine and heroin, meaning they may be more likely to answer dishonestly. Instead, they suggest asking about cannabis separately, to encourage honesty.
“Providers can then ask how frequently cannabis is used, for what purpose — such as medically for pain, sleep, or anxiety or recreationally to relax — in what form (smoked, eaten, applied topically) and if they know how much THC and CBD it contains," co-author Dr Alison Moore said.
"Once the provider has this type of information, they can then educate the patient about potential risks of use.”
The team notes that though use for older age groups has gone up, the perceived risk of regular risk by these age groups has gone down.
“Although cannabis may be helpful for some chronic symptoms, it is important to weigh that potential benefit with the risk," Moore added, "including ending up in an emergency department."
The study was published in the Journal of the American Geriatrics Society.