Cannabis use and cannabis use disorder among older adults in the USA

BACKGROUND AND AIMS: Cannabis use is increasing among older adults in the United States (US); however, little is known regarding details of use or cannabis use disorder (CUD) in this population. This study aimed to describe cannabis use and CUD among older adults in the US. DESIGN: Secondary analysis of the 2021-2024 National Survey on Drug Use and Health, an annual cross-sectional nationally representative sample of noninstitutionalized people aged ≥12 living in the US. SETTING: United States. PARTICIPANTS: Noninstitutionalized individuals age ≥65 years (unweighted N = 21 189). MEASUREMENTS: We estimated the prevalence of cannabis use by recency (any past 12-month use and past 30-day use), meeting two or more Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 CUD criteria, as well as CUD severity and individual CUD criteria among adults age ≥65 years who used cannabis in the past 12 months. Cannabis use and CUD were compared across sociodemographic and health-related characteristics, modality of use (2022-2024 only), and individual CUD criteria. Bivariable generalized linear regression models estimated the relative risk (RR) of CUD for older adults with each characteristic and modality of cannabis use. RESULTS: An estimated 8.9% of older adults used cannabis in the past 12 months, and among them, 11.4% met criteria for CUD (76.0% mild, 20.1% moderate, and 3.9% severe CUD). Smoking was the most common modality of past 12-month use (65.8%), followed by eating or drinking (40.5%), and vaping (15.4%); 19.9% had a doctor recommend any cannabis use. Among older adults with CUD, the most common CUD criteria met were spending time obtaining, using, and recovering from the drug's effects (74.4%) and craving (67.5%). Male older adults were at higher risk for CUD than their female counterparts [RR = 1.69, 95% confidence interval (CI): 1.12-2.55], as were those ever arrested and booked (RR = 1.59, 95% CI = 1.07-2.37), with past-year mental illness (RR = 2.93, 95% CI: 1.85-4.65), past-year tobacco use (RR = 1.52, 95% CI: 1.04-2.20) or drug use other than cannabis (RR = 3.22, 95% CI: 2.15-4.84), smoking as a mode of cannabis use (RR = 4.94, 95% CI: 2.39-10.23), and frequent cannabis use (e.g., ≥300 days vs. <300 days per year, RR = 3.70, 95% CI: 2.30-5.96). SUMMARY: One in nine older adults in the United States who have used cannabis in the past 12 months meet criteria for cannabis use disorder. Cannabis use screening, cannabis use disorder treatment, and additional intervention to prevent worsening severity are needed to minimize cannabis-related harms among older US adults.