Cannabis Use Disorder Among Older Adults
Publication Date: January 1, 2020
Last Updated: March 14, 2022
RECOMMENDATIONS
1: Cannabis should generally be avoided by older adults who have:
a. A history of, or are currently experiencing, mental health disorders, problematic substance use, or Substance Use Disorder (SUD).
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b. Cognitive impairment, cardiovascular disease, cardiac arrhythmias, coronary artery disease, unstable blood pressure, or impaired balance.
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2: Clinicians should be aware of the following:
a. The current evidence base on the medical use of cannabis is relatively limited, and cannabis and most derivative products have not been approved as therapeutic agents by Health Canada, with the exception of two pharmaceutical grade cannabinoid products. Clinicians should keep informed about new evidence regarding possible indications and contraindications for cannabis and cannabinoid use.
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b. The common signs and symptoms associated with cannabis use, cannabis-induced impairment, cannabis withdrawal, CUD, and common consequences of problematic cannabis use.
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c. The potential adverse effects of cannabis use in older adults, such as changes in depth perception risking balance instability and falls, changes in appetite, cognitive impairment, cardiac arrhythmia, anxiety, panic, psychosis, and depression.
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d. Mental health disorders which are commonly comorbid with CUD such as depression, anxiety, and schizophrenia/psychosis.
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3: In order to support the retention of information, clinicians should provide education and counselling with regard to cannabis and cannabinoids to older patients and their family members/caregivers both verbally and in writing. (, )
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4: Clinicians should counsel patients, caregivers, and families to be aware that older adults can be more susceptible than younger adults to some dose-related adverse events associated with cannabis use. (High, Strong)
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5: Clinicians should advise patients, caregivers, and families about potentially increased risks associated with higher potency delta-9- tetrahydro-cannabinol (THC) extracts, or higher potency strains of cannabis when compared to those with lower THC content. (Low, Strong)
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6: Clinicians should advise patients, caregivers, and families of risks associated with different modes of use of cannabis and cannabis products (e.g., smoking, vaporizing, oils, sprays, etc.) and counsel patients on these risks. (Moderate, Strong)
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7: Clinicians should educate patients to avoid illegal synthetic cannabinoids (e.g., K2 and SPICE,) because of the potential to cause serious harm. (Low, Strong)
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8: Clinicians should educate patients on the risk of cannabis-induced functional impairment especially if the patient is cannabis-naive or titrating to a new dose. It is recommended that the starting dose should be as low as possible and gradually increased over time if needed. (High, Strong)
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9: Clinicians should counsel patients on the potential long-term effects of frequent cannabis use including respiratory problems, precancerous epithelial changes, and cognitive impairment. Patients should also be counselled on the risk of exacerbation of mental health conditions with CUD, especially when high THC strains are used. (Moderate, Strong)
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10: Clinicians should advise patients, caregivers, and families that:
a. Cannabis may impair the ability to safely drive a motor vehicle for up to 24 hours.
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b. The use of both cannabis and alcohol together results in synergistic impairment, increases risks for driving, and should be avoided.
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c. It is dangerous to ride as a passenger with a driver who has used cannabis within the previous 24 hours.
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11: Patients, caregivers, and families should be provided with information about the signs, symptoms, and risks of cannabis withdrawal. (High, Strong)
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12: Clinicians should initiate non-judgmental discussions related to cannabis and cannabinoid use. Careful histories should be obtained from patients, caregivers, and families about signs and symptoms of CUD that may be similar to those of age-related nervous system changes, such as drowsiness, dizziness, memory impairment, and falls. (High, Strong)
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13: All patients regardless of age should be screened for:
a. The use of non-medical and medically authorized cannabis and cannabinoids, and illicit synthetic cannabinoids as well as tobacco, alcohol, and other drugs.
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b. The amount and type of cannabis or cannabinoid used, and its frequency, by those who acknowledge any use. Those who acknowledge any recent use (any in the past month) should then go on to targeted screening using the Cannabis Use Disorder Identification Test (CUDIT).
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14: Clinicians should be aware that the diagnostic accuracy of some screening tools may be variable given that some of the symptoms of aging may overlap with those of CUD. (Moderate, Weak)
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15: Assessment of CUD in older adults should evaluate:
a. Modes of use: i.e., ingesting, smoking, vaping, use of extracts, topicals, nabilone, and nabiximols, etc., and consider the risks/ benefits/harms of all that apply to the patient.
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b. Frequency and dosage.
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16: Clinical assessment of CUD in older adults should evaluate the signs and symptoms of cannabis withdrawal, with consideration that the rapid reduction or abrupt discontinuation of cannabis use may also be associated with withdrawal symptoms. (High, Strong)
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17: When assessing patients, clinicians should be aware of the risk of cannabis hyperemesis syndrome in association with chronic cannabis use, especially with higher potency preparations. (High, Strong)
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18: The Screening, Brief Intervention, and Referral to Treatment) (SBIRT) approach should be considered for assessing and managing CUD similarly to other SUDs. (Low, Strong)
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19: Peer support programs should be considered for individuals with CUD. (Moderate, Strong)
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20: It is recommended that a variety of psychosocial approaches be considered for harm reduction or relapse prevention including: Cognitive Behavioural Therapy (CBT), Motivational Interviewing (MI), Mindfulness Based Relapse Prevention (MBRP), Motivational Enhancement Therapy (MET), and Contingency Management (CM). (Moderate, Strong)
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21: There are currently no established pharmacological treatments that have been demonstrated to be safe and effective for either cannabis withdrawal symptoms or CUD. (, )
[Consensus]
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22: Accredited residential treatment should be considered as appropriate for treating CUD if the individual is unable to effectively reduce or cease their cannabis use. (Low, Strong)
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Recommendation Grading
Overview
Title
Cannabis Use Disorder Among Older Adults
Authoring Organization
Canadian Coalition for Seniors’ Mental Health
Endorsing Organization
American Psychiatric Association
Publication Month/Year
January 1, 2020
Last Updated Month/Year
December 16, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Adult, Older adult
Health Care Settings
Ambulatory, Correctional facility
Intended Users
Social worker, psychologist, addiction treatment specialist, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Rehabilitation, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D002188 - Cannabis
Keywords
Cannabis use disorder, recreational activities
Source Citation
Bertram JR, Porath A, Seitz D, Kalant H, Krishnamoorthy A, Nickerson J, Sidhu A, Smith A, Teed R. Canadian Guidelines on Cannabis Use Disorder Among Older Adults. Can Geriatr J. 2020 Mar 30;23(1):135-142. doi: 10.5770/cgj.23.424. PMID: 32226572; PMCID: PMC7067149.