While older adults who use cannabis for medical reasons are more than four times as likely as recreational users to tell doctors about it, a new study suggests that fewer than two in five patients using medical cannabis do discuss it with a health professional. Researchers examined data on 17,685 adults aged 50 years and older who participated in the 2018 and 2019 National Survey of Drug Use and Health (NSDUH), including 1,615 (8.9%) individuals who reported past-year cannabis use. Overall, just 17% of those who did report prior year cannabis use also reported discussing it with a health professional. Recreational users were less apt to discuss cannabis with a doctor or other clinician (12.3%) than people using cannabis for medical reasons (38.7%), the study found. When recreational users also used cannabis for medical reasons, however, they were more apt to discuss it with a clinician (36.8%). "Older adults may worry about how doctors would respond as stigma about cannabis use is still prevalent and some doctors may oppose their use given the lack of scientific evidence of its therapeutic effects and concerns about adverse effects," said study coauthor Namkee Choi of the Steve Hicks School of Social Work at the University of Texas at Austin. "Also, residents in a state where cannabis use is not yet legalized are likely to be concerned about potential legal implications," Choi said by email. The majority of people reporting prior-year cannabis use (72.3%) did live in states with medical cannabis laws, researchers report in the The American Journal of Drug and Alcohol Use. Among prior-year cannabis users, individuals who reported medical use had a higher mean number of chronic health conditions (1.15) than people who reported recreational use (0.88). Fewer people who reported cannabis use in the past year also reported any outpatient, emergency department or inpatient hospital visits (85.9%) than individuals who didn't report prior-year cannabis use (89.5%). And, few people who used cannabis for medical reasons got it from a medical dispensary (19.6%). "This suggests that at least some of the people that use cannabis medically are self-medicating," said Dr. Silvia Martins, director of the Substance Use Epidemiology Unit at the Mailman School of Public Health at Columbia University in New York City. One limitation of the study stems from the wording of the cannabis question in the NSDUH data, Dr. Martins, who wasn't involved in the study, said by email. "The NSDUH question about medical cannabis use does not restrict the definition of 'medical use' only to those that received a medical doctor's recommendation to use cannabis," Dr. Martins said. Another limitation is that even though the NSDUH question about discussing drug use with a health professional references cannabis, the data collected doesn't specify whether any discussions specifically concerned cannabis, the study team notes. "Clinicians need to ask older adults questions about their cannabis use and educate them about potential adverse effects on cognition, falls/other injuries, and drug-drug interactions especially given that older adults tend to take other multiple prescription and over-the-counter medications," Choi said. —Lisa Rapaport Source
