Elsevier

Drug and Alcohol Dependence

Volume 191, 1 October 2018, Pages 374-381
Drug and Alcohol Dependence

Full length article
Marijuana use by middle-aged and older adults in the United States, 2015–2016

https://doi.org/10.1016/j.drugalcdep.2018.07.006Get rights and content

Highlights

  • Estimates of past-year marijuana use has increased for middle-aged and older adults.

  • Older marijuana users were more likely to use other substances compared to non-users.

  • Screening for concurrent substance use among older marijuana users is an imperative.

Abstract

Background

Marijuana use is increasing among middle-aged and older adults in the US, but little is understood of its pattern of use by this population.

Methods

We performed a cross-sectional analysis of responses from 17,608 adults aged ≥50 years from the 2015 and 2016 administrations of the National Survey on Drug Use and Health. Prevalence of past-year marijuana use was estimated and compared between middle-aged adults (age 50–64) and older adults (≥65). Characteristics of past-year marijuana users including demographics, substance use, chronic disease, and emergency room use, were compared to non-marijuana users and stratified by age group. Marijuana use characteristics were also compared between middle-aged and older adults. We used multivariable logistic regression to determine correlates of past-year marijuana use.

Results

Prevalence of past-year marijuana use was 9.0% among adults aged 50–64 and 2.9% among adults aged ≥65. Prevalence of past-year alcohol use disorder (AUD), nicotine dependence, cocaine use, and misuse of prescription medications (i.e., opioids, sedatives, tranquilizers) were higher among marijuana users compared to non-users. In adjusted models, initiation of marijuana use <19 years of age [adjusted odds ratio (AOR) = 13.43, 95% confidence interval (CI) 9.60, 18.78)], AUD (AOR = 2.11, 95% CI 1.51, 2.94), prescription opioid misuse (AOR 2.49, 95% CI 1.61, 3.85), nicotine dependence (AOR = 1.90, 95% CI 1.59, 2.26), and cocaine use (AOR 7.43, 95% CI 4.23, 13.03), were all associated with increased odds of past-year marijuana use.

Conclusion

Marijuana use is becoming more prevalent in this population and users are also at high risk for other drug use.

Introduction

Attitudes towards marijuana use are changing considerably in the United States (U.S.) with a growing number of states legalizing medical and/or recreational marijuana (Gallup, 2018). Although current users are more likely to be young adults, the Baby Boomer generation is unique as it has had more experience with marijuana compared to any generation preceding them (Han and Moore, 2018). Prevalence of current marijuana use decreases with age (Substance Abuse and Mental Health Services Administration [SAMHSA], 2016), but the Baby Boomer generation—which is now comprised of middle-aged and older adults often with prior experience with marijuana—is now experiencing large increases in recent use. A previous study using nationally representative data, from 2006 to 2013, found a 57.8% relative increase in past-year marijuana use among adults aged 50–64 and a 250% relative increase for adults aged 65 and older (Han et al., 2017).

Despite increases in recent marijuana use by older adults, few studies have examined correlates of use in this population, especially among adults with multiple chronic conditions. Marijuana may have benefits for older adults for neuropathic pain, spasticity, anorexia, and nausea and vomiting (Briscoe and Casarett, 2018). In addition, medical marijuana laws have shown to be associated with significant reductions in opioid prescribing for the Medicare Part D population (Bradford et al., 2018), which could reduce the use and risks of opioids for older adults. However, there may be acute and chronic health risks associated with marijuana use by older adults as well as interactions with prescribed medications (Han and Moore, 2018).

With more US adults supporting the legalization of marijuana (Gallup, 2018), it is imperative to understand the changing patterns of marijuana use by both middle-aged older adults who are more likely to have underlying chronic disease compared to younger adults. While data on the risks and benefits of marijuana use for middle-aged and older adults remain limited, identifying subgroups of older adults who may be at heightened risk for the adverse effects associated with marijuana use (e.g., through concomitant use of other drugs) is also important. Therefore, we used national data from the National Survey on Drug Use and Health (NSDUH) to provide updated estimates of the prevalence of marijuana use and to examine demographic and other drug use characteristics of its users among middle-aged and older adults.

Section snippets

Data source and study population

Data from adults aged ≥50 surveyed in the 2015 and 2016 (n = 17,608) NSDUH were analyzed. Analyses were limited to these two most recent cohorts as NSDUH revised much of its questionnaire in 2015, limiting our ability to examine trends over time (SAMHSA, 2016). NSDUH is a cross-sectional survey of non-institutionalized individuals in the 50 US states and the District of Columbia. NSDUH obtained a nationally representative probability sample of individuals through four stages. Surveys were

Results

Weighed sample characteristics are shown in Table 1. Prevalence of past-year marijuana use was 9.0% for adults aged 50–64 and 2.9% for adults aged >65, and prevalence of past-month use was estimated to be 5.7% for adults aged 50–64 and 1.7% for adults aged >65. More than half (54.5%) of adults aged 50–64 are estimated to have ever used marijuana with over a fifth (22.4%) of adults aged >65 estimated to have ever used.

Table 2 presents comparisons between marijuana users and non-users stratified

Discussion

Using the most recent data from a nationally representative survey of older adults in the US, we estimate that 9.0% of adults aged 50–64 and 2.9% of adults aged >65 used marijuana in the past year. Thus, use may be increasing among this older population as prevalence appears to be higher compared to an earlier study that found that 7.1% of adults aged 50–64 and 1.4% of adults aged >65 used marijuana in 2012–2013 (Han et al., 2017). Utilizing new survey questions added to NSDUH in 2013, we found

Conclusions

Our study characterizes the correlates of marijuana use by middle-aged and older adults and identifies a subgroup of older marijuana users who also engage in potentially risky unhealthy substance use. This emphasizes the importance of screening this population for polysubstance use. While the prevalence of marijuana use in this population will likely continue to increase, the risks and benefits are still unclear, and providers need to inform their older patients of the lack of current research

Conflicts of interest

No conflict declared.

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers K23DA043651 (PI: Han) and K01DA038800 (PI: Palamar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Contributors

All authors are responsible for this reported research. B. Han conceptualized and designed the study, helped interpret results, drafted the initial manuscript, and revised the manuscript. J. Palamar designed the study, conducted the statistical analyses, helped interpret results, and critically reviewed and edited the manuscript. All authors read and approved the final manuscript.

Acknowledgments

The authors would like to thank the Inter-university Consortium for Political and Social Research for providing access to these data (http://www.icpsr.umich.edu/icpsrweb/landing.jsp).

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