Cannabis-Related Emergency Room Visits Are on the Rise Among Older People, Study Finds
Emergency department visits related to cannabis use among older adults have increased dramatically over the past 15 years, according to a new study published in the Journal of the American Geriatrics Society.
The study, which examined emergency department (ED) visiting data from hospitals across California, found that ED visits for cannabis-related reasons among those aged 65 or older increased by a staggering 1,808% between 2005 and 2019. Black adults, males, and adults with more comorbidities were also found to have had the highest increases in ED visiting rates within this older demographic.
Based on these findings, and the growing rates of cannabis usage among those aged 65 and older, the researchers say that it is important for primary care providers to be routinely asking their patients about their cannabis usage habits, and to make sure that they are aware of the potential risks of cannabis use.
Cannabis use linked to more ED visits
For this study, researchers from the University of California San Diego School of Medicine examined ED visit data that was reported to the California Department of Healthcare Access and Information (HCAI) from all non-federal hospitals in California between 2005 and 2019. Specifically, the researchers were looking for ED visit records relating to patients aged 65 and over that included a primary or secondary diagnosis of cannabis abuse, cannabis dependence, or cannabis poisoning.
They found a total of 21 cases per 100,000 ED visits in 2005 that matched these parameters. This ED visit rate had risen to 395 cases per 100,000 ED visits in 2019 – a 1,804% relative increase.
“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,” said the study’s first author Benjamin Han, in a statement. Han is a geriatrician in the Division of Geriatrics, Gerontology, and Palliative Care at the UC San Diego School of Medicine.
“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.”
As explained in the paper, cannabis intoxication can slow reaction time and impair attention, which can increase the risk of falls or other accidents. Cannabis has also been associated with an increased risk of developing psychosis and other psychiatric problems that can cause significant distress. The American Heart Association also recently warned against the potential risks of cannabis to heart health.
Breaking the study data into smaller subgroups, the researchers found that the 65-74 age group had the highest ED visit rate in 2019, compared to those aged 75-84 and 85 and over. Black adults had the highest ED visit rate for 2019 when comparing across different racial demographics. Additionally, although older males had the highest ED visit rate in 2019 when comparing based on sex, older females actually had a larger relative percentage increase in ED visits across the whole study period.
The researchers also observed that the overall rate of cannabis-related ED visits among older people rose sharply between 2013 and 2017 before leveling off again. For context, California passed its recreational cannabis legalization measure in late 2016 and its first legal recreational sales occurred in early 2018.
“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,” the researchers wrote.
Doctors should ask all patients about their cannabis use habits
These findings highlight the importance of proper research and education on the potential risks of cannabis use, the researchers say.
“We know from work in alcohol that older adults are more likely to make a change in substance use if they see that it is linked to an undesirable medical symptom or outcome – so linking cannabis use similarly could help with behavioral change,” said co-author Alison Moore, chief of the Division of Geriatrics, Gerontology, and Palliative Care at the UC San Diego School of Medicine.
“Although cannabis may be helpful for some chronic symptoms, it is important to weigh that potential benefit with the risk, including ending up in an emergency department,” Han added.
The researchers recommend that primary care providers should be proactive in routinely discussing cannabis use with their older patients. But how this discussion happens is also important. According to Moore, current screening questionnaires have a tendency to mention cannabis in the same breath as illicit substances such as cocaine or methamphetamines. This association may make a patient less forthcoming with their answers on cannabis.
“Instead, asking a question like, ‘Have you used cannabis — also known as marijuana — for any reason in the last 12 months?’ would encourage older adults to answer more frankly,” Moore said.
“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,” Moore continued. “Once the provider has this type of information, they can then educate the patient about potential risks of use.”