A Geriatrics Practice Built a Medical Cannabis Clinic — Here Is What They Found

Preliminary data from 144 visits across 30 months reveal high clinical complexity and frequent drug interactions among older adults seeking medical cannabis, but the report offers no clinical outcomes data and leaves the question of effectiveness entirely unanswered.

Why This Matters

Cannabis use among older adults is rising sharply, yet most of this use occurs outside any clinical supervision, in a population defined by polypharmacy, multimorbidity, and heightened vulnerability to drug interactions and adverse effects. Geriatric medicine has largely lacked structured models for integrating cannabis oversight into routine care. This report from an academic geriatrics practice offers one of the first concrete, replicable frameworks for doing so, arriving at a moment when clinicians face growing patient demand but have almost no institutional guidance to draw on.

Clinical Summary

As medical cannabis legalization expands, older adults represent one of the fastest-growing user populations, yet they remain among the least studied and most pharmacologically vulnerable. Researchers at Virginia Commonwealth University Health described the development and 30-month implementation of a physician-led medical cannabis clinic embedded within a geriatric primary care practice. Published in the Journal of the American Geriatrics Society as a program implementation report, the model was designed around the premise that structured clinical oversight, including pharmacy-led drug utilization review, could mitigate the safety risks posed by unsupervised cannabis use in patients with extensive comorbidity and polypharmacy burdens.

Across 144 clinic visits from January 2022 through July 2024, the patient population was notably complex: mean age was 65 years, with an average of 20.9 comorbidities and 14.7 concurrent medications. Pain was the dominant qualifying condition at 88.9% of visits, followed by anxiety and insomnia. Drug utilization reviews identified a mean of 4.6 interactions per patient, and 66% of patients were already taking CNS depressants. Crucially, the report presents no clinical outcomes whatsoever, including no data on symptom improvement, adverse events, hospitalizations, or changes in opioid or benzodiazepine use. The authors acknowledge that these findings are preliminary and that future work must assess whether the model actually improves patient safety or health outcomes compared to unstructured cannabis use.

Dr. Caplan’s Take

What this report gets right is the fundamental premise: older adults using cannabis need structured clinical oversight, and the data on polypharmacy and drug interactions make that case compellingly. A mean of 4.6 drug interactions per patient, with two-thirds of patients on CNS depressants, is not a population that should be navigating cannabis use on its own. The gap, however, is significant. We have a well-designed care model and a clear safety rationale, but zero evidence that the model actually changes outcomes. Patients regularly ask me whether a cannabis clinic like this would help them, and the honest answer right now is that it would ensure someone is watching for dangerous interactions, but we cannot yet say it leads to better symptom control or fewer harms.

In practice, what I take from this is reinforcement of what we already do: every older patient using or considering cannabis gets a thorough medication reconciliation, with particular attention to CNS depressants, anticoagulants, and drugs with narrow therapeutic windows. I treat this as a medication management visit, not a cannabis endorsement visit. The VCU model formalizes that approach, which is valuable, but clinicians should not confuse the existence of a structured program with proof that the program works.

Clinical Perspective

This report sits very early in the research arc. It establishes that embedding cannabis oversight in geriatric primary care is logistically achievable and characterizes the population that presents for such care. It does not, however, address whether structured oversight reduces adverse events, improves symptom management, decreases polypharmacy, or changes healthcare utilization. Clinicians should interpret the findings as a descriptive baseline that justifies further study rather than as evidence supporting the adoption of this specific model over alternative approaches. The data do confirm what pharmacological reasoning already suggests: that this population carries substantial interaction risk and warrants careful medication review when cannabis is part of the picture.

From a safety standpoint, the prevalence of concurrent CNS depressant use (66%) deserves particular clinical attention. Cannabis compounds, especially THC, can potentiate sedation, increase fall risk, and exacerbate cognitive impairment in patients already on benzodiazepines, opioids, or sedating antidepressants. Cytochrome P450 interactions, particularly involving CYP3A4 and CYP2C19, add another layer of complexity. The actionable recommendation for clinicians today is straightforward: any older adult using or initiating cannabis should receive a formal drug utilization review, ideally involving a pharmacist, with explicit attention to CNS depressants and hepatically metabolized medications with narrow therapeutic indices.

Study at a Glance

Study Type

Retrospective descriptive case series and program implementation report

Population

Older adults (mean age 65 years) in a single academic geriatric primary care practice

Intervention

Physician-led medical cannabis clinic with pharmacy-led drug utilization review

Comparator

None

Primary Outcomes

None assessed; descriptive characterization of visit demographics, comorbidities, medications, and drug interactions only

Sample Size

144 clinic visits over 30 months

Journal

Journal of the American Geriatrics Society (JAGS)

Year

2024

DOI or PMID

Not provided in source data

Funding Source

Not specified

What Kind of Evidence Is This

This is a program implementation report and retrospective descriptive case series, published under a geriatric care models and quality improvement category. It sits near the base of the evidence hierarchy, below observational cohort studies and far below controlled trials. The most important inference constraint is that its purely descriptive design, with no comparison group and no outcome measurement, precludes any conclusion about whether the clinic model improves safety, symptom management, or any other clinical endpoint.

How This Fits With the Broader Literature

The broader literature on cannabis use in older adults has grown substantially in recent years, with survey-based and observational studies documenting rising prevalence, common indications such as chronic pain and insomnia, and safety concerns around polypharmacy and falls. Studies such as those by Abuhasira et al. (2018) and Minerbi et al. (2019) have described outcomes in older cannabis users but typically in dispensary or survey settings without integrated clinical oversight. This VCU report extends the literature by proposing and describing a clinic-based model, but it does not yet add outcome data to the evidence base. It aligns with consensus recommendations from the American Geriatrics Society and others that cannabis use in older adults warrants structured clinical monitoring, while falling short of providing evidence that any specific monitoring model is superior to usual care.

Common Misreadings

The most likely overinterpretation is inferring that because the clinic was successfully implemented and identified drug interactions, it therefore improved patient safety or clinical outcomes. The report contains no outcomes data of any kind. Identifying a drug interaction during a medication review is not the same as demonstrating that the identification led to a medication change, that the change prevented an adverse event, or that the patient was better off as a result. Similarly, the high comorbidity and polypharmacy figures powerfully illustrate the need for oversight but do not demonstrate that the oversight provided here was effective. Feasibility and necessity are not the same as benefit.

Bottom Line

This report demonstrates that a structured medical cannabis clinic can operate within an academic geriatric primary care practice and documents the striking clinical complexity of the patients it serves. It provides no evidence that the model improves outcomes, reduces harms, or is superior to alternative approaches. Its contribution is establishing a replicable framework and a descriptive baseline for the rigorous effectiveness studies that must follow before clinical recommendations can be made.

References

1. Program implementation report describing a medical cannabis clinic in geriatric primary care at VCU Health, Richmond, VA. Published in the Journal of the American Geriatrics Society, 2024. Models of Geriatric Care, Quality Improvement, and Program Dissemination category.
2. Abuhasira R, Schleider LB, Mechoulam R, Novack V. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. Eur J Intern Med. 2018;49:44-50.
3. Minerbi A, Hauser W, Fitzcharles MA. Medical cannabis for older patients. Drugs Aging. 2019;36(1):39-51.