#78
Strong Clinical Relevance
High-quality evidence with meaningful patient or clinical significance.
Clinicians may be missing critical drug interactions and adverse effects in older adults because most cannabis users in this population do not disclose their use during medical encounters. Improving communication about cannabis use is essential for geriatric patients who may be vulnerable to cognitive impairment, falls, and medication interactions. Healthcare providers should proactively ask about cannabis use during history-taking to ensure comprehensive medication reviews and safe clinical decision-making.
A recent study reveals that fewer than 20% of older adults disclose their cannabis use to healthcare providers, representing a significant gap in clinical communication that may compromise medical safety and care quality. This communication barrier is particularly concerning given that older patients often use cannabis for chronic pain, anxiety, and sleep disorders while simultaneously taking multiple medications with potential drug interactions. The reasons for non-disclosure likely include lingering stigma around cannabis use, uncertainty about legal status, fear of clinical judgment, and lack of provider knowledge or comfort discussing cannabis therapeutically. This communication gap creates risks including missed drug-drug interactions, unmonitored adverse effects, and inability to optimize treatment plans that might incorporate cannabis as part of a comprehensive pain or symptom management strategy. Clinicians should proactively normalize cannabis discussions during medication reviews and establish non-judgmental assessment practices to encourage older patients to disclose all substances they are using. Creating an open dialogue about cannabis use in older adults is essential for providing safe, comprehensive care and understanding the full medication and supplement picture that affects their health outcomes.
“The silence around cannabis in clinical encounters with older adults represents a significant gap in our duty to understand what our patients are actually using, because without that conversation we can’t assess drug interactions, adjust other medications appropriately, or help them use cannabis safely if they choose to.”
? The substantial communication gap between older adults and their clinicians regarding cannabis use represents a significant clinical vulnerability, as this population often uses cannabis while taking multiple medications with potential for drug interactions and adverse effects. This underreporting likely reflects a combination of factors including patient embarrassment, clinician discomfort or lack of knowledge about cannabis in geriatrics, and outdated perceptions that cannabis use is uncommon in older populations, though prevalence has been rising in this age group. The limited discussion prevents clinicians from understanding the full medication picture, assessing reasons for use (pain, insomnia, anxiety), evaluating product safety and quality, and monitoring for cognitive or fall-related harms that are particularly concerning in older adults. Healthcare providers should proactively normalize conversations about cannabis by routinely including it in substance use screening, staying informed about product composition and drug interactions, and recognizing that older patients may not volunteer this information without direct, non-judgmental inquiry
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