#86
High Practical Relevance
This paper does not test outcomes, but it speaks directly to a real clinical bottleneck: patients are asking about cannabis, while many physicians still feel underprepared to advise them.
This is a small mixed-methods physician survey, not a treatment trial. Its value is in showing how often cannabis conversations are already happening in practice, and how incomplete clinician training still appears to be, especially for older adults.
Older Adults
Primary Care
Physician Education
Cannabis Counseling
| Audience | Patients, caregivers, clinicians, and health system leaders |
| Primary Topic | How primary care physicians discuss therapeutic cannabis with older versus younger adults |
| Source | Read the full article |
Medical Cannabis Counseling for Older Adults: What This Physician Survey Actually Shows
Medical cannabis counseling for older adults is becoming more important as more patients ask about cannabis for pain, sleep, and anxiety, yet this brief 2026 study suggests many primary care physicians still do not feel adequately prepared to guide them. The paper is useful not because it proves cannabis works or fails, but because it highlights a widening gap between patient demand and clinician confidence, especially when age-specific risks enter the conversation.
For the public: Patients may assume their primary care doctor has clear, detailed answers about medical cannabis, but this paper suggests that is often not the case. Many physicians reported discussing routes of administration and safety concerns, yet fewer seemed comfortable getting into the practical details patients often want, especially around dosing.
For clinicians: The study captures a familiar reality. Cannabis conversations are already happening in ordinary practice, but training appears to lag behind demand. Even in a California academic system, where exposure to these questions may be higher than in many settings, most physicians still did not feel competent discussing medical cannabis use.
For careful readers: This is a small, cross-sectional mixed-methods project, not an efficacy trial and not a prescribing guideline. Its main contribution is descriptive: it shows what physicians say they are doing, what they worry about in older versus younger adults, and where uncertainty still shapes clinical conversations.
For patients and families: Older adults increasingly use or consider cannabis for symptoms like pain, anxiety, and insomnia. If the clinicians they trust feel unsure how to counsel them, patients may end up relying on guesswork, online claims, friends, or retail staff rather than individualized medical guidance.
For providers: The paper underscores that cannabis counseling is no longer a niche topic. It now sits squarely inside routine primary care, and medical cannabis counseling for older adults may require extra attention to falls, cognition, medication interactions, living situation, and product formulation rather than a one-size-fits-all conversation.
For systems and educators: This is also an implementation problem. Patient interest is scaling faster than clinician preparedness, which means health systems, residency programs, and continuing education pathways may need more practical, age-aware cannabis education even before definitive evidence answers every therapeutic question.
| Study Type | Cross-sectional mixed-methods study with survey plus qualitative interview |
| Population | Internal medicine and family medicine physicians from five clinics within one academic health system in San Diego |
| Exposure or Intervention | Physician-reported experience, comfort, and counseling practices regarding cannabis for therapeutic purposes in younger and older adults |
| Comparator | Younger adults aged 21 to 64 years versus adults aged 65 years and older |
| Primary Outcomes | Perceived competence discussing cannabis, beliefs about which products may benefit patients, whether physicians initiate discussions, and qualitative themes around counseling concerns |
| Sample Size or Scope | 20 physicians; mean age 42.8 years; 60% female; 50% internal medicine and 50% family medicine |
| Journal | Journal of the American Geriatrics Society |
| Year | 2026 |
| DOI | 10.1111/jgs.70284 |
| Funding or Conflicts | Supported in part by the Sam and Rose Stein Institute for Research on Aging at UC San Diego; authors reported no conflicts of interest |
This paper supports a simple conclusion: cannabis counseling is already part of routine care, but many physicians still feel undertrained, and older adults raise safety questions that deserve more deliberate, age-specific discussion.
The investigators surveyed and interviewed 20 primary care physicians working in an academic health system in San Diego between June and October 2023. They asked about cannabis education, comfort discussing therapeutic cannabis, beliefs about CBD- and THC-containing products, whether patients raise the topic, and how physicians think differently about younger adults versus adults aged 65 and older.
All physicians reported that patients in both age groups ask about cannabis for therapeutic use, and about half said they initiate these conversations themselves. Most did not feel competent discussing medical cannabis, many talked about route of administration more than dosing, and most were more comfortable imagining benefit from CBD than from THC. Qualitatively, physicians described counseling under conditions of uncertainty, often using a harm-reduction frame. For older adults, they emphasized falls, medication interactions, cognitive effects, and concerns about living alone. For younger adults, they emphasized experimentation, higher-THC product use, and greater perceived risk of misuse or dependency. Medical cannabis counseling for older adults appeared in the study as a real practice need, but not one most respondents felt fully equipped to meet.
This sits low to moderate in the evidence hierarchy, but that is not a flaw if we read it for what it is. It is a descriptive study of clinician attitudes and reported practices, useful for identifying training gaps and implementation problems. It does not test patient outcomes, compare counseling strategies, or determine whether any specific cannabis recommendation improves health.
First, the sample is very small. Twenty physicians from one academic system can surface patterns, but cannot define how most physicians nationwide think or practice.
Second, the setting matters. California physicians may encounter cannabis questions more often than clinicians in more restrictive states, so the findings may not travel neatly across regulatory environments.
Third, these are self-reported attitudes and recollections. They tell us what physicians say they do and believe, not what happens in every actual clinical encounter.
Fourth, the age categories are broad. Grouping all adults 65 and older together may blur important differences between a healthy 66-year-old and a medically complex 88-year-old, which matters greatly when discussing cannabis safety and dosing.
It does not show that cannabis is effective for any condition, that one product type is best, that older adults should or should not use cannabis, or that physician discomfort necessarily leads to poor patient outcomes. It also does not provide a validated dosing framework, prescribing protocol, or age-specific treatment algorithm.
This paper is best read as a snapshot of an important gap. Patients are asking about cannabis, clinicians are trying to respond, and older adults bring distinctive safety considerations that many physicians know about but may not yet feel fully trained to manage. The study does not settle clinical questions about cannabis, but it does make one point hard to ignore: the conversation is already here, and the medical system needs to catch up.
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Frequently Asked Questions About Medical Cannabis Counseling for Older Adults
What was this study actually trying to find out?
It asked how primary care physicians discuss cannabis for therapeutic purposes with patients, and whether their concerns differ for younger adults versus adults aged 65 and older.
Did this paper test whether cannabis works for older adults?
No. It did not test treatment outcomes. It studied physician perspectives, reported practices, and counseling themes.
Were physicians comfortable discussing cannabis?
Most were not. Many reported limited confidence, despite regularly encountering patient questions about therapeutic cannabis.
What concerns did physicians raise for older adults?
They most often raised concern about falls, medication interactions, sedation, cognitive effects, and how cannabis might affect older adults who live alone or already have impairment.
What concerns did physicians raise for younger adults?
They more often worried about experimentation, higher-THC product use, misuse, and dependency risk.
Did physicians seem more comfortable with CBD than THC?
Yes. In the survey, physicians were more likely to agree that CBD-containing products might help patients than THC-only products.
Does this paper mean doctors should avoid discussing cannabis until better data exist?
No. If anything, it suggests the opposite. These conversations are already happening, so clinicians need better ways to have them carefully and responsibly.
Can this study tell us how physicians across the country practice?
Not reliably. The sample was small and came from one California academic health system, so the findings may not generalize to every practice environment.
Why is age-specific counseling so important here?
Because the same product may behave differently in different patients. In older adults, comorbidities, medications, body composition, gait stability, cognition, and social context can all shift the balance of risk and benefit.
What is the most careful takeaway from this paper?
The safest takeaway is that clinician education needs to improve. This paper does not prove cannabis efficacy, but it does show that patients need more informed, practical medical guidance than many systems are currently set up to provide.
