#52 Clinical Context
Background information relevant to the evolving cannabis medicine landscape.
Clinicians miss opportunities to identify substance use disorders and drug-drug interactions in older adults when screening is inconsistent, potentially leading to adverse health outcomes and inappropriate medication management. Low screening rates mean seniors may not receive evidence-based counseling about cannabis risks including falls, cognitive impairment, and interactions with common medications like anticoagulants. Implementing routine substance use screening in geriatric practice can improve safety, guide treatment decisions, and address a significant care gap in an increasingly diverse older population.
This epidemiologic study reveals a significant screening gap in geriatric primary care, with only approximately one-third of older US adults reporting substance use screening during recent healthcare visits. Underscreening in this population is clinically concerning given the increasing prevalence of cannabis use among older adults, potential drug-drug interactions with common medications, and the risk of substance use disorders that may present atypically or be masked by cognitive decline. The low screening rate suggests many clinicians may underestimate substance use risk in older patients or lack awareness of updated guidelines recommending routine screening across all age groups, potentially leading to missed diagnoses and suboptimal treatment planning. This gap in practice represents a missed opportunity for early identification of problematic use patterns, particularly as older adults may use cannabis for chronic pain or insomnia while remaining unaware of adverse effects or interactions with their existing medications. Clinicians should implement systematic substance use screening protocols in older adult populations using brief validated tools and leverage these conversations to educate patients about cannabis safety and potential risks in the context of aging physiology and polypharmacy.
“What we’re seeing here is a significant gap in our clinical practice. As physicians, we need to be screening all our older patients systematically for cannabis use, not just illegal drugs, because the pharmacokinetics change with age and drug interactions become much more complex. Until we normalize these conversations across primary care, we’re missing important safety information that could affect everything from fall risk to medication management.”
🧓 The low screening rate for cannabis and illicit drug use among older adults represents a significant clinical gap, particularly as cannabis legalization expands access and older adults increasingly use these substances for pain, sleep, and other conditions. This screening deficit is concerning because older patients are at higher risk for adverse drug interactions, polypharmacy complications, and cognitive or fall-related harms from cannabis use, yet providers may lack awareness of consumption patterns or miss opportunities for counseling. Several factors likely contribute to underscreening, including provider discomfort discussing substance use with older patients, time constraints in busy practices, and outdated assumptions that drug use is uncommon in this age group. Given the evolving landscape of cannabis products, potencies, and formulations, clinicians should consider integrating brief, non-judgmental substance use screening into routine visits with older adults, particularly those on multiple medications or presenting with falls, cognitive changes, or sleep disturbances, to
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