#52
Clinical Context
Background information relevant to the evolving cannabis medicine landscape.
Clinicians may be missing substance use disorders in older adults due to inconsistent screening practices, potentially delaying diagnosis and treatment of conditions that compound existing comorbidities. Demographic and clinical biases in screening decisions create gaps in care that could lead to adverse drug interactions, falls, and cognitive decline in this vulnerable population. Implementing universal screening protocols for cannabis and drug use in older adults would improve case identification and enable earlier intervention to optimize medication management and safety.
A study examining screening practices for cannabis and illicit drug use in older adults found that only approximately one-third of this population receives such screening, with significant variations based on demographic factors and underlying health conditions. The disparity in screening rates suggests that some older patients at risk for substance use disorders or harmful drug interactions may not be identified through routine clinical assessment. Given that older adults often take multiple medications with potential interactions with cannabis and other substances, and that cannabis use in this population is increasing, underscreening represents a potential gap in comprehensive medication review and safety monitoring. These findings highlight that clinicians may be making unconscious demographic assumptions that lead to inconsistent substance use screening across the older adult population. For practicing clinicians, implementing systematic and universal screening protocols for cannabis and drug use in all older adult patients, regardless of age, comorbidities, or perceived risk factors, would help identify potential harms and enable safer, more informed treatment decisions.
“What we’re seeing here is a significant gap in our screening practices, and it matters because older adults are increasingly using cannabis—often without disclosing it to their physicians—which creates real risks for drug interactions, falls, and cognitive effects that we might otherwise attribute to aging or other conditions. Until we make universal substance screening a routine part of geriatric care regardless of a patient’s demographics, we’re going to continue missing important contributors to morbidity in this vulnerable population.”
🧓 The significant underscreening of cannabis and drug use in older adults documented in this study highlights a critical gap in preventive care, particularly given the rising prevalence of cannabis use in this population and potential drug interactions with polypharmacy. Demographic and comorbidity-based disparities in screening suggest that providers may hold implicit assumptions about which older patients are at risk, potentially missing important substance use that could complicate medical management or contribute to falls, cognitive changes, and medication nonadherence. The heterogeneity of screening practices across different patient subgroups also raises questions about whether current screening tools and workflows are well-adapted to this age group’s unique patterns of use and health vulnerabilities. Clinicians should consider adopting systematic, universal screening approaches for cannabis and other substances in older adult populations regardless of demographic characteristics, integrating brief validated instruments into routine visits to identify potential harms and inform medication reconciliation discussions.
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