A small study of 20 primary care physicians at a California academic health system found that roughly half felt incompetent counseling patients about medical cannabis, and only 10% had ever received training specific to older adults. As cannabis use among adults 65 and older continues to rise, this training gap carries real clinical consequences for a population facing unique risks including falls, polypharmacy interactions, and cognitive impairment.

Cannabis use among adults aged 65 and older has grown substantially over the past decade, and these patients routinely ask their primary care physicians about it. Yet the medical education system has largely failed to equip frontline clinicians with the knowledge they need to counsel safely, especially for older adults managing multiple medications and facing heightened risks of falls and cognitive decline. When physicians lack confidence and training, the result is not that patients stop using cannabis; the result is that patients use it without informed clinical guidance.

The rising prevalence of cannabis use among older adults has created a counseling demand that most primary care physicians are not trained to meet. This cross-sectional mixed-methods study, published as a research letter, recruited 20 primary care physicians (half internal medicine, half family medicine) from five clinics within a single academic health system in San Diego, California. Each physician completed a structured survey and a brief qualitative teleconference interview between June and October 2023. The researchers aimed to characterize physician attitudes, self-perceived competency, and age-differentiated concerns about counseling patients on therapeutic cannabis use.

All 20 physicians reported that patients across age groups ask about cannabis, yet approximately 45 to 50 percent felt incompetent advising either younger or older patients. Only 10% had ever received cannabis education focused specifically on older adults. Physicians broadly favored CBD over THC, with 80 to 85 percent agreeing CBD products might benefit patients, compared to just 20 percent for THC products. Qualitative interviews revealed distinct age-related concerns: fall risk, polypharmacy interactions, and cognitive impairment for older adults, versus dependency, high-THC misuse, and recreational overlap for younger adults. Physicians described defaulting to informal harm-minimization strategies such as low starting doses and avoiding concurrent sedatives. The authors emphasize that the study’s tiny sample size and single-institution design make these findings hypothesis-generating only, and they call for larger, multi-site investigations to inform curriculum development.

This study names a problem I see every single day. The researchers are right that the competency gap is real, and they deserve credit for documenting it systematically, even in a small sample. But the numbers here are so small that the specific percentages should not be taken at face value. What matters is the qualitative signal: physicians recognize their patients are using cannabis, they feel unprepared, and they are improvising. That rings true well beyond San Diego. The gap between patient demand and physician readiness is not narrowing on its own.

In my practice, I do not wait for the training pipeline to catch up. I treat cannabis like any other therapeutic tool: I ask about it proactively, I assess the whole medication list, and I counsel on dosing, route, timing, and drug interactions with the same rigor I apply to any prescription. For older adults specifically, I prioritize low-THC formulations, avoid inhalation routes when respiratory risk is present, and coordinate closely with pharmacists about CYP enzyme interactions. Physicians who feel unprepared should seek out continuing medical education from clinicians who actually work in this space rather than hoping that formal curricula will arrive soon enough.

This study sits at the very beginning of the research arc on physician cannabis literacy. It does not test an intervention, validate a training model, or measure patient outcomes. Its value lies in identifying the problem with some structure rather than relying on anecdotal consensus. For the practicing clinician, the most useful finding is the qualitative documentation of distinct age-group risk profiles that physicians already intuit but have not been formally trained to address. The emergence of informal harm-minimization strategies across these interviews suggests that even untrained physicians are arriving at sensible first principles, which could inform future guideline development.

From a pharmacological standpoint, the physicians’ caution around THC in older adults is well-founded. THC is metabolized primarily through CYP2C9 and CYP3A4, enzymes that are heavily engaged by common medications in geriatric polypharmacy, including warfarin, statins, calcium channel blockers, and proton pump inhibitors. Fall risk is compounded by THC’s psychomotor effects, and even modest doses can impair balance in patients already taking benzodiazepines or anticholinergics. Clinicians managing older patients who use cannabis should proactively review the medication list for CYP-mediated interaction risk, favor oral or topical routes over inhalation, and start with the lowest feasible THC dose while monitoring for dizziness, sedation, and gait instability.