Routine Screening Not VA Policy
Click to Enlarge: Results shown are weighted percentages for any and exclusive use of cannabis by modes of use (smoking, vaping, dabbing, or edibles) among those who used cannabis in the past 30 days (n = 1193 [10.3% of the total sample of 4503]). Any use indicates those who reported any cannabis use in the past 30 days by the forms shown (e.g., any use of inhaled cannabis includes 78.3% of those who reported any smoking, vaping, and/or dabbing regardless of the use of edibles). Exclusive use indicates those who reported cannabis use exclusively by the forms shown (e.g., exclusive use of inhaled cannabis includes 63.1% of those who reported any inhaled use [smoking, vaping, or dabbing] and no edibles). In contrast, 21.7% of respondents with past 30-day cannabis use reported the use of edible cannabis only. Multiple forms include reporting any 2 or more forms of use (smoking, vaping, dabbing, and/or edibles). Source: JAMA Network Open
Current VA policy is not to do that, the authors pointed out.
Researchers from the San Francisco VA Healthcare System and the University of California, San Francisco also found that more than one-third of the veterans who used the product in the past 30 days had some type of cannabis-use disorder.
They also reported in JAMA Network Open that risk factors for cannabis use were similar to those observed in other populations, including young people.1
“Frequent and inhaled cannabis use was associated with higher odds of any cannabis use disorder,” the study team wrote. “Routine health screening for cannabis use in Veterans Health Administration clinical settings is necessary to identify older adults with cannabis use.”
In the cross-sectional study of 4,503 respondents aged 65 to 84 years at the VHA in 2020-2023), 10% reported past 30-day cannabis use, 36% of whom had CUD. Younger respondents, those reporting anxiety, those with one or more deficits in activities of daily living, those with past-month illicit drug use and those with frequent, inhaled or recreational cannabis use had higher odds for CUD, according to the researchers. Interviews occurred between Feb. 5, 2020, and Aug. 29, 2023.
“Asking about cannabis use as part of routine health behavior screening in Veterans Health Administration clinical settings may help identify older adults with cannabis use or CUD,” they suggest.
The study points out that not much is known about patterns (forms, frequency and reasons) and factors associated with cannabis use in veterans 65 and older. The (aged ≥65 years).
The 4,503 participants had a weighted mean age of 73.3, and 85.4% were men. Most, 58.2% (95% CI, 55.3%-61.0%) had ever used cannabis, 28.9% (95% CI, 26.0%-31.8%) of whom reported using cannabis for medical reasons; the most common usage was for pain (56.4%; 95% CI, 50.9%-61.9%), mood or mental health (18.4%; 95% CI, 14.7%-22.1%) and sleep (16.0%; 95% CI, 11.9%-20.0%), the researchers were told.
More than 10% reported past 30-day cannabis use (10.3%; 95% CI, 8.9%-11.7%), with 52.4% (95% CI, 45.4%-59.4%) of those using cannabis for 20 days or more. The most common forms of use were smoking (72.4%; 95% CI, 65.4%-79.3%) and edibles (36.9%; 95% CI, 29.8%-43.9%).
The study advised that characteristics associated with past 30-day use included:
- younger age (65–75 years),
- economic hardship,
- tobacco and illicit drug use, and
- residing in a state with recreationally legal cannabis.
Among those with past 30-day cannabis use, 36.3% (95% CI, 30.1%-42.6%) screened positive for CUD, with higher odds among younger respondents, according to the study. It was especially common among veterans reporting anxiety, with 1 or more deficits in activities of daily living, with illicit drug use, with frequent cannabis use and who used cannabis recreationally.
The authors pointed out that past 30-day inhaled cannabis use, compared with edibles only, was associated with increased odds of any CUD (adjusted odds’ ratio, 3.56; 95% CI, 1.12-11.26).
Legalization an Issue
“Previous studies have suggested an increase in cannabis use among older people, with less than 1% (ranging from 0.4% to 0.7%) of adults 65 years or older reporting past-year cannabis use in 2005 to 2006 compared with 8.4% in 2022,” the researchers wrote. “Smoking is the most common form of cannabis use among those 60 years or older and is perceived as less harmful than tobacco smoking. Expansion of state-directed legalization of medical and recreational cannabis, which leads to greater accessibility of cannabis products, has contributed to higher rates of cannabis use and CUD.”
Background information in the article noted that, between 2017 and 2022, a significant increase in CUD-related encounters among Medicare beneficiaries 65 years or older was recorded, with the highest rates in states where recreational and medical cannabis was legal.
“Despite older adults generally holding more negative beliefs about cannabis, legalization might have shifted cannabis perceptions toward its social acceptance among this age group,” study authors suggested. “Older people use cannabis for medical reasons, such as management of pain, mental health, and sleep, which can influence their risk perception and increase the frequency of use.”
The study team called for more research on patterns of consumption and correlates of CUD among the older population, adding, “Older people are generally at higher risks for impairment of activities of daily living (ADLs), frailty and associated falls, as well as hospitalizations and mortality and thus may be particularly susceptible to adverse effects of cannabis, even if used for therapeutic purposes.”
The researchers pointed out that cannabis use increases the risk of neuropsychiatric disorders, respiratory symptoms and cardiovascular outcomes that remain the primary causes of death in older adults.
“Another negative consequence of cannabis use is the risk of CUD, which has become one of the most prevalent substance use disorders in the U.S.,” they added. “Data from the early 1990s to mid-2000s indicate that approximately 20% to 30% of those who use cannabis may develop CUD, with higher risks for people who use cannabis daily. However, these data rely on reports largely from younger populations. In recent years, frequent cannabis use has increased in the general U.S. population 12 years and older, but the frequency of current cannabis use and its association with CUD in older adults remains unclear.”
The study is the only one recently to focus on the patterns and correlates of current cannabis use and CUD in adults 65 years or older at a national level, according to the authors, who advised, “Older veterans are another understudied population in cannabis research. Unlike younger age groups (18–25 years), veterans 65 years or older are less likely to use recreational cannabis, are more likely to use medicinal cannabis recommended by a health care professional, and report use for pain management, insomnia, and mental health (eg, posttraumatic stress disorder [PTSD]).”
The article pointed out that, overall, cannabis use and CUD among U.S. veterans, including VHA patients, have been increasing since the early 2000s, especially in states that have legalized cannabis. While, in early and mid-2000s, past-year CUD estimates were 1.38% among VHA patients and 1.8% among U.S. veterans in general, the most recent 2020 data of veterans aged 22 to 99 years (mean [SD] age, 62.2 [15.7] years) showed a rate of 2.7% for past 6-month CUD diagnoses.
One concern was that odds for moderate to severe CUD did not differ significantly among those who used cannabis recreationally versus for medical reasons only.
Although the U.S. Preventive Services Task Force recommends screening for any unhealthy substance use, the VA has opted not to engage in universal drug screening or screening for cannabis use at this juncture, the researchers explained. “The common and frequent cannabis use among older veterans in our study is concerning and suggests that this decision may need to be reconsidered.”
They added, “Screening and informing older veterans about risks of cannabis use is critical because cannabis use may confer more health risks than benefits.”
- Pravosud V, Lum E, Vali M, et al. Cannabis Use Among Older Adults. JAMA Netw Open. 2025;8(5):e2510173. doi:10.1001/jamanetworkopen.2025.10173