Older marijuana users: Life stressors and perceived social support

Does Social Support Moderate the Association between Adverse Childhood Experiences and Substance-Related Problems?

Background: More than half of individuals in the United States have had adverse childhood experiences (ACEs), which can result in physical and mental distress. ACEs has been linked with greater likelihood of harmful alcohol and drug use. Research has found that protective factors, such as social support, may potentially buffer against harmful substance use engagement among those who have experienced ACEs. The purpose of this study was to examine associations between perceived social support, ACEs, and alcohol and cannabis-related problems. Moreover, this study aimed to examine if specific domains of perceived social support (family, friends, and significant other) moderated the relationship between ACEs and alcohol and cannabis-related problems. Method: Validated measures of ACEs, perceived social support, and alcohol and cannabis problems were collected in a sample of 401 emerging adults via Prolific Academic (an online data collection platform). Results: Overall perceived social support and domains such as perceived family and friend social support moderated the relationship between ACEs and alcohol-related problems but not ACEs and cannabis-related problems. The association between ACEs and alcohol-related problems was strongest at low levels of perceived family and friend social support. Perceived social support was not associated with cannabis-related problems. Conclusions: Lack of social support is a potential risk factor for alcohol-related problems among emerging adults. Bolstering perceived social support from family and friends among those who have experienced ACEs may be beneficial in intervention and treatment efforts aiming to reduce harmful substance use in this population.

Impacts of medical and non-medical cannabis on the health of older adults: Findings from a scoping review of the literature

BACKGROUND

Cannabis legalization has enabled increased consumption in older adults. Age-related mental, physical, and physiological changes may lead to differences in effects of cannabis in older adults compared to younger individuals.

OBJECTIVE

To perform a scoping review to map the evidence regarding the health effects of cannabis use for medical and non-medical purposes in older adults.

METHODS

Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched for systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized/observational studies (NRSs) assessing the health effects and associations of cannabis use (medical or non-medical) in adults ≥ 50 years of age. Included studies met age-related inclusion criteria or involved a priori identified health conditions common among older adults. Records were screened using a liberal accelerated approach and data charting was performed independently by two reviewers. Descriptive summaries, structured tables, effect direction plots and bubble plots were used to synthesize study findings.

FINDINGS

From 31,393 citations, 133 publications describing 134 unique studies (26 SRs, 36 RCTs, 72 NRSs) were included. Medical cannabis had inconsistent therapeutic effects in specific patient conditions (e.g., end-stage cancer, dementia), with a number of studies suggesting possible benefits while others found no benefit. For medical cannabis, harmful associations outnumbered beneficial, and RCTs reported more negative effects than NRSs. Cannabis use was associated with greater frequencies of depression, anxiety, cognitive impairment, substance use and problematic substance use, accidents/injuries, and acute healthcare use. Studies often were small, did not consistently assess harms, and did not adjust for confounding.

DISCUSSION

The effects of medical cannabis are inconsistent within specific patient conditions. For older adults, generally, the available evidence suggests cannabis use may be associated with greater frequencies of mental health issues, substance use, and acute healthcare use, and the benefit-to-risk ratio is unclear. Studies with a balanced assessment of benefits and harms may guide appropriate public health messaging to balance the marketing pressures of cannabis to older adults.

Preparedness for healthy ageing and polysubstance use in long-term cannabis users: a population-representative longitudinal study

BACKGROUND

Cannabis is often characterised as a young person's drug. However, people who began consuming cannabis in the 1970s and 1980s are no longer young and some have consumed it for many years. This study tested the preregistered hypothesis that long-term cannabis users show accelerated biological ageing in midlife and poorer health preparedness, financial preparedness, and social preparedness for old age.

METHODS

In this longitudinal study, participants comprised a population-representative cohort of 1037 individuals born in Dunedin, New Zealand, between April, 1972, and March, 1973, and followed to age 45 years. Cannabis, tobacco, and alcohol use and dependence were assessed at ages 18 years, 21 years, 26 years, 32 years, 38 years, and 45 years. Biological ageing and health, financial, and social preparedness for old age were assessed at age 45 years. Long-term cannabis users were compared using independent samples t tests with five groups: lifelong cannabis non-users, long-term tobacco users, long-term alcohol users, midlife recreational cannabis users, and cannabis quitters. In addition, regression analyses tested dose-response associations for continuously measured persistence of cannabis dependence from age 18 years to 45 years, with associations adjusted for sex, childhood socioeconomic status, childhood IQ, low childhood self-control, family substance dependence history, and persistence of alcohol, tobacco, and other illicit drug dependence.

FINDINGS

Of 997 cohort members still alive at age 45 years, 938 (94%) were assessed at age 45 years. Long-term cannabis users showed statistically significant accelerated biological ageing and were less equipped to manage a range of later-life health, financial, and social demands than non-users. Standardised mean differences between long-term cannabis users and non-users were large: 0·70 (95% CI 0·46 to 0·94; p<0·0001) for biological ageing, -0·72 (-0·96 to -0·49, p<0·0001) for health preparedness, -1·08 (-1·31 to -0·85; p<0·0001) for financial preparedness, and -0·59 (-0·84 to -0·34, p<0·0001) for social preparedness. Long-term cannabis users did not fare better than long-term tobacco or alcohol users. Tests of dose-response associations suggested that cannabis associations could not be explained by the socioeconomic origins, childhood IQ, childhood self-control, and family substance-dependence history of long-term cannabis users. Statistical adjustment for long-term tobacco, alcohol, and other illicit drug dependence suggested that long-term cannabis users' tendency toward polysubstance dependence accounted for their accelerated biological ageing and poor financial and health preparedness, although not for their poor social preparedness (β -0·10, 95% CI -0·18 to -0·02; p=0·017).

INTERPRETATION

Long-term cannabis users are underprepared for the demands of old age. Although long-term cannabis use appears detrimental, the greatest challenge to healthy ageing is not use of any specific substance, but rather the long-term polysubstance use that characterises many long-term cannabis users. Substance-use interventions should include practical strategies for improving health and building financial and social capital for healthy longevity.

FUNDING

The National Institute on Aging and the UK Medical Research Council. The Dunedin Research Unit is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation and Employment.

Cannabis Use and Misuse in Older Adults

Cannabis is the most frequently used illegal psychoactive substance by older adults. With population aging, legalization and medicalization of cannabis, and changes in perceptions of older adults toward its use, recreational and medical cannabis use/misuse is on the rise in seniors. Although there are solid data related to the adverse events of cannabis in older adults, efficacy data are lacking. Older adults are at increased risk of developing cannabis use disorder alongside other medical and psychiatric comorbidities. We review the benefits and risks associated with cannabis use, and screening and management strategies for cannabis use disorder in older adults.

Alcohol use among older adults and health care utilization

OBJECTIVE

Examinations of the association between health care utilization and levels of alcohol use are lacking in nationally representative samples of older adults. The present study set out to fill this gap by demonstrating how various aspects of health care utilization are associated with alcohol use among older adults in the United States.

METHOD

Cross-sectional panel data from 11 years of the National Health and Interview Survey were used to examine prevalence and rates of alcohol use among older adults (n = 106,511) and associations with demographic variables and recency of health care use, health care office visits, and use of emergency room/emergency department.

RESULTS

About 70% of older adults (aged 65+; mean age = 74.1, SD = 0.04) had drunk alcohol in their lifetime, and 15.8% were current moderate or heavy drinkers. Results of an adjusted multinomial logistic regression revealed that individuals with any lifetime alcohol use had more recent health care visits and more office visits (but not current heavy users) than lifetime abstainers. Former alcohol users had more ER/ED visits but current moderate users at all levels had fewer ER/ED visits than lifetime abstainers, controlling for sex, race, educational attainment, marital status, and concurrent tobacco use.

CONCLUSION

Older adults who have any history of alcohol use are more likely than abstainers to have had recent health care visits, more office visits, (but not moderate or heavy users), and less likely to have had an emergency department visit.

Prevalence of substance use and substance-related disorders among US Veterans Health Administration patients

BACKGROUND

Substance use and related disorders are common among US Veterans, but the population burden of has never been directly assessed among Veterans Health Administration (VA) patients. We surveyed VA patients to measure substance use and related disorders in the largest US integrated healthcare system.

METHODS

We surveyed N = 6000 outpatients from 30 geographically-representative VA healthcare systems. We assessed substance use (lifetime, past 12-month, daily in past 3 months) and past 12-month disorders following DSM-5 criteria and estimated the association with Veteran characteristics (age, gender, race/ethnicity, socioeconomic status, VA utilization).

RESULTS

Alcohol was the most commonly-reported substance (24% used past 12 months, 11% daily in past 3 months, 10% met criteria for alcohol use disorder), followed by cannabis (42% lifetime use, 12% use in past 12 months, 5% daily use in past 3 months, 3% met criteria for cannabis use disorder). Overall, 5% met criteria for non-alcohol drug use disorder (13% for substance use disorder (SUD)). SUD prevalence was highest for young Veterans and those who were unemployed or otherwise not employed for wages. Past 12-month cannabis use was common, even among older adults (65-74 years: 10%; 75 and older: 2%).

CONCLUSIONS

Prevalence data are important inputs into decisions around population health monitoring, treatment capacity, and quality measurement strategies. Substance use and SUD are more prevalent than previously reported, and VA may need to screen for non-alcohol drugs to identify patients who need care. More tailored assessment may be needed for cannabis use, high-prevalence subgroups, and older adults.

Marijuana use/nonuse among those aged 50+: comparisons of use-to-nonuse, initiation/reinitiation, and continued use over 24 months

OBJECTIVES

To examine: (1) correlates of use-to-nonuse (use 13-24 months ago, but no past-year use), initiation/reinitiation (no use 13-24 months ago, but past-year use), and continued use over a 24-month period; and (2) associations of past-year marijuana use disorder with use/nonuse among older adults.

METHOD

The 2015-2017 National Survey on Drug Use and Health provided data (N = 26,322 aged 50+). We used multinomial and binary logistic regression analyses to compare users-to-nonusers and initiators/reinitiators to continued users (N = 2304).

RESULTS

In the 50-64 age group, 2.1% were users-to-nonusers, 2.2% initiators/reinitiators, and 7.2% continued users. In the 65+ age group, the corresponding percentages were 0.7%, 0.7%, and 2.4%. Residence in states with medical marijuana laws, nicotine dependence, and other illicit drug use were associated with a lower likelihood of use-to-nonuse than continued use. Alcohol use disorder was associated with a higher likelihood of initiation/reinitiation. Parole/probation status was associated with higher likelihood of use-to-nonuse. Moderate/great marijuana risk perceptions were associated with a higher likelihood of both use-to-nonuse and initiation/reinitiation. The odds of marijuana use disorder did not differ between continued users and initiators/reinitiators or between medical and recreational users.

CONCLUSION

Most older users continued using over 24 months. Substantial numbers had marijuana and other substance use problems that require treatment.

Social Isolation Profiles and Older Adult Substance Use: A Latent Profile Analysis

OBJECTIVES

The aim of this study was to determine substance use among older adults based upon their social isolation and loneliness profiles.

METHODS

Data were derived from the New Jersey Older Adult Survey on Drug Use and Health (OASDUH). Latent profile Analysis (LPA) was used to determine the profiles of older adults (N = 801) based on five dimensions of social isolation and loneliness. Logistic and generalized ordered logistic regressions were conducted to assess the relationship between the latent profiles and substance use.

RESULTS

LPA identified five social isolation/loneliness profiles. The "connected and active" group had the lowest odds of cigarette use. The "alone but not lonely" group had the highest odds of cigarette use, alcohol use, and high-risk drinking. The "alone and lonely" group had the highest odds of non-medical drug use.

DISCUSSION

In working with older adults who are using substances, it is important to inquire about their social isolation and loneliness. Cognitive behavioral therapy for the "alone and lonely" group may be beneficial, as it has been deemed effective in reducing loneliness and enhancing social network.

Using actor-partner interdependence modeling to understand recent illicit opioid use and injection drug use among men in community supervision and their female partners in New York City

BACKGROUND

The United States' opioid crisis disproportionately affects individuals in the criminal justice system. Intimate partners can be a source of social support that helps reduce substance use, or they can serve as a driver of continued or increased substance use. Better understanding of the association between intimate partner characteristics and illicit opioid use and injection drug use among individuals in community supervision could be vital to developing targeted interventions.

METHODS

Using actor-partner interdependence models, we examined individual and partner characteristics associated with recent illicit opioid use and injection drug use among males in community supervision settings in New York City (n = 229) and their female partners (n = 229).

RESULTS

Higher levels of depression (aOR 1.98, 95% CI [1.39-2.82], p ≤ 0.01) and anxiety (aOR 1.98, 95% CI [1.42-2.75], p ≤ 0.01) were associated with recent opioid use among males in community supervision. Females with a partner having higher levels of anxiety were more likely to have recently used opioids (aOR 1.52, 95% CI [1.06-2.16], p ≤ 0.05). Males with a female partner with higher levels of anxiety (aOR 2.16, 95% CI [1.31-3.56], p ≤ 0.01) or depression (aOR 1.70, 95% CI [1.01-2.86], p ≤ 0.05) were more likely to recently inject drugs. Women with a male partner who had been in prison were more likely to have recently injected drugs (aOR 3.71, 95% CI [1.14-12.12], p ≤ 0.05), but women who had a male partner who had been arrested in the past three months were less likely to have recently injected (aOR 0.08, 95% CI [0.02-0.46], p ≤ 0.01).

CONCLUSIONS

Results suggest that recent individual illicit opioid use and injection drug use is associated not only with individual-level factors, but also with partner factors, highlighting the need for couple-based approaches to address the opioid epidemic.

Mental Health and Cognition in Older Cannabis Users: a Review

Background

The impact of cannabis use on mental health and cognition in older adults remains unclear. With the recent legalization of cannabis in Canada, physicians will need up-to-date information about the mental and cognitive effects of cannabis use in this specific population.

Method

A narrative review was conducted to summarize the literature on mental health and cognitive effects of cannabis use in older adults using Medline (OvidSP).

Results

A total of 16 studies were identified, including nine cross-sectional studies on mental health comorbidities reported by older cannabis users. The self-reported prevalence of mental and substance use disorders is approximately two to three times higher in older adults who report past-year cannabis use, compared to older adults who report using more than one year ago or never using. The remaining seven clinical trials found that short-term, low-dose medical cannabis was generally well-tolerated in older adults without prior serious mental illness. However, mental/cognitive adverse effects were not systematically assessed.

Conclusion

Although preliminary findings suggests that low-dose, short-term medical cannabis does not carry significant risk of serious mental health and cognitive adverse effects in older adults without prior psychiatric history, epidemiological studies find a correlation between past-year cannabis use and poor mental health outcomes in community-dwelling older adults. These findings may indicate that longer term cannabis use in this population is detrimental to their mental health, although a direct causal link has not been established. Larger, longitudinal studies on the safety of medical cannabis in older adults are needed.

Self-reported cognition and marijuana use in older adults: Results from the national epidemiologic survey on alcohol and related conditions-III

Marijuana use among older adults is on an unprecedented rise, yet little is known about its effects on cognition in this population where, due to advanced age, risk for cognitive decline is high. Thus, we investigated whether marijuana use and use characteristics were associated with self-reported cognition among older adults ages ≥ 50 years using the National Epidemiologic Survey on Alcohol and Related Conditions-III. Respondents either had never used marijuana ("never": n = 10,976), used but not in the past 12 months ("former": n = 2990), or used in the past 12 months ("current": n = 712). Self-reported cognition was measured using the Executive Function Index. Marijuana and substance use characteristics were obtained using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Covariates included demographics, mental health and disability, and comorbid mental and substance use disorder. Using general linear models of cross-sectional data, we found that current users, particularly those with cannabis use disorder, reported worse cognition than never or former users, but these effects were small in magnitude. Among both former and current users, greater duration of past use was associated with worse cognition. Frequent use within the past 12 months was associated with worse cognition among current users, but daily users reported better cognition compared to monthly or weekly users. Thus, marijuana use may impact self-reported cognition in older adulthood, although these effects may be subtle, specific to particular use characteristics, and possibly affected by self-awareness of deficits. Future work using objective measures such as neuropsychological testing or neuroimaging may better elucidate these effects.

Effects of medical and non-medical cannabis use in older adults: protocol for a scoping review

INTRODUCTION

With its legalisation and regulation in Canada in 2018, the proportion of Canadians reporting cannabis use in 2019 increased substantially over the previous year, with half of new users being aged 45+ years. While use in older adults has been low historically, as those born in the 1950s and 1960s continue to age, this demographic will progressively have more liberal attitudes, prior cannabis exposure and higher use rates. However, older adults experience slower metabolism, increased likelihood of polypharmacy, cognitive decline and chronic physical/mental health problems. There is a need to enhance knowledge of the effects of cannabis use in older adults. The following question will be addressed using a scoping review approach: what evidence exists regarding beneficial and harmful effects of medical and non-medical cannabis use in adults >50 years of age? Given that beneficial and harmful effects of cannabis may be mediated by patient-level (eg, age, sex and race) and cannabis-related factors (eg, natural vs synthetic, consumption method), subgroup effects related to these and additional factors will be explored.

METHODS AND ANALYSIS

Methods for scoping reviews outlined by Arksey & O'Malley and the Joanna Briggs Institute will be used. A librarian designed a systematic search of the literature from database inception to June 2019. Using the OVID platform, Ovid MEDLINE will be searched, including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase Classic+Embase, and PsycINFO for reviews, randomised trials, non-randomised trials and observational studies of cannabis use. The Cochrane Library on Wiley will also be searched. Eligibility criteria will be older adult participants, currently using cannabis (medical or non-medical), with studies required to report a cannabis-related health outcome to be eligible. Two reviewers will screen citations and full texts, with support from artificial intelligence. Two reviewers will chart data. Tables/graphics will be used to map evidence and identify evidence gaps.

ETHICS AND DISSEMINATION

This research will enhance awareness of existing evidence addressing the health effects of medical and non-medical cannabis use in older adults. Findings will be disseminated through a peer-reviewed publication, conference presentations and a stakeholder meeting.

TRIAL REGISTRATION NUMBER

DOI 10.17605/OSF.IO/5JTAQ.

Cannabis use in older drivers in Colorado: The LongROAD Study

This study examined cannabis use and driving outcomes among older drivers in Colorado, which has legalized medical and recreational use. The associations of self-reported past-year cannabis use with diverse driving outcomes were assessed in 598 drivers aged 65-79 (51% female, 70% with postsecondary education), using regression analysis to adjust for health and sociodemographic characteristics. Two hundred forty four (40.8%) drivers reported ever using cannabis. Fifty-four drivers (9.0%) reported past-year use, ranging from more than once a day (13.0%) to less than once a month (50.0%). Of past-year users, 9.3% reported cannabis use within 1 h of driving in the past year. Past-year users were younger, less highly educated, lower income, and reported significantly worse mental, emotional, social and cognitive health status than drivers without past-year use. Past-year users were four times as likely to report having driven when they may have been over the legal blood-alcohol limit (adjusted OR [aOR] = 4.18; 95% CI: 2.11, 8.25) but were not more likely to report having had a crash or citation (aOR = 1.36; 95% CI: 0.70, 2.66) in the past year. Users and non-users had similar scores on self-rated abilities for safe driving (adjusted beta=-0.04; 95% CI: -0.23, 0.15) and on driving-related lapses, errors and violations in the past year (adjusted beta = 0.04; 95% CI: -0.04, 0.12). Further study is needed to establish driving risks and behaviours related to cannabis use, independent of other associated risk factors, among older adults.

Component Model of Addiction Treatment: A Pragmatic Transdiagnostic Treatment Model of Behavioral and Substance Addictions

Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions including etiology, course, and neurobiology. Yet, the treatment of behavioral and substance use addictions tends to be separated. However, we argue that a more effective and efficient treatment approach is to conceptualize behavioral and substance use addictions as different expressions of a common underlying disorder and, in treatment, to address the underlying mechanisms common to both. To this end, the article presents a developing transdiagnostic treatment model of addictions that targets underlying similarities between behavioral and substance use addictions, called the component model of addiction treatment (CMAT). The CMAT is transdiagnostic in that it can be used in the treatment of both behavioral and substance use addictions. It is pragmatic in that it targets component vulnerabilities, which are enduring, yet malleable, individual psychological, cognitive, and neurobiological characteristics that are common to all addictive disorders and have been demonstrated to be modifiable. A working model of CMAT is presented, including proposed component vulnerabilities: lack of motivation, urgency, maladaptive expectancies, deficits in self-control, deficits in social support, and compulsivity, as well as their potential intervention possibilities. Future directions and potential implications of the CMAT are discussed.

Marijuana Use Among Adults 50 Years or Older in the 21st Century

Background: Marijuana is the most commonly used illicit drug among older adults. As an older population grows in the United States that has a tolerant attitude toward marijuana use, the dynamics of marijuana use and the effects of marijuana on personal, social, and health outcomes among older adults require attention. Objectives: This review summarizes epidemiological literature on marijuana use among older adults. Method: A literature search was conducted using PubMed, AgeLine, and an online search engine from January 2000 to December 2017, resulting in 18 articles. Results: The greatest increase in marijuana use was observed among those in the older adult population 50 years or older, and those 65 years or older had the greatest increase in marijuana use in the older adult population. Common correlates of marijuana use among those in the older population included being male, being unmarried, having multiple chronic diseases, having psychological stress, and using other substances such as alcohol, tobacco, other illicit drugs, and prescription drugs. Conclusion: The increased use of marijuana in older populations requires surveillance and additional research to understand the use and effects of marijuana in older populations to avoid negative health outcomes.

Impact of Regular Cannabis Use on Biomarkers of Lower Urinary Tract Function

OBJECTIVE

To evaluate the differences in the composition and quantities of urine peptides in regular cannabis users and nonusers by liquid chromatography tandem mass spectrometry analysis.

MATERIALS AND METHODS

Urine specimens from healthy control subjects and cannabis users were utilized to identify the differences in the number and quantity of urine proteins by liquid chromatography tandem mass spectrometry analysis. Significantly altered proteins were determined by a permutation testing statistical method. Heat map, dendrogram, pathway, and network analyses were performed to assess the degree of expression and the potential relationships between proteins in both groups.

RESULTS

A total of 1337 proteins were detected in both groups with 19 proteins being significantly altered in cannabis users. Innate immunity and carbohydrate metabolic pathways were highly linked with upregulated proteins in the cannabis group. Additionally, 91 proteins were present and 46 proteins were absent only in cannabis users in comparison with the control cohort. Our results suggest that regular use of cannabis is associated with significant alterations in a number of urinary peptides, with a large number of proteins present or absent only in cannabis users. Pathway analyses demonstrated an increased immune response in cannabis users compared with controls.

CONCLUSION

Our observations potentially indicate activation (or inhibition) of specific signaling pathways in the lower urinary tract during chronic exposure to exogenous cannabinoids. Our study provides initial proteomic knowledge for future investigations on the potential role of exocannabinoids in the development of intravesical therapies to treat lower urinary tract disorders.

Trends and correlates of marijuana use among late middle-aged and older adults in the United States, 2002-2014

BACKGROUND

Recent trend studies suggest that marijuana use is on the rise among the general population of adults ages 18 and older in the United States. However, little is known about the trends in marijuana use and marijuana-specific risk/protective factors among American adults during the latter part of adulthood.

METHOD

Findings are based on repeated, cross-sectional data collected from late middle-aged (ages 50-64) and older adults (ages 65 and older) surveyed as part of the National Survey on Drug Use and Health between 2002 and 2014.

RESULTS

The prevalence of past-year marijuana use among late middle-aged adults increased significantly from a low of 2.95% in 2003 to a high of 9.08% in 2014. Similarly, the prevalence of marijuana use increased significantly among older adults from a low of 0.15% in 2003 to a high of 2.04% in 2014. Notably, the upward trends in marijuana use remained significant even when accounting for sociodemographic, substance use, behavioral, and health-related factors. We also found that decreases in marijuana-specific protective factors were associated with the observed trend changes in marijuana use among late middle-aged and older adults, and observed a weakening of the association between late-middle aged marijuana use and risk propensity, other illicit drug use, and criminal justice system involvement over the course of the study.

CONCLUSIONS

Findings from the present study provide robust evidence indicating that marijuana use among older Americans has increased markedly in recent years, with the most evident changes observed between 2008 and 2014.