Risk Factors for Cannabis-Related Mental Health Harms in Older Adults: A Review

ABSTRACT

Objectives: This paper reviews research on the topic of cannabis use and mental health harms in older adults and illustrates potential contributing factors and special clinical considerations for working with this population. Known risk factors for cannabis-related mental disorders and mental health problems are outlined, first for the general population and then specifically for older adults.

Methods: Studies were identified through online databases using a variety of search words. Articles were included in the review if they were peer-reviewed or published by a reputable national organization, published in English, and were pertinent to the topic of mental health harms of cannabis use.

Results: Risk factors that emerged from the literature review aligned with the following categories: (1) patterns of use (i.e., potency of product, frequency of use), (2) personal characteristics (i.e., age, sex, social demographics), (3) psychosocial constructs (motivations, perceptions), and (4) morbidities (mental health, medication interactions).

Conclusions: Frequent use was associated with increased risk for mental health consequences related to cannabis use. Certain motives for use (i.e., using to cope, using as a sleep aid) may increase susceptibility to cannabis-related harms, although more empirical work is required. Mental health conditions may predispose to cannabis-related harms through a variety of mechanisms, including increased vulnerability for cannabis-related psychiatric disorders, poorer prognosis for preexisting psychiatric disorders, and possibility of cannabis-medication interactions. Personal characteristics (younger age, being male, lower socioeconomic status) predict more frequent cannabis use, which may dispose to adverse outcomes.

Clinical Implications: Predictors of cannabis-related harms hold relevance for public health messaging, as well as clinical interventions. Understanding how cannabis interacts with sociodemographic factors, mental health morbidities, and medications is crucial in providing accurate guidance to patients about their recreational cannabis use and in informing prescriber decisions about medicinal cannabis.

KEYWORDS:

• Cannabis
• older adults
• mental health
• addictions
• risk factors

Clinical implications

• Prescribers must carefully consider cannabis-medication interactions when treating patients with mental health conditions. This is especially pertinent to the older adult population given the increasing rates of cannabis use and common occurrence of polypharmacy among this patient group.

• It is important that clinicians consider the motivational model for substance use. For example, using cannabis to cope and/or as a sleep aid may increase a patient’s risk for cannabis-related mental health harms; thus, if a patient is using cannabis for a sleep aid, for example, it is important to explore alternative treatment avenues such as sleep hygiene, cognitive behavioral therapy, and non-cannabis pharmaceutical options.

• Further research is necessary in order to identify whether cannabis plays a role in cognitive decline and/or the development or progression of minor and major neurocognitive disorders. This investigation is relevant to the prevention, diagnosis, and treatment of neurocognitive disorders.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. These databases were used as they aligned with the content expertise of the authors and the topic of the paper.

2. Although other evidence exists to support bidirectional mechanisms underlying relations between anxiety, depression, and cannabis use (Crippa et al., 2009).

3. An exception to this may be cannabis-induced psychosis, which has a growing body of longitudinal research to support cannabis as an etiological factor for psychosis in vulnerable populations (Moore et al., 2007; Semple et al., 2005).