Altered States: New Research & Federal Support For Cannabis & CBD For Older Adults

While we know that cannabis use has risen among older adults in recent years, many in the medical community continue to warn about some of the hazards and concerns that may accompany such use, especially as data to support the potential benefits of cannabis is lacking in many respects. A recent review in JAMA reports that about 27% of US adults have used cannabis for medical purposes (often pain relief or as a sleep aide), and about 10.5% report using CBD for therapeutic purposes. While there have been a few notable exceptions for FDA approval of cannabis for such medical conditions as chemo-induced nausea or pediatric seizure disorders, by and large, the scientific evidence supporting the use of cannabis for medical purposes has been insufficient or severely limited. However, there exists significant anecdotal evidence from patients of its value, especially as it relates to its use for chronic pain management. But warnings persist, including concerns about overconsumption (current cannabis availability tends to be much stronger than what was previously produced), concerns about cannabis use among cardiovascular patients, and concerns about the effect of cannabis on cognitive function and potential negative interaction with other medications. There are also new reports of increasing visits of older adults to emergency rooms due to the use of cannabis, CBD, and hemp-derived products.

In contrast, however, we are beginning to see more scientifically conducted research supporting the benefits of cannabis use for older adults. This past Fall, a new study in Nature Medicine examined the use of cannabis oil with CBD in the treatment of chronic back pain. Researchers found that the cannabis blend outperformed a placebo for the relief of lower back pain. Another study compared cannabis use to opioids for lower back pain and found that cannabis was as effective, if not better, than opioids, without some of the side effects of opioids, such as constipation and dependency. Moreover, brand new research looking at the cognitive and brain health effects of cannabis found surprisingly positive results. First, a new study out of Colorado was published in the Journal of Studies on Alcohol and Drugs, examining the link between cannabis use and brain health in middle-aged and older adults. Looking at data from over 26,000 participants who were part of the UK Biobank, these researchers found that moderate cannabis use in adults aged 40-77 was generally associated with larger brain volume in certain brain regions and superior cognitive function, as opposed to the more negative effects on brain health that are often suggested to result from cannabis use. In essence, the use of cannabis may actually have a protective effect on the aging brain, especially in areas critical for memory and learning (such as the hippocampus region). While the study results had limitations and are considered nuanced, it’s considered a valuable step in understanding the potential impact on the aging brain of cannabis, especially given the prevalence of its use among older adults. 

Another recent study also examined the connection between cannabis, cognition, and dementia risk among older adults. This observational study, published in BMJ Mental Health, found that cannabis use does not appear to be linked to faster cognitive decline or higher dementia risk in older adults. Previous research in this area has been inconsistent or insufficient, but this new research used data from 2 large cohorts and examined test results from 5 different cognitive tests comparing cannabis and non-cannabis users. In fact, cannabis users performed better on some tests than non-users (though that may have been due to the profile of the cannabis-using population rather than the actual use of cannabis). While this is not a clear sign that using cannabis is risk-free, and it underscores the need for more research, it is important to be examining the use of cannabis on brain health later in life, especially given the longevity we are seeing among older populations these days.

And more research, including US-based research, may be on its way, given pending changes in Federal oversight of cannabis. Research involving cannabis has been limited in the United States as it has been classified as a Schedule I drug (comparable to substances like heroin), meaning its availability for research purposes has been severely restricted. However, in December, President Trump signed an Executive Order asking for a speedy reclassification of cannabis to a Schedule III drug, which would permit much more funding for clinical trials and allow pharmaceutical companies to apply for FDA approval of cannabis-related drugs. In fact, several marijuana derived drugs may quickly seek such approval, including a sleep apnea drug, a lower back pain medication, and a spray to address muscle spasms in MS patients. Along with the reclassification request was the announcement of a pilot program for Medicare to cover costs for certain CBD products, which has been thought to be an effective alternative treatment for conditions such as anxiety, insomnia, and chronic pain. As of the publication of this post, neither the reclassification to a Schedule III drug nor the pilot Medicare program has come into effect, though the pilot program is expected to begin in April 2026. There is some concern that the pilot program may get ahead of the scientific evidence supporting the usage of CBD for certain conditions, thus undermining the FDA’s authority to ensure the safety and efficacy of drugs. The extent of coverage under the pilot and how/whether evidence will be collected as a result of the pilot remains unclear. What is clear is that momentum is building to bring the use of CBD and cannabis into mainstream medicine as alternative treatments for certain ailments common among older adults. For now, the best advice is to maintain ongoing and regular conversations with your primary care providers to help determine what makes sense for your specific situation.