Stanford Medicine clinicians have highlighted five areas of concern for seniors: cardiovascular strain, falls, memory and thinking problems, interactions with common medicines, and dependence. Their warning reflects a broader shift in medical opinion as more older adults use cannabis for pain, sleep, anxiety and relaxation, often without discussing it with doctors.
Modern cannabis products are far stronger than the marijuana many older adults may remember from earlier decades. High-potency flower, concentrates, vape oils and edibles can contain levels of tetrahydrocannabinol, or THC, that sharply increase intoxication. Edibles add a particular hazard because their effects can take one to three hours to appear, prompting some users to take extra doses before the first one has worked.
Doctors say age changes the way the body handles drugs. Slower metabolism, reduced kidney and liver function, lower muscle mass and multiple chronic illnesses can make older adults more vulnerable to side effects. A dose tolerated by a younger person may cause dizziness, confusion, low blood pressure or prolonged impairment in someone in their seventies or eighties.
Cardiovascular risk is one of the central concerns. Cannabis can raise heart rate and blood pressure soon after use, while some studies have linked it to higher risks of heart attack, stroke and other vascular problems. That matters because heart disease is already common among older adults, and many users may have hypertension, diabetes, arrhythmia or prior cardiac disease.
Falls are another major risk. THC can affect balance, reaction time, coordination and judgment. Older adults are already more prone to falls because of weaker muscles, impaired vision, neuropathy and the use of sedatives or blood pressure medicines. A cannabis-related fall can lead to hip fracture, head injury, hospitalisation and loss of independence.
Cognitive effects are also drawing more scrutiny. Cannabis may worsen short-term memory, attention and decision-making, particularly when products are high in THC. For older adults with mild cognitive impairment, early dementia, depression or sleep disorders, the added confusion can be difficult to distinguish from disease progression. Some emerging research has not found a clear link between light cannabis use and faster dementia progression, but specialists say the evidence remains too limited to treat cannabis as risk-free.
Drug interactions may be the least visible danger. Many people over 65 take several prescriptions, including blood thinners, diabetes medicines, antidepressants, opioids, sleep aids and drugs for high blood pressure. Cannabis compounds can alter sedation, blood pressure and liver enzyme activity, potentially intensifying or weakening the effect of other medicines. Combining cannabis with alcohol, benzodiazepines, opioids or sleep medication can increase drowsiness and respiratory risk.
Dependence is also possible, despite the perception that cannabis is non-addictive. Regular use can lead to tolerance, withdrawal symptoms, cravings and continued use despite harm. Cannabis use disorder is more likely among daily users and those using high-THC products. Among older adults, dependence may be missed because cannabis is often framed as a medical aid rather than a substance requiring monitoring.
Use among older adults has risen sharply. Past-month cannabis use among Americans aged 65 and above reached about 7 per cent in 2023, up from 4.8 per cent in 2021. The increase has been driven by legalisation, reduced stigma, aggressive marketing and the search for alternatives to opioids, sleeping pills and anti-anxiety drugs.
Supporters argue that cannabis can help some patients manage chronic pain, chemotherapy-related nausea, spasticity and poor sleep. For some older adults, lower-dose products may reduce reliance on stronger sedatives or opioid painkillers. But clinicians caution that benefits vary widely, product labels can be inconsistent, and older adults are often excluded from clinical trials, leaving gaps in evidence about safety and dosing.
Medical specialists are urging seniors not to treat cannabis like an ordinary supplement. They recommend discussing use with a clinician, especially for people with heart disease, memory problems, balance issues, liver or kidney disease, or those taking multiple medications. Starting with very low doses, avoiding high-THC concentrates, keeping edibles away from others, and not driving after use are among the practical safeguards.
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