Efficacy and safety of medical cannabinoids in older adults: systematic review

Introduction and clinical context

As life expectancy rises, so does the number of older people living with chronic pain, sleep disorders and other hard-to-manage conditions. Medical cannabinoids emerge as an investigated alternative for these conditions, but the geriatric population imposes its own challenges of efficacy and, above all, safety. This systematic review gathers and critically appraises the studies on the use of cannabinoids in older people, offering a qualified overview of the available evidence to support clinical decisions.

Methodology and findings

As a systematic review, the work followed a structured literature search to gather the relevant studies on medical cannabinoids in older people, evaluating efficacy and safety outcomes. The result is a portrait of the state of the art: although there are signs of symptomatic benefit, the evidence base specific to old age is still limited and heterogeneous, which reinforces the need for clinical trials designed specifically for this population. The review thus serves as a reference for better-informed practice. The authors further stress that extrapolating results obtained in younger adults to the geriatric population should be done with caution, given the physiological differences of aging.

Mechanism of action and safety

Cannabinoids interact with the endocannabinoid system, present in the central and peripheral nervous systems, influencing pain perception, sleep and mood. In the older person, the altered pharmacokinetics — with slower metabolism and elimination — and polypharmacy require low starting doses and careful titration. Adverse effects such as sedation, dizziness and cognitive changes deserve monitoring, given the risk of falls and mental confusion. Individualizing the treatment, considering comorbidities and other medications in use, is the basis of safe use in this age group. When well indicated and monitored, the therapy can broaden the range of options for refractory symptoms that limit the older person's autonomy and well-being.

Regulation in Brazil (Anvisa)

Access in Brazil is regulated by Anvisa, mainly through RDC 660/2022 (patient import with prescription) and RDC 1,015/2026 (manufacturing and import framework). Therapeutic use should always be individualized and followed by a healthcare professional. This content is informative and scientific and does not replace medical guidance.