Medical cannabis use and health impact in older adults: recent findings

Introduction and clinical context

The use of medical cannabis among older people is growing worldwide, driven by the search for relief from chronic pain, insomnia, anxiety and symptoms associated with neurodegenerative diseases. This growth, however, raises an essential question: how safe and effective is cannabis in this specific population, marked by frailty, multiple comorbidities and the simultaneous use of several medications? This review gathers the recent findings on the topic, with particular attention to the care needed when prescribing cannabinoids to older adults.

Methodology and findings

The work consolidates the available literature on the efficacy and safety of medical cannabis in old age, synthesizing studies of different designs. In the field of efficacy, reports of improvement in pain, sleep and quality of life stand out. In the field of safety, the review draws attention to specific precautions — especially polypharmacy and cardiovascular risk —, which require an individualized assessment. The central message is one of balance: there are consistent signs of benefit, but use needs to be monitored closely, with periodic review of the prescription. The authors emphasize that the decision to prescribe should weigh the therapeutic goal, the patient's overall health status and the set of medications already in use.

Mechanism of action and safety

Cannabinoids act on the endocannabinoid system, modulating pain, mood and sleep. In the older person, two factors make safety a priority. First, polypharmacy: CBD, for example, inhibits liver enzymes of the cytochrome P450 complex, which metabolize various drugs, and can alter the levels of those medications in the body. Second, cardiovascular and fall risk, aggravated by effects such as hypotension, dizziness and drowsiness. Relative precautions include unstable cardiovascular disease and the concomitant use of anticoagulants and psychotropics. Hence the recommendation of low doses, slow titration and continuous follow-up.

Regulation in Brazil (Anvisa)

In Brazil, Anvisa regulates access through RDC 660/2022 (patient import, with prescription) and RDC 1,015/2026 (new manufacturing and import framework). For the older patient, individualized prescription and follow-up are even more important given the picture of polypharmacy. This content is informative and does not replace the assessment of a healthcare professional.