Is Cannabis Safe After 65? What Every Family Should Know

Cannabis use among adults over 65 is surging. Legalization is spreading, stigma is fading, and many older adults are turning to cannabis not just recreationally but to address real symptoms — chronic pain, insomnia, and anxiety. As a physician who works with aging adults every day, I want families to understand something most people aren't hearing: the cannabis available today is fundamentally different from what existed 30 or 40 years ago, and for adults over 65, that difference carries real medical risk.

I've reviewed the current literature on this topic. Here's what families need to know.

The Potency Problem

In the 1970s, cannabis typically contained 1 to 4 percent THC — the primary psychoactive compound. Today, standard cannabis products run 20 to 40 percent THC. That is not the same drug. And most older adults who last tried cannabis decades ago have no frame of reference for how different the experience is now. Their bodies are processing something dramatically more potent, and metabolizing it far more slowly than they would have at age 25. Older adults have reduced hepatic function, increased body fat where THC accumulates, and slower clearance times. The practical result: the same dose hits harder and lasts longer.

Risk #1: Cardiovascular Disease

A comprehensive review published in Nature Reviews Cardiology in February 2025 by researchers at the Stanford Cardiovascular Institute outlines the mechanisms by which THC drives inflammation in the endothelial cells lining blood vessels. A separate study published in Cell in 2022 by Stanford researchers demonstrated that THC binds to cannabinoid receptors in vascular tissue, activating inflammatory cytokines that trigger endothelial dysfunction and oxidative stress — key drivers of atherosclerosis. A systematic review and meta-analysis of 24 studies published in the journal Heart found that cannabis use was associated with a 29% increase in heart attacks, a 20% increase in stroke, and more than double the risk of cardiovascular death — though this was studied in primarily younger adult populations and may not be directly transposable to adults over 65.

The only prospective study conducted specifically in adults over 65 — a UCSF-led study of 4,285 veterans aged 66 to 68 with coronary artery disease, published in Circulation in July 2025 — found that cannabis smoking was not independently associated with elevated rates of heart attack, stroke, cardiovascular death, or all-cause mortality after 3.3 years of follow-up. The authors noted that the high prevalence of tobacco use and competing risk factors in this population may have made it harder to isolate the cardiovascular impact of cannabis alone.

What this means for families: the biological mechanism — THC-driven vascular inflammation — is plausible regardless of age, and older adults already carry significantly higher baseline cardiovascular risk. But the clinical data in older populations does not yet confirm the elevated risk seen in younger adults. This is an area where the science is still evolving, and one that physicians and families should continue to watch closely.

Risk #2: Falls

This is the risk most families don't think about. Research from the University of Iowa found that older chronic cannabis users have higher fall risk and measurable walking impairments. Critically, users may not perceive that their balance is impaired. They feel fine. The data says otherwise.

For an older adult, a fall is not a minor event. It can mean a hip fracture, a hospital stay, surgery, prolonged rehabilitation, and a permanent decline in independence. Falls are already among the leading causes of injury and death in adults over 65. Adding an impairing substance — particularly one whose potency has increased five- to tenfold — compounds that risk in ways that families often underestimate.

Risk #3: Drug Interactions

This may be the most underappreciated risk on this list. The majority of adults over 65 take multiple prescription medications. A clinical trial published in Clinical Pharmacology & Therapeutics by researchers at Johns Hopkins found that CBD combined with THC inhibited CYP2C19 enzyme activity by 207%, CYP2C9 by 77%, and CYP3A by 56%. THC interacts with the same enzyme system that metabolizes many common medications older adults use — blood thinners like warfarin, statins, sedatives like midazolam, and many others.

The clinical consequence is unpredictable drug levels — too much of one medication, not enough of another — creating a cascade of potential adverse effects that neither the patient nor their physician may recognize as cannabis-related. This is compounded by the fact that older adults may not feel comfortable disclosing cannabis use to their physician.

Risk #4: Cannabis Use Disorder

Many people assume cannabis is not addictive. The clinical data does not support that assumption. A cross-sectional study of 4,503 veterans aged 65 to 84 published in JAMA Network Open found that among those reporting recent cannabis use, 36% met diagnostic criteria for cannabis use disorder. A separate longitudinal study published in the Journal of Addiction Medicine found that CUD diagnoses are rising fastest among adults over 65. Higher potency products carry higher addictive potential, and the dramatic increase in THC concentration over the past two decades is a meaningful contributing factor.

Cognitive Effects: An Evolving Picture

There are ongoing studies examining the acute and chronic cognitive effects of THC specifically in older adults, including research at Yale examining age-related differences in memory and anxiety under the influence of THC. This is an evolving area of research. While the preliminary signals suggest that older brains may be more vulnerable to THC's cognitive effects, we need larger and longer-term studies before drawing definitive conclusions. I expect the evidence base here to become much clearer in the next few years.

A Note on CBD

Many older adults have turned to over-the-counter CBD products specifically because they believe CBD is the "safe" alternative to THC. This deserves its own discussion, because the picture is more nuanced than most people realize.

CBD (cannabidiol) is not psychoactive in the way THC is — it won't produce a high. And there is legitimate clinical interest in its potential therapeutic applications. A systematic review of 11 randomized controlled trials examining CBD for anxiety disorders found that while results across studies were often contradictory, the data suggest CBD may reduce anxiety with minimal adverse effects compared to placebo. For pain, however, a large systematic review and meta-analysis of 65 RCTs involving 7,017 participants found no evidence of a meaningful difference between cannabinoids and placebo. For sleep, the evidence remains early and inconclusive.

In short: the RCT evidence for CBD across these indications is mixed and still maturing. There is biological plausibility and some promising signals, but we do not yet have the kind of robust, replicated trial data that would support a strong clinical recommendation.

More importantly for older adults, CBD is not without risk — particularly regarding drug interactions. The Johns Hopkins study on cannabinoid-drug interactions found that CBD was actually the primary driver of CYP450 enzyme inhibition, not THC. CBD inhibited CYP2C19 activity by 207% — an enzyme critical for metabolizing blood thinners, proton pump inhibitors, and certain antidepressants. For an older adult taking warfarin or omeprazole, adding CBD could meaningfully alter drug levels without their physician's knowledge.

There is also a significant quality control problem. The CBD market is largely unregulated. A Johns Hopkins study published in JAMA Network Open tested over 100 OTC CBD products and found that only 24% were accurately labeled. THC was detected in 35% of the products tested, including some labeled as "THC-free."

The bottom line on CBD: it is not inherently dangerous, but it is not inherently safe either — especially for older adults managing multiple medications. If your parent is using CBD, their physician needs to know. And if they're going to use it, pharmaceutical-grade products with verified third-party testing (such as those bearing NSF or USP certification) offer greater quality assurance than unregulated dispensary or online products.

Physician-Supervised Use and FDA-Approved Cannabis-Derived Products

There is a critical distinction between unsupervised use and physician-supervised medical use of regulated products. The FDA has approved four cannabis-related prescription medications:

• Epidiolex (cannabidiol / CBD) — the only FDA-approved drug derived directly from the cannabis plant. Approved for treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex.

• Marinol / Syndros (dronabinol) — a synthetic THC available in capsule and oral solution form. Approved for chemotherapy-associated nausea and vomiting, and anorexia associated with weight loss in AIDS patients.

• Cesamet (nabilone) — a synthetic compound similar to THC. Approved for chemotherapy-associated nausea and vomiting.

These products have undergone rigorous clinical trials demonstrating safety and efficacy for their approved indications. They are prescribed at known, standardized doses, monitored by a physician, and managed in the context of the patient's full medication profile and medical history.

For older adults who believe cannabis may help them with pain, sleep, or other symptoms, the appropriate path is a conversation with their physician. A physician can evaluate whether an FDA-approved cannabinoid product is appropriate, whether there are evidence-based alternatives, and how cannabis might interact with existing medications.

What Families Should Do

Have the conversation. If your parent is using cannabis, they need to tell their physician. No judgment — but their doctor needs this information to manage drug interactions, assess cardiovascular risk, and provide safe care. The single greatest risk factor in this area is silence.

Address the underlying symptoms. If your parent is turning to cannabis for pain, sleep, or anxiety, those are real medical concerns that deserve a proper clinical evaluation. There may be more effective, evidence-based treatments available. The goal isn't to dismiss what they're experiencing — it's to make sure they're getting the right care rather than self-medicating with an unregulated product.

Watch for falls. If your parent is using cannabis and also has balance issues, mobility challenges, or takes blood pressure medication, the fall risk is compounding. This is where families need to pay close attention — particularly because the user may not recognize their own impairment.

The Bottom Line

Cannabis is not inherently good or bad for older adults. But the conversation needs to be more nuanced than "it's natural" or "it's legal now." Legality and safety are not the same thing — alcohol and tobacco are legal, but no physician would call them risk-free, especially in an older population managing multiple chronic conditions.

The risks are specific, the drug interactions are real, and the potency of today's products is nothing like what existed a generation ago. If your parent is using cannabis — or thinking about it — the most important step is an honest conversation with their physician. That's where safety starts.