We're only describing the tip of the iceberg.
Across American emergency rooms, a quiet pattern has emerged: older adults arriving with confusion, falls, and psychiatric distress — many of them having turned to cannabis as a gentler alternative to the pharmaceuticals of their past. A CDC-partnered study now confirms what clinicians were only beginning to suspect: adverse cannabis events among adults over 50 nearly doubled between 2020 and 2023, exposing a gap between the cultural perception of cannabis as harmless and the pharmacological reality of aging bodies. The story is not one of recklessness, but of a generation seeking relief in an unregulated landscape, without the guidance or the warnings they deserved.
- Emergency visits tied to cannabis among adults 50 and older surged from 4,408 to 7,490 in just two years — and researchers believe these numbers capture only a fraction of the actual harm.
- Older adults are using cannabis at rising rates — roughly 12% of those aged 50 to 80 — often to escape prescription medications, but entering a market where labels are incomplete and FDA oversight is absent.
- The adverse effects are not trivial: confusion, paranoia, fainting, falls, and broken bones — precisely the cascade of preventable events that geriatric medicine exists to stop.
- The lead researcher discovered the gap personally when a relative in her nineties was quietly using cannabis for back pain — prompting him to realize his own patients had likely never been asked.
- Clinicians are now being urged to screen for cannabis use routinely, while advocates push for FDA evaluation, clearer labeling, and honest conversations between patients and physicians before the next fall happens.
Over the past three years, older Americans have been arriving in emergency rooms with symptoms they struggle to explain — confusion, fainting, psychiatric distress, falls that fracture bones. Many had been using cannabis, believing it a safer, more natural alternative to the prescription medications they had taken for years. A new CDC-partnered study confirms the trend is accelerating: emergency visits for cannabis-related adverse events among adults 50 and older nearly doubled from 4,408 visits in 2020–2021 to 7,490 in 2022–2023. Researchers caution that even these figures are likely an undercount, capturing only those who sought emergency care.
The surge mirrors a broader shift in access and attitude. Cannabis is now legal for medical use in most states and recreationally in nearly half, and roughly 12 percent of Americans aged 50 to 80 now use it — many seeking relief from chronic pain or insomnia without relying on prescriptions. But expanded availability has not brought expanded safety. Products often contain multiple active compounds with unclear labeling, and the FDA has not adequately evaluated them. Older bodies process substances differently than younger ones; a dose that causes mild drowsiness in a 40-year-old can produce dangerous confusion in someone decades older.
Geriatrician Jerry Gurwitz, who led the research, became personally invested in the question when he learned a relative in her nineties had been quietly using cannabis for back pain — and that he had never thought to ask his own patients about their use. His clinical principle is clear: recommend a treatment only when you are confident the benefits outweigh the risks. With cannabis in older adults, he says, that confidence does not yet exist.
His recommendations are practical and urgent. Patients over 50 should speak openly with their physicians before using cannabis, exploring alternatives like physical therapy or behavioral approaches for sleep. Clinicians should screen for cannabis use routinely — and when an older patient presents with a new fall, confusion, or unexplained anxiety, cannabis should be among the first questions asked. Until labeling improves and regulatory oversight catches up, caution remains the most defensible prescription.
Over the past three years, something quiet has been happening in American emergency rooms. Older people are arriving with confusion, fainting spells, psychiatric symptoms they can't explain, falls that break bones. Many of them have been using cannabis—a product they believed was safe, natural, a gentler alternative to the prescription painkillers and sleeping pills their doctors had given them for years. A new study suggests this trend is accelerating, and the medical community is only now beginning to pay attention.
Researchers led by Jerry Gurwitz, a geriatrician at a major academic medical center, partnered with the CDC to examine emergency department visits among Americans aged 50 and older between 2016 and 2023. They were looking specifically for visits tied to adverse effects from cannabinoid products—medical marijuana, CBD, hemp-derived compounds. What they found was striking: the number of such visits nearly doubled in just two years, jumping from 4,408 visits during 2020 and 2021 to 7,490 visits during 2022 and 2023. But Gurwitz was careful to note that even these numbers likely represent only a fraction of the actual harm. The study captured only emergency department visits. It did not include urgent care visits, phone calls to doctors, or the countless adverse events that never prompted anyone to seek medical attention at all.
The surge reflects a simple fact: cannabis is now far more accessible than it was a decade ago. Medical cannabis is legal in the majority of states. Recreational cannabis is legal in nearly half of all states plus Washington, D.C. As availability has expanded, so has use. National survey data suggest that roughly 12 percent of Americans between ages 50 and 80 are now using cannabis, many of them seeking relief from chronic pain or insomnia without relying on prescription medications. But expanded access has not brought expanded safety. Products often contain multiple active compounds, and neither manufacturers nor consumers can always say with certainty what is actually in them. The FDA has not adequately evaluated these products. Labels are frequently unclear or incomplete. Gurwitz became personally invested in the question when he learned that a relative in her nineties had been using a cannabis product for back pain. She eventually stopped because of side effects, but the experience prompted him to realize that many of his own patients had probably been using cannabis without ever mentioning it to him—because he had never asked.
The adverse effects documented in the study are not minor inconveniences. Patients experienced confusion and altered mental status. Some developed psychiatric symptoms including anxiety and paranoia. Others fainted, fell, or suffered gastrointestinal distress. These are precisely the kinds of preventable events that geriatricians spend their careers trying to avoid. Older adults are inherently more sensitive to medications than younger people. Their bodies process drugs differently. Their organs function less efficiently. A dose that causes mild drowsiness in a 40-year-old might cause dangerous confusion in an 80-year-old. Cannabis, despite its reputation as a natural and therefore safe substance, does not exempt itself from this basic pharmacology.
The problem is compounded by the fact that Gurwitz's study examined only legal, medically used products. Recreational cannabis use among older adults is also rising, and when combined with alcohol—something many older people consume regularly—the risks for serious adverse events may increase further still. Yet even within the narrow scope of medical use, the evidence is troubling enough that Gurwitz has begun to question whether cannabis can be recommended at all for older patients. His principle as a clinician is straightforward: prescribe a medication only when you know it works, and only when you are confident that the benefits for a particular patient will outweigh the risks. With cannabis, he said, he cannot make that claim with any certainty.
For patients over 50 considering cannabis, or for adult children concerned about an aging parent's use, Gurwitz recommends a direct conversation with a physician. Ask whether cannabis is truly the best choice for your condition. Ask what alternatives exist—physical therapy for pain, behavioral strategies for insomnia, other non-pharmacological approaches that may carry fewer risks. Ask specifically about side effects that are more likely in older adults: confusion, falls, fainting, gastrointestinal problems. And for clinicians, Gurwitz has a clear message: ask your patients about cannabis use. Screen for it routinely, especially in older adults with chronic pain or sleep disturbances. If an older patient develops a new symptom—a change in mental status, a fall, unexplained anxiety—ask about cannabis. Until the FDA has adequately evaluated these products, until manufacturers are required to label them clearly, until both patients and doctors understand how cannabis affects aging bodies, the safest approach is caution.
Notable Quotes
While these products have become widely available, we don't always know what's in them, and they haven't been adequately evaluated by the FDA.— Dr. Jerry Gurwitz
My general principle as a geriatrician is to prescribe medications only when I know they're efficacious and where we're pretty sure that the benefits in a particular patient will outweigh the risks. I can't say that with any certainty in this case.— Dr. Jerry Gurwitz
The Hearth Conversation Another angle on the story
Why is this happening now? Cannabis has been around for decades.
Access changed everything. It went from illegal and hard to find to legal and on the shelf at the corner store in most states. Older people who might have dismissed it before now see it as a legitimate option, especially when they're tired of prescription painkillers.
But surely older people know their own bodies. If something made them feel bad, wouldn't they stop?
You'd think so. But cannabis has this reputation as natural and therefore safe. People don't always connect the confusion or the fall to the product they started taking last month. And by the time they end up in the emergency room, the damage is done.
The study mentions that doctors aren't even asking about cannabis use. That seems like an obvious oversight.
It is. Most physicians trained before cannabis became mainstream don't think to ask about it. They see an older patient with confusion or a fall and run tests for other causes—stroke, infection, medication interactions. Cannabis doesn't appear on their radar.
What about the products themselves? Are they actually dangerous, or is it just a dosing problem?
That's the real mystery. Nobody knows exactly what's in most of these products. They contain multiple active compounds in varying concentrations. You could buy the same product twice and get different amounts of active ingredients. That uncertainty alone makes it risky for older bodies.
So what's the path forward? Do we ban these products for older adults?
Gurwitz isn't calling for a ban. He's calling for honesty—FDA evaluation, clear labeling, doctors asking questions, patients understanding the real risks. Right now we're flying blind.