Modes of Cannabis Use and Mental Health Outcomes Among Older Adults in the United States.

Jagasia K.; Simi T.; Lai A.; Tien-Smith A.; Nguyen A.; Moore A.; Yang K.; Palamar J. · Journal of the American Geriatrics Society · 2026

**Background & Methods** This cross-sectional analysis examined cannabis use patterns and mental health outcomes in older adults aged ≥65 years using pooled data from the 2022-2024 National Survey on Drug Use and Health (N=1,515). Generalized linear models (Poisson regression) assessed associations between four modes of cannabis consumption (smoking, ingested forms, inhaled concentrates, and other routes) and four mental health outcomes: cannabis use disorder (CUD), major depressive episode (MDE), serious psychological distress (SPD), and suicidal ideation (SI), adjusting for sociodemographic factors, use frequency, and concurrent substance use. **Key Findings** • Smoking was the predominant consumption mode (66.0%), followed by ingested forms (42.1%), inhaled concentrates (17.1%), and other routes (16.8%); females showed higher prevalence of ingested forms and other routes while males favored smoking and concentrates. • Smoking (aPR=3.99; 95% CI: 1.92-8.28) and ingested forms (aPR=1.46; 95% CI: 1.03-2.09) were independently associated with cannabis use disorder in adjusted analyses. • No cannabis consumption mode demonstrated significant associations with major depressive episodes, serious psychological distress, or suicidal ideation among older adults. **Dosage & Administration** Not reported. The study examined modes of consumption without specifying THC/CBD concentrations, frequency of use beyond categorical classification, or standardized dosing protocols. **Safety & Adverse Effects** Not reported. While the study identified cannabis use disorder as an outcome measure, specific adverse effects or safety concerns beyond CUD were not documented. **Evidence Quality** This study is a secondary analysis of national survey data, representing observational evidence (Level III). Key limitations include: cross-sectional design precluding causal inference; reliance on self-reported data subject to recall and social desirability bias; exclusion of institutionalized older adults limiting generalizability; inability to establish temporal relationships; unmeasured confounders (e.g., reason for cannabis use, comorbidities); small sample sizes for some subgroup analyses potentially limiting precision; and lack of biomarker confirmation of cannabis use. The nationally representative sampling frame and adjustment for multiple covariates represent methodological strengths. These findings provide descriptive epidemiology but require prospective cohort or experimental designs to establish causality between consumption modes and mental health trajectories in geriatric populations.

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