Psychiatric and substance use disorders among adults over age 50 who use cannabis: A matched cohort study using electronic health record data.

INTRODUCTION: Adults over age 50 increasingly use cannabis, but few studies have examined co-occurring psychiatric and substance use disorders (SUDs) in this population. The current study utilized electronic health record (EHR) data to compare adults age 50 + with ICD-10 cannabis codes (cases) and matched controls on common psychiatric and SUDs from 2016 to 2020. METHOD: Patients age 50 + from an integrated healthcare system in Hawai'i were identified using ICD-10 codes for cannabis (use, abuse, and dependence) from 2016 to 2018. In a matched cohort design, we selected non-cannabis-using controls (matched on sex and age) from the EHR (n = 275) and compared them to cases (patients with an ICD-10 cannabis code; n = 275) on depressive and anxiety disorders and SUDs (i.e., tobacco, opioid, and alcohol use disorders) over a two-year follow-up period. RESULTS: Participants were 62.8 years (SD = 7.3) old on average; and were White (47.8 %), Asian American (24.4 %), Native Hawaiian or Pacific Islander (19.3 %), or Unknown (8.5 %) race/ethnicity. Conditional multiple logistic regression was used to estimate odds ratios comparing cases vs controls. Participants with an ICD-10 cannabis code had a significantly greater risk of major depressive disorder (OR = 10.68, p < 0.0001) and any anxiety disorder (OR = 6.45, p < 0.0001), as well as specific anxiety or trauma-related disorders (e.g., generalized anxiety disorder, PTSD) and SUDs (ORs 2.72 - 16.00, p < 0.01 for all). CONCLUSIONS: Over a two-year period, diverse adults age 50 + in Hawai'i with ICD-10 cannabis codes experienced higher rates of subsequent psychiatric and SUDs compared to controls. These findings can guide efforts to inform older adults about possible cannabis-related risks.

Chronic health conditions, acute health events, and healthcare utilization among adults over age 50 in Hawai'i who use cannabis: A matched cohort study.

BACKGROUND: Research on cannabis-related health outcomes in diverse older adults is limited. The current study utilized a matched cohort study design to compare older adults in Hawai'i with identified cannabis diagnoses and matched controls on chronic health conditions, acute health events, and healthcare utilization from 2016 to 2020. METHOD: Patients age 50 + were identified using ICD-10 diagnostic codes for cannabis use, abuse, and dependence using electronic health record data from an integrated health system (Kaiser Permanente Hawai'i). Those with cannabis diagnoses (n = 275) were compared to matched non-using controls (n = 275; based on age, sex) on chronic health conditions (coronary heart disease, hypertension, COPD, chronic non-cancer pain), acute health events (myocardial infarction, respiratory symptoms, stroke, persistent or cyclic vomiting, injuries), and healthcare utilization (outpatient, inpatient, and emergency department visits) following case identification for two years. RESULTS: Participants were 19.3% Native Hawaiian/Pacific Islander, 24.4% Asian, 47.8% White, and 8.5% Other/Unknown, with an average age of 62.8 years (SD=7.3). Adjusting for covariates as possible, participants with a cannabis diagnosis had significantly greater risk of coronary heart disease, chronic non-cancer pain, stroke, myocardial infarction, cyclic vomiting, and injuries, over time, compared to controls. Cannabis use was associated with any and greater frequency of outpatient, inpatient, and emergency department visits. CONCLUSIONS: In a diverse sample, older adults who used cannabis had worse health conditions and events and used more health services over a two-year period. Future studies should evaluate cannabis-related health outcomes, effects of cannabis problem severity, as well as implications for healthcare in aging populations.

Mental health treatment use among cannabis users aged 50+: Associations with cannabis use characteristics.

BACKGROUND: This study examined associations of mental health treatment use and perceived treatment need with cannabis use characteristics (medical vs. nonmedical use, initiation age, use frequency, and cannabis use disorder) among past-year cannabis users aged 50+. METHODS: Data came from the 2015-2019 National Survey of Drug Use and Health (N = 44,007). After comparing past-year cannabis users with nonusers and nonmedical users with medical users on sociodemographic and health-related factors, the research questions were examined with logistic regression models. RESULTS: In addition to mental disorders, medical use, compared to nonmedical use, was associated with higher odds of psychotherapeutic prescription medication use (AOR = 1.47, 95 % CI = 1.07-2.01) and any mental health treatment (prescription medication, outpatient care and/or inpatient care) (AOR = 1.51, 95 % CI = 1.13-2.03). Compared to 1-29 days of use, nonmedical users who used on 100-199 days (AOR = 0.60, 95 % CI = 0.40-0.89) and medical users who used on 200-365 days users (AOR = 0.48, 95 % CI = 0.26-0.87) had lower odds of treatment receipt. Factors associated with increased odds of receiving treatment included discussion with a healthcare professional about drug use, higher education, and having health insurance. Other illicit drug use, chronic illnesses, and female gender were associated with higher odds of perceived treatment need, while having health insurance was associated with lower odds. CONCLUSIONS: Some older adults may use medical cannabis as an adjunct to professional mental health treatment while others may use it as a substitute. Affordability and accessibility gaps followed by cultural and personal sense of stigma and self-sufficiency beliefs appear to be barriers to receiving professional care.

Older-Adult Marijuana Users in Substance Use Treatment: Characteristics Associated with Treatment Completion.

More older adults are using marijuana and receiving substance use treatment. We used the 2015-2017 Treatment Episode Data Set-Discharges (TEDS-D) to identify characteristics associated with treatment discharge among those aged 50+ whose admission involved marijuana use. Among these discharges (N = 130,287), 7.0% had been admitted for marijuana use only and 93.0% for polysubstance use (13.0% marijuana-primary, 57.7% marijuana-secondary, and 22.3% marijuana-tertiary), and the overall treatment completion rate was 45%. Using logistic regression, we examined associations of detoxification, residential rehabilitation, and outpatient treatment completion with type of marijuana and other substance involvement. Compared to marijuana-only cases, marijuana-tertiary cases had higher odds of completing detoxification (AOR = 1.54, 95% CI = 1.16-2.03), marijuana-secondary cases had higher odds of completing residential rehabilitation (AOR = 1.19, CI = 1.01-1.40), and all polysubstance cases had lower odds of completing outpatient treatment. Of the polysubstance cases, treatment completion odds were higher for those with alcohol problems but lower for those with other illicit drug problems. Previous treatment, referral source, psychiatric problems, first age of marijuana use, and racial/ethnic minority status were significant factors in treatment completion. Better strategies are needed to promote treatment retention and completion among older adults admitted for marijuana use problems, especially those who also have other illicit drug problems.

Older marijuana users in substance abuse treatment: Treatment settings for marijuana-only versus polysubstance use admissions.

OBJECTIVE: Growing numbers of older adult marijuana users make understanding the marijuana-related treatment needs and treatment-related characteristics of this age group increasingly important. In this study, we examined four types of marijuana-involved admissions (marijuana as the only substance; marijuana as the primary substance with other secondary/tertiary substances; marijuana as the secondary substance; and marijuana as the tertiary substance) by treatment setting. METHODS: Data came from the 2012-2017 Treatment Episode Data Set-Admissions (TEDS-A), which includes 851,652 admissions by those aged 55+. Using multinomial logistic regression analysis, we focused on the 120,286 marijuana-involved admissions to test the hypothesis that polysubstance use would be associated with a higher likelihood of using detoxification and rehabilitation settings than ambulatory/outpatient settings. RESULTS: Of all marijuana-involved admissions, 7.5% were marijuana-only, 12.7% were marijuana-primary, 58.4% were marijuana-secondary, and 21.4% were marijuana-tertiary admissions. Compared to marijuana-only admissions, admissions involving other substances were associated with a higher likelihood of detoxification and rehabilitation than ambulatory/outpatient treatment (e.g., RRR = 5.79, 95% CI = 5.08-6.61 for detoxification and RRR = 3.19, 95% CI = 2.89-3.52 for rehabilitation among marijuana-tertiary admissions). Referral source, first age of marijuana use, race/ethnicity, and homelessness were significant covariates. CONCLUSIONS: Given increasing numbers of older-adult marijuana users, healthcare providers should screen older adults for marijuana and other substance use, and substance abuse treatment programs should become more responsive to older adults' needs.

Meals on Wheels: exploring potential for and barriers to integrating depression intervention for homebound older adults.

The purpose of this study was to explore Meals on Wheels' (MOW) organizational potential for integrating depression screening, referral, and treatment for homebound older adults. In a survey of 164 MOW administrators, MOW's current practice of depression services was examined, and the administrators' perception of MOW's organizational potential was measured focusing on external environment, financial resources, staffing/skills, and values and goals. Only 20 out of 164 MOWs provide depression screening, and 19 provide in-home counseling for their clients, while 86 provide referral services. About 64-72% of MOWs that are not current providers of screening and/or referrals want to provide the services, and 21% of those that are not current providers of in-home counseling want to provide it.

Utilization of complementary and alternative medicines for mental health problems among Asian Americans.

Using the Asian sample (n = 2,095) of the National Latino and Asian American Study, 2002-2003, this study examined the prevalence and correlates of the use of complementary and alternative medicines (CAM) and traditional/conventional mental health services (TCMHS) for mental health problems. Of those with a probable DSM-IV diagnosis of any mental disorder, 45.2, 26.1, and 28.7%, respectively, used CAM alone, both CAM and TCMHS, and TCMHS alone for their mental health problems. The corresponding rates for those not meeting the DSM-IV criteria were 71.8, 9.3, and 18.8%. Of those with a probable DSM-IV diagnosis, the use of CAM only was significantly positively associated with level of education, English proficiency, and perceived discrimination. The TCMHS use was also significantly positively associated with English proficiency. Although Asian Americans with severe mental health problems are more likely to access TCMHS than CAM alone, the utilization of TCMHS still appears to be low.

Depression in older nursing home residents: the influence of nursing home environmental stressors, coping, and acceptance of group and individual therapy.

Based on in-depth interviews with 65 older nursing home residents, this study examined the residents' own understanding and perceptions of depressive symptoms, causes of their depression, their self-reported coping strategies, and their preferences for acceptable depression interventions. About half (n = 32) of all interviewees stated that they were either feeling depressed or experiencing negative affects. The major themes related to the causes of their depression were loss of independence, freedom and continuity with their past life; feelings of social isolation and loneliness; lack of privacy and frustration at the inconvenience of having a roommate and sharing a bathroom; loss of autonomy due to the institutional regimen and regulations; ambivalence toward cognitively impaired residents; ever-present death and grief; staff turnover and shortage; and stale programming and lack of meaningful in-house activities. Self-reported coping mechanisms included religion and stoicism, a sense of reality, positive attitude and family support. In regard to depression treatment, the interviewees appeared to prefer nursing home programs that reduce their isolation over group or individual psychotherapy.