How does cannabis affect older adults differently, and is it safe for seniors?

Cannabis use among adults 65+ is the fastest-growing demographic segment, driven by pain, sleep, and anxiety management. Older adults face distinct pharmacological considerations: (1) Pharmacokinetics: Reduced hepatic metabolism (lower CYP450 activity) increases THC plasma levels and duration. Increased body fat raises THC volume of distribution. (2) Sensitivity: Age-related CB1 receptor changes and reduced dopamine tone may alter effects. (3) Drug interactions: Polypharmacy is common in seniors — CBD inhibits CYP2C9 (warfarin), CYP3A4 (statins, calcium channel blockers), and CYP2D6 (antidepressants). (4) Falls risk: Cannabis impairs balance and coordination; falls are the leading cause of injury death in seniors. (5) Cardiovascular: Tachycardia from THC is more dangerous in patients with existing cardiac disease. A 2020 JAMA Internal Medicine study found cannabis use associated with increased falls and fractures in adults 65+. Start low, go slow is especially critical in this population.