Why we think it’s important 

This article is important because it provides critical insights into how state-level cannabis legalization affects health care encounters for cannabis-related disorders among older adults, a demographic often overlooked in cannabis research. By highlighting the trends and differences in health care utilization between states with varying legalization statuses, the study discussed in this article underscores the need for targeted public health strategies and policy considerations to address the unique challenges faced by older adults in an evolving legal landscape. 

The article “State Cannabis Legalization and Trends in Cannabis-Related Disorders in US Older Adults, 2017 to 2022” provides a comprehensive analysis of the impact of state-level cannabis legalization on the prevalence of cannabis-related health care encounters among Medicare beneficiaries aged 65 and older. Utilizing a robust dataset spanning five years, the authors effectively characterize how legalization for medical use and recreational use correlates with reported cannabis-related disorders. 

Introduction and Methodology 

As cannabis legalization continues to spread across the United States, understanding its health implications, particularly among older adults, is crucial. This cross-sectional study leverages Medicare enrollment records, Fee-for-Service (FFS) claims, and Medicare Advantage (MA) encounter data from 2017 to 2022 to examine trends in cannabis-related health care encounters. The study is methodologically sound, adhering to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guideline and analyzing data with appropriate statistical tools, including the Mann-Kendall test to assess trends over time. The STROBE reporting guideline provides a 22-item checklist to ensure transparent, complete, and accurate reporting of cohort, case-control, and cross-sectional studies. It covers essential aspects like study design, participants, variables, data sources, bias, statistical methods, and results, facilitating the interpretation and replication of observational research. 

The inclusion criteria were clearly defined, focusing on beneficiaries continuously enrolled in FFS or MA for a significant period before the study. Exclusions were rational, removing long-term nursing home residents and those receiving dialysis, likely to control for confounding health conditions that could skew the results. 

Key Findings 

The study found a marked increase in health care encounters related to cannabis disorders across all states, regardless of their legalization status. Notably, the highest rates were observed in states where both medical and adult use of cannabis was legal, with 45.4 encounters per 10,000 beneficiaries in 2022. States with only medical legalization followed closely, and even states where cannabis remained illegal saw significant increases. 

A particularly interesting aspect of the results was the setting of these encounters. The rise in non-emergency department outpatient settings suggests that many older adults might be seeking regular medical advice or treatment related to cannabis use, rather than emergency care. This could indicate a level of normalization and increased willingness to discuss cannabis use with health care providers. 

Furthermore, the study highlighted a greater average annual increase in cannabis-related disorder rates among Medicare Advantage (MA) enrollees compared to Fee-for-Service (FFS) enrollees. MA plans, offered by private insurers, provide all Original Medicare benefits plus additional services like vision and dental, typically within a network and with managed care coordination. In contrast, FFS under Original Medicare allows beneficiaries to see any provider that accepts Medicare without network restrictions but does not include extra benefits like vision or dental. This discrepancy of increase in cannabis-related disorders could be due to differences in health care management and billing practices between MA and FFS, a point the authors suggest warrants further investigation. 

Discussion and Implications 

The discussion effectively contextualizes the findings within the broader landscape of cannabis legalization and its societal implications. The authors note that while the data suggest a correlation between legalization status and increased health care encounters, several factors complicate a direct causal inference. For instance, legalization might reduce the stigma associated with cannabis use, leading to higher rates of self-reporting and diagnosis. Moreover, variations in state policies, demographics, and health care practices could also influence the observed trends. 

The article does not shy away from discussing its limitations. The descriptive nature of the study means that it cannot account for all potential confounding factors, such as socio-economic variables, comorbidities, and the impact of the COVID-19 pandemic. Additionally, the inability to distinguish between marijuana and federally legal hemp in the data is a noteworthy limitation, given the different regulatory frameworks and potential health impacts of these substances. 


Overall, this study provides valuable insights into how state-level cannabis legalization might influence health care encounters related to cannabis disorders among older adults. The findings underscore the importance of considering legalization’s broader health implications, especially as more states move towards legalizing cannabis. While the study stops short of establishing causality, it opens the door for further research into the nuanced ways legalization might affect public health. 

In conclusion, “State Cannabis Legalization and Trends in Cannabis-Related Disorders in US Older Adults, 2017 to 2022” is a significant contribution to our understanding of cannabis use and its implications for older populations. The increasing trend of cannabis-related health care encounters in states with legalized use highlights the need for ongoing monitoring and tailored health interventions to address the unique needs of older adults in this evolving legal landscape. 

Perez-Vilar S, Freyria Duenas P, Radin R, et al. State Cannabis Legalization and Trends in Cannabis-Related Disorders in US Older Adults, 2017 to 2022. JAMA Netw Open. 2024;7(6):e2417634. doi:10.1001/jamanetworkopen.2024.17634