Skip to main content
Log in

Prescribed Medical Cannabis Use Among Older Individuals: Patient Characteristics and Improvements in Well-Being: Findings from T21

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript



Previous research has suggested that the use of cannabis-based medicinal products is increasing most rapidly among older aged individuals (65+ years). Despite this, little is known about the characteristics of older people using cannabis-based medicinal products and their effectiveness.


We aimed to document the characteristics, outcomes and prescribing patterns of individuals aged 65+ years receiving prescribed cannabis compared to younger individuals receiving prescribed cannabis.


Data from T21, an observational study of patients seeking treatment with medicinal cannabinoids, including self-report ratings of quality of life (assessed via the EQ-5D-5L), general health (assessed via the visual analogue scale of the EQ-5D-5L), mood (assessed via the Patient Health Questionnaire-9) and sleep (assessed using four items derived from the Pittsburgh Sleep Quality Index) were available at treatment entry [n = 4228; 198 (4.7%) 65+ years] and at a 3-month follow-up [n = 2455; 98 (4.2%) = 65+ years].


Relative to younger individuals, those aged over 64 years were more likely to be female (52.5% vs 47.0%; p < 0.001), more likely to report pain as their primary condition (76.3% vs 45.6%; p < 0.001) and less likely to report current daily use (20.2% vs 60.3%, p < 0.001). They received fewer cannabis-based medicinal products (mean = 1.4 vs 2.1; F(1,2199) = 32.3, p < 0.001) and were more likely to receive a prescription for a cannabidiol dominant oil (17.5% vs 5.7%; p < 0.001) and less likely to receive a prescription for delta-9-tetrahydrocannabinol dominant flower (32.5% vs 75.2%; p < 0.001). There were significant improvements across all measures of well-being (p < 0.001), but the extent of improvements in sleep were more marked in younger individuals (p < 0.001).


There are important differences between individuals aged 65+ years and younger individuals receiving cannabis-based medicinal products. Older aged individuals experience considerable improvement in health and well-being when prescribed cannabis-based medicinal products.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Hall W, Lynskey M. Assessing the public health impacts of legalizing recreational cannabis use: the US experience. World Psychiatry. 2020;19(2):179–86.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Han BH, Sherman S, Mauro PM, Martins SS, Rotenberg J, Palamar JJ. Demographic trends among older cannabis users in the United States, 2006–13. Addict. 2017;112(3):516–25.

    Article  Google Scholar 

  3. Salas-Wright CP, Vaughan MG, Cummings-Vaughan LA et al. Trends and correlates of marijuana use among late middle-aged and older adults in the United States, 2002–2014. Drug Alcohol Depend. 2017;171:97–106.

    Article  PubMed  Google Scholar 

  4. Yang KH, Kaufmann CN, Nafsu R et al. Cannabis: an emerging treatment for common symptoms in older adults. J Am Geriatr Soc. 2021;69(1):91–7.

    Article  PubMed  Google Scholar 

  5. Kostadinov V, Roche A. Bongs and baby boomers: trends in cannabis use among older Australians. Australas J Ageing. 2017;36(1):56–9.

    Article  PubMed  Google Scholar 

  6. Rotermann M. Analysis of trends in the prevalence of cannabis use and related metrics in Canada. Health Rep. 2019;30(6):3–13.

    Article  PubMed  Google Scholar 

  7. Carliner H, Brown QL, Sarvet AL, Hasin DS. Cannabis use, attitudes, and legal status in the U.S.: a review. Prev Med. 2017;104:13–23.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tumati S, Lanctôt KL, Wang R, Li A, Davis A, Herrmann N. Medical cannabis use among older adults in Canada: self-reported data on types and amount used, and perceived effects. Drugs Aging. 2022;39(2):153–63.

    Article  PubMed  Google Scholar 

  9. Schlag AK, Zafar RR, Lynskey MT, Athanasiou-Fragkouli A, Phillips LD, Nutt DJ. The value of real world evidence: the case of medical cannabis. Front Psychiatry. 2022;13:1027159.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Olsson F, Erridge S, Tait J et al. An observational study of safety and clinical outcome measures across patient groups in the United Kingdom Medical Cannabis Registry. Expert Rev Clin Pharmacol. 2023;16(3):257–66.

    Article  CAS  PubMed  Google Scholar 

  11. Lynskey MT, Schlag AK, Athanasiou-Fragkouli A, Badcock D, Nutt DJ. Characteristics of and 3-month health outcomes for people seeking treatment with prescribed cannabis: real-world evidence from Project Twenty21. Drug Sci Policy Law. 2023;9:20503245231167372.

    Article  Google Scholar 

  12. Couch D. Left behind: the scale of illegal cannabis use for medicinal intent in the UK. Accessed 29 May 2024.

  13. Office for National Statistics. Drug misuse in England and Wales—Office for National Statistics. Accessed 5 Apr 2024.

  14. Minerbi A, Häuser W, Fitzcharles M-A. Medical cannabis for older patients. Drugs Aging. 2019;36(1):39–51.

    Article  PubMed  Google Scholar 

  15. Wolfe D, Corace K, Butler C et al. Impacts of medical and non-medical cannabis on the health of older adults: findings from a scoping review of the literature. PLoS ONE. 2023;18(2):e0281826.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kaufmann CN, Kim A, Miyoshi M, Han BH. Patterns of medical cannabis use among older adults from a cannabis dispensary in New York State. Cannabis Cannabinoid Res. 2022;7(2):224–30.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Croker JA, Bobitt JL, Arora K, Kaskie B. Assessing health-related outcomes of medical cannabis use among older persons: findings from Colorado and Illinois. Clin Gerontol. 2021;44(1):66–79.

    Article  PubMed  Google Scholar 

  18. Sakal C, Lynskey M, Schlag AK, Nutt DJ. Developing a real-world evidence base for prescribed cannabis in the United Kingdom: preliminary findings from Project Twenty21. Psychopharmacology. 2022;239(5):1147–55.

    Article  CAS  PubMed  Google Scholar 

  19. Schlag AK, Lynskey M, Fayaz A et al. Characteristics of people seeking prescribed cannabinoids for the treatment of chronic pain: evidence from Project Twenty 21. Front Pain Res. 2022;3:891498.

    Article  Google Scholar 

  20. Drug Science. T21 clinics. Available from: Accessed 5 Apr 2024.

  21. GMC. Information for doctors on cannabis-based products for medicinal use (CBPMs). Accessed 3 May 2024.

  22. Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. 2018;27(1):7–22.

    Article  PubMed  Google Scholar 

  23. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.

    Article  CAS  PubMed  Google Scholar 

  24. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Cleeland C. Measurement of pain by subjective report. Chapman CR Loeser JD, editors. Advances in pain research and management. Vol. 12. Issues in pain measurement. New York: Raven Press; 1989. p. 391–403.

  26. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med. 1994;23(2):129–38.

    CAS  Google Scholar 

  27. IBM Corp. IBM SPSS Statistics for Windows, Version 29.0. Armonk: IBM Corp; 2022.

  28. Jugl S, Goodin AJ, Brown JD. Climbing the evidence pyramid: dosing considerations for medical cannabis in the management of chronic pain. Med Cannabis Cannabinoids. 2023;6(1):41–5.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Brown JD, Costales B, van Boemmel-Wegmann S, Goodin AJ, Segal R, Winterstein AG. Characteristics of older adults who were early adopters of medical cannabis in the Florida Medical Marijuana Use Registry. J Clin Med. 2020;9(4):1166.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Arora K, Qualls SH, Bobitt J, Milavetz G, Kaskie B. Older cannabis users are not all alike: lifespan cannabis use patterns. J Appl Gerontol. 2021;40(1):87–94.

    Article  PubMed  Google Scholar 

  31. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51.

    Article  PubMed  Google Scholar 

  32. Arkell TR, Downey LA, Hayley AC, Roth S. Assessment of medical cannabis and health-related quality of life. JAMA Netw Open. 2023;6(5): e2312522.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gilman JM, Schuster RM, Potter KW et al. Effect of medical marijuana card ownership on pain, insomnia, and affective disorder symptoms in adults. JAMA Netw Open. 2022;5(3):e222106.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sznitman SR, Meiri D, Amit BH, Rosenberg D, Greene T. Posttraumatic stress disorder, sleep and medical cannabis treatment: a daily diary study. J Anxiety Disord. 2022;92: 102632.

    Article  PubMed  Google Scholar 

  35. Tervo-Clemmens B, Schmitt W, Wheeler G et al. Cannabis use and sleep quality in daily life: an electronic daily diary study of adults starting cannabis for health concerns. Drug Alcohol Depend. 2023;243:109760.

    Article  CAS  PubMed  Google Scholar 

  36. Stockings E, Campbell G, Hall W et al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018;159(10):1932–54.

    Article  CAS  PubMed  Google Scholar 

  37. Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17(6):739–44.

    Article  PubMed  Google Scholar 

  38. Smith RT, Gruber SA. Contemplating cannabis? The complex relationship between cannabinoids and hepatic metabolism resulting in the potential for drug-drug interactions. Front Psychiatry. 2023;13:1055481.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Doohan PT, Oldfield LD, Arnold JC, Anderson LL. Cannabinoid Interactions with cytochrome P450 drug metabolism: a full-spectrum characterization. AAPS J. 2021;23(4):91.

    Article  CAS  PubMed  Google Scholar 

  40. Zendulka O, Dovrtělová G, Nosková K et al. Cannabinoids and cytochrome P450 interactions. Curr Drug Metab. 2016;17(3):206–26.

    Article  CAS  PubMed  Google Scholar 

Download references


We express our gratitude to the patients involved in Project T21 who contributed their data to the study. We thank our partners whose generosity is enabling Project T21 patients to receive their CBMPs at a reduced rate: Somai Pharmaceuticals, Ethypharm, 4CLabs and Blackpoint Biotech. We are grateful to the partners who previously supported T21: Alta Flora, Cellen Biotech Ltd, JMCC Group, Khiron Life Sciences Corp., Lyphe Group and BOD Australia. These partners were not involved in the study design, collection, analysis and interpretation of data, writing of this article or the decision to submit it for publication.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael T. Lynskey.

Ethics declarations


The authors received no financial support for the research, authorship and/or publication of this article.

Conflict of interest

Drug Science receives an unrestricted educational grant from a consortium of medical cannabis companies to further its mission, which is the pursuit of an unbiased and scientific assessment of drugs regardless of their regulatory class. All Drug Science committee members including the Chair, are unpaid by Drug Science for their effort and commitment to this organisation. Anne K. Schlag is a scientific advisor to Somai Pharmaceuticals and Evolve. None of the authors (Michael T. Lynskey, Hannah Thurgur, Alkyoni Athanasiou-Fragkouli, Anne K. Schlag, David J. Nutt) would benefit from the wider prescription of medical cannabis in any form.

Ethics approval

According to the National Health Service Health Research Authority, T21 is classified as research; however, based on the Medical Research Council decision tools, research ethics committee review and approval are not required.

Consent to participate

All individuals provide signed informed consent for their data to be used for research purposes.

Consent for publication

Not applicable.

Availability of data and material

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available as they contain information that could compromise the privacy of research participants.

Code availability

Not applicable.

Author contributions

The authors confirm contribution to the paper as follows: study conception and design: ML, AKS, DJN; data collection: ML, AA, AKS, DJN; analysis and interpretation of results: ML, AA; manuscript preparation and editing: ML, HT. All authors reviewed the results and approved the final version of the manuscript.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lynskey, M.T., Thurgur, H., Athanasiou-Fragkouli, A. et al. Prescribed Medical Cannabis Use Among Older Individuals: Patient Characteristics and Improvements in Well-Being: Findings from T21. Drugs Aging 41, 521–530 (2024).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: