Prescription Pain Reliever Use and Misuse Among Marijuana Users Aged 50+ Years

Background and Purpose: Marijuana use among U.S. adults, including those aged 50+, has risen as more states have legalized marijuana for medical and/or recreational use. Some individuals report substituting marijuana for opioids to manage pain, but dual medical and/or recreational marijuana and prescription opioid use is common. Although opioid prescribing has declined in response to the opioid crisis, prescription pain reliever (PPNR) use is higher among older than younger adults given their greater likelihood of chronic pain. As a basis for intervening in harmful dual use, we examined rates and correlates of dual marijuana and PPNR use and misuse among past-year marijuana users aged 50+.

Methods: Using t and χ² tests, we examined (1) rates of marijuana nonuse and use and PPNR nonuse, use, and misuse, and (2) the physical and mental health and sociodemographic characteristics of groups by use status among all 35,229 respondents aged 50+ to the 2015-2018 National Survey of Drug Use and Health. Then, using multinominal logistic regression and relative risk ratios, we examined the risk of PPNR use but no misuse and the risk of PPNR misuse, compared to PPNR nonuse, among the 2,632 past-year marijuana users based on their physical and mental health and sociodemographic characteristics.

Results: Among those aged 50+, from 2015 to 2018, marijuana use increased to 8.0% and PPNR use decreased to 36.1%; however, PPNR misuse rates remained constant (2.5%). About 4% of those aged 50+ used both marijuana and PPNR, and 0.7% used marijuana and misused PPNR. Of marijuana users, about half used PPNR in the past year. Multinomial logistic regression showed that compared to marijuana users who did not use PPNR, (1) the risks of PPNR use/no misuse were higher among those who had more chronic medical conditions, major depressive episode (MDE), and medical marijuana use and lower among those with a college degree, income above poverty, and health insurance, and those who used marijuana on 300+ days (compared to 1-11 days), and (2) the risk of PPNR misuse, compared to no PPNR use, was lower among non-Hispanic Blacks compared to non-Hispanic Whites (RRR=0.49, 95% CI=0.28-0.85) but higher among those with more chronic medical conditions (RRR=1.26, 95% CI=1.06-1.50), MDE (RRR=2.31, 95% CI=1.32-4.05), first marijuana use before age 18 (RRR= 1.55, 95% CI=1.03-2.35), marijuana use disorder (RRR=5.54, 95% CI=2.77-11.08), and other illicit drug use disorder (RRR=18.44, 95% CI=9.77-34.78).

Conclusions and Implications: Correlates of dual marijuana and PPNR use and misuse among older adults are poor physical health, mental health problems, and problematic marijuana use. Given older adults’ high healthcare use rates, health professionals should be well versed in identifying marijuana and PPNR misuse and use disorders among this population. Older adults need evidence-based education regarding marijuana, PPNR, and dual use, especially with regard to treating their physical and mental health problems. Those engaged in marijuana and PPNR misuse need age-appropriate treatment, including medication-assisted treatment when indicated. Special attention is needed to increase services for older adults with substance use problems, especially those too young for Medicare who lack health insurance.