What are the health effects of cannabis usage?

By Matthew Parish, Associate Editor

Sunday 8 February 2026

Cannabis has travelled an unusually short distance from counterculture symbol to mass consumer product. In North America and parts of Europe it is marketed as a sleep aid, a pain reliever and, increasingly, a companion to ageing. Yet the scientific literature still shows an awkward mismatch between public confidence and clinical certainty. The most recent wave of studies does not so much settle the argument as sharpen it: cannabis and cannabinoid medicines appear capable of delivering real benefits for some middle aged and older patients, particularly in chronic pain and sleep, but the same period has produced more convincing signals of cardiovascular and cognitive risk in vulnerable groups. 

The central difficulty is definitional. “Cannabis” in everyday speech covers several different exposures:

Much of the public conversation treats these as interchangeable. The medical literature increasingly insists that they are not. 

Where the evidence for benefit is becoming clearer

The most credible “positive health effects” for middle aged and older adults remain clustered around symptom control rather than disease prevention. The National Academies’ landmark review, while now older, set the tone by distinguishing between areas where evidence is substantial, limited or absent. Her core message still holds: outside a handful of indications, cannabis is not a general tonic, but cannabinoids may have therapeutic value in defined circumstances. 

Chronic pain and function

Chronic pain is the commonest stated reason older people give for cannabis use, and it is also the area where clinical trials and systematic reviews have most to work with. A 2024 systematic review summarised studies across formulations such as nabiximols and dronabinol and reported that many studies found statistically significant pain reduction, although the quality and consistency of evidence varied and the best evidence has tended to be in neuropathic pain rather than the diffuse aches of ageing. 

More striking is the emergence of late stage trials for standardised extracts. In 2025 a phase 3 study of a full spectrum Cannabis sativa extract, VER-01, reported efficacy and safety for chronic low back pain, a condition heavily represented amongst older patients and often treated with long term opioids. The accompanying reporting has emphasised not only pain reduction but also improved sleep and gastrointestinal tolerability compared with opioid regimens, which matters because constipation, sedation and falls are not minor side effects in later life. 

If one wanted a cautious “best case” narrative for older adults, it would run as follows: standardised cannabinoid medicines could offer modest to meaningful relief for selected chronic pain syndromes, reduce reliance on opioids for some patients and improve sleep as a secondary benefit. The strongest version of that narrative, however, leans upon regulated preparations and trial settings, not on the unlabelled variability of many retail products. 

Sleep, anxiety and the softer outcomes

Sleep is often treated as a “soft” endpoint, yet sleep disruption is tightly bound to pain, depression and cardiovascular risk. Observational studies and reviews continue to report self assessed improvements in sleep quality amongst people using medical cannabis for pain and related conditions, although these designs cannot fully separate pharmacological benefit from expectancy effects and the natural fluctuations of chronic symptoms. 

CBD, in particular, is frequently presented as a gentler option for older adults. Research describing CBD use amongst older people often finds that users report perceived benefits for pain, sleep or anxiety, but the evidence base is still heavily observational and vulnerable to selection bias, inconsistent dosing and product mislabelling. The practical implication is not that CBD “does nothing”, but that the science has not yet earned the confidence of the marketing.

The less comfortable findings, especially for ageing brains and hearts

If recent trials have strengthened the case for targeted symptom relief, recent epidemiology has also strengthened the case for vigilance. Two clusters of harm are particularly relevant to middle aged and older populations: cardiovascular events and cognitive outcomes.

Cardiovascular risk

In June 2025, BMJ Group reporting on a systematic review and meta analysis of real world data described positive associations between cannabis use and major adverse cardiovascular events, including signals for stroke and acute coronary syndromes and a reported association with cardiovascular death. Other research in 2025 has similarly highlighted associations between cannabis exposure and certain cardiovascular outcomes, with some analyses suggesting stronger associations in middle aged groups and in women, a reminder that “average risk” can hide important subgroup vulnerability. 

These studies do not prove that cannabis directly causes heart attacks or strokes. They do, however, push the burden of proof in a more cautious direction, particularly because older adults are more likely to have hypertension, atrial fibrillation, diabetes or established coronary disease and are more likely to take interacting medicines. 

Dementia signals linked to acute care presentations

The most unsettling recent evidence concerns dementia risk following cannabis related emergency department visits or hospitalisations. A large Ontario cohort study published in 2025 examined adults aged 45 and older and reported that those with incident acute care for cannabis had a higher subsequent risk of dementia diagnosis compared with those with acute care for other reasons and compared with the general population. The same research noted steep rises over time in cannabis related acute care rates in both the 45 to 64 and 65 plus age brackets, which is as much a public health warning as a clinical one. 

This evidence should be read with care. It is plausible that people presenting to hospital already differ from typical users in ways that also raise dementia risk, including comorbid mental illness, polysubstance use, frailty, falls or cardiovascular disease. The finding is therefore not a verdict on all use, but it is a strong argument against complacency and against the idea that cannabis is inherently “safer” for older adults because it is now legal in some jurisdictions. 

Severe harms cluster around problematic use

A related point is that harms concentrate at the severe end of the spectrum. A 2025 cohort study in JAMA Network Open reported that people with hospital based care for cannabis use disorder had substantially increased risk of death over subsequent years compared with the general population, with elevated risks across multiple causes. That does not describe the median older adult experimenting with a low dose edible for sleep, but it does describe the ceiling of risk when use becomes disordered or entangled with other vulnerabilities.

So what counts as a “positive health effect” in later life?

The most honest answer is modest and conditional. The recent research supports a narrower set of benefits than popular culture suggests:

That combination suggests a future that looks less like lifestyle branding and more like ordinary medicine: targeted, dose defined and hedged with warnings.

A sensible clinical posture, without moralism

For clinicians the emerging direction is pragmatic. Older patients are using cannabis whether medicine approves or not, so the safest approach is frank discussion: what product, what dose, what route, what purpose and what side effects. The best recent evidence for benefit points towards regulated preparations studied in trials, not home experimentation.  The best recent evidence for harm points towards cardiovascular vulnerability, falls, delirium and the subgroup whose use leads to emergency care, which should trigger careful review rather than a shrug. 

Public policy is lagging behind this nuance. Legalisation debates often frame cannabis as either a menace or a harmless pleasure. The recent literature suggests it is neither. For middle aged and older people, cannabis resembles many other pharmacologically active substances: capable of relief, capable of harm and most safely handled when its dose and context are known rather than guessed.

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Reading List

National Academies of Sciences, Engineering, and Medicine (2017)

The Health Effects of Cannabis and Cannabinoids

A foundational consensus report that still frames much of the contemporary debate. While now several years old, its careful separation of substantial, limited and insufficient evidence remains methodologically exemplary. Particularly useful for distinguishing symptom relief from disease modification, and for reminding readers how thin the evidence base once was — a useful baseline against which newer studies can be judged.

Bramness et al., JAMA Network Open (2024–2025)

Cannabis Use and Health Outcomes in Middle and Older Age: Observational Evidence

A series of large observational analyses drawing on health system data. Especially relevant for understanding real world use patterns, comorbidities and outcomes in adults over 45. Valuable for its scale and for highlighting cardiovascular and mortality associations without claiming causal certainty.

Vermersch et al., Nature Medicine (2025)

Efficacy and Safety of a Full-Spectrum Cannabis sativa Extract for Chronic Low Back Pain (VER-01 Trial)

One of the most important recent clinical trials for older adults. Phase 3 data showing clinically meaningful pain reduction with a standardised extract, alongside secondary benefits for sleep and acceptable tolerability. Particularly relevant because low back pain is common in later life and often managed with opioids.

Reuters Health Reporting on VER-01 (2025)

Cannabis-Derived Drug Shows Advantage over Opioids in Chronic Pain

Not primary research, but a clear and accessible summary of the VER-01 findings and their implications for opioid sparing strategies. Useful for contextualising trial results within broader debates about ageing, pain management and polypharmacy.

BMJ Group Systematic Review and Meta-Analysis (2025)

Cannabis Use and Cardiovascular Outcomes

A comprehensive synthesis of observational data examining associations between cannabis use and major adverse cardiovascular events. Particularly important for older readers because baseline cardiovascular risk rises sharply with age. The paper does not prove causation, but it meaningfully shifts the risk discussion.

Myran et al., Ontario Population Cohort Study, PubMed-indexed (2025)

Incident Cannabis-Related Acute Care and Subsequent Dementia Risk

One of the most concerning recent studies. Examines adults aged 45 and over and finds elevated dementia diagnoses following cannabis-related emergency or hospital care. Essential reading for understanding why “benign” narratives around cannabis and ageing are increasingly being questioned.

SAGE Journals Review (2025)

Medical Cannabis, Sleep and Quality of Life in Older Adults

A narrative and systematic review focusing on sleep outcomes. Useful for exploring why many older users report benefit, while also highlighting the limitations of self-reported data, placebo effects and heterogeneous dosing.

PMC Review on CBD Use in Older Adults (2024–2025)

Patterns, Perceived Benefits and Risks of Cannabidiol in Ageing Populations

A helpful overview of CBD-specific research, including the gap between consumer perception and clinical evidence. Particularly relevant given the rapid commercialisation of CBD products marketed to older people.

Taken together, this literature supports a restrained conclusion: cannabinoids have a growing, evidence-based role in symptom management for selected older patients, especially in chronic pain and sleep disturbance, but recent research also strengthens the case for caution, particularly in relation to cardiovascular health and cognitive outcomes. This balance — relief without romanticism — is where the current science most clearly points.