Medical cannabis in older adults: real-world evidence from a retrospective observational study

<title>Abstract</title> <p>Background Older adults remain underrepresented in clinical trials despite their healthcare needs related to multimorbidity, polypharmacy, frailty, and symptom burden. Their participation in medical cannabis research has been further limited due to concerns regarding their increased susceptibility to cannabinoid-related adverse effects. Consequently, evidence to guide clinical decision-making in this population remains limited. Real-world observational studies can help address this gap by providing complementary evidence on the safety and clinical outcomes of medical cannabis in routine practice. Methods We conducted a retrospective observational descriptive study using medical records from a specialized medical cannabis practice in Colombia. Patients aged ≥ 65 years who initiated physician-supervised treatment with standardized cannabis between January 2024 and September 2025 were eligible. Baseline analyses included all eligible patients (n = 124); longitudinal analyses included those with at least one follow-up visit ≥ 3 months after treatment initiation (n = 44). Outcomes included safety, prescribing patterns, symptom evolution, clinically effective doses, and changes in concomitant medication. Results Median age was 74 years, and women accounted for more than two-thirds of the cohort. The most frequent diagnoses were pain-related and musculoskeletal disorders, cancer and neurodegenerative and non-degenerative neurological disorders, and the predominant symptoms were pain, insomnia, and mood/behavioral. Oral oil-based formulations were the most prescribed. During follow-up, symptom severity decreased significantly across the three main symptom domains, with improvement in approximately 90% of patients. Documented clinically effective doses remained low, typically within a few mg/day of THC, CBD and/or CBG. Overall medication burden remained stable, although dose reductions or discontinuations of concomitant medications occurred in 25% of patients. Adverse events affected approximately one-third of patients, were mild or moderate, and were mainly somnolence and dizziness. No treatment-related serious adverse events, falls, or hospitalizations were recorded. Conclusions In this real-world cohort, medical cannabis was associated with favorable symptom evolution, low clinically effective doses, and an acceptable safety profile. Although causal inferences cannot be drawn from this retrospective observational study, these findings add to the growing evidence that cannabis may represent a therapeutic option for selected older adults under specialist supervision. Prospective multicenter studies are needed to further define its benefit-risk balance.</p>