What Are the Signs of Cannabis Use Disorder After 65?
About 1 in 9 older adults who used cannabis in the past year meet clinical criteria for a use disorder, and the signs at home are concrete: near-daily smoking, hours a day spent on it, cravings, and needing more for the same effect. Three quarters of those cases are still mild. That's the window where cutting back and behavioral therapy work.
The number comes from a UC San Diego analysis of 21,189 adults 65 and older in the 2021 to 2024 National Survey on Drug Use and Health, published in Addiction on September 28, 2026. About 8.9% used cannabis in the past year. Of those, 11.4% met DSM-5 criteria for cannabis use disorder. Three quarters of those cases were mild, one in five moderate, fewer than one in twenty severe. That severity split is the part most coverage skips, and it's what changes what you do.
What "mild" looks like at 65+
A use disorder isn't defined by how much someone smokes. It's defined by whether the use is starting to run the day. Two criteria met in a year is the threshold; two or three is mild, four or five moderate, six or more severe. Three signs dominated in older users.
| Warning sign | How often older users endorse it | What it looks like day to day |
|---|---|---|
| Time spent obtaining, using, or recovering from cannabis | 74.4% | Hours a day tied up in getting it, using it, or coming down |
| Craving | 67.5% | Strong urges to use between uses |
| Tolerance | 48.3% | Needing more to get the same effect |
Cravings and creeping tolerance are what most people picture when they hear "dependence." The first one is sneakier. Losing hours to getting it, using it, and coming down is easy to explain away as a routine. That's why it shows up most.
Why daily smoking is where a disorder appears
Frequency and route drive most of the risk. Older adults using cannabis 300 or more days a year were nearly four times more likely to meet the criteria. Smoking was the main route for about two thirds of users.
This is the pattern many older adults were told was reasonable: daily use for pain, sleep, or anxiety, taken by the fastest-acting route. The data don't say that use was wrong. They say daily inhaled use is where a disorder most often shows up. An earlier study of older veterans in VA care found 36% of past-30-day users met the criteria, and more than half were using 20 or more days a month. Same signal, more concentrated sample.
What to do while most cases are still mild
If you or a parent is smoking on most days and one or more of the top signs are there, raise it with a primary care clinician now. The severity split is what makes this treatable. Cognitive behavioral therapy, motivational enhancement therapy, and contingency management have consistent randomized-trial evidence for reducing cannabis use and dependence severity in adults. Effects are strongest during treatment and taper after, which is a real limit, but they're the best-tested option and they work best while use is still mild. In May 2026, SAMHSA issued a primary care advisory asking clinicians to screen older adults for cannabis use disorder and refer them into these therapies.
No medication is FDA-approved for it. A large randomized trial of N-acetylcysteine at 1,200 mg twice daily was no better than placebo. Nabiximols and dronabinol help with withdrawal and retention but aren't cures. Two candidates are in later-stage trials: PleoPharma's PP-01 for cannabis withdrawal, and Aelis Farma's AEF0117, a CB1 signaling inhibitor.
For someone unwilling to stop, two moves lower risk in the meantime. Cut frequency below daily. Swap smoking for a lower-dose oral route. Neither is a treatment on its own, but both reduce the exposure driving the disorder.
Where the evidence stops
No randomized trial of treatment has been done specifically in adults 65 and older. The behavioral therapy data come from younger adults and get applied up. The new study is cross-sectional, so it names the pattern that goes with a disorder but can't prove daily smoking caused it. And clinicians don't yet have age-tailored deprescribing guidance for cannabis the way they do for benzodiazepines.
None of that changes the practical picture. If the pattern is there, the question isn't whether to worry. It's whether to act while most cases are still mild, or wait for the severe end of the split to answer it.