Cannabis for sleep in older adults: use has outpaced the science.

Cannabis use among older adults, defined here as those over 50 years of age, has increased rapidly, and sleep disturbance is among the most common reasons for use. Yet, despite growing use of cannabis and individual cannabinoids to facilitate sleep, evidence supporting their efficacy, tolerability and safety in older adults remains limited. Most experimental studies of cannabinoids and sleep have been conducted in younger adults, often using products and formulations that differ substantially from those currently available. The subjective perception of improved sleep, which may drive increased use is often not supported by objective polysomnography or actigraphy data. Aging is accompanied by changes in sleep physiology, pharmacokinetics, body composition, the endocannabinoid system, multimorbidity, and polypharmacy that may alter cannabinoid effects. As a result, findings derived from younger populations may not generalize to older adults. Furthermore, regular and repeated use of tetrahydrocannabinol (THC) and cannabis leads to the development of tolerance and withdrawal-related sleep disruption complicates interpretation of longer-term effects. The evidence for cannabidiol (CBD) and cannabinol (CBN) in sleep remains sparse. Rigorous studies specifically enrolling older adults are virtually nonexistent. Given the rapid growth of cannabis use for sleep in this population, randomized controlled trials incorporating both subjective and objective sleep measures, age-specific pharmacokinetics, drug interactions, and longer-term outcomes are urgently needed to guide clinical care.