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Event-level Analysis of Medical Cannabis in Older Adults: Trajectories of Symptom Clusters across the Day and Associations with Use-related Pathology

Robert Dvorak
University of Central Florida

Co-Authors: Daniel Paulson, Michael Dunn, Madison Maynard
University of Central Florida

Background: Older adults are at an elevated risk of medical complications due to polypharmacy. Increasingly, older adults are turning to Medical Cannabis (MC) to address medical issues. However, there is little evidence of MC efficacy on event-level symptoms in older adults. Further, it is unclear if therapeutic effects increase problematic use patterns.

Objective: (1) To examine the momentary associations between MC and clusters of physical and psychiatric symptoms at the daily level. (2) To examine if the effects of MC on symptom clusters are associated with problematic and/or pathological use patterns.

Methods: A sample of older adults (n = 106) were recruited through social media. Participants had medical conditions approved for treatment using MC. Once enrolled, participants received text messages to complete six daily assessments of symptoms for 15 days.

Results: Participants provided 5,156 momentary assessments across 1,106 cannabis use days. Trajectories of symptoms were examined across the day leading up to, and following, use initiation. On use days, there was a decline in all symptoms following use. This was most robust for subjective pain and weaker for negative affect, trauma symptoms, and nausea. Negative affect, pain, and nausea evinced momentary negative reinforcement associations with subjective cannabis intoxication. Negative reinforcement parameters were subsequently associated with adverse cannabis use outcomes. The decline in post-use trauma symptoms and the momentary negative reinforcement effect for negative affect were both associated with cannabis use disorder symptoms. The momentary negative reinforcement effect for pain and nausea were associated with higher cannabis use problems, but not use disorder symptoms.

Conclusions: These data suggest that MC may be effective in reducing common symptom clusters. However, the negative reinforcing effect may complicate the therapeutic nature, increasing cannabis use disorder symptoms among those with higher reinforcement for psychiatric symptoms and increasing cannabis use problems (though not use disorder symptoms) among those with higher reinforcement for physical symptoms. Identifying behavioral interventions to maximize benefits while minimizing costs may increase the efficacy and safety of MC as an effective therapy in older adults.