The Question Nobody Asked: Assessing Cannabis Use in Older Adults as a Routine Part of Nursing Care
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RN to BSN Program, Aspen University
N490: Issues and Trends in Professional Nursing
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Month Day, Year
The Question Nobody Asked: Assessing Cannabis Use in Older Adults as a Routine Part of Nursing Care
Cannabis has moved from the margins of American life to the pharmacy counter in a single generation. Most states now permit medical use, many permit adult recreational use, and products containing cannabidiol are sold in grocery stores. Yet in many clinical settings the admission history still asks about alcohol and tobacco in detail and about cannabis, if at all, with a single yes or no. That gap matters most for older adults, the age group whose cannabis use has been rising fastest and who are most vulnerable to its interactions and side effects. This paper summarizes what the evidence says about cannabis benefits and harms, explains why older adults deserve particular attention, and argues that a structured, nonjudgmental cannabis history should be a routine part of nursing assessment.
Benefits and Harms in the Research
The most comprehensive review of the research to date came from an expert committee that graded the evidence for more than a hundred health outcomes (National Academies of Sciences, Engineering, and Medicine [NASEM], 2017). The committee found conclusive or substantial evidence that cannabis or cannabinoids are effective for chronic pain in adults, that oral cannabinoids reduce chemotherapy-induced nausea and vomiting, and that they improve patient-reported spasticity in multiple sclerosis. For many other claimed uses, including sleep and anxiety, the evidence was limited or insufficient.
The same review found substantial evidence of harms, including an increased risk of motor vehicle crashes and an association between cannabis use and the development of psychotic disorders, with the highest risk among the most frequent users (NASEM, 2017). A review in the New England Journal of Medicine added that about one in eleven people who use cannabis develops addiction, a proportion that rises with earlier and heavier use, and that acute use impairs short-term memory and motor coordination (Volkow et al., 2014). A nurse does not need to take a position on legalization to act on those findings; they describe risks that belong in any assessment.
Why Older Adults Need Particular Attention
Older adults are the fastest growing group of cannabis users in the United States. Analyses of national survey data found steady increases in use among adults aged 50 and older between 2006 and 2013 (Han et al., 2017), and past-year use among adults aged 65 and older rose from about 2.4 percent in 2015 to about 4.2 percent in 2018 (Han & Palamar, 2020). Many of these users are new to cannabis or returning to it after decades, often for pain or sleep, and many buy edibles or concentrates far more potent than products available when they last used.
Three features of later life make that pattern risky. Older adults take more prescription drugs, and both cannabidiol and tetrahydrocannabinol are processed by liver enzymes that metabolize many common medications; a review of interaction data identified clinically relevant potential interactions with anticoagulants such as warfarin, some antiepileptic drugs, and other agents with narrow therapeutic ranges (Brown & Winterstein, 2019). Older adults are also more sensitive to dizziness and sedation, which raises fall risk, and they are more likely to have cognitive changes that cannabis can worsen or mask. Finally, edibles act slowly, and an older adult who takes a second dose because the first seems not to be working can end up with a much larger effect than intended.
A Composite Case
Consider a composite patient built for this paper: a 74-year-old woman admitted after a fall at home. Her medication list includes warfarin for atrial fibrillation, sertraline, and a blood pressure medication, and her admission INR is higher than her usual range. On the standard history she answers no to illicit drug use. When the nurse later asks, in a matter-of-fact way, whether she uses anything for her knee pain or sleep that did not come from a prescription, she describes a cannabidiol oil she started two months ago and a THC gummy she takes some nights, bought at a dispensary on her daughter's advice.
Each detail matters clinically. The cannabidiol may have contributed to the rise in her INR, the evening gummy may have contributed to the unsteadiness that led to the fall, and neither product appears anywhere in her record. She did not hide it; the original question simply did not ask about it in terms she recognized as applying to her.
What a Good Cannabis History Looks Like
A useful cannabis history asks about products, not just use. The nurse asks what the patient takes, in what form (smoked, vaped, edible, oil, topical), whether it contains THC, cannabidiol, or both, how much and how often, where it was bought, and what it is for. The question is framed the way questions about supplements are framed, as part of making the medication list accurate, and it is asked of every adult rather than only those the nurse suspects.
The nurse then acts on the answer within nursing scope. Products are added to the medication list so pharmacists and prescribers can screen for interactions; findings such as an unexplained INR change, sedation, or falls are reported to the prescriber with the cannabis history attached; and teaching covers slow onset of edibles, the risks of combining cannabis with alcohol or sedatives, and not driving after use. The nurse does not recommend or discourage cannabis as a treatment, which is outside nursing scope in most states, but ensures that the people who make those decisions have the information they need.
Nurses also need education to do this well. Many practicing nurses were taught about cannabis only as an illicit drug, and a unit that adds a cannabis history to its admission assessment should pair it with a short in-service on product types, typical interactions, and the difference between what state law allows and what the evidence supports.
Conclusion
Cannabis is now part of the medication history whether or not the admission form says so. For older adults, whose use is rising and whose risks from interactions, sedation, and falls are highest, an unasked question can mean an unexplained bleed or a preventable fall. The evidence supports a few therapeutic uses and documents real harms, and nurses do not have to resolve the policy debate to act on it. Asking every patient about cannabis products in plain, nonjudgmental language, recording the answer, and passing it to the prescriber is a small change in practice that fits squarely within what nurses already do.
References
Brown, J. D., & Winterstein, A. G. (2019). Potential adverse drug events and drug-drug interactions with medical and consumer cannabidiol (CBD) use. Journal of Clinical Medicine, 8(7), Article 989. https://doi.org/10.3390/jcm8070989
Han, B. H., & Palamar, J. J. (2020). Trends in cannabis use among older adults in the United States, 2015-2018. JAMA Internal Medicine, 180(4), 609-611. https://doi.org/10.1001/jamainternmed.2019.7517
Han, B. H., Sherman, S., Mauro, P. M., Martins, S. S., Rotenberg, J., & Palamar, J. J. (2017). Demographic trends among older cannabis users in the United States, 2006-13. Addiction, 112(3), 516-525. https://doi.org/10.1111/add.13670
National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. The National Academies Press. https://doi.org/10.17226/24625
Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. B. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219-2227. https://doi.org/10.1056/NEJMra1402309
How this N 490 Module 5 example is structured
Module 5 of Issues and Trends in Professional Nursing is an introduction to cannabis for nurses, and the written work in many sections is a paper on what nurses need to know about cannabis and how it affects practice. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example avoids a legalization essay and argues for one practice change. It grades the evidence in both directions, narrows to older adults with a trend and three risk mechanisms, uses a composite case to show why standard questions miss cannabis products, and sets out the history and follow-through that stay inside nursing scope.
N490 Module 5 questions, answered
What does N490 Module 5 usually ask for?
The module is an introduction to cannabis for nurses, and the assignment is commonly a paper on the evidence, the legal and professional issues and what nurses should know or do. Aspen does not publish module deliverables, so your classroom's prompt and rubric set the exact questions and length.
Should the paper argue for or against legalization?
Only if the prompt asks for it. Most nursing rubrics reward a paper that stays on clinical ground: what the evidence shows, what risks patients face and what nurses do about them. The sample separates the policy question from the clinical one in a single sentence and then stays clinical.
Can a nurse recommend cannabis to a patient?
In most states recommending cannabis as a treatment is outside nursing scope, and your paper should say so if it discusses practice. What nurses can do is assess use accurately, document it, report relevant findings and teach about safe use, which is the role the sample describes.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.