{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:32:53Z","timestamp":1789752773461,"version":"4.0.1"},"reference-count":53,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T00:00:00Z","timestamp":1587168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006827","name":"Florida Department of Health","doi-asserted-by":"publisher","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/100006827","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Use of medical marijuana is increasing in the United States and older adults are the fastest growing user group. There is little information about the characteristics and outcomes related to medical marijuana use. This study is a descriptive analysis of older adults (aged \u226550 years old) who were early adopters of a medical marijuana program in the U.S. state of Florida. Per state legislation, initial and follow-up treatment plans were submitted to the University of Florida College of Pharmacy. Data collection included demographics, clinical history, medical conditions, substance use history, prescription history, and health status. Follow-up treatment plans noted changes in the chief complaint and actions taken since the initial visit. Of the state\u2019s 7548 registered users between August 2016 and July 2017, N = 4447 (58.9%) were older adults. Patients utilized cannabidiol (CBD)-only preparations (45%), preparations that had both tetrahydrocannabinol (THC) and CBD (33.3%) or were recorded to use both CBD-only and THC + CBD products (21.7%). The chief complaints indicating medical cannabis treatment were musculoskeletal disorders and spasms (48.4%) and chronic pain (45.4%). Among other prescription medications, patients utilized antidepressants (23.8%), anxiolytics and benzodiazepines (23.5%), opioids (28.6%), and cardiovascular agents (27.9%). Among all drug classes with potential sedating effects, 44.8% of the cohort were exposed to at least one. Patients with follow-up visits (27.5%) exhibited marked improvement as assessed by the authorizing physicians. However, the patient registry lacked detailed records and linkable information to other data resources to achieve complete follow up in order to assess safety or efficacy. Future improvements to registries are needed to more adequately capture patient information to fill knowledge gaps related to the safety and effectiveness of medical marijuana, particularly in the older adult population.<\/jats:p>","DOI":"10.3390\/jcm9041166","type":"journal-article","created":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T05:48:52Z","timestamp":1587448132000},"page":"1166","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Characteristics of Older Adults Who Were Early Adopters of Medical Cannabis in the Florida Medical Marijuana Use Registry"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2973-1021","authenticated-orcid":false,"given":"Joshua D.","family":"Brown","sequence":"first","affiliation":[{"name":"Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"},{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianna","family":"Costales","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6518-7254","authenticated-orcid":false,"given":"Sascha","family":"van Boemmel-Wegmann","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0020-8720","authenticated-orcid":false,"given":"Amie J.","family":"Goodin","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"},{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Segal","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6518-5961","authenticated-orcid":false,"given":"Almut G.","family":"Winterstein","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"},{"name":"Consortium for Medical Marijuana Clinical Outcomes Research, Center for Drug Evaluation &amp; Safety, Department of Pharmaceutical Outcomes &amp; Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA"},{"name":"Department of Epidemiology, University of Florida College of Colleges of Public Health and Health Professions and Medicine, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,18]]},"reference":[{"key":"ref_1","unstructured":"National Conference of State Legislatures (NCSL) (2019, June 09). State Medical Marijuana Laws. Available online: http:\/\/www.ncsl.org\/research\/health\/state-medical-marijuana-laws.aspx."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.drugpo.2019.06.007","article-title":"Attitudes toward legalization of marijuana in the United States, 1986\u20132016: Changes in determinants of public opinion","volume":"71","author":"Denham","year":"2019","journal-title":"Int. J. Drug Policy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.drugalcdep.2011.06.011","article-title":"Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence","volume":"120","author":"Cerda","year":"2012","journal-title":"Drug Alcohol Depend."},{"key":"ref_4","unstructured":"(2019, June 09). Number of Legal Medical Marijuana Patients. Available online: https:\/\/medicalmarijuana.procon.org\/view.resource.php?resourceID=005889."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1001\/jama.2016.18900","article-title":"Use of marijuana for medical purposes among adults in the United States","volume":"317","author":"Compton","year":"2017","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1542\/peds.2017-1818","article-title":"Medical Cannabinoids in children and adolescents: A systematic review","volume":"140","author":"Wong","year":"2017","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1089\/can.2016.0007","article-title":"A Cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy","volume":"1","author":"Sexton","year":"2016","journal-title":"Cannabis Cannabinoid Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.drugpo.2017.01.011","article-title":"Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients","volume":"42","author":"Lucas","year":"2017","journal-title":"Int. J. Drug Policy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1111\/add.13670","article-title":"Demographic trends among older cannabis users in the United States, 2006\u20132013","volume":"112","author":"Han","year":"2017","journal-title":"Addiction"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.addbeh.2016.05.015","article-title":"Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample","volume":"61","author":"Lin","year":"2016","journal-title":"Addict. Behav."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e1911936","DOI":"10.1001\/jamanetworkopen.2019.11936","article-title":"A national survey of marijuana use among us adults with medical conditions, 2016\u20132017","volume":"2","author":"Dai","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/02791072.2019.1610199","article-title":"Characteristics associated with attitudes toward marijuana legalization in Michigan","volume":"51","author":"Ellis","year":"2019","journal-title":"J. Psychoact. Drugs"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1111\/jgs.15346","article-title":"Medical marijuana use in older adults","volume":"66","author":"Briscoe","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lloyd, S.L., and Striley, C.W. (2018). Marijuana use among adults 50 years or older in the 21st century. Gerontol. Geriatr. Med., 4.","DOI":"10.1177\/2333721418781668"},{"key":"ref_15","unstructured":"Guy, W. (2020, January 20). Clinical global impression (CGI). Available online: https:\/\/www.psywellness.com.sg\/docs\/CGI.pdf."},{"key":"ref_16","unstructured":"Sativex(R) (2005). Delta-9-Tetrahydrocannabinol and Cannabidiol, GW Pharma."},{"key":"ref_17","unstructured":"Hall, W., Renstrom, M., and Poznyak, V. (2016). The Health and Social Effects of Nonmedical Cannabis Use, World Health Organization."},{"key":"ref_18","first-page":"607","article-title":"Assessing the public health impacts of legalizing recreational cannabis use in the USA","volume":"97","author":"Hall","year":"2015","journal-title":"Clin. Pharm."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1080\/10826084.2018.1543327","article-title":"Understanding public attitudes toward cannabis legalization: Qualitative findings from a statewide survey","volume":"54","author":"Resko","year":"2019","journal-title":"Subst. Use Misuse"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1056\/NEJMra1402309","article-title":"Adverse health effects of marijuana use","volume":"370","author":"Volkow","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1001\/jama.2015.6358","article-title":"Cannabinoids for medical use: A systematic review and meta-analysis","volume":"313","author":"Whiting","year":"2015","journal-title":"JAMA"},{"key":"ref_22","first-page":"1","article-title":"Phytochemistry of cannabis sativa L.","volume":"103","author":"ElSohly","year":"2017","journal-title":"Prog. Chem. Org. Nat. Prod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.lfs.2005.09.011","article-title":"Chemical constituents of marijuana: The complex mixture of natural cannabinoids","volume":"78","author":"Elsohly","year":"2005","journal-title":"Life Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.lfs.2011.05.018","article-title":"Identification of cytochrome P450 enzymes responsible for metabolism of cannabidiol by human liver microsomes","volume":"89","author":"Jiang","year":"2011","journal-title":"Life Sci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Brown, J.D., and Winterstein, A.G. (2019). Potential adverse drug events and drug-drug interactions with medical and consumer cannabidiol (CBD) use. J. Clin. Med., 8.","DOI":"10.3390\/jcm8070989"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"237","DOI":"10.2174\/157488611798280924","article-title":"Safety and side effects of cannabidiol, a cannabis sativa constituent","volume":"6","author":"Bergamaschi","year":"2011","journal-title":"Curr. Drug. Saf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1089\/can.2016.0034","article-title":"An update on safety and side effects of cannabidiol: A review of clinical data and relevant animal studies","volume":"2","author":"Iffland","year":"2017","journal-title":"Cannabis Cannabinoid Res."},{"key":"ref_28","unstructured":"GW Research Ltd. (2019, June 09). Drug Approval Package: Epidiolex (Cannabidiol), Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/nda\/2018\/210365Orig1s000TOC.cfm."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Brown, J.D. (2020). Potential adverse drug events with tetrahydrocannabinol (THC) due to drug\u2013drug interactions. J. Clin. Med., 9.","DOI":"10.3390\/jcm9040919"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"571","DOI":"10.2174\/092986710790416326","article-title":"Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions","volume":"17","author":"Corsonello","year":"2010","journal-title":"Curr. Med. Chem."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"611","DOI":"10.2174\/138920011796504473","article-title":"Age-related changes in pharmacodynamics: Focus on drugs acting on central nervous and cardiovascular systems","volume":"12","author":"Trifiro","year":"2011","journal-title":"Curr. Drug Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1038\/sj.npp.1301412","article-title":"Drugs of abuse and the aging brain","volume":"33","author":"Dowling","year":"2008","journal-title":"Neuropsychopharmacology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2867","DOI":"10.1001\/jama.2008.892","article-title":"Use of prescription and over-the-counter medications and dietary supplements among older adults in the united states","volume":"300","author":"Qato","year":"2008","journal-title":"JAMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s40266-018-0550-6","article-title":"Potential drug-drug interactions in a cohort of elderly, polymedicated primary care patients on antithrombotic treatment","volume":"35","author":"Schneider","year":"2018","journal-title":"Drugs Aging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"343","DOI":"10.2165\/00002512-200825040-00007","article-title":"Drug-drug interactions in a geriatric outpatient cohort: Prevalence and relevance","volume":"25","author":"Tulner","year":"2008","journal-title":"Drugs Aging"},{"key":"ref_36","first-page":"377","article-title":"Potentially severe drug interactions in elderly outpatients: Results of an observational study of an administrative prescription database","volume":"34","author":"Nobili","year":"2009","journal-title":"J. Clin. Pharm."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"911","DOI":"10.2165\/00002018-200730100-00009","article-title":"The relationship between number of drugs and potential drug-drug interactions in the elderly: A study of over 600,000 elderly patients from the Swedish prescribed drug register","volume":"30","author":"Johnell","year":"2007","journal-title":"Drug Saf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/jgs.13884","article-title":"Predictive validity of the beers and screening tool of older persons\u2019 potentially inappropriate prescriptions (STOPP) criteria to detect adverse drug events, hospitalizations, and emergency department visits in the United States","volume":"64","author":"Brown","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"(2019). American geriatrics society 2019 updated AGS beers criteria(R) for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc., 67, 674\u2013694.","DOI":"10.1111\/jgs.15767"},{"key":"ref_40","first-page":"213","article-title":"STOPP\/START criteria for potentially inappropriate prescribing in older people: Version 2","volume":"44","author":"Byrne","year":"2015","journal-title":"Age Ageing"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1001\/archinternmed.2007.106","article-title":"The anticholinergic risk scale and anticholinergic adverse effects in older persons","volume":"168","author":"Rudolph","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1001\/jama.296.15.1858","article-title":"National surveillance of emergency department visits for outpatient adverse drug events","volume":"296","author":"Budnitz","year":"2006","journal-title":"JAMA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"755","DOI":"10.7326\/0003-4819-147-11-200712040-00006","article-title":"Medication use leading to emergency department visits for adverse drug events in older adults","volume":"147","author":"Budnitz","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1001\/jama.289.9.1107","article-title":"Incidence and preventability of adverse drug events among older persons in the ambulatory setting","volume":"289","author":"Gurwitz","year":"2003","journal-title":"JAMA"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1056\/NEJMsa1103053","article-title":"Emergency hospitalizations for adverse drug events in older Americans","volume":"365","author":"Budnitz","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"A155","DOI":"10.1016\/j.jval.2014.03.904","article-title":"Adverse drug events in the elderly occurring in emergency, inpatient, and outpatient departments in an administrative claims database","volume":"17","author":"Brown","year":"2014","journal-title":"Value Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1111\/j.1532-5415.1997.tb02964.x","article-title":"Adverse drug events in high risk older outpatients","volume":"45","author":"Hanlon","year":"1997","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_48","first-page":"635","article-title":"Burden of hospitalizations related to adverse drug events in the USA: A retrospective analysis from large inpatient database","volume":"26","author":"Poudel","year":"2017","journal-title":"Pharm. Drug Saf."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40290-019-00286-z","article-title":"Association of adverse drug events with hospitalization outcomes and costs in older adults in the USA using the nationwide readmissions database","volume":"33","author":"Riaz","year":"2019","journal-title":"Pharm. Med."},{"key":"ref_50","first-page":"1238","article-title":"Preventable drug-related hospital admissions","volume":"36","author":"Winterstein","year":"2002","journal-title":"Ann. Pharm."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/BF03040432","article-title":"The epidemiology of preventable adverse drug events: A review of the literature","volume":"115","author":"Schwappach","year":"2003","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_52","first-page":"1411","article-title":"Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care","volume":"41","author":"Thomsen","year":"2007","journal-title":"Ann. Pharm."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1093\/ajhp\/60.17.1750","article-title":"Nature of preventable adverse drug events in hospitals: A literature review","volume":"60","author":"Kanjanarat","year":"2003","journal-title":"Am. J. Health Syst. Pharm."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1166\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:45:07Z","timestamp":1760363107000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,18]]},"references-count":53,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["jcm9041166"],"URL":"https:\/\/doi.org\/10.3390\/jcm9041166","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,18]]}}}