Medical Cannabis Certifications for Alzheimer Disease Agitation Decline in Recreational States
Key Clinical Summary
- Nineteen US states list Alzheimer disease (AD) or related agitation as a qualifying condition for medical cannabis.
- Fewer than 1% of medical cannabis certifications are for AD or agitation symptoms.
- Recreational legalization may be reducing medical cannabis program participation for AD-related agitation.
A 2024–2025 review of US state medical cannabis programs found that Alzheimer disease and agitation associated with dementia remain qualifying conditions in 19 of 38 states. Despite this widespread policy inclusion, AD-related certifications comprise less than 1% of all medical cannabis authorizations. The findings raise questions about clinical utility and highlight the need for careful monitoring of cannabis use for behavioral symptoms in long-term care.
Study Findings
Researchers examined publicly available reports from state regulatory agencies overseeing medical cannabis programs between 2024 and 2025. Among the 38 states with medical cannabis laws, 19 (50%) recognize Alzheimer disease or agitation related to dementia as qualifying conditions.
However, AD-related certifications accounted for fewer than 1% of all medical cannabis authorizations nationwide, indicating that few patients or providers pursue cannabis for agitation management. The authors noted a trend toward declining certifications in states that later legalize recreational cannabis, suggesting that patients may obtain products outside medical programs—bypassing clinical oversight and formal documentation.
While limited preclinical and anecdotal data suggest potential benefits for behavioral symptoms such as agitation or restlessness, robust randomized clinical trial evidence is lacking.
Clinical Implications for Long-Term Care
For long-term care and geriatric clinicians, these findings underscore the importance of monitoring cannabis use among residents with dementia-related agitation. Even though legalization expands access, clinical oversight often diminishes—particularly in states where recreational cannabis is permitted.
Agitation and behavioral disturbances are common and challenging aspects of Alzheimer care, often managed through environmental interventions and psychotropic medications. Cannabis-based products have been explored as alternatives, yet safety data remain limited, and adverse effects—including sedation, falls, and neuropsychiatric changes—are potential risks in frail older adults.
Long-term care professionals should consider integrating screening protocols for cannabis use into behavioral health assessments, encourage interdisciplinary communication, and educate caregivers about the variability of cannabis formulations and potency. Given the aging population, even a small proportion of users represents a growing absolute number of older adults who may seek cannabis for agitation relief, reinforcing the need for informed, cautious clinical engagement.
Conclusion
Although Alzheimer-related agitation remains a qualifying condition for medical cannabis in half of US states, actual use is uncommon and declining in states with recreational access. Clinicians in long-term and post-acute care settings should maintain awareness of patient cannabis use, prioritize safety monitoring, and advocate for rigorous clinical trials to guide evidence-based care.
Reference
Bonar EE, Tan CY, Patyk A, Lei L, Maust DT. Agitation in Alzheimer's disease as a qualifying condition for medical cannabis in the United States: a brief report on current trends. Am J Geriatr Psychiatry. Published online June 11, 2025. doi:10.1016/j.jagp.2025.06.003
