Cannabis, nicotine use up in late midlife

Clinical takeaway: Screening guidance already covers all US adults at any age, but these data suggest the practical gap may be in the execution. Ask older adults about current cannabis and non-cigarette nicotine by product, and ask every age group how often rather than whether. 

Almost every patient intake form in American medicine asks about cigarettes and alcohol. Very few query patients about nicotine pouches or vapes, and fewer still inquire about cannabis. That was defensible when the products barely existed and usage was not widespread. But it's precisely the substances often missing from the routine screening form that are climbing in usage. 

Screening also often leans on an assumption that substance use peaks in the 20s and gradually thins out with age. For fifty years the data largely agreed, but the latest national survey data run counter to that long-standing narrative and suggest that newer forms may elude existing tools. 

Cannabis use in the past year among adults 55 to 65 reached 21.3%, up from 18.1% the year before and the highest level ever recorded for the group. Drinking rose in this group too, to 80.3% from 77.2%, and the share who reported no alcohol at all dropped. These figures are based on the 2025 Monitoring the Future survey of about 11,000 US adults ages 19 to 65, all followed since their last year of high school. 

Nicotine went up in almost every form in the late midlife group. Over the past year, large cigars rose to 9.1% from 7.6%, smokeless tobacco to 7.4% from 5.7%, nicotine pouches to 5.7% from 4.3%, and hookah to 4.7% from 3.4%. Nearly three in 10 reported using nicotine in some form, up from one in four. Cigarettes were the one thing that did not move, at 14.0%. 

Young adults have adopted vapes widely. Among those 19 to 30, one-quarter vaped nicotine in the past year, nearly double the share in 2017, when the question was first asked. Cannabis vaping was close behind at 22.1%. Pouch use reached 12.7%, up from 4.8% two years earlier. Cigarette use trailed at 18.6%. 

Overall, cigarette smoking stayed near historic lows, and drinking measures fell to record lows in every group except the oldest, though alcohol remains the most commonly used substance by a wide margin. Cannabis and nicotine vaping both sat at or near record highs, and nicotine pouches more than doubled in two years. Psychedelic use dropped after a decade of increases. Cocaine and methamphetamine use held low or declined, while prescription opioids ticked up.

Cannabis was used daily by a record number of adults across age ranges: 11.8% of 19 to 30, 8.5% of 35 to 50, and 6.2% of 55 to 65. In the sole group with comparable year-over-year data, adults 40 to 50, symptoms of cannabis use disorder rose to 6.5% while the share using no cannabis at all fell.

Daily cannabis use is a clinically meaningful figure, and it rose in every age group. A patient who uses cannabis every day is a different patient from one who used it twice last year, but an intake form may treat them the same.

"It is reassuring to continue to see relatively low smoking rates and a continuing decline in alcohol use among adults. At the same time, rising rates of cannabis, nicotine, and certain other drug use warrant attention. Continued monitoring is vital for understanding the changing drug landscape so that we can develop effective interventions to support public health," said Nora Volkow, MD, director of the National Institute on Drug Abuse. 

Source: Patrick M, et al. (2026 Jul) Monitoring the Future Longitudinal Panel Study Annual Report. National data on substance use among adults ages 19 to 65, 1976–2025