Cannabis use and risks of respiratory and all-cause morbidity and mortality: a population-based, data-linkage, cohort study

Vozoris, Nicholas T.; Zhu, Jingqin; Ryan, Clodagh M.; Chow, Chung‐Wai; To, Teresa

doi:10.1136/bmjresp-2022-001216

Cited by 12 publications

(5 citation statements)

References 33 publications

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“…Our secondary outcome was the composite end point of all-cause hospitalization, all-cause emergency department (ED) visit, or all-cause mortality within 90 or 180 days of the urine drug screening. We chose this secondary composite outcome (time to first event) because findings from several studies 14 , 15 suggested that cannabis use was associated with increased rates of ED visits and hospitalization. In addition, the composite outcome captures all 3 possible harms in the period under observation.…”

Section: Methodsmentioning

confidence: 99%

Association of a Positive Drug Screening for Cannabis With Mortality and Hospital Visits Among Veterans Affairs Enrollees Prescribed Opioids

et al. 2022

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ImportanceCannabis has been proposed as a therapeutic with potential opioid-sparing properties in chronic pain, and its use could theoretically be associated with decreased amounts of opioids used and decreased risk of mortality among individuals prescribed opioids.ObjectiveTo examine the risks associated with cannabis use among adults prescribed opioid analgesic medications.Design, Setting, and ParticipantsThis cohort study was conducted among individuals aged 18 years and older who had urine drug screening in 2014 to 2019 and received any prescription opioid in the prior 90 days or long-term opioid therapy (LTOT), defined as more than 84 days of the prior 90 days, through the Veterans Affairs health system. Data were analyzed from November 2020 through March 2022.ExposuresBiologically verified cannabis use from a urine drug screen.Main Outcomes and MeasuresThe main outcomes were 90-day and 180-day all-cause mortality. A composite outcome of all-cause emergency department (ED) visits, all-cause hospitalization, or all-cause mortality was a secondary outcome. Weights based on the propensity score were used to reduce confounding, and hazard ratios [HRs] were estimated using Cox proportional hazards regression models. Analyses were conducted among the overall sample of patients who received any prescription opioid in the prior 90 days and were repeated among those who received LTOT. Analyses were repeated among adults aged 65 years and older.ResultsAmong 297 620 adults treated with opioids, 30 514 individuals used cannabis (mean [SE] age, 57.8 [10.5] years; 28 784 [94.3%] men) and 267 106 adults did not (mean [SE] age, 62.3 [12.3] years; P &lt; .001; 247 684 [92.7%] men; P &lt; .001). Among all patients, cannabis use was not associated with increased all-cause mortality at 90 days (HR, 1.07; 95% CI, 0.92-1.22) or 180 days (HR, 1.00; 95% CI, 0.90-1.10) but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.01-1.07) and 180 days (HR, 1.04; 95% CI, 1.01-1.06). Among 181 096 adults receiving LTOT, cannabis use was not associated with increased risk of all-cause mortality at 90 or 180 days but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.02-1.09) and 180 days (HR, 1.05; 95% CI, 1.02-1.09). Among 77 791 adults aged 65 years and older receiving LTOT, cannabis use was associated with increased 90-day mortality (HR, 1.55; 95% CI, 1.17-2.04).Conclusions and RelevanceThis study found that cannabis use among adults receiving opioid analgesic medications was not associated with any change in mortality risk but was associated with a small increased risk of adverse outcomes and that short-term risks were higher among older adults receiving LTOT.

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Section: Methodsmentioning

confidence: 99%

Association of a Positive Drug Screening for Cannabis With Mortality and Hospital Visits Among Veterans Affairs Enrollees Prescribed Opioids

et al. 2022

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“…This study again represents patient presentations that would pose a significant burden on the healthcare system. A case–control cohort study examining individuals in Ontario, Canada from 2014 to 2017 found that cannabis users had a significantly higher odd of an all-cause ED visit (OR 1.22, 95% CI 1.13 to 1.31) but odds of mortality were not affected ( 17 ).…”

Section: Literature Updatementioning

confidence: 99%

“…Cannabis adverse events may represent an all or nothing approach to healthcare needs, if the adverse event reached the level of requiring an ED visit, it was a "significant burden" on hospital resources (15). Another example of how intensive care can be for cannabis intoxicated patients relates to a trauma patient study performed in Los Angeles, California which was not focused on mental health impacts of cannabis, but showed that cannabis use was associated with increased use of mechanical ventilation in trauma patients who had used cannabis (16). This study again represents patient presentations that would pose a significant burden on the healthcare system.…”

Section: Potential Impacts Of Cannabis Related Ed Visits On Ed Resourcesmentioning

confidence: 99%

“…The percentage of fatally injured drivers in the United States that had cannabis in their system in 2000 was 9.0%, but by 2018 it had risen to 21.8% in comparison to alcohol involvement which had remained stable (63). Additionally, when trauma patients were assessed, one study found 43% of these patients in 2016 had at least cannabis in their system and that injuries associated with the presence of cannabis were more likely to require mechanical ventilation (16). Another study done in Georgia showed that the odds of dying with cannabis were greater than those of cocaine if presentation to the ED was required (64).…”

Section: Limitations Of Icd Based Studiesmentioning

confidence: 99%

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Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate?

2023

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We have previously reviewed the types and numbers of cannabis-associated adverse events that have mental health presentations that are encountered in the Emergency Department. A particular challenge in examining these events is disentangling cannabis use adverse events from adverse events associated with use of multiple recreational substances. Since that review was published, cannabis legalization for recreational use has greatly expanded world-wide and with these changes in the legal climate has come clearer information around the frequency of adverse events seen in the Emergency Department. However, as we examined the current state of the literature, we also examined some of research designs and the biases that may be impacting the validity of the data in this field. The biases both of clinicians and researchers as well as research approaches to studying these events may be impacting our ability to assess the interaction between cannabis and mental health. For example, many of the studies performed examining cannabis-related admissions to the Emergency Department were administrative studies that relied on front line clinicians to identify and attribute that cannabis use was associated with any particular admission. This narrative review provides an overview on what we currently know about mental health adverse events in the Emergency Department with a focus on the mental health impacts both for those with and without a history of mental illness. The evidence that cannabis use can adversely impact genders and sexes differently is also discussed. This review outlines what the most common adverse events related to mental health with cannabis use are; as well as noting the most concerning but much rarer events that have been reported. Additionally, this review suggests a framework for critical evaluation of this field of study going forward.

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“…A recent systematic review concluded that THC administered orally has a variable pharmacokinetic profile, which differs between formulations, with high variability, including in the case of similar formulations [ 30 ]. Furthermore, data on the demographic-specific impact of cannabis use [ 29 , 31 , 32 , 33 ], substance use disorders [ 34 , 35 , 36 ], abuse, dependence and risks come only from retrospective reports [ 37 , 38 ]. Therefore, randomized controlled trials on standardized GMP-level cannabis products are needed to reduce the results’ unpredictability when using medical cannabis, to increase the efficacy and safety of compound formulations for therapeutic uses, and to support further investigations regarding the use of cannabis in specific conditions and pathologies.…”

Section: Introductionmentioning

confidence: 99%

Acute Toxicity and Pharmacokinetic Profile of an EU-GMP-Certified Cannabis sativa L. in Rodents

Filipiuc,

Ştefănescu,

Solcan

et al. 2023

Pharmaceuticals

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The conundrum of Cannabis sativa’s applications for therapeutical purposes is set apart by the hundreds of known and commercially available strains, the social, cultural and historical context, and the legalization of its use for medical purposes in various jurisdictions around the globe. In an era where targeted therapies are continuously being developed and have become the norm, it is imperative to conduct standardized, controlled studies on strains currently cultivated under Good Manufacturing Practices (GMP) certification, a standard that guarantees the quality requirements for modern medical and therapeutic use. Thus, the aim of our study is to evaluate the acute toxicity of a 15.6% THC: <1% CBD, EU-GMP certified, Cannabis sativa L. in rodents, following the OECD acute oral toxicity guidelines, and to provide an overview of its pharmacokinetic profile. Groups of healthy female Sprague-Dawley rats were treated orally with a stepwise incremental dose, each step using three animals. The absence or presence of plant-induced mortality in rats dosed at one step determined the next step. For the EU GMP-certified Cannabis sativa L. investigated, we determined an oral LD50 value of over 5000 mg/kg in rats and a human equivalent oral dose of ≈806.45 mg/kg. Additionally, no significant clinical signs of toxicity or gross pathological findings were observed. According to our data, the toxicology, safety and pharmacokinetic profile of the tested EU-GMP-certified Cannabis sativa L. support further investigations through efficacy and chronic toxicity studies in preparation for potential future clinical applications and especially for the treatment of chronic pain.

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Cannabis use and risks of respiratory and all-cause morbidity and mortality: a population-based, data-linkage, cohort study

Cited by 12 publications

References 33 publications

Association of a Positive Drug Screening for Cannabis With Mortality and Hospital Visits Among Veterans Affairs Enrollees Prescribed Opioids

Association of a Positive Drug Screening for Cannabis With Mortality and Hospital Visits Among Veterans Affairs Enrollees Prescribed Opioids

Mental health adverse events with cannabis use diagnosed in the Emergency Department: what are we finding now and are our findings accurate?

Acute Toxicity and Pharmacokinetic Profile of an EU-GMP-Certified Cannabis sativa L. in Rodents

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