Prescription Synthetic Oral Cannabinoid use Among Older Adults with Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study

Abstract

Background

Synthetic oral cannabinoids (nabilone and dronabinol) may have adverse respiratory effects. Our purpose was to describe the scope, pattern, and patient characteristics associated with incident off-label synthetic oral cannabinoid use among older adults with chronic obstructive pulmonary disease (COPD) compared to older adults without COPD.

Methods

This was a retrospective, population-based, cohort study using Ontario, Canada, heath administrative data. Individuals aged 66 years or older were included, and physician-diagnosed COPD was identified using a previously validated, highly specific algorithm. Incident off-label oral cannabinoid use was examined between April 1, 2005 and March 31, 2015. Descriptive statistics were used to describe drug use patterns. Multiple logistic regression was used to identify patient characteristics associated with incident drug use.

Results

There were 172,282 older adults with COPD and 1,068,256 older adults without COPD identified between April 1, 2005 and March 31, 2015. Incident synthetic oral cannabinoid use during this period occurred with significantly greater (p < 0.001) frequency among older adults with COPD (0.6%) versus older adults without COPD (0.3%). Compared to those without COPD, older adults with COPD used synthetic cannabinoids for significantly longer durations and more frequently at higher doses.

Conclusions

Although incident off-label oral cannabinoid use was relatively low among all older Ontarian adults, this drug class was used with greater frequency and more often in potentially concerning ways among older adults with COPD. These findings raise possible safety concerns, but further research on the respiratory safety of oral cannabinoids among individuals with COPD is needed.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. We thank Brogan Inc., Ottawa for use of their Drug Information Database. P. C. Austin was supported in part by a Mid-Career Investigator Award from the Heart and Stroke Foundation. A. S. Gershon was supported in part by a Canadian Institutes of Health Research New Investigator Award. P. A. Rochon holds the Retired Teachers of Ontario/ERO Chair in Geriatric Medicine at the University of Toronto.

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Correspondence to Nicholas T. Vozoris.

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Funding

This research was funded by a Grant from the Lung Association—Ontario Grant Review/Grant-In-Aid. The funder had no role in the study design; in the collection, analysis, or interpretation of data; or in the writing of the article and the decision to submit it for publication. All authors are independent from the funder.

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All authors have completed the Author Declaration Form. NTV, ZY, PL, PCA, ALS, SSG, DEO, ASG and PAR declare that they have no conflicts of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the St. Michael’s Hospital Research Ethics Board (approval #16-378), the Sunnybrook Health Sciences Centre Research Ethics Board (approval # not available), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies involving animals performed by any of the authors.

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Permission to undertake this retrospective study without informed consent was granted by the St. Michael’s Hospital Research Ethics Board (approval #16-378) and the Sunnybrook Health Sciences Centre Research Ethics Board (approval # not available).

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Vozoris, N.T., Yao, Z., Li, P. et al. Prescription Synthetic Oral Cannabinoid use Among Older Adults with Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study. Drugs Aging 36, 1035–1045 (2019). https://doi.org/10.1007/s40266-019-00707-3

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