COPD patients increasingly use prescription synthetic oral cannabinoid drugs to treat chronic musculoskeletal pain, insomnia and refractory dyspnea, though there is little evidence to support such use, according to Dr. Nicholas T. Vozoris of the University of Toronto, in Canada, and colleagues.
Using data from the ICES health administrative database for the province of Ontario and linked databases, the researchers evaluated respiratory morbidity and mortality in people 66 years and older with COPD who had been prescribed nabilone or dronabinol, two synthetic oral cannabinoid drugs. They focused on the first 60 days after the drugs were dispensed.
In the overall analysis, new cannabinoid use was not associated with increased hospitalizations for COPD or pneumonia, outpatient respiratory exacerbations, emergency department visits for COPD or pneumonia, or COPD- or pneumonia-related mortality.
But all-cause mortality was 64% (P=0.01) higher among the 2,106 new users than among 2,106 propensity-score-matched nonusers (72 vs. 51 deaths), the researchers report in Thorax.
Rates of all-cause mortality were 3.6-fold higher among new users than among nonusers who experienced no exacerbations in the year prior to the index date, but not in any of the other exacerbation-frequency subgroups.
There was a dose-response relationship between new cannabinoid use and both hospitalization rates for COPD or pneumonia and for all-cause mortality.
The findings mean "that there is a significantly increased risk of adverse events occurring in association with" new use of prescription cannabinoid drugs "among older adults with COPD and that this information should be discussed with patients and incorporated in prescribing decision-making and management plans," the authors conclude.
"Our results highlight the potential importance of using lower drug dosing to help minimise the occurrence of cannabinoid-related adverse events," they write, adding that "cannabinoids may not be a safer alternative to opioids in the older adult COPD population."
Dr. Donald Tashkin of David Geffen School of Medicine at UCLA, in Los Angeles, who recently reviewed the pulmonary effects of inhaled cannabis smoke, told Reuters Health by email, "Since COPD patients in general are at increased risk of both acute infectious bronchitis and pneumonia, it is possible that this risk might be augmented due to the immunosuppressive effect of oral cannabinoids. What I find particularly surprising about this finding, however, is that it was evident within a relatively short time."
"In view of the findings reported by Vozoris et al., it would be prudent not to prescribe high-dose nabilone to elderly patients with COPD," he said. "This precaution is the main message that physicians should take away from this report."
Dr. Vozoris did not respond to a request for comments.
By Will Boggs MD
SOURCE: https://bit.ly/2SEWqNI Thorax, online September 30, 2020.
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