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Older adults with chronic obstructive pulmonary disease found to be more likely to use synthetic cannabinoids, raising safety concerns: new study

Toronto, September 24, 2019

By Anna Wassermann

Dr. Nicholas Vozoris
Dr. Nicholas Vozoris

A study published today in Drugs & Aging found that older adults in Ontario with chronic obstructive pulmonary disease (COPD) were twice as likely to use prescription synthetic oral cannabinoids compared to older adults without COPD.

Using provincial health administrative databases, researchers found that while synthetic oral cannabinoid use was relatively low among adults over the age of 66 with COPD (0.6 per cent), this group was twice as likely to be using these drugs compared to adults of the same age without COPD (0.3 per cent).

The research led by St. Michael’s Hospital in Toronto and the not-for-profit research institute ICES raises concerns about the use of synthetic cannabinoids, man-made versions of tetrahydrocannabinol (THC) – a key chemical in marijuana. When ingested, THC activates receptors in the central nervous system, producing a variety of potential effects including sedation, anxiety, muscle weakness and pain relief.

COPD is a progressive lung disease that causes breathing difficulty, but it can be associated with a variety of other problems too, like chronic muscle pain and insomnia. Psychoactive drug classes, like cannabinoids, are often prescribed to help reduce pain, promote sleep and decrease difficult-to-control breathlessness.

“Our study showed that patients and clinicians are turning to cannabinoids more frequently to manage the symptoms associated with COPD, but little is known about the potential dangers associated with this medication class,” said Dr. Nicholas Vozoris, lead author, a respirologist at St. Michael’s and an associate scientist at the hospital’s Li Ka Shing Knowledge Institute and ICES.

“Previous studies by our team found that other psychoactive drugs, like opioids and benzodiazepines, are frequently used in COPD. We wanted to find out if this was the case too for synthetic oral cannabinoids.”

Researchers also found that synthetic oral cannabinoids were used more frequently in subgroups of older adults with COPD at heightened risk for adverse events, such as those with psychiatric disease and those receiving other sedating psychoactive medications.

“Safety recommendations provided for these medications advise against prescribing cannabinoids in these groups,” said Dr. Vozoris. “And yet these individuals with COPD are being exposed at greater rates.”

The team also found that synthetic oral cannabinoids were used more often in potentially concerning ways among older adults with COPD, including more frequently at higher doses and for longer durations of time.

“Though the use of these drugs isn’t too frequent today, without careful monitoring of the way they’re being prescribed and used now, we could end up with larger problems in the future,” Dr. Vozoris said.

As one of the first studies to describe the use of this drug class in individuals with COPD, Dr. Vozoris said these results provide a basis for future research to examine the effects of oral synthetic cannabinoid use on respiratory outcomes among individuals with COPD.

The results also provide a foundation for clinicians to make more informed decisions regarding the use of this drug class.

“We hope that clinicians read our paper and walk away with a better understanding of this drug class,” said Dr. Vozoris. “We’d like them to reflect on their own prescribing practices and ensure cannabinoid drugs are used and prescribed with vigilance.”


This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.


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