Adverse events caused by cannabinoids in middle aged and older adults for all indications: a meta-analysis of incidence rate difference

Latha Velayudhan; Sara Pisani; Marta Dugonjic; Katie McGoohan; Sagnik Bhattacharyya

doi:10.1093/ageing/afae261

Adverse events caused by cannabinoids in middle aged and older adults for all indications: a meta-analysis of incidence rate difference

Latha Velayudhan, Sara Pisani, Marta Dugonjic, Katie McGoohan, Sagnik Bhattacharyya

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Cannabinoid-based medicines (CBMs) are being used widely in older people. However, information on the incidence of adverse events (AEs) is limited.

OBJECTIVE: To quantify the incidence rate difference (IRD) of AEs in middle aged and older adults of age ≥50 years receiving CBMs and also examine associations with weekly doses.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: MEDLINE, PubMed, EMBASE, CINAHL, PsychInfo, Cochrane Library and ClinicalTrials.gov (1st Jan 1990-12th June 2023).

METHODS: We included randomised clinical trials (RCTs) using CBMs with mean participant age ≥50 years for medicinal purposes for all clinical indications. Paired reviewers independently screened studies, extracted data and appraised risk of bias. We estimated pooled effect-sizes IRD under the random-effects model.

RESULTS: Data from 58 RCTs (37 moderate-high quality studies, pooled n = 6611, mean age range 50-87 years, 50% male, n = 3450 receiving CBMs) showed that compared with controls, the incidence of all-cause and treatment-related AEs attributable to delta-9-tetrahydrocannabinol (THC)-containing CBMs were: THC alone [IRD:18.83(95% Confidence Interval [CI], 1.47-55.79) and 16.35(95% CI, 1.25-48.56)] respectively; THC:cannabidiol (CBD) combination [IRD:19.37(95% CI, 4.24-45.47) and 11.36(95% CI, 2.55-26.48)] respectively. IRDs of serious AEs, withdrawals and deaths were not significantly greater for CBMs containing THC with or without CBD. THC dose-dependently increased the incidence of dry mouth, dizziness/lightheadedness, mobility/balance/coordination difficulties, dissociative/thinking/perception problems and somnolence/drowsiness. The interaction of weekly THC:CBD doses played a role in mostly neurological, psychiatric and cardiac side-effects.

CONCLUSIONS: Although CBMs in general are safe and acceptable in middle aged and older adults, one needs to be mindful of certain common dose-dependent side-effects of THC-containing CBMs.

Original language	English
Journal	Age and Ageing
Volume	53
Issue number	11
DOIs	https://doi.org/10.1093/ageing/afae261
Publication status	Published - 1 Nov 2024

Keywords

Humans
Aged
Middle Aged
Incidence
Cannabinoids/adverse effects
Aged, 80 and over
Male
Randomized Controlled Trials as Topic
Female
Age Factors
Risk Factors
Dronabinol/adverse effects

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10.1093/ageing/afae261

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@article{fa4bb5639f734a6e9305b7f19c222a95,

title = "Adverse events caused by cannabinoids in middle aged and older adults for all indications: a meta-analysis of incidence rate difference",

abstract = "BACKGROUND: Cannabinoid-based medicines (CBMs) are being used widely in older people. However, information on the incidence of adverse events (AEs) is limited.OBJECTIVE: To quantify the incidence rate difference (IRD) of AEs in middle aged and older adults of age ≥50 years receiving CBMs and also examine associations with weekly doses.DESIGN: Systematic review and meta-analysis.DATA SOURCES: MEDLINE, PubMed, EMBASE, CINAHL, PsychInfo, Cochrane Library and ClinicalTrials.gov (1st Jan 1990-12th June 2023).METHODS: We included randomised clinical trials (RCTs) using CBMs with mean participant age ≥50 years for medicinal purposes for all clinical indications. Paired reviewers independently screened studies, extracted data and appraised risk of bias. We estimated pooled effect-sizes IRD under the random-effects model.RESULTS: Data from 58 RCTs (37 moderate-high quality studies, pooled n = 6611, mean age range 50-87 years, 50% male, n = 3450 receiving CBMs) showed that compared with controls, the incidence of all-cause and treatment-related AEs attributable to delta-9-tetrahydrocannabinol (THC)-containing CBMs were: THC alone [IRD:18.83(95% Confidence Interval [CI], 1.47-55.79) and 16.35(95% CI, 1.25-48.56)] respectively; THC:cannabidiol (CBD) combination [IRD:19.37(95% CI, 4.24-45.47) and 11.36(95% CI, 2.55-26.48)] respectively. IRDs of serious AEs, withdrawals and deaths were not significantly greater for CBMs containing THC with or without CBD. THC dose-dependently increased the incidence of dry mouth, dizziness/lightheadedness, mobility/balance/coordination difficulties, dissociative/thinking/perception problems and somnolence/drowsiness. The interaction of weekly THC:CBD doses played a role in mostly neurological, psychiatric and cardiac side-effects.CONCLUSIONS: Although CBMs in general are safe and acceptable in middle aged and older adults, one needs to be mindful of certain common dose-dependent side-effects of THC-containing CBMs.",

keywords = "Humans, Aged, Middle Aged, Incidence, Cannabinoids/adverse effects, Aged, 80 and over, Male, Randomized Controlled Trials as Topic, Female, Age Factors, Risk Factors, Dronabinol/adverse effects",

author = "Latha Velayudhan and Sara Pisani and Marta Dugonjic and Katie McGoohan and Sagnik Bhattacharyya",

note = "{\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.",

year = "2024",

month = nov,

day = "1",

doi = "10.1093/ageing/afae261",

language = "English",

volume = "53",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "11",

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TY - JOUR

T1 - Adverse events caused by cannabinoids in middle aged and older adults for all indications

T2 - a meta-analysis of incidence rate difference

AU - Velayudhan, Latha

AU - Pisani, Sara

AU - Dugonjic, Marta

AU - McGoohan, Katie

AU - Bhattacharyya, Sagnik

N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.

PY - 2024/11/1

Y1 - 2024/11/1

N2 - BACKGROUND: Cannabinoid-based medicines (CBMs) are being used widely in older people. However, information on the incidence of adverse events (AEs) is limited.OBJECTIVE: To quantify the incidence rate difference (IRD) of AEs in middle aged and older adults of age ≥50 years receiving CBMs and also examine associations with weekly doses.DESIGN: Systematic review and meta-analysis.DATA SOURCES: MEDLINE, PubMed, EMBASE, CINAHL, PsychInfo, Cochrane Library and ClinicalTrials.gov (1st Jan 1990-12th June 2023).METHODS: We included randomised clinical trials (RCTs) using CBMs with mean participant age ≥50 years for medicinal purposes for all clinical indications. Paired reviewers independently screened studies, extracted data and appraised risk of bias. We estimated pooled effect-sizes IRD under the random-effects model.RESULTS: Data from 58 RCTs (37 moderate-high quality studies, pooled n = 6611, mean age range 50-87 years, 50% male, n = 3450 receiving CBMs) showed that compared with controls, the incidence of all-cause and treatment-related AEs attributable to delta-9-tetrahydrocannabinol (THC)-containing CBMs were: THC alone [IRD:18.83(95% Confidence Interval [CI], 1.47-55.79) and 16.35(95% CI, 1.25-48.56)] respectively; THC:cannabidiol (CBD) combination [IRD:19.37(95% CI, 4.24-45.47) and 11.36(95% CI, 2.55-26.48)] respectively. IRDs of serious AEs, withdrawals and deaths were not significantly greater for CBMs containing THC with or without CBD. THC dose-dependently increased the incidence of dry mouth, dizziness/lightheadedness, mobility/balance/coordination difficulties, dissociative/thinking/perception problems and somnolence/drowsiness. The interaction of weekly THC:CBD doses played a role in mostly neurological, psychiatric and cardiac side-effects.CONCLUSIONS: Although CBMs in general are safe and acceptable in middle aged and older adults, one needs to be mindful of certain common dose-dependent side-effects of THC-containing CBMs.

AB - BACKGROUND: Cannabinoid-based medicines (CBMs) are being used widely in older people. However, information on the incidence of adverse events (AEs) is limited.OBJECTIVE: To quantify the incidence rate difference (IRD) of AEs in middle aged and older adults of age ≥50 years receiving CBMs and also examine associations with weekly doses.DESIGN: Systematic review and meta-analysis.DATA SOURCES: MEDLINE, PubMed, EMBASE, CINAHL, PsychInfo, Cochrane Library and ClinicalTrials.gov (1st Jan 1990-12th June 2023).METHODS: We included randomised clinical trials (RCTs) using CBMs with mean participant age ≥50 years for medicinal purposes for all clinical indications. Paired reviewers independently screened studies, extracted data and appraised risk of bias. We estimated pooled effect-sizes IRD under the random-effects model.RESULTS: Data from 58 RCTs (37 moderate-high quality studies, pooled n = 6611, mean age range 50-87 years, 50% male, n = 3450 receiving CBMs) showed that compared with controls, the incidence of all-cause and treatment-related AEs attributable to delta-9-tetrahydrocannabinol (THC)-containing CBMs were: THC alone [IRD:18.83(95% Confidence Interval [CI], 1.47-55.79) and 16.35(95% CI, 1.25-48.56)] respectively; THC:cannabidiol (CBD) combination [IRD:19.37(95% CI, 4.24-45.47) and 11.36(95% CI, 2.55-26.48)] respectively. IRDs of serious AEs, withdrawals and deaths were not significantly greater for CBMs containing THC with or without CBD. THC dose-dependently increased the incidence of dry mouth, dizziness/lightheadedness, mobility/balance/coordination difficulties, dissociative/thinking/perception problems and somnolence/drowsiness. The interaction of weekly THC:CBD doses played a role in mostly neurological, psychiatric and cardiac side-effects.CONCLUSIONS: Although CBMs in general are safe and acceptable in middle aged and older adults, one needs to be mindful of certain common dose-dependent side-effects of THC-containing CBMs.

KW - Humans

KW - Aged

KW - Middle Aged

KW - Incidence

KW - Cannabinoids/adverse effects

KW - Aged, 80 and over

KW - Male

KW - Randomized Controlled Trials as Topic

KW - Female

KW - Age Factors

KW - Risk Factors

KW - Dronabinol/adverse effects

U2 - 10.1093/ageing/afae261

DO - 10.1093/ageing/afae261

M3 - Article

C2 - 39602500

SN - 0002-0729

VL - 53

JO - Age and Ageing

JF - Age and Ageing

IS - 11

ER -

Adverse events caused by cannabinoids in middle aged and older adults for all indications: a meta-analysis of incidence rate difference

Abstract

Keywords

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