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^*

^*Corresponding author for this work

King's College London

Research output: Contribution to journal › Review 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
Article number	afae261
Journal	Age and Ageing
Volume	53
Issue number	11
DOIs	https://doi.org/10.1093/ageing/afae261
Publication status	Published - 1 Nov 2024

Keywords

adverse events
cannabidiol
cannabinoid-based medication
delta-9-tetrahydrocannabinol (THC)
middle aged and older adults
older people
systematic review

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10.1093/ageing/afae261

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@article{0b9712f5de9d49a089ae1492fbe95052,

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 = "adverse events, cannabidiol, cannabinoid-based medication, delta-9-tetrahydrocannabinol (THC), middle aged and older adults, older people, systematic review",

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

note = "Publisher Copyright: {\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",

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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 - Publisher Copyright: © 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 - adverse events

KW - cannabidiol

KW - cannabinoid-based medication

KW - delta-9-tetrahydrocannabinol (THC)

KW - middle aged and older adults

KW - older people

KW - systematic review

UR - http://www.scopus.com/inward/record.url?scp=85210994564&partnerID=8YFLogxK

U2 - 10.1093/ageing/afae261

DO - 10.1093/ageing/afae261

M3 - Review article

C2 - 39602500

AN - SCOPUS:85210994564

SN - 0002-0729

VL - 53

JO - Age and Ageing

JF - Age and Ageing

IS - 11

M1 - afae261

ER -

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

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