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Morbidity and mortality associated with prescription cannabinoid drug use in COPD
  1. Nicholas T Vozoris1,2,3,4,
  2. Priscila Pequeno3,
  3. Ping Li3,
  4. Peter C Austin3,5,
  5. Anne L Stephenson1,2,4,5,
  6. Denis E O'Donnell6,
  7. Sudeep S Gill3,6,
  8. Andrea S Gershon1,3,7,
  9. Paula A Rochon1,3,8
  1. 1 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Respirology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
  3. 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  4. 4 Keenan Research Centre in the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
  5. 5 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  6. 6 Department of Medicine, Queen’s University, Kingston, Ontario, Canada
  7. 7 Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  8. 8 Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Nicholas T Vozoris, University of Toronto Faculty of Medicine, Toronto, ON M5S 1A8, Canada; nick.vozoris{at}


Introduction Respiratory-related morbidity and mortality were evaluated in relation to incident prescription oral synthetic cannabinoid (nabilone, dronabinol) use among older adults with chronic obstructive pulmonary disease (COPD).

Methods This was a retrospective, population-based, data-linkage cohort study, analysing health administrative data from Ontario, Canada, from 2006 to 2016. We identified individuals aged 66 years and older with COPD, using a highly specific, validated algorithm, excluding individuals with malignancy and those receiving palliative care (n=185 876 after exclusions). An equivalent number (2106 in each group) of new cannabinoid users (defined as individuals dispensed either nabilone or dronabinol, with no dispensing for either drug in the year previous) and controls (defined as new users of a non-cannabinoid drug) were matched on 36 relevant covariates, using propensity scoring methods. Cox proportional hazard regression was used.

Results Rate of hospitalisation for COPD or pneumonia was not significantly different between new cannabinoid users and controls (HR 0.87; 95% CI 0.61–1.24). However, significantly higher rates of all-cause mortality occurred among new cannabinoid users compared with controls (HR 1.64; 95% CI 1.14–2.39). Individuals receiving higher-dose cannabinoids relative to controls were observed to experience both increased rates of hospitalisation for COPD and pneumonia (HR 2.78; 95% CI 1.17–7.09) and all-cause mortality (HR 3.31; 95% CI 1.30–9.51).

Conclusions New cannabinoid use was associated with elevated rates of adverse outcomes among older adults with COPD. Although further research is needed to confirm these observations, our findings should be considered in decisions to use cannabinoids among older adults with COPD.

  • clinical epidemiology
  • COPD epidemiology

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  • Contributors NTV: conceptualisation; funding acquisition; wrote original draft. PP and PL: formal analysis. NTV, PP, PL, PCA, ALS, DEO, SSG, ASG and PAR: methodology. NTV, PP, PL, PCA, ALS, DEO, SSG, ASG and PAR: writing, review and editing.

  • Funding This research was funded by a grant from The Lung Association - Ontario Grant Review/Grant-In-Aid.

  • Disclaimer 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. The analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI. 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.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.