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Vigano A, Moride Y, Hachem Y, Canac-Marquis M, Gamaoun R, Kalaba M, Martel MO, Perez J, Néron A, Beaulieu P, Desroches J, Ware M. The Quebec Cannabis Registry: Investigating the Safety and Effectiveness of Medical Cannabis. Cannabis Cannabinoid Res 2023; 8:1106-1116. [PMID: 36579921 PMCID: PMC10714117 DOI: 10.1089/can.2022.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: To investigate the safety and effectiveness of medical cannabis (MC) in the real-world clinical practice setting. Design: A 4-year prospective noncomparative registry of adult patients who initiated MC for a variety of indications. This paper reports on patients followed for up to 12 months, with interim visits at 3, 6, and 9 months after enrollment. Setting: Public or private outpatient clinics certified to authorize MC in the province of Quebec, Canada. Participants: Overall, 2991 adult (age ≥18 years) patients (mean age 51 years; 50.2% women) were enrolled between May 2015 and October 2018, with the last follow-up ending in May 2019. Interventions/Exposures: Cannabis products (dried, oil, or other) purchased from a Canadian licensed cannabis producer as authorized by physicians. Main Outcome Measures: The primary outcomes were self-reported pain severity, interference and relief (Brief Pain Inventory [BPI]), symptoms using the Revised Edmonton Symptom Assessment System (ESAS-r) and health-related quality of life dimensions (EQ-5D-5L) at baseline and each follow-up visit. The secondary outcomes were self-reported adverse events (AEs) and characteristics of cannabis treatment. Results: All patient-reported outcomes (BPI, ESAS-r, and EQ-5D-5L) showed a statistically significant improvement at 3 months (all p<0.01), which was maintained or further improved (for pain interference, tiredness, and well-being) over the remainder of the 12-month follow-up. Results also revealed clinically significant improvements in pain interference and tiredness, anxiety, and well-being from baseline. There were 79 AE reports (77 patients), 16 met the regulatory definition of seriousness, in which only 8 AEs were certainly or probably related to MC. Conclusions: MC directed by physicians appears to be safe and effective within 3 months of initiation for a variety of medical indications.
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Affiliation(s)
- Antonio Vigano
- Medical Cannabis Program in Oncology, Cedars Cancer Center, McGill University Health Centre, Montreal, Canada
| | - Yola Moride
- Faculty of Pharmacy, University of Montreal, Montreal, Canada
- Rutgers The State University of New Jersey, Center for Pharmacoepidemiology and Treatment Science, New Brunswick, New Jersey, USA
| | - Yasmina Hachem
- Medical Cannabis Program in Oncology, Cedars Cancer Center, McGill University Health Centre, Montreal, Canada
| | | | - Rihab Gamaoun
- Medical Cannabis Program in Oncology, Cedars Cancer Center, McGill University Health Centre, Montreal, Canada
| | - Maja Kalaba
- Canopy Growth Corporation, Smiths Falls, Canada
| | - Marc O. Martel
- Faculty of Dentistry & Department of Anesthesia, McGill University, Montreal, Canada
| | - Jordi Perez
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Canada
| | - Andrée Néron
- McGill University Health Centre, Montreal, Canada
| | - Pierre Beaulieu
- Department of Anesthesiology & Pain Medicine, Université de Montréal Faculté de Medecine, Montreal, Canada
| | - Julie Desroches
- Département de Pharmacologie, Université de Montréal, Montreal, Canada
| | - Mark Ware
- Department of Family Medicine, McGil University, Montreal, Canada
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Lavallée M, da Silveira CG, Akinola S, Méthot J, Piché ME, Bérard A, Thibault M, Gonella JM, Gimenes FRE, Leclerc J. Reporting Rates of Opioid-Related Adverse Events Since 1965 in Canada: A Descriptive Retrospective Study. Drugs Real World Outcomes 2021; 9:153-163. [PMID: 34529224 PMCID: PMC8844319 DOI: 10.1007/s40801-021-00275-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background Patients with chronic or acute/postoperative pain frequently use opioids. However, opioids may cause considerable adverse reactions (ARs), such as respiratory depression, which could be lethal. Unfortunately, only 5% of drug-related ARs (including those to opioids) are reported to health authorities. Therefore, little is known regarding the occurrence of opioid-related ARs at the population level. Objective The aim of this study was to investigate how the rates of reported opioid-related ARs have changed in Canada since 1965. Methods Our retrospective study examined trends of reported opioid-related ARs occurring in hospitalized and outpatients. Data on opioid-related ARs and mortality between 1965 and 2019 were obtained from the Canada Vigilance and Statistics Canada databases. Descriptive and Joinpoint regression analyses were performed. Results Oxycodone and normethadone were the most and least involved opioid agents, respectively, among the 18,407 reported ARs. The highest rate of reported opioid ARs (3.8 per 100,000 person-years) was recorded in 2012, whereas the lowest was recorded in 1965 (0.1 per 100,000 person-years). Between 1965 and 2019, annual rates climbed by 4.2% (95% confidence interval [CI] 3.1–5.2), and many fluctuations were observed: 1965–1974: +22.3% (95% CI 12.0–33.6); 1974–2000: − 4.1% (95% CI − 5.3 to − 2.9); 2000–2008: +30.3% (95% CI 22.6–38.4); 2008–2014: +4.1% (95% CI − 1.5 to 10.1); 2014–2017: −26.0% (95% CI − 44.7 to − 0.9); and, finally, 2017–2019: +35.4% (95% CI 3.8–76.7). Conclusion Reported opioid-related ARs have increased since 1965, although fluctuations were observed in recent decades. The absolute number of opioid-related ARs might be seriously underestimated. Future studies should look into how to close this gap. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00275-2.
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Affiliation(s)
- Maude Lavallée
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | | | - Samuel Akinola
- Department of Nursing, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Julie Méthot
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Canada.,Faculty of Pharmacy, Université Laval, Quebec City, Canada
| | - Marie-Eve Piché
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Anick Bérard
- Centre de recherche du Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Magalie Thibault
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | | | | | - Jacinthe Leclerc
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada. .,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Canada. .,Faculty of Pharmacy, Université Laval, Quebec City, Canada.
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