Abstract
BackgroundCannabis has been rapidly legalized in North America; however, limited evidence exists around its side effects. Health Canada defines side effect as a harmful and unintended response to a health product. Given drug safety concerns, this study’s purpose was to review the unintended side effects of cannabis in otolaryngology.MethodsThe Preferred Reporting Items For Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases. (PROSPERO: CRD42020153022). English studies in adults were included from inception to the end of 2019. In-vitro, animal, and studies with n < 5 were excluded. Primary outcome was defined as unintended side effects (defined as any Otolaryngology symptom or diagnosis) following cannabis use. Oxford Centre for Evidence-Based Medicine: Levels of Evidence and risk of bias using the Risk of Bias in randomized trials (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tools were assessed.. Two authors independently reviewed all studies; the senior author settled any discrepancies.ResultsFive hundred and twenty-one studies were screened; 48 studies were analysed. Subspecialties comprised: Head and Neck (32), Otology (8), Rhinology (5), Airway (5), Laryngology (1). Cannabis use was associated with unintended tinnitus, vertigo, hearing loss, infection, malignancy, sinusitis, allergic rhinitis, thyroid dysfunction, and dyspnea. About half (54.1%) of studies showed increased side effects, or no change in symptoms following cannabis use. Oxford Levels of Evidence was 2–4 with substantial heterogeneity. Risk of bias assessment with RoB2 was low to high and ROBINS-1 was moderate to critical.ConclusionThis was the first comprehensive scoping review of unintended side effects of cannabis in Otolaryngology. The current literature is limited and lacks high-quality research Future randomized studies are needed to focus on therapeutic effects of cannabis in otolaryngology. Substantial work remains to guide clinicians to suggest safe, evidence-based choices for cannabis use.Graphic abstract
Highlights
Cannabis is one of the most commonly used drugs in North America
The study was limited to the adult population because most jurisdictions require a legal age limit to consume cannabis. This scoping review was undertaken to better understand the safety profile of cannabis and its potential for unintended side effects related to Otolaryngology
This review indicated that cannabis use is associated with several side effects, including hearing loss, head and neck (H&N) malignancy, and human papilloma virus (HPV) infection
Summary
Cannabis is one of the most commonly used drugs in North America. Nearly half of the American population has used cannabis at least once in their lifetime, Phulka et al J of Otolaryngol - Head & Neck Surg (2021) 50:56Cannabis is derived from a flowering plant. Cannabis is one of the most commonly used drugs in North America. There are three main forms of cannabis, based on the part of the plant that the drug is produced from: marijuana, hashih, and hash oil [3]. Marijuana is the least potent form and manufactured from the dried flowers and leaves. Hashish is manufactured from the resin or secreted gum of the plant. Hash oil is the most potent and manufactured from the thick oil obtained from hashish [4]. There are three routes of delivery of this drug: oral, dermal, and inhaled. Cannabis has been rapidly legalized in North America; limited evidence exists around its side effects. This study’s purpose was to review the unintended side effects of cannabis in otolaryngology
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