一些人主张使用大麻龙而不是阿片类药物来治疗慢性非癌性疼痛，因为前一种药物可能具有更好的安全性。我们就多个临床重要结果比较了大麻龙使用事件与阿片类药物事件使用的安全性。基于人群的回顾性队列研究。加拿大安大略省。12 岁及以上，在索引日期之前的过去 3 年内被诊断患有肌肉骨骼疾病的人。大麻龙使用事件，阿片类药物使用事件作为参考组.在索引日期后的3个月内，我们分别评估了肺炎、机动车事故、跌倒或骨折、精神活性物质使用导致的精神和行为障碍以及全因死亡率。总共对18,863名大麻龙使用者进行了倾向评分匹配相同数量的阿片类药物使用者。在总体匹配分析中，大麻龙使用者与阿片类药物使用者相比，肺炎（风险比 [HR] 0.78，95% CI 0.63-0.96）、跌倒或骨折（HR 0.56，95% CI 0.50-0.64）的发生率显着降低和全因死亡率（HR 0.79，95% CI 0.65-0.95），但精神或行为障碍的发生率显着较高（HR 2.23，95% CI 1.45-3.43）。就机动车辆事故率而言，各组之间没有显着差异。未测量的混杂因素可能会影响结果。虽然相对于阿片类药物，大麻龙的使用可降低肺炎、跌倒或骨折以及全因死亡率的发生率，但同时与不良心理健康结果发生率增加相关。这种混合安全结果的情况引起了人们对用大麻隆广泛替代阿片类药物的政策方法的担忧。安大略省卫生部。© 2024。作者，获得普通内科医学会的独家许可。

Some have advocated that nabilone be used rather than opioids to manage chronic, noncancer pain, since the former drug may have a better safety profile.We compared the safety of incident nabilone use relative to incident opioid use with respect to multiple clinically important outcomes.A population-based, retrospective cohort study.Province of Ontario, Canada.Persons aged 12 years and older, diagnosed with a musculoskeletal condition within the past 3 years prior to the index date.Incident nabilone use, with incident opioid use serving as the reference group.Within 3 months following the index date, we separately evaluated for pneumonia, motor vehicle accidents, falls or fractures, mental and behavioral disorder due to psychoactive substance use, and all-cause mortality.A total of 18,863 incident nabilone users were propensity score matched to an equal number of opioid users. In the overall matched analysis, incident nabilone users vs. incident opioid users had significantly lower rates of pneumonia (hazard ratio [HR] 0.78, 95% CI 0.63-0.96), falls or fractures (HR 0.56, 95% CI 0.50-0.64), and all-cause mortality (HR 0.79, 95% CI 0.65-0.95), but significantly higher rate of mental or behavioral disorder (HR 2.23, 95% CI 1.45-3.43). There was no significant difference between groups with respect to rate of motor vehicle accidents.Unmeasured confounding may have influenced results.While usage of nabilone relative to opioids was associated with reduced rates of pneumonia, falls or fractures, and all-cause mortality, it was simultaneously associated with an increased rate of adverse mental health outcomes. This picture of mixed safety results raises concerns with the policy approach of broadly substituting use of opioids with nabilone.Ontario Ministry of Health.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.