Cardiovascular Risk Associated with Medical Use of Opioids and Cannabinoids: A Systematic Review
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CARDIOVASCULAR RISK HEALTH POLICY (W. ROSAMOND, SECTION EDITOR)
Cardiovascular Risk Associated with Medical Use of Opioids and Cannabinoids: A Systematic Review Eugenia Wong 1 & Shabbar I. Ranapurwala 1,2 Published online: 30 August 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose of Review The long-term use of opioid and cannabinoid medications to control chronic pain and treat opioid use disorders now involves a large proportion of the population in the United States. Yet, the cardiovascular risks of opioids are not well understood. This systematic review summarizes the current literature to assess the potential cardiovascular disease risks associated with opioid and cannabinoid medications. Recent Findings The role of long-term methadone use in increasing QT interval among people receiving methadone treatment for substance use disorders is well established. Routine electrocardiogram screenings among patients receiving methadone treatment may be helpful in early identification and prevention of ventricular arrhythmias. There is limited, but credible evidence of increased risk for myocardial infarction among patients using opioid medications for chronic pain, and equivocal evidence that opioids may lead to hypotension in the short term. Further, there is no evidence indicating that opioid pain medications increase the risk of stroke or pulmonary embolism. However, the majority of the reviewed studies include limited internal and external validity due to poor confounding control, exposure misclassification, confounding by indication, small sample size, and nongeneralizable special populations. We also did not find any human studies evaluating the cardiovascular effects of cannabinoids. Summary While the effects of methadone on cardiac conduction are well known and interventions at the healthcare practice level may help prevent potential harm, more good quality research is needed to better understand cardiovascular risk associated with the use of opioids and cannabinoids. Keywords Opioids . Cannabinoids . Cardiovascular . QT interval . Myocardial infarction . Torsades de pointes
Background The active ingredient of opium, morphine, was first isolated more than 200 years ago, and not long afterwards, its utility for minor anesthesia and the treatment of chronic pain came to be recognized [1]. Compounded by a common belief that pain This article is part of the Topical Collection on Cardiovascular Risk Health Policy * Shabbar I. Ranapurwala [email protected] Eugenia Wong [email protected] 1
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 137 E Franklin St, Suite 4240-A, Chapel Hill, NC 27516, USA
2
Injury Prevention Research Center, University of North Carolina at Chapel Hill, 137 E Franklin St, Suite 500, CB# 7505, Chapel Hill, NC 27599, USA
in the United States was not being managed appropriately [2], the development of partially and fully synthetic opiates led to an increase in opioid pain reliever pr
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