Cannabis-positive spine surgery patients used more opioids postoperatively | Research

The takeaway

Spine surgery patients who tested positive for THC preoperatively showed higher 90-day opioid consumption than THC-negative patients, with the strongest effect in those who also used other drugs.

People interested in cannabis use and postoperative pain management.

Higher 90-day opioid use in THC-positive spine surgery patients

What the researchers found

THC-positive and multi-drug-positive patients showed higher 90-day morphine milligram equivalents (MMEs) compared to THC-negative controls. Emergency department visits and readmission rates at 90 days were not statistically significantly different between groups, though multi-drug patients trended toward more ED visits and readmissions.

Why it matters

As spine surgeons increasingly encounter patients who use cannabis, understanding its association with postoperative opioid needs helps inform pain management planning and patient counseling.

The numbers in context

252 THC-negative controls, 54 THC-only positive, 47 multi-drug positive. Both THC-positive groups showed higher 90-day MMEs than controls. 90-day ED visit and readmission rate differences were not statistically significant.

How the study worked

Retrospective chart review of 353 spine surgery patients divided into three groups based on preoperative urine drug screening: THC-negative (n=252), THC-positive only (n=54), and THC-plus-other-drugs positive (n=47). MMEs, 90-day ED visits, and readmission rates were compared.

What this study cannot tell us

Retrospective design with relatively small THC-positive groups. Cannot determine whether THC use itself caused higher opioid consumption or whether other confounding factors (chronic pain severity, tolerance) explain the difference. No information on cannabis use patterns or timing.

How to read the evidence

Small retrospective chart review with unequal group sizes and no control for confounders like baseline pain severity. The association is suggestive but not definitive.

When this study was published

Published in 2024 in the Journal of the AAOS Global Research & Reviews.

The bigger picture

This study adds to a mixed literature on whether cannabis use increases or decreases postoperative opioid needs. While some studies suggest cannabis reduces opioid use, this spine surgery data points in the opposite direction, highlighting that the relationship may depend on surgical context and patient population.

Questions still open

Does cannabis tolerance cross over to increase opioid requirements, or do cannabis users have underlying differences in pain severity? Would controlled perioperative cannabis use produce different results? Are there specific spine procedures where the effect is stronger?

Common questions

Does cannabis use increase opioid needs after surgery?

In this spine surgery study, patients who tested positive for THC used more opioids over 90 days. However, the study cannot determine whether cannabis use itself caused higher opioid needs or whether other factors were responsible.

Did cannabis users have more complications after surgery?

ED visits and readmission rates were not statistically significantly different, though multi-drug users showed a trend toward more visits. The main difference was in opioid consumption.

Read the original research

The Effect of Marijuana on Postoperative Spine Patients' Emergency Department Visits, Readmission Rates, and Opioid Consumption.

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 8(2)

View on PubMed ↗Publisher’s paper ↗

Citation

Buddle, Vincent Patrick; Lee, Maximillian; Feng, James; Khurana, Eric; Park, Ahyoung; Park, Daniel. (2024). The Effect of Marijuana on Postoperative Spine Patients' Emergency Department Visits, Readmission Rates, and Opioid Consumption.. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 8(2). https://doi.org/10.5435/JAAOSGlobal-D-23-00206