Cannabis-positive spine surgery patients used more opioids postoperatively

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.

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.

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

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.

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.