Trauma patients who tested positive for THC used more than twice the opioids during hospitalization

What the researchers found

THC-positive trauma patients had significantly higher median opioid use during hospitalization (155 MME vs. 62 MME, p<0.0001), including in the ED, floor, and ICU. The THC group also had higher injury severity scores, were more likely to have other substances present, and were more likely to receive an opioid prescription at discharge and require mechanical ventilation.

Why it matters

Understanding the relationship between cannabis use and opioid needs in trauma patients can help clinicians plan pain management. The finding of higher opioid use in THC-positive patients challenges narratives that cannabis reduces opioid consumption.

The numbers in context

750 patients total. 160 (21%) THC-positive. Median opioid use: 155 MME (THC+) vs. 62 MME (THC-), p<0.0001. THC group: higher ISS (10 vs. 9), higher AIS (3 vs. 2). 64.6% male overall. Median age: 56 years.

How the study worked

Retrospective cohort study at a level 1 trauma center (October 2017-December 2019). 750 adult trauma patients with urine drug screens within 48 hours of arrival were included. Patients were grouped by THC status (160 positive, 590 negative). Multivariable regression analyzed opioid utilization.

What this study cannot tell us

THC-positive patients had higher injury severity, which alone could explain higher opioid use. Co-occurring substance use was more common in the THC group, confounding the analysis. Urine drug screening detects recent use but not active intoxication. Retrospective design.

How to read the evidence

Retrospective cohort from a single trauma center with good sample size. Confounded by higher injury severity and polysubstance use in the THC group, limiting ability to attribute opioid differences to cannabis alone.

When this study was published

Published in 2024 with data from 2017-2019.

The bigger picture

The cannabis-opioid relationship is debated. Population-level studies suggest cannabis access may reduce opioid prescribing, but this patient-level trauma data shows the opposite pattern. The contradiction may reflect different mechanisms at play in acute trauma versus chronic pain management.

Questions still open

• Is the higher opioid use driven by greater injury severity, cross-tolerance, or other factors? Would actively prescribed medical cannabis during trauma hospitalization change the opioid use pattern? Are THC-positive trauma patients at higher risk for post-discharge opioid dependence?

Common questions

Read the original research

Evaluation of pre-hospital cannabis exposure and hospital opioid utilization in a trauma population: A retrospective cohort.

Injury, 55(5), 111305

Citation

Chang, Alexander J; Mallat, Ali F; Edwards, Marc J; Gabra, Joseph N; Cucci, Michaelia D. (2024). Evaluation of pre-hospital cannabis exposure and hospital opioid utilization in a trauma population: A retrospective cohort.. Injury, 55(5), 111305. https://doi.org/10.1016/j.injury.2023.111305

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