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

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.

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.

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 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.

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.