Cannabis-using IBD patients received more opioids during hospitalization | Research

The takeaway

Among 423 hospitalized inflammatory bowel disease patients, preadmission cannabis use was associated with higher inpatient opioid exposure even after controlling for disease severity and prior opioid use.

Gastroenterologists, pain management specialists, IBD patients who use cannabis

12.1 additional IV morphine mg equivalents/day associated with cannabis use

What the researchers found

Preadmission cannabis use was significantly correlated with higher inpatient opioid exposure (coefficient = 12.1 IV morphine mg equivalents/day; 95% CI: 2.6-21.5) after adjusting for IBD severity, pain scores, and preadmission opioid use.

Why it matters

Opioid use in IBD patients is associated with excess mortality, and inpatient opioid exposure predicts post-discharge opioid use. If cannabis-using patients receive more opioids during hospitalization, it raises questions about pain management strategies for this population.

The numbers in context

423 IBD patients studied; cannabis use coefficient = 12.1 IV morphine mg equivalents/day (95% CI: 2.6-21.5); first pain score coefficient = 1.3 (95% CI: 0.6-2.0); preadmission opioid use coefficient = 22.3 (95% CI: 17.0-27.6)

How the study worked

Retrospective cohort study of 423 adults hospitalized for IBD at a large academic health system from March 2017 to April 2018. Opioid exposure was calculated as total IV morphine milligram equivalents divided by length of stay. Multivariable linear regression adjusted for confounders including disease severity and preadmission opioid use.

What this study cannot tell us

Retrospective design from a single institution. Cannabis use was self-reported and binary (yes/no) without dosage or frequency details. Cannot determine causation. Patients lacked cannabis access during hospitalization, which may have affected pain management needs.

How to read the evidence

Retrospective cohort with appropriate statistical controls, but single-center design and binary cannabis use measurement limit conclusions.

When this study was published

Published in 2021 using 2017-2018 hospital data.

The bigger picture

This finding complicates the narrative that cannabis can serve as an opioid substitute. In this hospital setting where patients lacked access to cannabis, those who used it before admission ended up receiving more opioids, not fewer.

Questions still open

Would providing cannabis access during hospitalization reduce opioid requirements? Does regular cannabis use alter pain perception or tolerance in ways that increase opioid needs when cannabis is unavailable?

Common questions

Did cannabis use cause higher opioid needs?

The study found an association, not causation. Cannabis-using patients may have had higher pain levels, different pain thresholds, or withdrawal effects from losing cannabis access during hospitalization.

How strong was the cannabis effect compared to prior opioid use?

Preadmission opioid use had a stronger association (coefficient = 22.3) than cannabis use (coefficient = 12.1), but both were independently significant predictors of inpatient opioid exposure.

Read the original research

Preadmission Cannabis Use Is Positively Correlated With Inpatient Opioid Dose Exposure in Hospitalized Patients With Inflammatory Bowel Diseases.

Inflammatory bowel diseases, 27(4), 500-506

View on PubMed ↗Publisher’s paper ↗

Citation

Dalal, Rahul S; Palchaudhuri, Sonali; Snider, Christopher K; Lewis, James D; Mehta, Shivan J; Lichtenstein, Gary R. (2021). Preadmission Cannabis Use Is Positively Correlated With Inpatient Opioid Dose Exposure in Hospitalized Patients With Inflammatory Bowel Diseases.. Inflammatory bowel diseases, 27(4), 500-506. https://doi.org/10.1093/ibd/izaa104