Cannabis-using IBD patients received more opioids during hospitalization

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.

Dalal, Rahul S et al.·Inflammatory bowel diseases·2021·Moderate EvidenceRetrospective Cohort
RTHC-03083Retrospective CohortModerate Evidence2021RETHINKTHC RESEARCH DATABASErethinkthc.com/research

Quick Facts

Study Type
Retrospective Cohort
Evidence
Moderate Evidence
Sample
N=423

What This Study 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.

Key Numbers

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 They Did This

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.

Why This Research 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 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.

What This Study Doesn't 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.

Questions This Raises

  • ?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?

Trust & Context

Key Stat:
12.1 additional IV morphine mg equivalents/day associated with cannabis use
Evidence Grade:
Retrospective cohort with appropriate statistical controls, but single-center design and binary cannabis use measurement limit conclusions.
Study Age:
Published in 2021 using 2017-2018 hospital data.
Original Title:
Preadmission Cannabis Use Is Positively Correlated With Inpatient Opioid Dose Exposure in Hospitalized Patients With Inflammatory Bowel Diseases.
Published In:
Inflammatory bowel diseases, 27(4), 500-506 (2021)
Database ID:
RTHC-03083

Evidence Hierarchy

Meta-Analysis / Systematic Review
Randomized Controlled Trial
Cohort / Case-ControlFollows or compares groups over time
This study
Cross-Sectional / Observational
Case Report / Animal Study

Looks back at existing records to find patterns.

What do these levels mean? →

Frequently Asked 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 More on RethinkTHC

Cite This Study

RTHC-03083·https://rethinkthc.com/research/RTHC-03083

APA

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

MLA

Dalal, Rahul S, et al. "Preadmission Cannabis Use Is Positively Correlated With Inpatient Opioid Dose Exposure in Hospitalized Patients With Inflammatory Bowel Diseases.." Inflammatory bowel diseases, 2021. https://doi.org/10.1093/ibd/izaa104

RethinkTHC

RethinkTHC Research Database. "Preadmission Cannabis Use Is Positively Correlated With Inpa..." RTHC-03083. Retrieved from https://rethinkthc.com/research/dalal-2021-preadmission-cannabis-use-is

Access the Original Study

Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.

This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.