Opioid-naive cannabis users undergoing lumbar fusion used lower daily opioid doses but were nearly 5 times more likely to develop opioid use disorder.
Spine surgeons, pain management specialists, and addiction medicine physicians.
18.94% vs 3.96% OUDopioid use disorder rate in cannabis users vs. non-users after lumbar fusion, despite lower daily doses
What the researchers found
Cannabis users had similar rates of opioid prescription (49.78%) but lower daily doses (51.1 vs. 59.72 MME, p=0.003) at 6 months. However, OUD diagnosis was significantly higher (18.94% vs. 3.96%, p<0.0001).
Why it matters
This paradoxical finding — lower doses but higher addiction — suggests cannabis use may be a marker for addiction vulnerability rather than a protective factor against opioid overuse.
The numbers in context
87,958 records screened, 454 matched patients (227 per group). Opioid use rates equal (49.78%). Cannabis users: lower daily MME (51.1 vs. 59.72, p=0.003). OUD: 18.94% vs. 3.96% (p<0.0001).
How the study worked
Retrospective matched cohort study using an all-payer claims database (January 2010-October 2020) of single-level lumbar fusion patients.
Who was studied
454 matched opioid-naive patients undergoing single-level lumbar fusion (227 cannabis users, 227 non-users).
What this study cannot tell us
Claims data cannot capture cannabis use accurately. OUD diagnosis may reflect screening bias. Cannot determine causation. Cannabis use dose/frequency unknown.
How to read the evidence
Matched retrospective cohort from large claims database; robust finding but cannot establish causation.
When this study was published
Data spanning 2010-2020.
The bigger picture
This study complicates the narrative that cannabis can simply substitute for opioids. While cannabis users needed lower opioid doses, they were nearly 5 times more likely to develop addiction, suggesting underlying vulnerability.
Replication
Large claims-based study; prospective replication with cannabis use details needed.
Funding
Not specified in abstract
Conflicts of interest
Not specified in abstract
Questions still open
- Does cannabis use indicate pre-existing addiction vulnerability or does it directly increase opioid addiction risk?
- Should cannabis-using surgical patients receive enhanced addiction monitoring?
Read the original research
Postoperative Opioid Use Among Opioid-Naive Cannabis Users Following Single-Level Lumbar Fusions.
World neurosurgery, 175, e644-e652
Citation
Khalid, Syed I; Jiang, Sam; Khilwani, Harsh; Thomson, Kyle; Mirpuri, Pranav; Mehta, Ankit I. (2023). Postoperative Opioid Use Among Opioid-Naive Cannabis Users Following Single-Level Lumbar Fusions.. World neurosurgery, 175, e644-e652. https://doi.org/10.1016/j.wneu.2023.04.001