Opioid-naive cannabis users consumed significantly more prescription opioids after posterior lumbar spinal fusion surgery than non-users, despite having fewer comorbidities.
Spine surgeons, pain management specialists, anesthesiologists, and patients who use cannabis and face upcoming surgery.
What the researchers found
Among 220 opioid-naive patients, 29 cannabis users consumed significantly more postoperative prescription opioids (2,545 vs 1,380 morphine equivalent doses, p=.019) than 191 non-users. Cannabis users were younger (56 vs 65, p<.001), had more depression (31% vs 14%, p=.017), and lower comorbidity (1.38 vs 2.49, p=.002).
Why it matters
Cannabis is often promoted as an opioid alternative for pain, but this study found the opposite in surgical patients: cannabis users needed more opioids postoperatively.
The numbers in context
220 opioid-naive patients. 29 (13%) cannabis users. Post-discharge opioids: 2,545 vs 1,380 morphine equivalent doses (p=.019). Cannabis users younger (56 vs 65), more depression (31% vs 14%), lower comorbidity (1.38 vs 2.49).
How the study worked
Retrospective review of 220 opioid-naive patients who underwent one- or two-level posterior lumbar fusion surgery, categorized by preoperative cannabis use diagnosis.
What this study cannot tell us
Small cannabis user group (n=29). Retrospective design. Cannabis use identified by diagnosis codes, not objective testing. Single surgical procedure type.
How to read the evidence
Retrospective cohort from a single center with small cannabis user group, but the magnitude of the opioid difference is clinically meaningful.
When this study was published
2024 publication.
The bigger picture
Cross-tolerance between cannabinoid and opioid systems may explain why regular cannabis use raises rather than lowers postoperative opioid requirements.
Questions still open
- Does preoperative cannabis cessation normalize opioid requirements after surgery?
- Is the increased opioid need due to pharmacological cross-tolerance or differences in pain perception?
Common questions
Does cannabis reduce the need for opioids after surgery?
Why would cannabis users need more opioids?
Read the original research
Cannabis Use Is Associated With Increased Use of Prescription Opioids Following Posterior Lumbar Spinal Fusion Surgery.
Global spine journal, 14(1), 204-210
Citation
Moon, Andrew S; LeRoy, Taryn E; Yacoubian, Vahe; Gedman, Marissa; Aidlen, Jessica P; Rogerson, Ashley. (2024). Cannabis Use Is Associated With Increased Use of Prescription Opioids Following Posterior Lumbar Spinal Fusion Surgery.. Global spine journal, 14(1), 204-210. https://doi.org/10.1177/21925682221099857
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