Cannabis Users Were Less Likely to Go Opioid-Free After Colorectal Surgery | Research

The takeaway

About half of colorectal surgery patients used no opioids after discharge, but cannabis users were significantly less likely to achieve opioid-free recovery.

Surgeons, anesthesiologists, cannabis users facing surgery, and pain management researchers.

Cannabis users had 91% lower odds of opioid-free recovery

What the researchers found

Among 344 colorectal surgery patients, 51% used no opioids after discharge. Cannabis use was one of the strongest predictors of NOT achieving opioid-free recovery (OR = 0.09, posterior effect probability = 96%). Other predictors of opioid-free recovery included older age and fewer prescribed opioid pills.

Why it matters

Finding that half of patients can go opioid-free after major abdominal surgery is encouraging for reducing opioid prescribing. However, the strong association between cannabis use and opioid consumption raises important questions about whether cannabis users have different pain experiences or pain management needs.

The numbers in context

344 participants. 51% used no opioids after discharge. Cannabis use OR for opioid-free: 0.09 (96% probability). 92% received opioid prescriptions at discharge. 92% received acetaminophen. Median hospital stay: 3 days.

How the study worked

Prospective cohort of 344 adults undergoing elective colorectal surgery at 2 academic hospitals. Self-reported analgesic consumption was assessed weekly for 1 month after discharge. Bayesian model averaging identified predictors.

What this study cannot tell us

Observational design cannot determine causation. Self-reported cannabis use and analgesic consumption. Cannabis use was a relatively small subgroup. The association may reflect underlying differences in pain tolerance or reporting rather than a direct cannabis effect.

How to read the evidence

Well-designed prospective cohort from 2 academic hospitals with weekly follow-up, but observational design limits causal inference.

When this study was published

2026 study.

The bigger picture

This finding is consistent with other research showing cannabis users report more postoperative pain and use more opioids. Whether this reflects cross-tolerance, different pain sensitivity, or confounding factors remains an important clinical question.

Questions still open

Does cannabis use increase pain sensitivity through tolerance-related mechanisms? Should perioperative pain management be modified for cannabis users?

Common questions

Do cannabis users need more opioids after surgery?

This study found cannabis users were significantly less likely to achieve opioid-free recovery after colorectal surgery. The reasons are not fully clear and may involve tolerance, pain sensitivity, or other factors.

Can you skip opioids after colorectal surgery?

About half of patients in this study used no opioids after discharge, suggesting opioid-free recovery is feasible for many. Older patients and those with higher confidence in self-managing care were more likely to succeed.

Read the original research

Rates and predictors of postdischarge opioid-free analgesia after elective colorectal surgery: A prospective cohort study.

Surgery, 192, 110044

View on PubMed ↗Publisher’s paper ↗

Citation

Pook, Makena; Olleik, Ghadeer; Lapointe-Gagner, Maxime; Jain, Shrieda; Fermi, Francesca; Shirzadi, Samin; Nguyen-Powanda, Philip; Al Ben Ali, Sarah; Ghezeljeh, Tahereh Najafi; Alali, Naser; Dmowski, Katy; Kaneva, Pepa; Feldman, Liane S; Boutros, Marylise; Lee, Lawrence; Fiore, Julio F. (2026). Rates and predictors of postdischarge opioid-free analgesia after elective colorectal surgery: A prospective cohort study.. Surgery, 192, 110044. https://doi.org/10.1016/j.surg.2025.110044