Cannabis Use Is Associated With Increased Use of Prescription Opioids Following Posterior Lumbar Spinal Fusion Surgery

Moon, Andrew S.; LeRoy, Taryn E.; Yacoubian, Vahe; Gedman, Marissa; Aidlen, Jessica P.; Rogerson, Ashley

doi:10.1177/21925682221099857

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…For example, there was no increased risk seen in hip arthroscopy patients 20 while lumbar spinal fusion patients had an increased risk. 21 The greatest risk factor our study found for prolonged opioid use was opioid familiarity before revision TSA. This finding was expected because there has been a plethora of research showcasing how preoperative opioid use increases a patient's risk postoperatively.…”

Section: Discussionmentioning

confidence: 77%

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Risk Factors Associated With Prolonged Opioid Use After Revision Total Shoulder Arthroplasty

Abed,

Khalily,

Landy

et al. 2023

JAAOS Glob Res Rev

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Introduction: The purpose of this study was to determine which preoperative factors are associated with prolonged opioid use after revision total shoulder arthroplasty (TSA). Methods: The M157Ortho PearlDiver database was used to identify patients undergoing revision TSA between 2010 and 2021. Opioid use for longer than 1 month after surgery was defined as prolonged opioid use. Postoperative opioid use from 1 to 3 months was independently assessed. Multivariable logistic regression was used to evaluate the association between preoperative patient-related risk factors (age, Charlson Comorbidity Index, sex, depression, anxiety, substance use disorder, opioid use between 12 months to 1 week of surgery, tobacco use, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, previous myocardial infarction, and chronic ischemic heart disease) with prolonged postoperative opioid use. Odds ratios (OR) and their associated 95% confidence intervals (CI) were calculated for each risk factor. Results: A total 14,887 patients (mean age = 67.1 years) were included. Most of the patients were female (53.3%), and a large proportion were opioid familiar (44.1%). Three months after revision TSA, older age (OR = 0.96, CI 0.96 to 0.97) and male sex (OR = 0.90, CI 0.81 to 0.99) were associated with a decreased risk of prolonged postoperative opioid usage. Patients with preexisting depression (OR = 1.21, CI 1.08 to 1.35), substance use disorder (OR = 1.47, CI 1.29 to 1.68), opioid use (OR = 16.25, CI 14.27 to 18.57), and chronic obstructive pulmonary disorder (OR = 1.24, CI 1.07 to 1.42) were at an increased risk of prolonged postoperative opioid use. Discussion: Older age and male sex were associated with a decreased risk of prolonged opioid use after revision TSA. Depression, substance use disorder, opioid familiarity, and COPD were associated with prolonged opioid use after revision TSA.

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Section: Discussionmentioning

confidence: 77%

“…For example, there was no increased risk seen in hip arthroscopy patients 20 while lumbar spinal fusion patients had an increased risk. 21…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated With Prolonged Opioid Use After Revision Total Shoulder Arthroplasty

Abed,

Khalily,

Landy

et al. 2023

JAAOS Glob Res Rev

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“…Assessing patients undergoing various orthopaedic surgeries, Liu et al found cannabis use is associated with higher postoperative pain scores both at rest and with movement when compared to nonusers, though postoperative opioid use was not assessed [ 22 ]. While there remains a dearth of evidence describing the associations between preoperative cannabis use and postoperative factors following spine surgery, in one of few studies comparable to our own, Moon et al similarly found cannabis use was associated with increased usage of opioids postoperatively following posterior lumbar spinal fusion surgery [ 23 ]. However, Moon et al did not also evaluate the association between cannabis use and postoperative outcomes.…”

Section: Discussionmentioning

confidence: 84%

“…ECS also results in increased release of dopamine and endocannabinoids, endogenous neuroactive messengers that influence reward and pain pathways [ 25 , 26 , 28 ]. One hypothesis described by Moon et al proposes that increased postoperative opioid use is associated with preoperative cannabis use due to cannabis users self-medicating for increased preoperative pain compared to nonusers [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Cannabis Use Associated With an Increased Rate of Reoperation and Postoperative Opioid Use Following Anterior Cervical Decompression and Fusion

Razzouk¹,

Chung²,

Lindsey³

et al. 2022

Cureus

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The objective of this retrospective cohort study was to evaluate the associations among preoperative cannabis use, postoperative opioid use, and postoperative outcomes following elective anterior cervical decompression and fusion (ACDF). MethodsPatients who underwent one-or two-level ACDF were characterized preoperatively as active cannabis users, former users, or nonusers. Patients were also classified based on history of preoperative opioid use as chronic users, acute users, or nonusers. Groups were compared based on outcomes including the rate of emergency department visits six months postoperatively, rate of readmissions one year postoperatively, rate of reoperation two years postoperatively, and daily postoperative opioid use measured in milligram morphine equivalents (MMEs) at 0-6 months and 6-12 months postoperatively. ResultsOf the 198 patients included in this study, 13 (6.6%) were active cannabis users, 11 (5.6%) were former users, and 174 (87.8%) were nonusers. The rate of reoperation within two years was 23.1% for active cannabis users, 0% for former users, and 4.0% for nonusers (p=0.0075). The average daily opioid use in MMEs 6-12 months postoperatively was 49.4 for active cannabis users, 4.1 for former users, and 13.3 for nonusers (p=0.0014). For chronic opioid users, acute users, and nonusers, the average daily opioid use in MMEs 6-12 months postoperatively was 39.9, 18.4, and 5.7, respectively (p<.0001). ConclusionsHistory of cannabis use is associated with increased postoperative opioid use and increased rate of reoperation following elective ACDF.

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“…31 A similar pattern was observed In Boston. 32 Among college students, marijuana users were 12 times more likely to use opioids than non-users and higher levels of marijuana use was associated with greater likelihood of using opioids. 33 Among Maryland students followed for 12 years after elementary school, marijuana at age 14 was associated with more frequent use of opioids at age 19.…”

Section: Evidence For Biologic Mechanism Of Marijuana Legalization In...mentioning

confidence: 99%

United States Marijuana Legalization and Opioid Mortality Trends Before and During the First Year of the COVID-19 Pandemic

Bleyer,

Barnes,

Finn

2023

Preprint

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To determine if marijuana legalization reduced opioid mortality, the U.S. opioid and fentanyl subset death trends during the 2010-2019 decade were compared in states and District of Columbia (D.C.) (jurisdictions) that had implemented marijuana legalization with states that had not. Acceleration of opioid mortality during 2020, first year of the COVID-19 pandemic, was also compared in recreational and medicinal-only legalizing jurisdictions. Joinpoint methodology was applied to Centers for Disease Control and Prevention WONDER data. Trends in legalizing jurisdictions were cumulative aggregates. The overall opioid and fentanyl death rates and percentage of opioid deaths due to fentanyl increased more during 2010-2019 in jurisdictions that legalized marijuana than in those that did not (pairwise comparison p = 0.007, 0.05, and 0.006, respectively). By 2019, the opioid and fentanyl death rates were 44% and 50% greater in the legalizing than non-legalizing jurisdictions, respectively. When the COVID-19 pandemic hit in 2020, jurisdictions that implemented recreational marijuana legalization before 2019 had significantly greater increases in both overall opioid and fentanyl death rates than jurisdictions with medicinal-only legalization. For all opioids, the mean (95% confidence interval [CI]) 2019-to-2020 increases were 46.5% (95% CI, 36.6% to 56.3%) and 29.1% (95% CI 20.2% to 37.9%), respectively (p = 0.02). For fentanyl, they were 115.6% (95% CI, 80.2% to 151.6%) and 55.4% (95% CI, 31.6% to 79.2%), respectively (p = 0.01). Marijuana legalization is correlated with worsening of the U.S. opioid epidemic, and especially during the COVID-19 pandemic with recreational legalization.

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Cannabis Use Is Associated With Increased Use of Prescription Opioids Following Posterior Lumbar Spinal Fusion Surgery

Cited by 21 publications

References 28 publications

Risk Factors Associated With Prolonged Opioid Use After Revision Total Shoulder Arthroplasty

Risk Factors Associated With Prolonged Opioid Use After Revision Total Shoulder Arthroplasty

Preoperative Cannabis Use Associated With an Increased Rate of Reoperation and Postoperative Opioid Use Following Anterior Cervical Decompression and Fusion

United States Marijuana Legalization and Opioid Mortality Trends Before and During the First Year of the COVID-19 Pandemic

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