367 Postoperative Opioid Use Among Cannabis Users Following One-, Two-, and Three-Level Lumbar Fusions

Abstract

INTRODUCTION: Opioids are critical for pain management following spine surgery. Given the devastating consequences of the opioid epidemic, strategies to minimize dosing and chronic use of opioids should be developed. METHODS: This retrospective study used medical coding to identify patients who had undergone 1-3 level lumbar fusions between January 2010 and October 2020. Propensity score matching based on demographics and comorbidities created two equal cohorts concerning cannabis use history. Opioid utilization rates (morphine milligram equivalents/day) and overuse rates six months after the index procedure were assessed. RESULTS: 1,216 patients were matched and distributed equally into cannabis and non-cannabis user cohorts. Lower rates of opioid utilization were found among cannabis users versus control as early as two months after fusion (47.7% versus 41.1%, p < 0.05), a relationship which persisted at six months as well (46.2% versus 37.7%, p < 0.01). Lower rates of high-dose opioid utilization (=100 MME per day) were also found in the cannabis user cohort during the initial period of 14-30 days following surgery (6.91% versus 3.79%, p < 0.05). This relationship also approached significance 121-150 days after surgery (3.13% versus 1.32%, p = 0.051). CONCLUSIONS: In this study, patients with a history of cannabis use were less likely to use opioids as early as two months postoperatively. They had lower rates of high-dose opioid utilization in the immediate postoperative period. While this study cannot say whether cannabis is a beneficial adjunctive therapy for pain, clearly physicians should be aware of their patients’ cannabis use patterns to provide appropriate dose titration over time.