Cannabis Use Common in Post-Surgery Patients on Opioid Tapering

FORT LAUDERDALE, Fla. — Half of surgical patients in a program aiming to taper post-operative opioid use said they had taken some form of cannabis in the past, either for recreation or to reduce surgery pain, a single-center study found.

Of the 165 patients included in the retrospective study, 26% reported use of a cannabis product in the past month, and 25% reported cannabis use outside that 30-day window, according to data presented by Meher Kalkat, BS, a medical student at Johns Hopkins University School of Medicine in Baltimore, at the American Academy of Pain Medicine annual meeting.

“Patients who reported cannabis use were more likely to be younger and were more likely to be unemployed or were on disability,” said Kalkat during her oral poster presentation.

In addition, “patients who reported using cannabis in the past 30 days had higher pain severity at initial visit than patients who had used cannabis, but not within the past 30 days,” she said. “Aside from that, we didn’t find differences in the length of pain treatment, in the number of clinic visits, in their overall pain severity, or in their opioid use at their final visit.”

Kalkat added that there was no difference in use of cannabis products across types of surgery as well.

Despite mixed evidence for pain management, “we know individuals are still using cannabis products for this purpose,” said Kalkat. While data on the use of cannabis in post-surgery patients are limited, but previous research from the group suggested that a third use some form of cannabis product.

The researchers sought to investigate the types of cannabis-based products patients were using, how they were using them, and with what frequently they were using them.

For their study, the team accessed information from the Personalized Pain Program at Johns Hopkins, which provides coordinated multidisciplinary pain management in an attempt to reduce pain as well as to facilitate opioid tapering after surgery. The study included patients seen at the clinic from March 2020 to December 2021.

“The program includes acute and chronic pain specialists as well as anesthesiologists and surgeons at Johns Hopkins, and they work with patients preoperatively and postoperatively to decrease pain and taper opioids,” Kalkat said.

Demographics, pain intensity, and cannabis use were recorded at pain clinic visits. If a patient reported using cannabis products at any visit, they were included in the “past 30 days” group.

Median age of the participants in the study was 48 years, and about half were either unemployed or disabled. About 46% of patients who reported a history of cannabis use said they used the products for both medical and recreational purposes, 28% said they used the products solely for recreational purposes, and 14% reported that they used the products just for medical reasons.

About 42% of the individuals who used cannabis products reported using marijuana, 20% said they used cannabis oils, and 17% reported using edible products, according to Kalkat.

Roughly one-third of cannabis users said they were unsure of the tetrahydrocannabinol (THC) ratio (an indicator of the marijuana effect on the body) for the products they used, while about 40% said they believed their products had a balanced ratio.

The researchers plan to perform further analyses by expanding the research out to other pain clinics, she said.

Kalkat noted that the study has limitations — cannabis usage was self-reported, which has inherent biases; the sample size was small; and it was conducted at one institution in one pain clinic.

In the brief question period, the audience asked how local laws regarding cannabis may have affected the study, and Kalkat said Maryland law has recently allowed for recreational use, but dispensaries for non-medical use are just being established; medical use cannabis dispensaries are open in the state.

In response to another question, Kalkat and other members of the research team said that the COVID-19 pandemic did not appear to influence the treatment pattern, which was supplemented through telemedicine visits.