Cannabis Use Linked to Increased Opioid Consumption After Lumbar Fusion

Patients undergoing lumbar spinal fusion surgery who were cannabis users consumed more opioids both prior to and after hospital discharge.

Following posterior lumbar spinal fusion surgery, patients who were cannabis users consumed more opioids both prior to and after hospital discharge. These findings were published in the Global Spine Journal.

Patients (N=301) who underwent 1- or 2-level posterior lumbar interbody fusion surgery at Tufts Medical Center, Boston, MA between 2016 and 2020 were retrospectively reviewed for this study. Postoperative opioid consumption was evaluated on the basis of self-reported cannabis use.

Patients who reported cannabis use (n=42) or no use (n=259) were 62.0% and 50.2% men, aged mean 56.43±12.17 and 64.86±11.45 years (P <.001), Charlson comorbidity index was 1.40±1.35 and 2.52±1.82 (P <.001), and 33.3% and 16.7% had depression (P =.010), respectively.

Similar trends were observed among the subset of patients who were opioid naïve, in which cannabis users (n=29) were younger, more had depression, and had fewer comorbidities than opioid-naive noncannabis users (n=191).

No significant differences in operating time, estimated blood loss, length of hospital stay, receipt of rehabilitation, or 30-day hospital readmission rate were observed on the basis of cannabis use.

The cannabis users tended to have higher in-house morphine equivalent dose (MED; mean, 266.43 vs 223.75; P =.081) and postdischarge MED (mean, 2358.97 vs 13.84.05; P =.085) with significantly higher in-house MED per day (mean, 102.09 vs 84.57; P =.034) compared with noncannabis users, respectively.

Among the subset of opioid-naïve patients, the cannabis users tended to have higher in-house MED (mean, 244.42 vs 167.94; P =.053) and in-house MED per day (mean, 88.28 vs 73.98; P =.080) with significantly higher postdischarge MED (mean, 2545.41 vs 1379.72; P =.019).

This study may have been limited by combining different surgical techniques and different surgeons. Furthermore, postdischarge opioid consumption was based on prescription fill not on usage.

This study suggested that pre-operative cannabis use should be considered in postoperative pain management, in which patients who use cannabis may consume more opioids following surgery.

“Pre-operative cannabis usage should be a consideration in managing postoperative pain in candidates for posterior lumbar interbody fusion surgery,” the study authors concluded.


Moon AS, LeRoy TE, Yacoubian V, Gedman M, Aidlen JP, Rogerson A. Cannabis use is associated with increased use of prescription opioids following posterior lumbar spinal fusion surgery. Global Spine J. 2022;21925682221099857. doi:10.1177/21925682221099857