Effect of Cannabis Use on Postoperative Opiate Requirements After Long Bone Fracture

Purpose: This study aims to investigate differences in inpatient postoperative opioid use after surgical treatment of long bone fractures across patients’ with and without self-reported cannabis use. Methods: A retrospective review of surgically treated long bone fractures identified via AO/OTA codes between 2019 and 2021 at one ACS level 1 hospital included record of clinical data, substance use patterns, operative characteristics, complication rates, and postoperative opioid intake. Medication dosages were converted to morphine equivalent dose (MED) for analysis. Chi-square, Independent Samples t-tests, Regression analyses, and Nonparametric tests were completed to compare relationships between predictor variables and outcomes. Results: 199 patients (84M, 115 F; mean age 53.67 years) were included, including fractures of the femur (44.7 %), tibia/fibula (39.7 %), humerus (11.1 %) and radius/ulna (4.5 %). The 30 individuals who self-reported cannabis use were significantly younger than those who did not (39.1 vs 56.3 years; Z = −4.23; p < 0.001) and were more often male (28.1 % vs 11.6 %; χ² = 4.92; p = 0.029). Of 29 individuals with other substance use disorders, 41.4 % also reported cannabis (n = 12; χ² = 14.5; p < 0.001). Cannabis users received 13.5 mg greater MED per day than non-users controlling for age, BMI, gender, race, ethnicity, other substance use, and fracture location [95 %CI (0.730, 1.370); p = 0.037]; however, additionally controlling for medical comorbidities resulted in a smaller difference (8.5 mg MED per day; p > 0.05). Conclusion: Cannabis use may be a predictor for greater opioid requirements following surgical treatment of long bone fractures; however, other patient factors may also influence these requirements.