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Self-Reported Marijuana Use Is Associated with Increased Use of Prescription Opioids Following Traumatic Musculoskeletal Injury

Bhashyam, Abhiram R., MD, MPP1; Heng, Marilyn, MD, MPH, FRCSC2,3; Harris, Mitchel B., MD2,3; Vrahas, Mark S., MD4; Weaver, Michael J., MD3,5

doi: 10.2106/JBJS.17.01400
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Background: Cannabinoids are among the psychoactive substances considered as alternatives to opioids for the alleviation of acute pain. We examined whether self-reported marijuana use was associated with decreased use of prescription opioids following traumatic musculoskeletal injury.

Methods: Our analysis included 500 patients with a musculoskeletal injury who completed a survey about their marijuana use and were categorized as (1) never a user, (2) a prior user (but not during recovery), or (3) a user during recovery. Patients who used marijuana during recovery indicated whether marijuana helped their pain or reduced opioid use. Prescription opioid use was measured as (1) persistent opioid use, (2) total prescribed opioids, and (3) duration of opioid use. Persistent use was defined as the receipt of at least 1 opioid prescription within 90 days of injury and at least 1 additional prescription between 90 and 180 days. Total prescribed opioids were calculated as the total morphine milligram equivalents (MME) prescribed after injury. Duration of use was the interval between the first and last opioid prescription dates.

Results: We found that 39.8% of patients reported never having used marijuana, 46.4% reported prior use but not during recovery, and 13.8% reported using marijuana during recovery. The estimated rate of persistent opioid use ranged from 17.6% to 25.9% and was not associated with marijuana use during recovery. Marijuana use during recovery was associated with increases in both total prescribed opioids (regression coefficient = 343 MME; 95% confidence interval [CI] = 87 to 600 MME; p = 0.029) and duration of use (coefficient = 12.5 days; 95% CI = 3.4 to 21.5 days; p = 0.027) compared with no previous use (never users). Among patients who reported that marijuana decreased their opioid use, marijuana use during recovery was associated with increased total prescribed opioids (p = 0.008) and duration of opioid use (p = 0.013) compared with never users.

Conclusions: Our data indicate that self-reported marijuana use during injury recovery was associated with an increased amount and duration of opioid use. This is in contrast to many patients’ perception that the use of marijuana reduces their pain and therefore the amount of opioids used.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Harvard Combined Orthopaedics Residency Program, Boston, Massachusetts

2Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts

3Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts

4Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California

5Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

E-mail address for A.R. Bhashyam: abhashyam@partners.org

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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