Patterns of Outpatient Multimodal Analgesic Use Among Postoperative Marijuana Users Undergoing ACDF and Lumbar Fusion.

Authors

• Rajkishen Narayanan
• Michael Carter
• Gregory Toci
• Rachel Huang
• Jonathan Dalton
• Yulia Lee
• Michael McCurdy
• Yunsoo Lee
• Nathaniel Pineda
• Shiraz Mumtaz
• Jose A Canseco
• Alan S Hilibrand
• Alexander R Vaccaro
• Christopher K Kepler
• Gregory D Schroeder

Publication/Presentation Date

3-1-2026

Abstract

STUDY DESIGN: Retrospective cohort study.

OBJECTIVES: To describe patterns of postoperative analgesia use (opioids, antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines) among postoperative marijuana users after anterior cervical discectomy and fusion (ACDF) and lumbar fusion.

SUMMARY OF BACKGROUND DATA: The use of marijuana for pain management is a controversial topic that lacks extensive research. As social and legal acceptance of marijuana increases, questions have arisen about its therapeutic potential alongside prescription analgesic pharmaceutical agents, necessitating further studies on this topic.

METHODS: Adult patients who underwent either ACDF or lumbar fusion surgery and used marijuana postoperatively were identified. A 1:1 propensity match incorporating patient demographics and levels fused was conducted to compare postoperative marijuana users to nonmarijuana users. One year preoperative and 1 year postoperative opioid use was obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Preoperative and postoperative utilization of antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines was obtained from patient chart review and PDMP.

RESULTS: Of the 126 included patients, 63 (50%) used marijuana postoperatively. A greater proportion of marijuana users undergoing lumbar fusion used opioids preoperatively compared with nonmarijuana users ( P =0.048). No significant differences in preoperative opioid use were demonstrated among ACDF patients. In both ACDF and lumbar fusion cohorts, no differences in postoperative opioid consumption were observed between marijuana and nonmarijuana users. Marijuana usage was associated with higher utilization of serotonin-norepinephrine reuptake inhibitors (SNRIs), specifically duloxetine, in the ACDF cohort ( P =0.024). No significant differences in rates of utilization of tricyclic antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines were observed in patients who consumed marijuana compared with nonmarijuana users.

CONCLUSIONS: Postoperative marijuana use was significantly associated with preoperative opioid use in lumbar fusion patients and duloxetine use in ACDF patients. Postoperative marijuana use was not significantly associated with gabapentinoid, muscle relaxant, or benzodiazepine use.

Volume

39

Issue

2

First Page

92

Last Page

92

ISSN

2380-0194

Published In/Presented At

Carter, M., Dalton, J., Olson, J., Meade, M., Huang, R., Narayanan, R., Buchan, L., Kohring, A., Hassan, W., Tewell, N., Fras, S., Bowen, G., von Suskil, M., Sabitsky, M., Toth, A., Kurd, M., Kaye, I. D., Cha, T., Woods, B., Mangan, J., … Kepler, C. (2026). Application of the 2022 CDC Guidelines-Does In-Hospital Opioid Dosage After Lumbar Fusion Affect Long-Term Opioid Use and Outcomes for Opioid Naïve Patients?. Spine, 51(16), 1157–1162. https://doi.org/10.1097/BRS.0000000000005503

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40991897

Department(s)

Administration and Leadership

Document Type

Article