Exploring the relationship between cannabis and narcotic use on preoperative health considerations in Canadian thoracolumbar patients: a CSORN study

• Published in: Canadian Journal of Surgery Vol. 65; pp. S116 - S117
• Main Authors: Dumas, Evelyne, Bigney, Erin, Fleury, Catherine, El-Mughayyar, Dana, Cherry, Ahmed, Vanderwint, Amanda, Richardson, Eden, Kerr, J, McPhee, Rory, Abraham, Ed, Manson, Neil, Attabib, Najmedden, Small, Chris, Couture, Jérôme, Goulet, Julien, Bédard, Sonia, Lebel, Karina, LaRue, Bernard
• Format: Journal Article
• Language: English
• Published: Ottawa CMA Impact, Inc 01-12-2022
• Subjects: Back pain; Marijuana; Narcotics
• ISSN: 0008-428X; 1488-2310

Background: This study aims to examine demographic and health status differences between patients who report the use of (1) cannabis, (2) narcotics, (3) cannabis and narcotics or (4) no cannabis or narcotic use. Methods: We conducted a retrospective cohort study of thoracolumbar patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN)registry after legalization of cannabis in Canada. Variables included age, sex, modified Oswestry Disability Index (mODI), numerical rating scales (NRS) for leg and back pain, tingling/numbness leg sensation, SF-12 quality of life mental component score, the Patient Health Questionnaire (PHQ-9) and general health state. An analysis of covariance with pathology as the covariate and post-hoc analysis was run. Results: The majority of the 704 patients enrolled (mean age 59 yr; 46.9% female) were nonusers (41.8%). More patients reported narcotic use than cannabis use (29.7% v. 12.9%), with 13.4% stating concurrent use. MCS scores were significantly lower for patients with concurrent use compared to no use (mean 39.95 v. 47.98, p = 0.001) or cannabis use (mean 45.66, p = 0.043). The narcotic-use cohort had significantly worse MCS scores (mean 41.37, p = 0.001) than the nouse cohort. Patients reporting no use and cannabis use (mean 41.39 v. 42.94) had significantly lower ODI scores than those reporting narcotic use (mean 54.91, p = 0.001) and concurrent use (mean 50.80, p = 0.001). Lower NRS-leg pain was reported in cannabis use (mean 5.72) compared with narcotic use (mean 7.19) and concurrent use (mean 7.03, p = 0.001). Patients with no use (mean 6.31) had significantly lower NRS-leg pain than those with narcotic use (p = 0.011) and significantly lower NRS-back pain (mean 6.17) than those with narcotic use (mean 7.16, p = 0.001) and concurrent use (mean 7.15, p = 0.012). Patients with cannabis use reported significantly lower tingling/numbness leg scores (mean 4.85) than those with no use (mean 6.14, p = 0.022), narcotic use (mean 6.67, p = 0.001) and concurrent use (mean 6.50, p = 0.01). PHQ-9 scores were significantly lower for the no-use (mean 6.99) and cannabis-use (mean 8.10) cohorts than for the narcotic-use (mean 10.65) and concurrent-use (mean 11.93) cohorts. Patients who reported narcotic use reported a significantly lower rating of their overall health state (mean 50.03) than those who reported cannabis use (mean 60.50, p = 0.011) and no use (mean 61.89, p = 0.001). Conclusion: Patients with preoperative narcotic use or concurrent use of narcotics and cannabis experienced higher levels of disability, pain and depressive symptoms and worse mental health functioning compared with patients with no cannabis or narcotic use and cannabis-only use.