Self-Reported Cannabis Use is Not Associated with Increased Opioid Use or Costs After Hip Arthroscopy

2022 ◽  
Author(s):  
Jacob T. Wood ◽  
Medical ◽  
Senthil Sambandam ◽  
Dane K. Wukich ◽  
Christopher L. McCrum
Keyword(s):  
Hip Arthroscopy ◽  
Cannabis Use ◽  
Opioid Use

scholarly journals Cannabis Use among Older Persons with Arthritis, Cancer and Multiple Sclerosis: Are We Comparing Apples and Oranges?

2021 ◽  
Vol 11 (5) ◽  
pp. 532
Author(s):  
Brian Kaskie ◽  
Hyojung Kang ◽  
Divya Bhagianadh ◽  
Julie Bobitt
Keyword(s):  
Multiple Sclerosis ◽  
Older Persons ◽  
Behavioral Outcomes ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Quality Of Sleep ◽  
Impact Processes ◽  
Lower Baseline

Although researchers have identified medications that relieve symptoms of multiple sclerosis (MS), none are entirely effective and some persons with multiple sclerosis (PwMS) use alternatives. Our study compared cannabis use among PwMS (N = 135) and persons diagnosed with arthritis (N = 582) or cancer (N = 622) who were age 60 and older, enrolled in the State of Illinois Medical Cannabis Program, and invited to complete a survey fielded between June and September, 2019. We used logistic regression to identify significant differences in self-reported effects of cannabis on psychological wellbeing, quality of life, and three behavioral outcomes, and we also considered effects of past year opioid use relative to these outcomes. We found that the majority of individuals from all groups used cannabis to address pain and improve quality of sleep. While PwMS reported lower baseline levels across all five outcomes, we found that the reported effects of cannabis were largely comparable across the groups. We also found that cannabis benefitted persons with sleep and digestive issues regardless of condition, whereas persons who used opioids in addition to cannabis were less likely to experience an improvement in any of the outcomes. This comparative evaluation suggests that cannabis’ effects are not specific to MS, arthritis, or cancer as much as they impact processes common among these distinct conditions. We also found evidence that cannabis may be a viable alternative to opioids for those with these conditions and experiencing pain.

scholarly journals Opioid Overprescription in Adolescents and Young Adults Undergoing Hip Arthroscopy

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0005
Author(s):  
Mahad M. Hassan ◽  
Omar F. Rahman ◽  
Zaamin B. Hussain ◽  
Stephane L. Burgess ◽  
Yi-Meng Yen ◽  
...  
Keyword(s):  
Young Adult ◽  
Hip Arthroscopy ◽  
Pain Syndrome ◽  
Adult Patients ◽  
Adolescent And Young Adult ◽  
Bivariate Analysis ◽  
Opioid Use ◽  
Duration Of Surgery ◽  
Opioid Medications ◽  
Arthroscopic Procedures

Background: Previous studies have examined factors related to the increased use of opioids after hip arthroscopy in adults. However, few have focused on the adolescent population. Purpose: The purpose of this study was to compare the opioids prescribed to opioids consumed after hip arthroscopic procedures in adolescent and young adult patients, and to determine patient or surgical factors associated with increased postoperative opioid use. Methods: Adolescent and young adult patients who underwent hip arthroscopy and associated arthroscopic interventions between January 2017 and January 2020 were included. Patients with a diagnosed pain syndrome or history of chronic pain, as determined by the patient taking opioid medications prior to surgery, were excluded. Daily postoperative opioid intake was recorded via pain-control logbooks. The outcome of the study was defined as the average total number of opioid tablets consumed postoperatively. Results: Fifty-eight patients returned completed logbooks, 72% of whom were female patients. The average age was 21.30 years (range, 14.9 – 34.2). Most patients (73%) were prescribed 30 oxycodone tablets. The median amount of tablets consumed was 7 (range, 0-41) over a median duration of 7 days (range, 1-22). The median ratio of tablets consumed to prescribed was 20% and the 95th percentile of opioids consumed was 28 tablets. Bivariate analysis showed that patient age at surgery was positively correlated to the total amount of tablets consumed (r=0.28, p=0.04) and to the ratio of tablets consumed to prescribed (r=0.30, p=0.03). Duration of surgery was negatively correlated to the number of days tablets were consumed (r=-0.31, p=0.03). Multivariate analysis showed that patients who were prescribed more than 30 tablets took on average 7.8 more tablets overall compared to those prescribed 30 or fewer tablets (p=0.003), and that for each additional year of age, the ratio of tablets consumed to prescribed increased by 1% (p=0.02). Conclusion: After undergoing hip arthroscopy and associated arthroscopic procedures, adolescents and young adult patients are commonly overprescribed opioids, consuming on average only one-fifth of the tablets prescribed. This finding mirrors trends in the pediatric knee arthroscopy literature and provides an opportunity to reassess current opioid prescribing behaviors in the adolescent and young adult populations. [Table: see text][Table: see text][Table: see text][Table: see text][Table: see text]

scholarly journals The association between cannabis use and outcome in pharmacological treatment for opioid use disorder

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Tea Rosic ◽  
Raveena Kapoor ◽  
Balpreet Panesar ◽  
Leen Naji ◽  
Darren B. Chai ◽  
...  
Keyword(s):  
Side Effects ◽  
Pharmacological Treatment ◽  
Addiction Treatment ◽  
Age Of Onset ◽  
Opioid Use Disorder ◽  
Cannabis Use ◽  
Self Report ◽  
Opioid Use ◽  
Differential Outcomes ◽  
Urine Drug

Abstract Background With the ongoing opioid crisis and policy changes regarding legalization of cannabis occurring around the world, it is necessary to consider cannabis use in the context of opioid use disorder (OUD) and its treatment. We aimed to examine (1) past-month cannabis use in patients with OUD, (2) self-reported cannabis-related side effects and craving, and (3) the association between specific characteristics of cannabis use and opioid use during treatment in cannabis users. Methods Participants receiving pharmacological treatment for OUD (n = 2315) were recruited from community-based addiction treatment clinics in Ontario, Canada, and provided information on past-month cannabis use (self-report). Participants were followed for 3 months with routine urine drug screens in order to assess opioid use during treatment. We used logistic regression analysis to explore (1) the association between any cannabis use and opioid use during treatment, and (2) amongst cannabis-users, specific cannabis use characteristics associated with opioid use. Qualitative methods were used to examine responses to the question: “What effect does marijuana have on your treatment?”. Results Past-month cannabis use was reported by 51% of participants (n = 1178). Any cannabis use compared to non-use was not associated with opioid use (OR = 1.03, 95% CI 0.87–1.23, p = 0.703). Amongst cannabis users, nearly 70% reported daily use, and half reported experiencing cannabis-related side effects, with the most common side effects being slower thought process (26.2%) and lack of motivation (17.3%). For cannabis users, daily cannabis use was associated with lower odds of opioid use, when compared  with occasional use (OR = 0.61, 95% CI 0.47–0.79, p < 0.001) as was older age of onset of cannabis use (OR = 0.97, 95% CI 0.94, 0.99, p = 0.032), and reporting cannabis-related side effects (OR = 0.67, 95% CI 0.51, 0.85, p = 0.001). Altogether, 75% of cannabis users perceived no impact of cannabis on their OUD treatment. Conclusion Past-month cannabis use was not associated with more or less opioid use during treatment. For patients who use cannabis, we identified specific characteristics of cannabis use associated with differential outcomes. Further examination of characteristics and patterns of cannabis use is warranted and may inform more tailored assessments and treatment recommendations.

scholarly journals Comparison of Male and Female Patients in Louisiana Medical Marijuana Dispensaries

2020 ◽  
Vol 9 (6) ◽  
pp. 1865
Author(s):  
H. Raymond Allen ◽  
Doug Boudreaux ◽  
Jeffrey N. Keller
Keyword(s):  
Medical Marijuana ◽  
Cannabis Use ◽  
Deep South ◽  
Opioid Use ◽  
Web Based ◽  
Male And Female ◽  
Female Patients ◽  
Patient Demographics ◽  
History Of ◽  
Males And Females

Relatively little is known in terms of patient demographics, indications, previous cannabis use, or the forms and dosages of medical marijuana (MM) dispensed for patients at MM dispensaries. Even less is known in terms of how male and female patients may differ in each of these aspects. The goal of the current study was to examine each of these variables using a retrospective analysis of deidentified patient data from MM dispensaries in Louisiana. Deidentified data were analyzed from web-based pharmacist–patient consultations at MM dispensaries throughout Louisiana. Data were collected during the first 6 months following the initiation of the MM dispensing program in Louisiana. A total of 1195 MM patients (598 male/597 female) were included in the analyses. The average age of the sample was 51.9 years (±14.8) and it was composed primarily of white patients (86.7%). Males and females were nearly identical in terms of average age, race, previous cannabis use, indication profile, and MM recommendations. Differences between males and females were observed in terms of opioid use, history of psychosis, presence of more than one indication, and the duration of previous cannabis use. Our data indicate that, in MM dispensaries of the Deep South state, there are numerous similarities—and some potentially important differences—between male and female MM patients. The importance of these differences, and the importance of continued data collection/analysis, for improving MM dispensing are discussed.

Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness

2018 ◽  
Vol 129 (3) ◽  
pp. 536-543 ◽  
Author(s):  
Matthias Behrends ◽  
Edward N. Yap ◽  
Alan L. Zhang ◽  
Kerstin Kolodzie ◽  
Sakura Kinjo ◽  
...  
Keyword(s):  
Placebo Group ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Recovery Room ◽  
Study Endpoint ◽  
Block Group ◽  
Opioid Use ◽  
Quadriceps Weakness ◽  
Pain Scores ◽  
Fascia Iliaca Block

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Ambulatory hip arthroscopy is associated with postoperative pain routinely requiring opioid analgesia. The potential role of peripheral nerve blocks for pain control after hip arthroscopy is controversial. This trial investigated whether a preoperative fascia iliaca block improves postoperative analgesia. Methods In a prospective, double-blinded trial, 80 patients scheduled for hip arthroscopy were randomized to receive a preoperative fascia iliaca block with 40 ml ropivacaine 0.2% or saline. Patients also received an intraarticular injection of 10-ml ropivacaine 0.2% at procedure end. Primary study endpoint was highest pain score reported in the recovery room; other study endpoints were pain scores and opioid use 24 h after surgery. Additionally, quadriceps strength was measured to identify leg weakness. Results The analysis included 78 patients. Highest pain scores in the recovery room were similar in the block group (6 ± 2) versus placebo group (7 ± 2), difference: −0.2 (95% CI, −1.1 to 0.7), as was opioid use (intravenous morphine equivalent dose: 15 ± 7mg [block] vs. 16 ± 9 mg [placebo]). Once discharged home, patients experienced similar pain and opioid use (13 ± 7 mg [block] vs. 12 ± 8 mg [placebo]) in the 24 h after surgery. The fascia iliaca block resulted in noticeable quadriceps weakness. There were four postoperative falls in the block group versus one fall in the placebo group. Conclusions Preoperative fascia iliaca blockade in addition to intraarticular local anesthetic injection did not improve pain control after hip arthroscopy but did result in quadriceps weakness, which may contribute to an increased fall risk. Routine use of this block cannot be recommended in this patient population.

scholarly journals Postoperative analgesia and opioid use following hip arthroscopy with ultrasound-guided quadratus lumborum block: a randomized controlled double-blind trial

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092099
Author(s):  
Liangjing Yuan ◽  
Ye Zhang ◽  
Chengshi Xu ◽  
Anshi Wu
Keyword(s):  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Opioid Consumption ◽  
Hip Surgery ◽  
Opioid Use ◽  
Ultrasound Guided ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Vas Scores ◽  
Time Point

Objective To investigate the postoperative analgesic effect of ultrasound-guided quadratus lumborum block (QLB) in patients undergoing arthroscopic hip surgery. Methods Patients who were scheduled to undergo elective arthroscopic hip surgery were randomly assigned to the QLB (Q) or control (C) group (n = 40 each). After general anesthesia induction, unilateral QLB was performed under ultrasound guidance in the Q group. The amount of opioid use via patient-controlled analgesia (PCA) and the resting and movement pain visual analog scale (VAS) scores when the patient left the postanesthesia care unit (PACU) and 4, 8, 12, and 24 hours after surgery were recorded. Postoperative complications were recorded for both groups. Results At 24 hours post-surgery, opioid consumption amounts via PCA (48.4 [48.1–48.6] mL) in the Q group were significantly lower compared with the C group (52.0 [51.0–53.8] mL). A significant reduction in opioid consumption was observed between the two groups at each time point. Resting and movement VAS scores at each time point were significantly lower in the Q compared with the C group. Conclusions Hip arthroscopy patients who received QLB and general anesthesia in combination had less pain and a lower opioid requirement within 24 hours postoperatively.

scholarly journals Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States

2018 ◽  
Vol 175 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Mark Olfson ◽  
Melanie M. Wall ◽  
Shang-Min Liu ◽  
Carlos Blanco
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use Disorder ◽  
Cannabis Use ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Prescription Opioid Use

scholarly journals Prolonged Postoperative Opioid Use After Arthroscopic Femoroacetabular Impingement Syndrome Surgery: Predictors and Outcomes at Minimum 2-Year Follow-up

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110389
Author(s):  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Justin Drager ◽  
Kyleen Jan ◽  
Jonathan Rasio ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Odds Ratio ◽  
Impingement Syndrome ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Femoroacetabular Impingement Syndrome ◽  
Prescription Refill

Background: The association between prolonged postoperative opioid use on outcomes after hip preservation surgery is not known. Purpose: To compare minimum 2-year patient-reported outcomes (PROs) between patients who required ≥1 postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) versus patients who did not require a refill and to identify preoperative predictors for patients requiring ≥1 postoperative opioid refill. Study Design: Cohort study; Level of evidence, 3. Methods: Data from consecutive patients who underwent arthroscopic surgery for FAIS between January 2012 and January 2017 were analyzed. Multivariate regression analysis was performed to classify patient and radiographic variables as predictive of requiring ≥1 opioid prescription refill after surgery. Patients completed the following PROs preoperatively and at 2-year follow-up: Hip Outcome Score— Activities of Daily Living subscale (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and 100-point visual analog scale (VAS) for pain and satisfaction. Scores were compared between patients needing additional prescription opioids and those who did not. Results: A total of 775 patients, of whom 141 (18.2%) required ≥1 opioid prescription refill, were included in the analysis. Patients requiring opioid refills had significantly lower 2-year postoperative PRO scores compared with patients not requiring refills: HOS-ADL (79.9 ± 20.3 vs 88.7 ± 14.9), HOS-SS (64.6 ± 29.5 vs 78.2 ± 23.7), mHHS (74.2 ± 21.1 vs 83.6 ± 15.9), iHOT-12 (63.6 ± 27.9 vs 74.9 ± 24.8), and VAS satisfaction (73.4 ± 30.3 vs 82.2 ± 24.9), as well as significantly more pain (26.8 ± 23.4 vs 17.9 ± 21.8) ( P ≤ .001 for all). Predictors of requiring a postoperative opioid refill included patients with active preoperative opioid use (odds ratio, 3.12 [95% confidence interval, 1.06-9.21]; P = .039) and larger preoperative alpha angles (odds ratio, 1.04 [95% confidence interval, 1.01-1.07]; P = .03). Conclusion: Patients requiring ≥1 opioid prescription refill after hip arthroscopy for FAIS had lower preoperative and 2-year PRO scores when compared with patients not requiring refills. Additionally, active opioid use at the time of surgery was found to be predictive of requiring additional opioids for pain management.

scholarly journals The association between health conditions and cannabis use in patients with opioid use disorder receiving methadone maintenance treatment

BJPsych Open ◽  
2019 ◽  
Vol 5 (6) ◽  
Author(s):  
Ieta Shams ◽  
Nitika Sanger ◽  
Meha Bhatt ◽  
Tea Rosic ◽  
Candice Luo ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Methadone Maintenance Treatment ◽  
Odds Ratio ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Current Treatment ◽  
Opioid Use Disorder ◽  
Cannabis Use ◽  
Health Conditions ◽  
Opioid Use

Background Cannabis is the most commonly used substance among patients in methadone maintenance treatment (MMT) for opioid use disorder. Current treatment programmes neither screen nor manage cannabis use. The recent legalisation of cannabis in Canada incites consideration into how this may affect the current opioid crisis. Aims Investigate the health status of cannabis users in MMT. Method Patients were recruited from addiction clinics in Ontario, Canada. Regression analyses were used to assess the association between adverse health conditions and cannabis use. Further analyses were used to assess sex differences and heaviness of cannabis use. Results We included 672 patients (49.9% cannabis users). Cannabis users were more likely to consume alcohol (odds ratio 1.46, 95% CI 1.04–2.06, P = 0.029) and have anxiety disorders (odds ratio 1.75, 95% CI 1.02–3.02, P = 0.043), but were less likely to use heroin (odds ratio 0.45, 95% CI 0.24–0.86, P = 0.016). There was no association between cannabis use and pain (odds ratio 0.98, 95% CI 0.94–1.03, P = 0.463). A significant association was seen between alcohol and cannabis use in women (odds ratio 1.79, 95% CI 1.06–3.02, P = 0.028), and anxiety disorders and cannabis use in men (odds ratio 2.59, 95% CI 1.21–5.53, P = 0.014). Heaviness of cannabis use was not associated with health outcomes. Conclusions Our results suggest that cannabis use is common and associated with psychiatric comorbidities and substance use among patients in MMT, advocating for screening of cannabis use in this population. Declaration of interest None.

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