Cannabis Use Disorder and Postoperative Pain: Elevated Analgesic Requirements After Surgical Repair of Hand Fractures

Cannabis is one of the most widely used psychoactive substances in the United States, yet clinical research on its impact in surgical settings remains limited. Despite its growing use and perceived analgesic potential, the effects of cannabis use disorder (CUD) on postoperative pain management are poorly understood. This study investigates whether patients with CUD exhibit increased postoperative analgesic requirements following surgical treatment of hand fractures.

We conducted a retrospective cohort study using TriNetX, a global federated health research network. Patients undergoing closed reduction percutaneous pinning for metacarpal or carpal fractures were grouped by the presence or absence of CUD (international statistical classification of diseases and related health problems, 10th revision: F12). Propensity score matching (1:1) was used to control for demographics, comorbidities, and fracture characteristics. The primary outcomes were 30-day postoperative use of opioids, nonopioids, and nonsteroidal anti-inflammatory drugs, quantified by the number of distinct days each medication class was recorded.

A total of 1092 matched patients (546 per group) were included. Patients with CUD had significantly higher odds of opioid (odds ratio [OR] = 3.00; 95% confidence interval [CI]: 2.06-4.55), nonopioid (OR = 3.67; 95% CI: 2.76-4.93), and NSAID use (OR = 1.83; 95% CI: 1.27-2.63). CUD patients also initiated analgesics earlier and had greater usage frequency, with significant differences in opioid and nonopioid use (P < 0.001).

Patients with CUD had more postoperative analgesics after closed reduction percutaneous pinning. These findings highlight the need for cannabis-specific preoperative screening and individualized, multimodal pain management strategies in this population.