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Cannabis Intoxicated Patients With Small Burns Require More Opioid Analgesics in the Acute Hospitalization Period
Sarah Wang
*, Amara Emeh, Artur Manasyan, Deborah Choe, Jordan Gasho, Eloise W. Stanton, Sunnie Wong, Elizabeth M. Boudiab, Maxwell Johnson, Haig A. Yenikomshian, T. Justin Gillenwater
Keck School of Medicine, San Marino, CA
Background: The incidence of cannabis use among burn patients is rising at a much faster rate compared to the general population. Studies in trauma patients have shown that cannabis users experience worse postoperative pain and require higher doses of rescue analgesics. In light of the increasing prevalence of cannabis use in burn patients and these findings, our study seeks to investigate the use of opioid analgesics in cannabis using burn patients to better understand this complex relationship.
Methods: A single institution retrospective study was conducted of adult burn patients with <20% total body surface area (TBSA) who tested positive for cannabis on admission urine toxicology from 2015-2024. These patients were matched in a 1:1 ratio based on age, gender, and TBSA, with controls that tested negative for cannabis. Primary outcomes were pain scores and opioid analgesic requirements in the acute hospitalization period (≤ 14 days). Opioid usage was converted into morphine milligram equivalents (MME) for baseline comparison.
Results: Our study included 76 cannabis positive burn patients and 76 controls. No significant differences were found in race (p= 0.494), ethnicity (p= 0.598), number of complications (p= 0.092), number of OR visits (p= 0.909), discharge disposition (p= 0.382), or mortality (p= 0.083). When controlling for the number of days administered, analysis showed that cannabis users required more opioid analgesics for dressing changes (24.5 vs 14.1 MME/day, p= 0.031). There was no significant difference between basal (p= 0.061), PRN (p= 0.508), and total (p= 0.932) opioid analgesic use. Cannabis users on average had a higher reported pain score (8.88 vs 7.95, p= 0.023).
Conclusion: This study demonstrates an association between cannabis use and an increased need for opioid analgesics during dressing changes, as well as higher pain scores in cannabis users, suggesting reduced pain tolerance in this group. Further understanding of the relations between cannabis use and pain tolerance could guide tailored pain management amongst this burn population.
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