Cannabis-intoxicated patients with small burns require more opioid analgesics in the acute hospitalization period.

Abstract

Cannabis is often used to alleviate chronic pain, but trauma patients that are cannabis users experience worse postoperative pain and require higher doses of rescue analgesics. This study investigated the association between cannabis use and opioid requirements in burn patients. 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 to 2024. These patients were matched in a 1:1 ratio based on age, gender, and TBSA, with cannabis-negative controls. Primary outcomes were pain scores and opioid analgesic requirements in the acute hospitalization period (≤ 14 days). Our study included 76 cannabis-positive patients and 76 controls. No significant differences were found in demographics or clinical characteristics. Analysis showed that cannabis users required more opioid analgesics for dressing changes (24.5 vs 14.1 morphine milligram equivalents (MME)/day, p = 0.031). There was no significant difference between basal, pro re nata (PRN), and total opioid analgesic use. Cannabis users on average had a higher reported pain score (8.88 vs 7.95, p = 0.023). Cannabis users had an increased need for opioid analgesics during dressing changes, as well as higher pain scores, suggesting reduced pain tolerance in this group.