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Patient Saf Surg. 2018 Jun 19;12:16. doi: 10.1186/s13037-018-0163-3. eCollection 2018.

The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury.

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1Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113 USA.
2Trauma Research Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228 USA.
Trauma Research Department, Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA.
4Trauma Research Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA.
5Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113 USA.
6Trauma Services Department, Penrose Hospital, 2222 N Nevada Drive, Colorado Springs, CO 80907 USA.
Trauma Services Department, Medical City Plano, 3901 W 15th St, Plano, TX 75075 USA.
8Trauma Services Department, St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228 USA.



Widespread legislative efforts to legalize marijuana have increased the prevalence of marijuana use and abuse. The effects of marijuana on pain tolerance and analgesic pain management in the acute pain setting have not been reported. Although marijuana has been shown to have antinociceptive effects and is approved for medical use to treat chronic pain, anecdotal evidence suggests marijuana users admitted with traumatic injuries experience poorer pain control than patients who do not use marijuana. We hypothesized that marijuana users would report higher pain scores and require more opioid analgesia following traumatic injury.


This retrospective pilot study included all patients involved in motor vehicle crashes, consecutively admitted to four trauma centers from 1/1/2016-4/30/2016. Marijuana status was examined as non-use and use, and was further categorized as chronic and episodic use. We performed a repeated measures mixed model to examine the association between marijuana use and a) average daily opioid consumption and b) average daily pain scores (scale 0-10). Opioid analgesics were converted to be equianalgesic to 1 mg IV hydromorphone.


Marijuana use was reported in 21% (54/261), of which 30% reported chronic use (16/54). Marijuana use was reported more frequently in Colorado hospitals (23-29%) compared to the hospital in Texas (6%). Drug use with other prescription/street drugs was reported in 9% of patients. Other drug use was a significant effect modifier and results were presented after stratification by drug use. After adjustment, marijuana users who did not use other drugs consumed significantly more opioids (7.6 mg vs. 5.6 mg, p <  0.001) and reported higher pain scores (4.9 vs. 4.2, p <  0.001) than non-marijuana users. Conversely, in patients who used other drugs, there were no differences in opioid consumption (5.6 mg vs. 6.1 mg, p = 0.70) or pain scores (5.3 vs. 6.0, p = 0.07) with marijuana use compared to non-use, after adjustment. Chronic marijuana use was associated with significantly higher opioid consumption compared to episodic marijuana use in concomitant drug users (11.3 mg vs. 4.4 mg, p = 0.008) but was similar in non-drug users (p = 0.41).


These preliminary data suggest that marijuana use, especially chronic use, may affect pain response to injury by requiring greater use of opioid analgesia. These results were less pronounced in patients who used other drugs.


Acute pain management; Marijuana; Substance abuse; Vehicular trauma

Conflict of interest statement

The study was approved from the Institutional Review Boards at each respective facility; informed consent was waived. Reference numbers: Swedish Medical Center: 987891; St. Anthony Hospital: 973145; Penrose Hospital: 975740; Medical City Plano: 103099.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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