Background: There are no national opioid-prescribing guidelines for acute postoperative pain, and prolonged opioid use (i.e. use >90 days after surgery) has been identified as the most common postoperative complication.  Cannabis has an analgesic effect that may reduce opioid use in these patients. The goal of this study is to explore the impact of state cannabis policies on rates of prolonged postoperative opioid use (PPOU).  

Methods: Using a 5% sample of 2016-2018 fee-for-service Medicare Claims, we evaluated prescriptions from beneficiaries who underwent 1 of 13 common surgical procedures (e.g. carpal tunnel release, colectomy, hemorrhoidectomy).  All beneficiaries had continuous insurance coverage and filled an opioid prescription. We excluded beneficiaries with extended hospital stays, additional surgeries, a diagnosis of opioid use disorder or chronic pain disorder, or who received hospice services.  To classify state cannabis policies, we utilized the Americans for Safe Access grading system. We calculated incidence of PPOU using raw percentages and compared incidence across state grades using c² tests.   

Results: In our sample (n=12,979), 17.8% of patients had PPOU. The majority of this sample was white (82.5%), female (60.5%), with a mean age of 70 years old. The majority of the sample lived in states that received an F grade (43.5%), with 24.5% living in B grade states, 12.1% living in C grade states, and 4% living in D grade states. There were significant differences in incidence of PPOU by state grade, c² (4)=58.90, p<0.001). States with a B grade had an incidence of PPOU of 15.4%, C with 13.2%, D with 16.3%, and F with 20.1%.  

Discussion: There appears to be an association between states medical cannabis access and patients PPOU. We will present results from a final analysis using logistic regression models, controlling for prior opioid use, comorbidities, age, and other relevant patient characteristics.