Medicinal Cannabis in Orthopaedic Practice

Lindsay T. Kleeman-Forsthuber, MD; Douglas A. Dennis, MD; Jason M. Jennings, MD, DPT

Disclosures

J Am Acad Orthop Surg. 2020;28(7):268-277. 

In This Article

Abstract and Introduction

Abstract

Cannabis has gained widespread public advocacy since its legalization in several states with recent evidence suggesting that its self-reported use has increased in patients undergoing a primary total joint arthroplasty. The endocannabinoid system has been proposed to play a role in decreasing the inflammatory cascade and enhancing pain management. For these reasons, interest has emerged in the orthopaedic community as a potential treatment or adjunct to treatment in many musculoskeletal conditions. However, the evidence to date is scant and precludes recommendations for its widespread use. Given the current paucity of evidence in the orthopaedic cohort, future research is warranted in this area to determine the efficacy and safety before endorsements can be made by orthopaedic surgeons.

Introduction

Pain management in orthopaedics remains one of the most challenging realms of clinical care for healthcare providers. The United States is now battling an unprecedented opioid epidemic that cumulatively costs the US economy roughly $78.5 billion annually.[1] The US population accounts for only 4.6% of the world population but consumes 80% of the global opioid supply.[2] Opioid-related deaths accounted for 1.68 million person-years of life lost in 2016 (a 345% increase from 2001) with the highest incidence in patients aged between 24 and 35 years (20% of all deaths in 2016).[3] Studies have shown that approximately 75% of patients seeking treatment for opioid addiction were introduced to them through prescription medications.[4] Opioid abuse has been shown to have a notable impact on surgical outcomes. Preoperative opioid use is associated with higher morbidity and mortality following elective orthopaedic procedures[5] with higher revision rates and inferior outcomes following total knee arthroplasty.[6] Healthcare providers and government officials must work together to find safe and effective alternatives to control both chronic and postsurgical pain to minimize exposure to opioids. In recent years, cannabis has emerged as a potential alternative or adjunct to opioids in management of pain related to musculoskeletal conditions, but most orthopaedic surgeons have little knowledge on its medical applications or efficacy.[7–10]

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