D. Donthula1, J. Klugh1, K. Motley1, C. Green1, L. Kao1, C. Wade1, J. Harvin1 1McGovern Medical School, Department Of Surgery, Houston, TEXAS, USA
Introduction:
Dronabinol has increasingly been used as an adjunct in multi-modal pain regimens (MMPR) to treat acute pain after injury and minimize opioid exposure, despite lack of evidence in the literature. We hypothesize that dronabinol use is independently associated with decreased inpatient opioid exposure and opioid prescribing at discharge.
Methods:
This secondary analysis of a randomized controlled trial (NCT03472469) included 1,561 patients. The effect of dronabinol on inpatient opioid exposure (total morphine milligram equivalents [MME/day]) and opioid prescriptions at discharge (yes/no) were estimated with stratification by risk and regression. All patients who received and did not receive dronabinol were compared. To minimize indication bias, patients who did and did not receive dronabinol were evaluated in four high-risk subgroups: smokers, patients with a positive urine drug screen (UDS) on admission, patients who scored high risk on the Opioid Risk Tool (ORT), and patients admitted to the intensive care unit (ICU). For all patients and each of the subgroups, generalized linear models adjusting for differences in baseline variables estimated the independent effect of dronabinol on the outcomes of interest (total MME and opioid prescription at discharge).
Results:
143 (9%) patients were given dronabinol. For all patients, dronabinol was associated with increased total MME (IRR 2.93, 95% CI 2.63-3.26, p<0.001) and no difference in opioid prescribing at discharge (IRR 1.62, 95% CI 0.93-2.82, p=0.088). In the 377 patients with a positive UDS, dronabinol was associated with increased total MME (IRR 2.29, 95% CI 1.79-2.94, p<0.001) and no difference in opioid prescribing at discharge (Table). In the 126 patients found to be high risk by the ORT, dronabinol was associated with increased total MME (IRR 3.39, 95% CI 2.76-4.18, p<0.001) and decreased opioid prescribing at discharge (Table). For the 460 smokers, dronabinol was associated with increased total MME (IRR 2.55, 95% CI 1.94-3.35, p<0.001) and no difference in opioid prescribing at discharge (Table). For the 525 patients admitted to the ICU, dronabinol was associated with increase total MME (2.82, 95% CI 1.86-4.26, p<0.001) and increased opioid prescriptions at discharge (Table).
Conclusion:
In this study, dronabinol was associated with increased opioid exposure in all groups, likely confounded by indication bias. However, dronabinol was associated with no difference or reduced opioid prescribing at discharge in two at-risk groups: those with a positive UDS and those screened as high risk by the ORT. This result indicates dronabinol may be beneficial in patients screened as high risk by the ORT and further evaluation is warranted.
