(1715) Impact of Adjunctive Dronabinol to Multimodal Pain Regimens Following Trauma

Introduction: Tetrahydrocannabinol (THC) users have been shown to have higher opioid requirements than non-THC users for achieving control of acute pain. Dronabinol, a synthetic form of delta-9-THC, has been suggested to reduce morphine milligram equivalents (MME) compared to placebo in patients following traumatic injury. This project's purpose was to evaluate if adjunctive dronabinol decreases MME required in trauma patients with a THC positive urine drug screen at admission.

Methods: This was a single-center, retrospective cohort study of adult patients admitted following trauma between 2019 and 2023 with a THC positive urine drug screen at the time of admission. Those prescribed dronabinol prior to admission, intubated longer than 48 consecutive hours, or those admitted less than 48 hours were excluded. The primary outcome was difference of required MME during hospitalization with adjunctive dronabinol compared to standard treatment. Secondary outcomes include utilization of multimodal pain regimens and MME of self-reported THC users. Additional secondary outcomes include rates of opioid prescribing and MME at discharge, hospital length of stay, and in-hospital mortality.

Results: A total of 100 patients were included in this study with 50 patients in each arm. Average daily MME during hospitalization was similar between dronabinol and non-dronabinol users [55.7 (34.0 - 80.3) vs 33.8 (20.17 - 77.02); p=0.075]. Self-admitted THC users in the dronabinol arm also received higher daily MME [64.55 (50.70 - 78.40) vs 47.33 (34.25 - 60.40); p=0.02]. Rates of opioid prescribing and median daily MME prescribed at discharge were similar between groups. Patients who received dronabinol had significantly higher utilization of gabapentin (98% vs 70%; p < 0.001) and lidocaine patches (74% vs 38%; p< 0.001). Dronabinol patients had a significantly longer length of stay (8.10 days vs 5.72 days; p< 0.001).

Conclusions: Adjunctive dronabinol use did not decrease MME during hospitalization in THC positive trauma patients. Further assessment is needed to determine dronabinol’s utility in multi-modal pain treatment.