The impact of cannabis on clinical outcomes in burn patients: A systematic review.

Sara Sheikh-Oleslami S.; Amir Khorrami A.; Anthony Papp A. · Burns : journal of the International Society for Burn Injuries · 2026

**Background & Methods** This systematic review evaluated cannabis exposure and clinical outcomes in hospitalized burn patients by searching MEDLINE, Embase, CINAHL, and Cochrane databases from inception through August 2025. Eight studies met inclusion criteria (sample sizes 64 to >300,000 patients), with cannabis exposure identified via toxicology screening, patient history, or administrative coding, and outcomes stratified by exposure status. **Key Findings** • Cannabis exposure was not consistently associated with increased inpatient mortality; national database studies actually reported lower adjusted mortality in cannabis-using patients despite other complications. • Cannabis-exposed patients demonstrated higher rates of infectious, respiratory, and thromboembolic complications, including increased wound infection rates, ventilator-associated pneumonia, and venous thromboembolism, along with prolonged ICU stays. • Single-center analyses reported increased opioid and anxiolytic medication requirements among cannabis users, suggesting cannabis did not adequately replace analgesic needs and was associated with higher reoperation rates. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Adverse effects in cannabis-exposed burn patients included increased rates of wound infections, ventilator-associated pneumonia, venous thromboembolism, and prolonged intensive care unit stays. Patients also demonstrated increased requirements for opioid and anxiolytic medications, contradicting assumptions that cannabinoid use would reduce opioid demand. **Evidence Quality** The evidence base is significantly limited by retrospective study design, inconsistent definitions of cannabis exposure across studies, and inability to adequately control for confounding variables including polysubstance use, burn severity, and demographic differences. Pronounced heterogeneity between single-center and national database studies complicates interpretation. The authors conclude that prospective, multicenter studies with detailed exposure characterization, standardized outcome measurement, and long-term follow-up are needed to clarify cannabis' mechanistic role in burn recovery and to establish evidence-based analgesic strategies for this population. The review suggests that cannabis positivity at admission warrants heightened clinical vigilance for infectious, respiratory, and thromboembolic complications rather than altered analgesic approaches.

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