Cannabis Use and Prolonged Opioid Utilization After Head and Neck Free Flap Reconstructive Surgery.

Jackert E.; Gallagher T.; Gamero M.; Thompson Z.; Li A.; Kokot N. · The Laryngoscope · 2026

**Background & Methods** This retrospective cohort study used the TriNetX database to examine head and neck cancer patients undergoing free flap reconstruction between 2005-2025, stratified by preoperative cannabis use history. Propensity score matching (n=532 per cohort) controlled for demographics, substance use patterns, and tumor characteristics, with multivariable Cox regression adjusting for behavioral health comorbidities. **Key Findings** • Cannabis users demonstrated significantly increased risk of prolonged postoperative opioid use compared to non-users: 3-6 months (RR: 1.19, 95% CI: 1.05-1.36), 6-9 months (RR: 1.35, 95% CI: 1.13-1.62), and 9-12 months (RR: 1.26, 95% CI: 1.04-1.52), with cannabis use remaining independently associated in adjusted analysis (HR: 1.42, 90% CI: 1.14-1.76). • Cannabis users showed increased gastrostomy tube dependence at 3 months postoperatively (RR: 1.56, 95% CI: 1.19-2.04), suggesting greater functional morbidity in the early recovery period. • No significant differences were observed in tracheostomy dependence between groups at any postoperative timepoint. **Dosage & Administration** Not reported. The study examined preoperative cannabis use history without specifying frequency, quantity, or route of administration. **Safety & Adverse Effects** The study identified prolonged opioid dependence and increased gastrostomy tube dependence as primary functional outcomes associated with cannabis use. Specific adverse events, medication side effects, or complications directly attributable to cannabis were not independently characterized. **Evidence Quality** This is a large retrospective cohort study with propensity score matching, representing moderate-to-good evidence quality. Limitations include: retrospective design with inherent selection and documentation biases; inability to establish causality; lack of specificity regarding cannabis use patterns (frequency, potency, timing relative to surgery); potential residual confounding despite adjustment for behavioral health comorbidities; and reliance on administrative database coding accuracy. The study's strength lies in its large matched cohorts and long follow-up period (up to 12 months), though the mechanism underlying increased opioid dependence remains unclear and may reflect altered pain perception, delayed wound healing, or behavioral factors rather than direct pharmacologic interaction.

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