Friend or Foe: The Use of Cannabis as a Potential Analgesic in Postoperative Lumbar Spine Surgery.

Cannabis is a plant-based product which has been documented in medicinal usage dating back nearly 5000 years ago in 400 AD. With time, cannabis would come to become the most grown, cultivated, trafficked, and abused illicit drug worldwide. As a result, cannabis became a schedule 1 substance having no accepted medical use. In 1996, however, cannabis emerged in the medicinal scene when California became the first state to allow legal access to cannabis for medicinal purposes under the Compassionate Use Act. As of November 8, 2023, 24 states, two territories, and the District of Columbia all enacted laws to help regulate not only the use of marijuana medicinally but recreational use as well. A large proponent for the shift regarding the utilization of medicinal cannabis occurred as a direct result of the opioid abuse crisis which came to fruition in the late 1990s due to their outstanding ability to mitigate the human kryptonite; Pain. The goal of the present literature review is to better consolidate and critically think about the usage of cannabis perioperatively and its utility as a postoperative pain mitigator. More so, many current review articles, systematic reviews, and retrospective reviews suggest deleterious effects of the patient population undergoing lumbar spine surgery who also engage in cannabis usage. However, a lack of level I evidence continues to exist surrounding the clinical question of cannabis usage as a perioperative pain mitigator, leading to inconclusive recommendations regarding its utility. The present review aims to highlight the multitude of conflicting research and identify gaps in questions, which may lead to better utilization and recognition of cannabis as either a helpful or hurtful pain remedy.