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ePoster session 3 – Station 5
EP098 Inpatient dronabinol utilization: an institutional retrospective study to determine reasons for use in orthopedic surgical patients
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  1. Alexandra Sideris1, 2, 3,
  2. William Chan1,
  3. Jiabin Liu1,2 and
  4. Stavros G Memtsoudis1, 4, 5
  1. 1Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA
  2. 2Department of Anesthesiology, Weill Cornell Medicine, New York, USA
  3. 3HSS Research Institute, Hospital for Special Surgery, New York, USA
  4. 4Department of Anesthesiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
  5. 5Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria

Abstract

Background and Aims Dronabinol is an FDA-approved synthetic delta-9-tetrahydrocannabinol medication indicated for chemotherapy-induced nausea and vomiting and cachexia associated with AIDS. It can also be used off-label for various reasons. The primary aims of this institutional retrospective chart review study were to determine the prevalence of and reasons for inpatient dronabinol use in orthopedic surgical patients. We hypothesized that dronabinol is being prescribed off-label to surgical patients to manage perioperative pain.

Methods After IRB approval, patients who received hospital-administered dronabinol at a large, urban, high-volume orthopedic surgery hospital were identified. Demographics, co-morbidities, preoperative cannabinoid use, surgery characteristics, and prescriber data were extracted from cases between December 2020 and 2022.

Results Inpatient dronabinol use increased between 2020 and 2022 but was prescribed in <0.5% of all surgical admissions (figure 1). Preliminary review of 249 cases revealed that 91.2% (n=227) of patients used cannabis or cannabidiol prior to admission. Dronabinol was explicitly prescribed for pain management (9.6%, n=24), reduction of postoperative nausea and vomiting (3.6%, n=9), appetite stimulation (5.2%, n=13), sleep (3.2%, n=8) and prevention or mitigation of cannabis withdrawal symptoms (4.0%, n=10) during hospitalization. Physician assistants ordered 47.8% (n=119) of the inpatient prescriptions (table 1).

Abstract EP098 Figure 1
Abstract EP098 Figure 1

Number of surgical cases with hospital-administered dronabinol

View this table:
Abstract EP098 Table 1

Patient and case characteristics

Conclusions Dronabinol was prescribed off-label for various perioperative issues, primarily to patients who reported preoperative cannabis use. Due to legal restrictions by the US federal government, patients cannot bring and use their cannabis products within a hospital setting, leaving them vulnerable to potential withdrawal symptoms or inadequately managed pain. Dronabinol may be a legal cannabinoid option for cannabis users during hospitalization.

  • cannabinoids
  • dronabinol
  • inpatient
  • orthopedics
  • surgery

https://doi.org/10.1136/rapm-2023-ESRA.160

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