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Video

Head and Neck Surgery

(A515) Cannabis Use and Post-Tonsillectomy Pain Management: Associations with Opioid Prescriptions

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Sara Muttar, BA

    MS3
    Northwestern University Feinberg School of Medicine
    Skokie, Illinois, United States

    • Co-Author(s)

  • OA

    Oluwatobiloba O. Ayo-Ajibola, BS

    Medical Student
    Keck School of Medicine of USC
    Los Angeles, CA, United States

    • Co-Author(s)

  • AP

    Asher C. Park, Other

    Medical Student
    Northwestern University Feinberg School of Medicine
    Chicago, Illinois, United States

  • Jonathan D. West, MD

    Resident
    University of Southern California/LAC USC Med Ctr
    Los Angeles, California, United States

    • Senior Author(s)

  • DK

    Daniel I. Kwon, MD

    Associate Professor of Head and Neck Surgery
    University of Southern California
    Los Angeles, California, United States

Disclosure(s):
Sara Muttar, BA: No relevant relationships to disclose.
Oluwatobiloba O. Ayo-Ajibola, BS: No relevant relationships to disclose.
Asher C. Park, Other: No relevant relationships to disclose.
Jonathan D. West, MD: No relevant relationships to disclose.
Daniel I. Kwon, MD: No relevant relationships to disclose.


Introduction: The relationship between cannabis use and pain management after tonsil surgery is unclear. This study evaluates how cannabis-related disorders affect opioid prescription post-tonsillectomy.

Methods: This study used the TriNetX Research database of health data from 118 million patients nationwide. The diagnosis of either cannabis dependence or abuse in the year before tonsillectomy/adenoidectomy defined patient cohorts. Exclusion criteria included prior history of opioid dependence, reception of opioids in the 6 months before surgery, and surgeries requiring anesthesia in the 6 months after surgery. We performed propensity score matching for factors associated with opioid use, including pain/psychiatric/neurologic conditions and substance abuse. The primary outcome was the receipt of a post-operative opioid or non-opioid prescription at 0-2, 2-6, and 6-12 weeks post-operation. Secondary outcomes included post-operative visits. After 1:1 matching, relative risks (RR) of outcomes were reported (significance set to p< 0.05).

Results: From January 2010 to August 2024, 321,762 patients received a tonsillectomy. 3,543 patients had a history of cannabis dependence or abuse (CDA: 1.10%) with 1,205 patients in each matched cohort (CDA and patients without a history of dependence/abuse (NCDA)). Within 2 weeks postoperatively, the CDA cohort was less likely to receive opioids (RR:0.77, 95%CI: 0.66-0.91, p< 0.001), more likely to be prescribed non-opioid analgesics (0.72, 0.61-0.85, p< 0.001) and receive a pain diagnosis (0.61, 0.44-0.84, p=0.003). They were less likely to present for follow-up at 2 (0.39, 0.28-0.53, p< 0.001), 6 (0.44, 0.36-0.54, p< 0.001), and 12 weeks (0.34, 0.21-0.55, p< 0.001). CDAs exhibited a significantly higher likelihood of ED visits after 6 weeks (1.66, 1.05-2.61, p=0.028).

Conclusions: As cannabis use history is associated with increased rates of pain and decreased rates of opioid prescription, it is essential to assess cannabis use before tonsillectomy and provide tailored yet equitable pain management strategies for those with cannabis-related disorders.