# 12-Month Patient-Reported Outcomes Among Urine Toxicology-Identified Substance Users After Elective Spine Surgery: A Prospective Longitudinal Cohort Study. > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/12-month-patient-reported-outcomes-among-urine-toxicology-identified-substa/ > **Published:** 2026-04-28T07:04:20-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T17:16:12-04:00 > **Clinical Summary:** While prior studies have examined the role of opioids, alcohol, and marijuana use on early postoperative outcomes after elective spine surgery, longitudinal ... --- CED Clinical Relevance  #60Notable Clinical Interest  Emerging findings or policy developments worth monitoring closely. 🔬 Evidence Watch  |  CED Clinic Journal Neurosurgery Study Type Cohort Population Human participants Why This Matters This item covers developments relevant to [cannabis medicine](https://cedclinic.com/essential-oils-industrial-hemp-antimicrobial-benefits/) and [clinical practice](https://cedclinic.com/cannabis-reproductive-health-women-clinical-evidence/). Clinicians monitoring evidence in this area should review the source material. Clinical Summary While prior studies have examined the role of opioids, alcohol, and marijuana use on early postoperative outcomes after elective spine surgery, [longitudinal studies](https://cedclinic.com/young-adult-substance-use-risks-memory-at-65/) evaluating the impact of objectively identified preoperative [substance use](https://cedclinic.com/stroke-risk-assessment-substance-use/) on 12-month outcomes are lacking. This prospective cohort study included adults who underwent preoperative urine toxicology (UTox) screening followed by elective spine surgery between September 2020 and February 2024. Chart review and phone outreach were completed to collect demographic, UTox, surgical, and patient-reported outcomes measures (PROMs) data up to 1-year postoperatively. PROMs, overall and stratified by UTox-identified alcohol, marijuana, and opioid use, were evaluated using repeated-measures analysis of variance (ANOVA) and mixed-effects regression analyses, adjusting for age, sex, BMI, comorbidities, and neurosurgical history. Among 185 participants (mean age 59.5, 57% female), preoperative UTox revealed 16% alcohol use, 23% marijuana Dr. Caplan’s Take “This is a development worth tracking. The clinical implications will become clearer as more evidence accumulates.” Clinical Perspective 🧠 Clinicians should review this item in the context of their current practice and patient population. 💬 Join the Conversation Have a question about how this applies to your situation? [Ask Dr. Caplan →](https://benjamincaplan.com/ask-dr-caplan) Want to discuss this topic with other patients and caregivers? [Join the forum discussion →](https://cedclinic.com/interact/discussion-forums/forum/cannabis-industry/) Have thoughts on this? Share it: [X Share on X](https://twitter.com/intent/tweet?text=Just%20read%20this%20on%20CEDclinic.com%3A%2012-Month%20Patient-Reported%20Outcomes%20Among%20Urine%20Toxicology-Identified%20Substance%20Users%20After%20Elective%20...%20%40drcaplan&url=https%3A%2F%2Fcedclinic.com%2F12-month-patient-reported-outcomes-among-urine-toxicology-identified-substa%2F)[in Share on LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fcedclinic.com%2F12-month-patient-reported-outcomes-among-urine-toxicology-identified-substa%2F)[🦅 Share on BlueSky](https://bsky.app/intent/compose?text=Just%20read%20this%3A%2012-Month%20Patient-Reported%20Outcomes%20Among%20Urine%20Toxicology-Identified%20Substance%20Users%20After%20Elective%20...%20via%20%40drcaplan.bsky.social%20https%3A%2F%2Fcedclinic.com%2F12-month-patient-reported-outcomes-among-urine-toxicology-identified-substa%2F)[📷 Follow on Instagram](https://www.instagram.com/drbenjamincaplan)[📝 Read more on Substack](https://doctorapprovedcannabis.substack.com/)[🔔 Subscribe via RSS](https://cedclinic.com/feed/) 📰 Source: [https://pubmed.ncbi.nlm.nih.gov/41837649/](https://pubmed.ncbi.nlm.nih.gov/41837649/) Table of Contents - [FAQ](#FAQ)[What gap in spine surgery research did this study aim to fill?](#What_gap_in_spine_surgery_research_did_this_study_aim_to_fill) - [How did researchers determine which patients were using substances before surgery?](#How_did_researchers_determine_which_patients_were_using_substances_before_surgery) - [How long were patients followed after their spine surgery?](#How_long_were_patients_followed_after_their_spine_surgery) - [Did the analysis account for age and other health differences?](#Did_the_analysis_account_for_age_and_other_health_differences) - [How common was marijuana use among patients in this study?](#How_common_was_marijuana_use_among_patients_in_this_study) - [Related](#Related) ## FAQ ### What gap in spine surgery research did this study aim to fill? Earlier studies had looked at how opioid, alcohol, and marijuana use affect early outcomes after elective spine surgery. What was missing were [longitudinal studies](https://cedclinic.com/young-adult-substance-use-risks-memory-at-65/) of how [substance use](https://cedclinic.com/stroke-risk-assessment-substance-use/) that is objectively identified before surgery relates to outcomes 12 months later, which is the question this prospective cohort study set out to address. ### How did researchers determine which patients were using substances before surgery? Substance use was identified objectively through urine toxicology screening, known as UTox, performed before surgery. The study included adults who had this preoperative screen and then went on to have elective spine surgery between September 2020 and February 2024. ### How long were patients followed after their spine surgery? Patients were followed for up to one year after surgery. The researchers used chart review and phone outreach to collect demographic, urine toxicology, surgical, and patient-reported outcome measures, so that recovery could be tracked through the 12-month postoperative period rather than only in the early phase after surgery. ### Did the analysis account for age and other health differences? Yes. Patient-reported outcomes were evaluated overall and separately for alcohol, marijuana, and opioid use, using repeated-measures analysis of variance and mixed-effects regression. These analyses adjusted for age, sex, body mass index, comorbidities, and neurosurgical history. ### How common was marijuana use among patients in this study? Among the 185 participants, whose average age was 59.5 years and 57% of whom were female, preoperative urine toxicology detected marijuana use in 23% and alcohol use in 16%. These figures reflect what the screening test detected before surgery. 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