# Combined Impact of Cannabinoids and Cocaine on Outcomes of Trauma Patients.

> **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637)
> **Publisher:** CED Clinic (https://cedclinic.com)
> **Canonical URL:** https://cedclinic.com/cannabinoids-cocaine-trauma-mortality-outcomes-study/
> **Published:** 2026-04-29T05:02:38-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T09:59:31-04:00
> **Clinical Summary:** New study finds no difference in hospital mortality between trauma patients using cannabinoids plus cocaine versus cannabinoids alone. Clinical implications rev

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CED Clinical Relevance  #56Monitored Relevance
Evidence Brief | CED ClinicTrauma patients testing positive for both cannabinoids and cocaine showed similar in-hospital mortality compared to those testing positive for cannabinoids alone in a large registry analysis.
TraumaCannabisCocainePolysubstanceMortality

Trauma patients testing positive for both cannabinoids and cocaine showed similar in-hospital mortality compared to those testing positive for cannabinoids alone in a large registry analysis.

What This Study Teaches Us

This registry analysis suggests that concurrent cocaine use may not substantially worsen mortality outcomes in trauma patients who already test positive for cannabinoids. The propensity score matching approach helps control for baseline differences between polysubstance and single-substance users, providing a more balanced comparison than crude analyses.

Why This Matters
Clinicians managing trauma patients with positive toxicology screens need evidence-based risk stratification. This data suggests that cannabinoid-positive patients may not require different acute care protocols based solely on concurrent cocaine detection, though other morbidity outcomes remain unexplored.

Study Snapshot

Study Type
Retrospective Cohort Study

Population
Trauma patients from TQIP database 2019-2023, n=120,951 total, with 12,116 matched pairs analyzed

Intervention
Pre-injury cannabinoid and cocaine use (CANB+COC group)

Comparator
Pre-injury cannabinoid use alone (CANB only group)

Primary Outcome
In-hospital mortality

Key Finding
No statistically significant difference in mortality between groups after propensity score matching

Journal
Surgery in Practice and Science

Year
2024

Clinical Bottom Line
In trauma patients testing positive for cannabinoids, concurrent cocaine use was not associated with increased in-hospital mortality after controlling for baseline characteristics. This finding may inform [risk assessment](https://cedclinic.com/ethical-legal-dilemmas-cannabis-use/) and resource allocation in trauma care settings.

What This Paper Does Not Show
This analysis does not demonstrate causation, examine non-mortality outcomes like length of stay or complications, or account for timing, dosage, or patterns of [substance use](https://cedclinic.com/stroke-risk-assessment-substance-use/). The study cannot determine whether cannabinoids or cocaine directly influence trauma outcomes versus serving as markers for other risk factors.

Where This Paper Deserves Skepticism
Registry data relies on toxicology testing that may miss recent use or detect metabolites from remote exposure. Propensity matching, while helpful, cannot control for unmeasured confounders like socioeconomic factors or chronic health conditions that influence both [substance use](https://cedclinic.com/stroke-risk-assessment-substance-use/) and trauma outcomes.

Dr. Caplan's Take
This finding surprises me given cocaine’s known cardiovascular and hemodynamic effects that could theoretically worsen trauma outcomes. However, registry studies like this are hypothesis-generating rather than definitive. I would not change my [clinical assessment](https://cedclinic.com/cannabis-use-disorder-neurobiology-attention-findings/) based on this single study, but it does suggest our assumptions about [polysubstance use](https://cedclinic.com/nicotine-e-cigarettes-smoking-cessation-success-umass-amherst/) in trauma may need refinement.

What a Careful Reader Should Take Away

This large registry analysis provides reassuring preliminary evidence that concurrent cocaine use may not worsen short-term mortality in cannabinoid-positive trauma patients. However, this observational finding requires validation and should not influence [clinical decision-making](https://cedclinic.com/cannabinoids-mental-health-systematic-review-evidence-insights/) about substance use screening or acute trauma management protocols.

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Table of Contents

- [FAQ](#FAQ)[Does concurrent cocaine use increase mortality risk in trauma patients who test positive for cannabinoids?](#Does_concurrent_cocaine_use_increase_mortality_risk_in_trauma_patients_who_test_positive_for_cannabinoids)
- [How common is polydrug use involving cannabis and cocaine in trauma patients?](#How_common_is_polydrug_use_involving_cannabis_and_cocaine_in_trauma_patients)
- [Should emergency physicians modify treatment protocols for trauma patients with positive drug screens for both cannabis and cocaine?](#Should_emergency_physicians_modify_treatment_protocols_for_trauma_patients_with_positive_drug_screens_for_both_cannabis_and_cocaine)
- [What are the limitations of this study’s findings for clinical decision-making?](#What_are_the_limitations_of_this_study8217s_findings_for_clinical_decision-making)
- [How should this research influence trauma center policies regarding drug screening?](#How_should_this_research_influence_trauma_center_policies_regarding_drug_screening)
- [Related](#Related)

## FAQ

#### Does concurrent cocaine use increase mortality risk in trauma patients who test positive for cannabinoids?

According to this large registry study of over 120,000 trauma patients, there was no significant difference in in-hospital mortality between patients testing positive for both cannabinoids and cocaine versus those testing positive for cannabinoids alone. This finding was confirmed using propensity score matching to control for baseline differences between groups.

#### How common is polydrug use involving cannabis and cocaine in trauma patients?

The study identified 12,116 matched pairs from a dataset of 120,951 qualifying trauma patients, indicating that concurrent cannabinoid and cocaine use represents a substantial subset of trauma cases. This highlights the clinical importance of understanding polydrug effects in emergency settings.

#### Should emergency physicians modify treatment protocols for trauma patients with positive drug screens for both cannabis and cocaine?

Based on this evidence showing similar mortality outcomes between cannabinoid-only and cannabinoid-plus-cocaine groups, standard trauma protocols should remain the primary focus. However, clinicians should still consider potential drug-related complications and interactions when managing these patients.

#### What are the limitations of this study’s findings for clinical decision-making?

While this study provides valuable mortality data, it was limited to in-hospital outcomes and may not capture longer-term effects or non-fatal complications. The study also relied on toxicology screening, which may not reflect recent use timing or dosage levels that could influence clinical outcomes.

#### How should this research influence trauma center policies regarding drug screening?

This study supports continued routine toxicology screening in trauma patients as it provides important epidemiological data, but suggests that positive screens for both substances may not require additional mortality risk stratification. The focus should remain on evidence-based trauma care protocols regardless of polydrug screen results.

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### Related

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### Verification & Medical Governance

- **Lead Clinical Author:** Benjamin Caplan, MD
- **Credentials:** Board Certified in Family Medicine (ABFM), Former CMO Canna Care Docs (250,000+ patients supervised), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House).
- **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`).
- **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/).
- **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637).
- **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).