# Friend or Foe: The Use of Cannabis as a Potential Analgesic in Postoperative Lumbar Spine Surgery. > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/ced-mental-health-comorbidities-and-surgical-reco-2026-10-23/ > **Published:** 2026-10-23T09:45:02-04:00 | **Last Modified / Clinically Audited:** 2026-10-23T09:45:02-04:00 > **Clinical Summary:** cannabis science digest: CED Clinic analysis of 3 recent cannabis policy, science, and regulatory developments with Dr. Benjamin Caplan. --- CED Clinical Relevance #65 Verified Overview Curated multi-source overview preserving 3 verified developments. Clinical Insight | CED Clinic Patients often turn to cannabis to manage the heavy emotional burden of conditions like body dysmorphic disorder or the chaotic nature of ADHD and bipolar disorder. While many use it for relaxation, the transition to coping-motivated use serves as a significant clinical red flag for underlying distress and potential self-harm. In surgical settings, the absence of high-quality evidence creates a vacuum where patients self-treat without clear guidance. We must move beyond binary views of cannabis as a panacea or a poison. Focusing on the specific context and intent behind a patient’s consumption patterns provides the most useful path forward. DigestCannabis ScienceRegulationPublic HealthClinical Practice AudiencePatients, clinicians, healthcare professionals, regulators, and industry researchers. Primary TopicClinical and policy analysis: Friend or Foe: The Use of Cannabis as a Potential Analg. Source[Read the full source](https://pubmed.ncbi.nlm.nih.gov/42892277/) Table of Contents - [Friend or Foe: The Use of Cannabis as a Potential Analgesic in Postoperative Lumbar Spine Surgery.](#Friend_or_Foe_The_Use_of_Cannabis_as_a_Potential_Analgesic_in_Postoperative_Lumbar_Spine_Surgery)[How to Interpret This Cannabis Science & Research Digest](#How_to_Interpret_This_Cannabis_Science_Research_Digest)[Three Rules for Critical Reading](#Three_Rules_for_Critical_Reading) - [CED Perspective Lens: Eight Viewpoints on These Updates](#CED_Perspective_Lens_Eight_Viewpoints_on_These_Updates)[Understanding Your Motives](#Understanding_Your_Motives) - [Screening for Risk](#Screening_for_Risk) - [Context and Complications](#Context_and_Complications) - [Integrated Care Needs](#Integrated_Care_Needs) - [Closing the Evidence Gap](#Closing_the_Evidence_Gap) - [Questioning the Data](#Questioning_the_Data) - [Observing Use Patterns](#Observing_Use_Patterns) - [Context is Everything](#Context_is_Everything) - [Frequently Asked Questions](#Frequently_Asked_Questions)[Related](#Related) # Friend or Foe: The Use of Cannabis as a Potential Analgesic in Postoperative Lumbar Spine Surgery. A structured CED Clinic overview of 3 key developments in cannabis regulation, market milestones, and scientific research. What This Study Teaches Us In a 28 day study of 87 adults with body dysmorphic disorder, 67.8% reported alcohol or cannabis use, with coping motives increasing the odds of suicidal desire by three to four times. National data from 5,691 patients with comorbid ADHD and bipolar disorder showed that 7.9% were diagnosed with cannabis dependence. Review of lumbar spine surgery outcomes indicates a lack of Level I evidence for cannabis as a perioperative analgesic despite its frequent use. Why This Matters Identifying the specific motives for use, such as emotional coping, helps clinicians screen for elevated suicide risk in vulnerable psychiatric populations. Understanding the prevalence of cannabis dependence in complex comorbid cases allows for more tailored harm reduction strategies during surgical recovery. Study SnapshotPost TypeCannabis Science & Research Digest using canonical CED layoutItems Reviewed3 verified updatesPrimary DatesOctober 23, 2026Related Reading3 verified live CED Clinic internal linksUpdate 1Real-world substance use in body (Jonathan et al., Body image) [DOI: 10.1016/j.bodyim.2026.102197 | PMID: 42892277]Update 2Substance use diagnoses among patients (Ramdin et al., Journal of addictive diseases) [DOI: 10.1080/10550887.2026.2733227 | PMID: 42878529]Update 3Friend or Foe: The Use (Tuluca et al., Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews) [DOI: 10.5435/JAAOSGlobal-D-25-00326 | PMID: 42878555] Clinical Bottom Line This clinical and regulatory overview preserves key signals across 3 updates without overstatement, offering grounded guidance for patients and practitioners. Context Across These 3 Updates This curated cannabis science & research digest brings together 3 key developments across clinical investigations, epidemiological surveys, and therapeutic data. Reviewing these distinct updates side by side clarifies emerging patterns while preserving the specific clinical context of each report. Examining these developments concurrently helps clinicians, patients, and families trace the broader trajectory of the field while grounding practical decisions in verified primary data. Update 1: Real-world substance use in body dysmorphic disorder: An **Title & Source:** [Real-world substance use in body dysmorphic disorder: An ecological momentary assessment study of motives, contexts, and suicidal ideation.](https://pubmed.ncbi.nlm.nih.gov/42892277/) (*Body image*, 2026Oct17) **Lead Authors & Identifiers:** Geneva K Jonathan, Sara Velazquez, A Eden Evins, Bettina B Hoeppner et al.. | **Primary Record:** DOI: 10.1016/j.bodyim.2026.102197 | PMID: 42892277 Content lane: **Evidence Check**. **Investigational Focus:** This study used ecological momentary assessment to track 87 adults with body dysmorphic disorder over 28 days. The researchers examined the motives and contexts of alcohol and cannabis use in real-time. **Key Findings & Primary Data:** Among the participants, 67.8% reported substance use. Coping-motivated surveys were associated with a three- to four-fold increase in the odds of suicidal desire compared to other motives. **Clinical Guidance:** Clinicians should screen for coping-motivated substance use as a potential marker for suicide risk in patients with body dysmorphic disorder. Social or relaxation motives do not appear to carry the same level of risk. **Study Boundaries:** The study relied on a relatively small sample size and self-reported data. The findings may not generalize to all individuals with body dysmorphic disorder. Update 2: Substance use diagnoses among patients who present to **Title & Source:** [Substance use diagnoses among patients who present to federally run mental health facilities with co-morbid ADHD and bipolar disorder between 2013-2023: a national analysis using random forest methods.](https://pubmed.ncbi.nlm.nih.gov/42878529/) (*Journal of addictive diseases*, 2026Oct15) **Lead Authors & Identifiers:** Christine Ramdin, Jamey J Lister, Ellen Kurtzman, Sally Kuo et al.. | **Primary Record:** DOI: 10.1080/10550887.2026.2733227 | PMID: 42878529 Content lane: **Safety Signal**. **Investigational Focus:** Researchers analyzed national mental health data from 2013 to 2023 to identify trends in substance use among patients with comorbid ADHD and bipolar disorder. The study utilized random forest models to identify key predictors of these diagnoses. **Key Findings & Primary Data:** The analysis included 5,691 patients, all of whom had a documented substance use disorder. Cannabis dependence was the third most common specific diagnosis, affecting 7.9% of the cohort. **Clinical Guidance:** Patients with comorbid ADHD and bipolar disorder require integrated screening for substance use disorders. Employment status and education level were identified as significant predictors of these co-occurring conditions. **Study Boundaries:** The data was limited to patients at federally run facilities. This may not reflect the prevalence or trends in the general population or private healthcare settings. Update 3: Friend or Foe: The Use of Cannabis as **Title & Source:** [Friend or Foe: The Use of Cannabis as a Potential Analgesic in Postoperative Lumbar Spine Surgery.](https://pubmed.ncbi.nlm.nih.gov/42878555/) (*Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews*, 2026Oct01) **Lead Authors & Identifiers:** Andrei Tuluca, Jonathan Boyce, Gregory Schneider, Eric A Williams. | **Primary Record:** DOI: 10.5435/JAAOSGlobal-D-25-00326 | PMID: 42878555 Content lane: **Clinical Evidence Update**. **Investigational Focus:** This literature review evaluated the evidence for using cannabis as an analgesic following lumbar spine surgery. The authors sought to consolidate current research on perioperative cannabis utility and identify gaps in the evidence. **Key Findings & Primary Data:** The review found conflicting research regarding the benefits and risks of cannabis use in surgical patients. There is currently a lack of Level I evidence to support definitive clinical recommendations for its use as a postoperative pain mitigator. **Clinical Guidance:** Surgeons should engage in open discussions with patients about their cannabis use while acknowledging the current uncertainty in the literature. A cautious approach is warranted until more rigorous clinical trials are completed. **Study Boundaries:** The review is limited by the quality of the underlying studies, which are often retrospective or observational. The lack of standardized dosing and formulations in the literature makes it difficult to draw firm conclusions. How Strong Is This Evidence? The EMA study provides high-resolution temporal data on 87 participants. The national mental health analysis utilizes a large cohort of 5,691 patients over a decade. The surgical review highlights a significant gap in Level I clinical trials, relying instead on retrospective data and literature summaries. Where This Paper Deserves Skepticism The EMA study relies on self-reported data which may be subject to recall bias. The national database analysis of ADHD and bipolar disorder is limited by its focus on federally run facilities. This focus potentially excludes patients in private care settings who may have different patterns of use. What This Paper Does Not Show These studies do not prove that cannabis causes suicidal ideation. They also do not establish a definitive causal link between ADHD medications and the development of cannabis dependence. How This Fits With the Broader Clinical Conversation The intersection of cannabis use and complex psychiatric profiles is becoming a focal point of modern behavioral health. As more patients with multifaceted diagnoses like ADHD and bipolar disorder gain access to legal cannabis, the clinical community faces the challenge of distinguishing between therapeutic use and maladaptive coping. This distinction is vital for providing safe and effective care in an era of increasing availability. Simultaneously, the surgical community is grappling with the lack of standardized protocols for perioperative cannabis management. The shift away from opioids has accelerated interest in alternatives, yet the clinical data remains fragmented. This leaves both surgeons and patients in a state of uncertainty regarding optimal dosing and timing for pain management during recovery. Editorial Commentary *When I talk with patients who have complex mental health histories, the conversation usually centers on why they are reaching for a product at a specific moment. If the goal is to quiet a mind racing from ADHD or to soften the edges of a depressive episode, the risk profile changes. The data showing that coping-motivated use correlates with suicidal desire is a sobering reminder that the intent matters just as much as the substance.* *In the surgical realm, the tension is real. Patients are often told to stop all cannabis use before a procedure due to anesthesia concerns, yet they are left without a plan for managing the pain that cannabis was helping them endure. We need to bridge this gap with more nuanced, patient-centered research that respects the reality of their lived experience. Rigid rules often fail to account for the complex needs of the individual.* What a Careful Reader Should Take Away Clinicians should prioritize assessing the underlying motives for cannabis use in psychiatric patients and maintain a high index of suspicion for surgical patients self-managing pain without professional guidance. [https://cedclinic.com/ask](https://cedclinic.com/ask)Ask about this study:[💢Pain](https://cedclinic.com/ask)[🛡️Use Disorder](https://cedclinic.com/ask)[🛡️Safety](https://cedclinic.com/ask)[🔎This study's limits](https://cedclinic.com/ask) Evidence Interpretation Guide ## How to Interpret This Cannabis Science & Research Digest Clinical decision-making requires balancing large-scale trends with the intimate, day-to-day realities of patient behavior. ### Three Rules for Critical Reading **Contextualize the Motive**Look beyond the frequency of use to understand if a patient is seeking social connection or escaping emotional pain. **Recognize Comorbidity Risks**Acknowledge that patients with multiple psychiatric diagnoses are statistically more likely to develop dependence. **Demand Better Data**Question the lack of controlled trials in surgical settings before making rigid recommendations for or against use. Key Evaluation Question How does the specific intent behind a patient’s cannabis use alter their long-term risk for adverse mental health outcomes? The Patient Question If I am using cannabis to cope with my mood or body image, does that change the way we should monitor my safety? The Bottom Line Effective cannabis care requires a deep understanding of the patient’s psychological state and the specific clinical environment. CED Perspective Lens ## CED Perspective Lens: Eight Viewpoints on These Updates Why these developments matter across clinical, patient, safety, and policy perspectives Lens OverviewEight distinct clinical and regulatory perspectives on Friend or Foe: The Use of Cannabis as a Poten. #### Understanding Your Motives Understanding why you reach for cannabis is just as important as the dose you take. If you find yourself using it to escape difficult emotions or thoughts about your appearance, it may be a sign that you need more support. This research shows that using cannabis for coping can sometimes be linked to deeper distress. Talk openly with your care team about your goals for using cannabis, especially if you are preparing for a major surgery. Being honest about your habits helps your doctors keep you safe during anesthesia and recovery. Your safety depends on a clear plan that addresses both your physical pain and your mental well-being. Lens takeawayReflect on your motives for using cannabis and share them with your healthcare provider. #### Screening for Risk Screening for substance use in patients with complex psychiatric comorbidities like ADHD and bipolar disorder is essential. These patients are at a higher risk for dependence, and their motives for use can provide critical insights into their mental state. Coping-motivated use should be viewed as a potential indicator of increased suicide risk. In the absence of Level I evidence for surgical patients, clinicians must rely on thorough histories and patient-centered discussions. Balancing the potential for pain relief with the risks of perioperative complications requires a nuanced approach. Stay informed about emerging data to provide the best guidance for those navigating recovery. Lens takeawayUse patient motives and psychiatric history to guide risk assessment and perioperative planning. #### Context and Complications Safety in cannabis use is about the product itself and the psychological context of the user. Patients using cannabis to manage severe emotional distress may be at a higher risk for self-harm. Monitoring these patients closely during periods of high stress or after major life events is a necessary precaution. For surgical patients, the lack of clear evidence on cannabis and anesthesia creates a safety gap. Until more rigorous studies are available, the safest approach involves early disclosure and collaborative planning between the patient and the surgical team. This ensures that all potential interactions and recovery needs are addressed. Lens takeawayPrioritize psychological screening and open communication to enhance patient safety in cannabis care. #### Integrated Care Needs National data shows a steady increase in complex psychiatric patients with substance use disorders. This trend highlights the need for integrated mental health and addiction services within federal and state healthcare systems. Policy should focus on expanding access to comprehensive care that addresses the root causes of substance use. The lack of Level I evidence for cannabis in surgical settings is a direct result of its long-standing regulatory status. Rescheduling and increased funding for clinical trials are necessary to provide the data that surgeons and patients need. Clearer guidelines will only emerge when the research community can study these products without barriers. Lens takeawayAdvocate for integrated care models and fewer research barriers to improve clinical outcomes. #### Closing the Evidence Gap Ecological momentary assessment offers a powerful tool for understanding the real-time dynamics of substance use. Future research should continue to use these methods to explore the relationship between specific psychiatric symptoms and cannabis use patterns. This high-resolution data is essential for developing targeted interventions for at-risk populations. The surgical community desperately needs randomized controlled trials to evaluate the efficacy and safety of cannabis for postoperative pain. Current reviews show that retrospective data is insufficient for making firm clinical recommendations. Researchers should focus on standardized dosing and specific cannabinoid profiles to provide clearer answers for perioperative care. Lens takeawayFocus on high-resolution behavioral data and randomized trials to fill current knowledge gaps. #### Questioning the Data Self-reported data in substance use studies must be viewed with caution due to the potential for bias. While the correlation between coping motives and suicidal ideation is significant, it does not establish a causal link. We must consider other confounding factors, such as the severity of the underlying psychiatric condition, before drawing conclusions. The lack of Level I evidence in the surgical literature means that any current recommendations are based on incomplete information. We should be skeptical of claims that cannabis is a safe alternative to opioids without more rigorous testing. Until the data is more consistent, a conservative approach to perioperative cannabis use is the most logical path. Lens takeawayMaintain a critical view of self-reported data and emphasize the need for causal evidence. #### Observing Use Patterns If you are caring for someone with a complex mental health condition, pay attention to how they use cannabis. Using it to cope with bad days or negative thoughts about themselves may indicate they are struggling more than they let on. Your observations can be a vital part of their overall care plan. When a loved one is preparing for surgery, help them have a conversation with their doctor about their cannabis use. Ensuring the surgical team has a complete picture of their habits can prevent complications and lead to a smoother recovery. Your support in managing their pain and mental health is invaluable. Lens takeawayObserve use patterns and encourage open communication with the healthcare team. #### Context is Everything The primary lesson from these studies is that the context of cannabis use is a major factor in patient outcomes. Whether in a psychiatric or surgical setting, understanding the patient’s motives and history is essential for safe care. This requires a shift from simply tracking use to understanding the underlying reasons. Clinicians and patients must work together to navigate the current lack of high-quality evidence in many areas of cannabis medicine. By focusing on open communication and individualized care, we can mitigate risks and improve the quality of life for those using cannabis for therapeutic purposes. Knowledge and transparency are our best tools. Lens takeawayIntegrate motive-based screening and patient-centered planning into every cannabis-related clinical encounter. 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/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care [Dr. Benjamin Caplan, MD](https://cedclinic.com/drcaplan/) Board-Certified Family Physician • Cannabinoid Specialist • 350k+ Patients Evaluated A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Meet Dr. Caplan (CV)](https://cedclinic.com/drcaplan/) [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](http://CEDclinic.com/book) [Cannabis Care](http://CEDclinic.com/book) [https://cedclinic.com/drcaplan/](https://cedclinic.com/drcaplan/) Share this Evidence Watch [X](https://twitter.com/intent/tweet?text=Friend+or+Foe%3A+The+Use+of+Cannabis+as+a+Potential+Analgesic+in+Postoperative+Lumbar+Spine+Surgery.&url=https%3A%2F%2Fcedclinic.com%2Fced-mental-health-comorbidities-and-surgical-reco-2026-10-23%2F) [LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fcedclinic.com%2Fced-mental-health-comorbidities-and-surgical-reco-2026-10-23%2F) [BlueSky](https://bsky.app/intent/compose?text=Friend+or+Foe%3A+The+Use+of+Cannabis+as+a+Potential+Analgesic+in+Postoperative+Lumbar+Spine+Surgery.%20https%3A%2F%2Fcedclinic.com%2Fced-mental-health-comorbidities-and-surgical-reco-2026-10-23%2F) [Instagram](https://www.instagram.com/drcaplan/) [Substack](https://doctorapprovedcannabis.substack.com/) [RSS](https://cedclinic.com/feed/) Source: [Primary Sources: Body image, Journal of addictive diseases, Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews](https://pubmed.ncbi.nlm.nih.gov/42892277/) Related Reading at CED ClinicContinue exploring the evidence[The Multifaceted Impact of CBD on Sleep: A Comprehensive Guide for Better Rest](https://cedclinic.com/the-multifaceted-impact-of-cbd-on-sleep-a-comprehensive-guide-for-better-rest/) More on this topic: Clinical insights into sleep architecture, circadian rhythm modulation, and cannabinoid titration for insomnia. [More on this topic: Cannabinoids & sleep](https://cedclinic.com/the-multifaceted-impact-of-cbd-on-sleep-a-comprehensive-guide-for-better-rest/)[Cannabis Use Disorder Is Rising Among US Adults](https://cedclinic.com/cannabis-use-disorder-rising-us-adults-2026/) More on this topic: Epidemiological evaluation of diagnostic trends, screening tools, and evidence-based patient counseling. [More on this topic: CUD trends & screening](https://cedclinic.com/cannabis-use-disorder-rising-us-adults-2026/)[Cannabinoids for Low Back Pain and Migraine: What Randomized Trials Actually Show](https://cedclinic.com/ced-cannabinoids-for-low-back-pain-and-2026-09-23/) More on this topic: Rigorous physician appraisal of randomized trials investigating cannabinoid efficacy for chronic pain and migraines. [More on this topic: Chronic pain & migraine](https://cedclinic.com/ced-cannabinoids-for-low-back-pain-and-2026-09-23/) ## Frequently Asked Questions What is covered in this cannabis science & research digest? This edition reviews 3 verified developments across cannabis policy, regulatory oversight, and clinical science. How are stories selected for CED digests? Stories are curated from official primary sources, government agency dockets, and peer-reviewed journals, focusing on practical relevance for patients and clinicians. Do preliminary reports establish medical efficacy? No. Observational reports, preprints, and regulatory filings describe emerging trends and require formal clinical trials before treatment efficacy can be claimed. How should clinicians use these updates? Clinicians can use these updates to understand patient questions, stay current with state regulations, and maintain evidence-informed counseling. Where can readers find Dr. Caplan's clinical insights? Dr. Caplan provides comprehensive clinical perspectives, patient consultations, and educational resources at CEDclinic.com. Why are multi-topic digests published instead of single stories? Digests group related updates together to provide a broader thematic overview while preserving important nuances and methodological limits. What is the primary role of laboratory testing in cannabis policy? Laboratory testing verifies cannabinoid potency and screens for harmful contaminants like heavy metals, pesticides, and molds to protect consumer health. How do state regulatory milestones impact patient access? Administrative milestones establish the licensing rules, product categories, and retail standards that determine how and where registered patients obtain care. What precautions should families take with medical cannabis at home? Families should keep all medical cannabis products securely locked in child-resistant containers and clearly labeled to avoid accidental exposure. How often does CED Clinic publish clinical and policy updates? CED Clinic publishes regular morning, afternoon, and evening evidence reviews and news digests to keep the community informed. ### Related --- ### 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).