Two new studies published in 2026 point to the same uncomfortable conclusion. Cannabis surgical risk is real, it is measurable, and the health system is not doing enough to address it. One study links cannabis use to significantly higher rates of complications after lower extremity fracture surgery. The other finds that most older adults who use cannabis are never screened or asked about it by their doctor.

Together, they make a compelling case that rising cannabis use is outpacing clinical readiness.

Fracture Surgery Outcomes Worsened by Cannabis Use

A large retrospective cohort study appeared in Scientific Reports in June 2026. It examined more than 241,000 adults who had surgical fixation of lower extremity fractures between 2015 and 2023. Researchers from the University of California, Los Angeles drew on de-identified electronic health records from over 90 health systems via the TriNetX Research Network. They compared outcomes across four groups: cannabis-only users, nicotine-only users, concurrent users of both substances, and non-users.

The findings were striking. Cannabis-only users were more than twice as likely to develop a deep implant infection compared with matched non-users. The risk ratio was 2.26. They also faced a 46% higher rate of nonunion or malunion, meaning the fractured bone failed to heal correctly. Reoperation rates were 30% higher. Blood transfusion rates were 70% higher.

Anxiety, Depression and Readmission Also Elevated

Cannabis surgical risk extended well beyond the operating theatre. Cannabis users were more than twice as likely to develop anxiety after surgery, with a risk ratio of 2.15. They were twice as likely to receive a diagnosis of depression, with a risk ratio of 2.01. Hospital readmission within one year was also significantly more common among cannabis users.

Nicotine-only users fared worse across a broader range of outcomes. These included wound dehiscence, pneumonia, myocardial infarction and death. But the most concerning findings came from patients using both substances at once.

Concurrent Use Compounds the Risk

Patients using cannabis and nicotine together faced higher rates of superficial wound infection and deep implant infection. Respiratory failure and amputation rates were also elevated when compared with cannabis-only users. Reoperation risk was 29% higher. Opioid prescribing after surgery was more than twice as common.

The authors described this as compounded perioperative risk. Both substances appear to work through overlapping mechanisms. They affect immune cell recruitment, inflammation resolution and wound healing. Cannabinoids suppress cytokine signalling. They may also reduce the body’s ability to mount an effective immune defence after surgical trauma.

No Evidence That Cannabis Reduces Opioid Use

One finding challenges a claim made by some cannabis advocates. Some argue that cannabis reduces reliance on opioids in pain management. This study found no evidence of that in a surgical population. Among concurrent users, opioid prescribing was actually higher.

The researchers also noted that cannabis exposure in the database was almost certainly undercounted. The National Survey on Drug Use and Health estimates that 6.8% of Americans aged 12 and over have a cannabis use disorder. That would predict around 10.2 million cannabis users in the TriNetX network. Yet only 1.67 million patients, roughly 1.11%, carried the relevant ICD-10 diagnosis code. This gap points to widespread underreporting and inconsistent clinical screening.

Most Older Cannabis Users Are Never Asked About It

A second study in the American Journal of Preventive Medicine in 2026 found cannabis complications after surgery are not the only concern. Older adults using cannabis are largely invisible to the healthcare system. The researchers drew on three years of nationally representative NSDUH data. The sample covered more than 14,000 adults aged 65 and over who had visited a healthcare provider in the previous year.

Only 36.8% reported that a doctor had ever asked whether they used cannabis or other illegal drugs. Among Hispanic and Latine older adults, that figure dropped to just 28%.

Fewer Than 1 in 5 Cannabis Users Had a Conversation

Among the 8.1% of older adults who reported past-year cannabis use, only 19.2% had discussed it with a clinician. Over 43% reported no screening and no discussion at all.

Discussions were more likely among people with two or more chronic conditions. The adjusted risk ratio was 1.78. They were also more likely among those with mild mental illness, adjusted risk ratio of 2.62. Among Hispanic and Latine older adults, however, discussions were far less common. Their adjusted risk ratio was 0.23 compared with White older adults. Female older adults were also less likely to discuss cannabis use than men who had already been screened.

Clinicians Are Often Unprepared

The study cited several reasons why these conversations rarely happen. Clinicians report knowledge gaps around cannabis. Many are uncertain about their role in states that have legalised medical cannabis. Some feel uncomfortable raising the topic. One study of Veterans Health Administration clinicians found that nearly a third did not routinely ask patients about cannabis use.

A Growing Population at Higher Risk

The scale of the problem is set to increase. Since 2022, daily cannabis users in the United States have outnumbered daily alcohol drinkers. Nearly half of all cannabis consumers report daily or near-daily use. All baby boomers will be over 65 by 2030. They are the first generation to have grown up with widespread cannabis availability.

Older adults face greater risks from psychoactive substances than younger people. Chronic disease is more prevalent. Medication regimens are more complex. Cannabis-related emergency department visits among adults aged 65 and over have risen sharply in California and Ontario, Canada over the past decade.

What Needs to Change

These two studies together expose a clear system-level gap. Cannabis surgical risk is now well-documented across multiple outcomes. Yet the clinical infrastructure for identifying and addressing cannabis use before surgery remains underdeveloped.

The TriNetX study called for universal preoperative cannabis screening in line with ASRA Pain Medicine consensus guidelines. These recommend assessing product type, route of administration, frequency and timing of last use. Surgeons need this information to counsel patients and manage perioperative risk.

Structural Fixes Are Available

The NSDUH study pointed to practical tools already available. Validated single-item screening questions can be integrated into routine clinical visits with minimal effort. Embedding cannabis screening in electronic health records would help ensure it happens consistently.

Gaps in screening among Hispanic and Latine older adults and among women are not individual failings. They reflect systemic barriers around language access, cultural competence and clinician bias. These require structural solutions.

Both studies make clear that cannabis complications after surgery and inadequate screening represent two sides of the same problem. The drug is more available, more widely used and more accepted than ever. The health system needs to respond accordingly.

Source: dbrecoveryresources