(O-H2) Understanding the Effect of Recreational Drug Use on Bone Health and Musculoskeletal Disease in Establishment of Pain Regimens

Objectives: To review the pathophysiology and deleterious effects of recreational drug use on bone health and musculoskeletal disease in order to establish appropriate screening and pain management regimens.

Background: In the past decade, recreational drug use has become rampant within the United States. The widespread use of recreational drugs raises significant concern regarding their effects on various organ systems. In addition, the use of cannabis and opioids in chronic pain management increases the prevalence of these substances among patients with musculoskeletal conditions whose bone health may already be compromised.

Methods: A literature review was conducted on the epidemiology, pathophysiology, and side effects of recreational drug use on musculoskeletal disease and bone health. Such information was utilized in the establishment of pain regimens and screening protocols for recreational drug users with chronic pain presenting to outpatient clinic and emergency departments.

Results: Cannabis, stimulants, opioids, hallucinogens, and inhalants are the most frequently used drugs in the U.S, especially among the adolescent population. [table 1]. Illicit substance use is particularly prevalent among individuals with chronic musculoskeletal ailments due to the analgesic effects of such substances. Despite their analgesic effects, cannabis, stimulants, opioids, and inhalants impact bone maintenance, specifically osteoblast and osteoclast activity, as well as impede hormone production. [table 2] Such substances therefore lead to inhibition of bone remodeling and development, manifesting as lower bone mineral density and increased fracture risk in chronic users. Consideration of their overall lower bone mineral density and increased fracture risk is crucial in establishment of acute and chronic pain regimens for such patients.

Conclusions: Although current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease, further research is warranted to evaluate the clinical effects of long-term substance use. Evaluation of such effects will aid in establishing appropriate pain management regimens, as well as appropriate screening and treatment plans for recreational drug users within outpatient clinics and emergency department visits.

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Funding (Optional): None