Understanding the effect of recreational drug use on bone health and musculoskeletal disease in the establishment of pain regimens

doi:10.5847/wjem.j.1920-8642.2024.062

Abstract

Abstract:

BACKGROUND The widespread use of recreational drugs has raised concerns regarding their effects on various organ systems. The use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be compromised. This article aims to review the pathophysiology and toxic effects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance use.

METHODS Medical literature published from 1970 until 2022 was identified utilizing MEDLINE/PubMed and the Cochrane Library. In addition to the databases, references were obtained through the use of reference lists of published articles identified by the aforementioned databases. The initial search terms included opioids, inhalants, hallucinogens, cannabis, stimulants, and bone health. There were no methodological limitations in relation to the initial acquisition and analysis of data.

RESULTS A total of 55 research articles were included in this review. Cannabis, stimulants, opioids, and inhalants impact bone maintenance, specifically osteoblast and osteoclast activity, as well as impede hormone production. These substances inhibit bone remodeling and development, manifesting as lower bone mineral density and increased fracture risk in chronic users.

CONCLUSION Although the 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. The evaluation of such effects will aid in establishing appropriate pain regimens, as well as appropriate screening and treatment plans for recreational drug users.

Key words: Musculoskeletal disorders, Bone health, Cannabis, Opioids, Stimulants

Ariella Gartenberg, Alexander Petrie, Winston Yen, Woojn Cho. Understanding the effect of recreational drug use on bone health and musculoskeletal disease in the establishment of pain regimens[J]. World Journal of Emergency Medicine, 2024, 15(5): 356-364.

Figures/Tables 2

Table 1.

Overview of frequently used recreational drugs in the USA

Drug class	Substances	Street name	Mechanism of action	Intoxication effects	Withdrawal effects	Treatment
Cannabinoids	· Cannabis · Cannabidiol (CBD)	Weed, grass, pot, ganja, skunk, blunts, hash, herb, joint, Mary Jane, pot, reefer, vape, and yerba	Interacts with cannabinoid receptor CB1 and CB2 leading to inhibition of adenylate cyclase	Euphoria, perceptual disturbances, mydriasis, conjunctival injection, increased appetite, dry mouth, paranoid delusions, hallucination, impaired reaction time, concentration, motor coordination, joviality, anxiety, tachycardia	Irritability, anxiety, depression, decreased appetite, weight loss, restlessness, sleep disturbances, headaches, tremors, abdominal pain, fever, chills, sweating	Intoxication · Supportive care Withdrawal · Psychosocial intervention
Stimulants	Illegal · Methamphe tamines · Cocaine · 3,4-Methyle nedioxymetha mpehtamine (MDMA) · Methcathinone · Bath salts Prescription · Adderall, Ritalin, Concerta, Vyvanse, Dexedrine · Modafinil · Fastin, Meridia, Preludin	Coke, blow, speed, uppers, crystal meth, molly, bloom, vanilla sky, ecstasy, XTC, X, bennies, crank, pellets, skippy	Cocaine · Inhibition of dopamine, serotonin, and norepinephrine uptake, increasing dopamine in the synaptic cleft Amphetamines · Increase release and inhibit reuptake of adrenaline, norepinephrine, serotonin, and dopamine leading to sympathetic stimulation MDMA · Agonist of the 5HT2A serotonin and D2 dopamine receptor and reuptake inhibitor of serotonin and dopamine, increasing their concatenations in the synaptic cleft	Euphoria, arousal, sweating, tachycardia, hypertension, chest pain, angina, mydriasis, tachyarrhythmia, hyperthermia, paranoia, hallucinations, decreased appetite, weight loss, agitation, psychosis	Depression, lethargy, anhedonia, difficulty in concentration, sleep disturbance, miosis, psychomotor agitation	Intoxication · Benzodiazepine · Labetalol · IV fluids · External cooling Withdrawal · Supportive care
Opioids	Natural · Opium Synthetic · Fentanyl · Methadone · Meperidine Semisynthetic · Heroin · Morphine · Codeine · Oxycodone · Hydrocodone · Hydromorphone	Smack, dope, horse, mud, big H, MPTP, lean, purple drank, OC, oxy, percs, vikes, and sippin syrup	Agonist effect on κ, δ, μ opioid receptors	Miosis, respiratory depression, altered mental status, constipation, bradycardia, hypothermia, seizures, rhabdomyolysis	Chills, rhinorrhea, piloerection, myalgias, nausea, vomiting, diarrhea, mydriasis, tachycardia, hypertension, hyperreflexia, insomnia, yawning, anxiety, agitation	Intoxication · Naloxone for acute overdose Withdrawal · Methadone, buprenorphine (long-acting opioids) · Cognitive behavior therapy
Hallucinogen	Classic · D-lysergic acid diethylamide (LSD) · Psilocybin · Peyote/Mescaline · N,N-dimethyl-tryptamine (DMT) Dissociative · Phencyclidine (PCP) · Ketamine · Dextrometh orphan	Acid, angel dust, peace pill, elephant tranquilizer, hog, shrooms, buttons, blotter, cubes, special K, and STP	Phencyclidine · Inhibition of dopamine, serotonin, norepinephrine reuptake LSD · Agonist of the 5HT2A serotonin receptor	Hallucinations, cognitive impairment, memory loss, speech deficits, hypertension, tachycardia, nystagmus, ataxia, muscle rigidity, palpitations, diaphoresis, tremor, blurred vision, incoordination	Not associated with symptoms of withdrawal	Intoxication · Supportive care · Benzodiazepine · External cooling · Haloperidol (for psychosis)
Inhalants	· Glue · Markers · Cleaning supplies · Spray paint · Aerosol sprays · Gases · Solvents · Nitrites	Poppers, whippits	Depression of the central nervous system	Respiratory depression, asphyxia, nausea, vomiting, nystagmus, tremor, muscle weakness, hyporeflexia, ataxia, slurred speech, headache, diplopia, hallucinations, agitation, somnolence, dizziness, confusion, drowsiness	Not associated with symptoms of withdrawal; chronic users experiencing tachycardia, irritability, hallucinations, insomnia, and headaches	Intoxication · Supportive care · Intubation · Psychotherapy

Table 1.

Table 2.

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Drug class	Effect on bone	Mechanism of action
Cannabinoids	9-tetrahydrocannabinol (THC) · Impaired bone healing · Inhibition of osteogenesis · Increased bone resorption Cannabinol (CBD) · Enhanced fracture healing · Inhibition of bone resorption	THC · Partial agonist of CB1 (higher affinity) and CB2 · Antagonist of GPR55 CBD · Antagonist of GPR55 (primary effect) · Agonist of CB2 and CB1 (less affinity)
Stimulants	Methamphetamines and cocaine · Decreased bone remodeling · Inhibition of osteogenesis · Deleterious effects on bone mass	Methamphetamines and cocaine · Upregulation of CART causes decrease in RANKL · Decrease in neuropeptide Y (NPY) levels · Catecholamine release · Penetrate and damage cell mitochondria
Opioids	Opioids including heroin · Inhibition of osteogenesis · Increased bone resorption · Progressive bone loss · Increased fracture risk	Opioids including heroin · Agonist effect on κ, δ, μ opioid receptors · Interferes with pulsatile GnRH release causing decreased primary sex hormones
Hallucinogen	Unknown	Unknown
Inhalants	Inhalant products · Delay in bone development (adolescents) · Deleterious effects on bone mass · Bone demineralization	Toluene containing products · Modulation of osteoblast and osteoclast activity