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.