Skip to main content

A Preliminary Study on the Influence of Cannabis and Opioid Use on Weight Loss and Mental Health Biomarkers Post-weight Loss Surgery



A subpopulation of weight loss surgery (WLS) patients endorse cannabis and/or opioid use; however, impact on post-WLS anxiety and depression is unclear. This study examined the influence of the independent and combined use of cannabis and opioids on (1) depression and anxiety, (2) duodenum serotonin and cortisol, and (3) total percent weight loss.

Materials and Methods

A cross-sectional analysis was conducted among patients (N = 18) who had biomarkers of serotonin and cortisol collected from the duodenum during WLS. Cannabis and opioid use was determined by self-reported lifetime, past-year, and past 30-day use. The Beck Anxiety Inventory and Depression Inventory-II assessed depression and anxiety symptoms. Total percent weight loss was calculated from pre-WLS and post-WLS weight (kg). Chi-squared analyses and t tests were conducted.


Over a quarter (27.8%) were cannabis-only users and 16.7% used a combination of cannabis and opioids. None reported using only opioids in this sample. Combination users presented with greater depressive symptoms (22.7%, p = 0.01) and greater total percent weight loss (34.1%, p = 0.04) than cannabis users (7.8, 23.2%, respectively). Cannabis users had greater serotonin (p = 0.02) and cortisol (p = 0.01) levels than combination users and never users.


Cannabis users had greater cortisol levels than never users and combination users. Combination users had greater weight loss and depression symptoms than cannabis users. Future studies should consider a larger sample size, utilization of a cohort design to address causality, and examination of the type, dose, and route of cannabis and opioid administration to further understand the impact of the combined use of cannabis and opioids post-WLS.

This is a preview of subscription content, access via your institution.


  1. 1.

    American Society for Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011-2017. 2018; Accessed June, 2019.

  2. 2.

    Li L, Wu LT. Substance use after bariatric surgery: a review. J Psychiatr Res. 2016;76:16–29.

    Article  Google Scholar 

  3. 3.

    Spadola CE, Wagner EF, Dillon FR, et al. Alcohol and drug use among postoperative bariatric patients: a systematic review of the emerging research and its implications. Alcohol Clin Exp Res. 2015;39(9):1582–601.

  4. 4.

    King WC, Chen JY, Belle SH, et al. Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2017;13(8):1337–46.

  5. 5.

    King WC, Chen JY, Courcoulas AP, et al. Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2017;13(8):1392–402.

  6. 6.

    Conason A, Teixeira J, Hsu CH, et al. Substance use following bariatric weight loss surgery. JAMA surgery. 2013;148(2):145–50.

  7. 7.

    Vidot DC, Prado G, De La Cruz-Munoz N, et al. Postoperative marijuana use and disordered eating among bariatric surgery patients. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2016;12(1):171–8.

  8. 8.

    American Society for Metabolic and Bariatric Surgery. Clinical Practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. 2013; Accessed January 4, 2020.

  9. 9.

    American Society for Metabolic and Bariatric Surgery. Position statement: alcohol use before and after bariatric surgery. 2016; Accessed January 4, 2020.

  10. 10.

    Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: results from the 2018 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration;2019.

  11. 11.

    Bauer FL, Donahoo WT, Hollis Jr HW, et al. Marijuana’s influence on pain scores, initial weight loss, and other bariatric surgical outcomes. The Permanente journal. 2018;22:18–002.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Rummell CM, Heinberg LJ. Assessing marijuana use in bariatric surgery candidates: should it be a contraindication? Obes Surg. Oct 2014;24(10):1764–70.

    Article  Google Scholar 

  13. 13.

    Donnadieu-Rigole H, Olive L, Nalpas B, et al. Prevalence of psychoactive substance consumption in people with obesity. Substance use & misuse. 2016;51(12):1649–54.

  14. 14.

    Substance Abuse and Mental Health Services Administration. Results from the 2017 National Survey on Drug Use and Health:Detailed Tables. 2018; Accessed January 23, 2019.

  15. 15.

    Chaudhry HJ, Hengerer AS, Snyder GB. Medical board expectations for physicians recommending marijuana. Jama. 2016;316(6):577–8.

    Article  Google Scholar 

  16. 16.

    Raebel MA, Newcomer SR, Bayliss EA, et al. Chronic opioid use emerging after bariatric surgery. Pharmacoepidemiol Drug Saf. Dec 2014;23(12):1247–57.

  17. 17.

    Raebel MA, Newcomer SR, Reifler LM, et al. Chronic use of opioid medications before and after bariatric surgery. Jama. 2013;310(13):1369–76.

    CAS  Article  Google Scholar 

  18. 18.

    Cron DC, Englesbe MJ, Bolton CJ, et al. Preoperative opioid use is independently associated with increased costs and worse outcomes after major abdominal surgery. Ann Surg. 2017;265(4):695–701.

  19. 19.

    Waljee JF, Cron DC, Steiger RM, et al. Effect of preoperative opioid exposure on healthcare utilization and expenditures following elective abdominal surgery. Ann Surg. 2017;265(4):715–21.

  20. 20.

    Osterhues A, von Lengerke T, Mall JW, et al. Health-related quality of life, anxiety, and depression in bariatric surgery candidates compared to patients from a psychosomatic inpatient hospital. Obes Surg. 2017;27(9):2378–87.

  21. 21.

    Ivezaj V, Grilo CM. When mood worsens after gastric bypass surgery: characterization of bariatric patients with increases in depressive symptoms following surgery. Obes Surg. 2015;25(3):423–9.

    Article  Google Scholar 

  22. 22.

    Muller A, Mitchell JE, Sondag C, et al. Psychiatric aspects of bariatric surgery. Current psychiatry reports. 2013;15(10):397.

  23. 23.

    de Zwaan M, Enderle J, Wagner S, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord. 2011;133(1–2):61–8.

  24. 24.

    Ivezaj V, Saules KK, Wiedemann AA. “I didn’t see this coming.”: why are postbariatric patients in substance abuse treatment? Patients’ perceptions of etiology and future recommendations. Obes Surg. 2012;22(8):1308–14.

    Article  Google Scholar 

  25. 25.

    Spadola CE, Wagner EF, Accornero VH, et al. Alcohol use patterns and alcohol use disorders among young adult, ethnically diverse bariatric surgery patients. Subst Abus. 2017;38(1):82–7.

  26. 26.

    Messiah SE, Vidot D, Spadola C, et al. Self-reported depression and duodenal cortisol biomarkers are related to weight loss. Bariatric Surgical Practice and Patient Care In Press.

  27. 27.

    Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis care & research. 2011;63(Suppl 11):S454–66.

    Article  Google Scholar 

  28. 28.

    Beck AT, Brown G, Steer RA. Beck Depression Inventory II. San Antonio, TX 1996.

  29. 29.

    Osman A, Kopper BA, Barrios FX, et al. The Beck Anxiety Inventory: reexamination of factor structure and psychometric properties. J Clin Psychol. 1997;53(1):7–14.

  30. 30.

    Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Antonio, TX 1990.

  31. 31.

    Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–7.

  32. 32.

    Yano JM, Yu K, Donaldson GP, et al. Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis. Cell. 2015;161(2):264–76.

    CAS  Article  Google Scholar 

  33. 33.

    Monteleone P, Brambilla F, Bortolotti F, et al. Serotonergic dysfunction across the eating disorders: relationship to eating behaviour, purging behaviour, nutritional status and general psychopathology. Psychol Med. Sep 2000;30(5):1099–110.

    CAS  Article  Google Scholar 

  34. 34.

    Leibowitz SF. The role of serotonin in eating disorders. Drugs. 1990;39(Suppl 3):33–48.

    CAS  Article  Google Scholar 

  35. 35.

    Steiger H. Eating disorders and the serotonin connection: state, trait and developmental effects. Journal of psychiatry & neuroscience : JPN. Jan 2004;29(1):20–9.

    Google Scholar 

  36. 36.

    Kaye WH, Frank GK, Bailer UF, et al. Serotonin alterations in anorexia and bulimia nervosa: new insights from imaging studies. Physiology & behavior. 2005;85(1):73–81.

    CAS  Article  Google Scholar 

  37. 37.

    Kaye WH, Bulik CM, Thornton L, et al. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. Dec 2004;161(12):2215–21.

  38. 38.

    Akimova E, Lanzenberger R, Kasper S. The serotonin-1A receptor in anxiety disorders. Biological psychiatry. 2009;66(7):627–35.

    CAS  Article  Google Scholar 

  39. 39.

    Wade TD, Bulik CM, Neale M, et al. Anorexia nervosa and major depression: shared genetic and environmental risk factors. Am J Psychiatry. Mar 2000;157(3):469–71.

  40. 40.

    Jimerson DC, Lesem MD, Kaye WH, et al. Eating disorders and depression: is there a serotonin connection? Biological psychiatry. 1990;28(5):443–54.

  41. 41.

    Hellhammer DH, Wust S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009;34(2):163–71.

    CAS  Article  Google Scholar 

  42. 42.

    Choi JC, Chung MI, Lee YD. Modulation of pain sensation by stress-related testosterone and cortisol. Anaesthesia. 2012;67(10):1146–51.

    CAS  Article  Google Scholar 

  43. 43.

    Lovallo WR, Enoch MA, Acheson A, et al. Cortisol stress response in men and women modulated differentially by the mu-opioid receptor gene polymorphism OPRM1 A118G. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2015;40(11):2546–54.

  44. 44.

    Christiansen JJ, Djurhuus CB, Gravholt CH, et al. Effects of cortisol on carbohydrate, lipid, and protein metabolism: studies of acute cortisol withdrawal in adrenocortical failure. J Clin Endocrinol Metab. 2007;92(9):3553–9.

  45. 45.

    O’Neill PA, Davies I, Fullerton KJ, et al. Stress hormone and blood glucose response following acute stroke in the elderly. Stroke. 1991;22(7):842–7.

  46. 46.

    Boyar RM, Hellman LD, Roffwarg H, et al. Cortisol secretion and metabolism in anorexia nervosa. The New England journal of medicine.27. 1977;296(4):190–3.

  47. 47.

    Backman O, Stockeld D, Rasmussen F, et al. Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery. Br J Surg. 2016;103(10):1336–42.

  48. 48.

    Ranganathan M, Braley G, Pittman B, et al. The effects of cannabinoids on serum cortisol and prolactin in humans. Psychopharmacology. 2009;203(4):737–44.

  49. 49.

    Bershad AK, Jaffe JH, Childs E, et al. Opioid partial agonist buprenorphine dampens responses to psychosocial stress in humans. Psychoneuroendocrinology. 2015;52:281–8.

  50. 50.

    Yardeni IZ, Shavit Y, Bessler H, et al. Comparison of postoperative pain management techniques on endocrine response to surgery: a randomised controlled trial. Int J Surg. 2007;5(4):239–43.

  51. 51.

    Kokka N, Garcia JF. Effects of delta 9-THC on growth hormone and ACTH secretion in rats. Life sciences. 1974;15(2):329–38.

    CAS  Article  Google Scholar 

  52. 52.

    Brown TT, Dobs AS. Endocrine effects of marijuana. J Clin Pharmacol. 2002;42(S1):90S–6S.

    CAS  Article  Google Scholar 

  53. 53.

    Facchinetti F, Grasso A, Petraglia F, et al. Impaired circadian rhythmicity of beta-lipotrophin, beta-endorphin and ACTH in heroin addicts. Acta Endocrinol. 1984;105(2):149–55.

  54. 54.

    Katz N, Mazer NA. The impact of opioids on the endocrine system. Clin J Pain. 2009;25(2):170–5.

    Article  Google Scholar 

  55. 55.

    Seyfried O, Hester J. Opioids and endocrine dysfunction. Br J Pain. 2012;6(1):17–24.

    Article  Google Scholar 

Download references


This research was funded by the Micah Batchelor Foundation.

Author information



Corresponding author

Correspondence to Denise C. Vidot.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vidot, D.C., Deo, S., Daunert, S. et al. A Preliminary Study on the Influence of Cannabis and Opioid Use on Weight Loss and Mental Health Biomarkers Post-weight Loss Surgery. OBES SURG 30, 4331–4338 (2020).

Download citation


  • Cannabis
  • Opioids
  • Bariatric surgery
  • Anxiety
  • Depression
  • Cortisol
  • Serotonin
  • Duodenum
  • Gut
  • Weight loss