Your Surgeon Wants To Know If You Smoke Pot

Medical professionals throughout the state of Colorado are recommending that patients disclose their marijuana use, citing recent evidence that suggest links between cannabis and both patients’ tolerance to anesthesia and surgery recovery time. 

Right away, that might sound sketchy. Even in medically and recreationally legal states, sharing one’s marijuana use can still feel sort of taboo. Colorado is in a unique position, though. As a pioneer for cannabis legalization, the Centennial State has long been ahead of the curve in terms of research, business and public, personal discussion. In comparison to those in states new to the fully legal scene, such as Michigan (2018) and Illinois (2019), Coloradans may feel more comfortable talking about it.

(High Times)

“It has been destigmatized here in Colorado,” said Dr. Andrew Monte, associate professor of emergency medicine and medical toxicology at the University of Colorado School of Medicine and UCHealth. “We’re ahead of the game in terms of our ability to talk to patients about it. We’re also ahead of the game in identifying complications associated with use.” According to the 2017 National Survey on Drug Use and Health, roughly 17 percent of Coloradans said they used marijuana in the previous 30 days, more than double the percentage of those who reported doing so a decade ago. 

Dr. Mark Twardowski, a specialist in family and internal medicine in Grand Junction, Colorado, published a small study of patients in May that found that marijuana users required more than triple the amount as did nonusers of propofol, a common sedation medicine. According to the study, “A total of 250 medical records were reviewed from 1 endoscopy center and 1 endoscopist to minimize the variability in sedation technique for the study purposes. The cohort was reviewed with regard to age and gender to determine whether differences were present among different groups as to the relative amount of sedation medication required in cannabis users vs nonusers.”

The results of the study “found that compared with people who did not regularly use cannabis, people who regularly used cannabis required an amount of sedation for endoscopic procedures that was significantly higher (P=.05).” The conclusion of the study added that, “A strong correlation appears to exist between the regular use of cannabis and the need for increased doses of the sedative medications fentanyl, midazolam, and propofol required in the performance of endoscopic procedures. The correlation could prove to be important in making medical decisions related to the sedation of cannabis users. Knowledge of a patient's use of cannabis prior to sedation can help prepare endoscopists, nurses, and anesthesia providers for the potential need for more medication, increased costs, and possible risks associated with dose-dependent adverse events.”

Dr. Joy Hawkins, a professor of anesthesiology at the University of Colorado School of Medicine and president of the Colorado Society of Anesthesiologists, says that a concern raised from anesthesiologists noticing cannabis users’ raised tolerance to propofol and other anesthesia drugs is that higher doses can potentially cause harmful side effects, such as depressed heart rate and low blood pressure.

In regards to post-surgery recovery, Dr. Mark Steven Wallace, chair of the pain medicine division in the anesthesiology department at the University of California-San Diego, said, “We’ve been hearing reports about patients using cannabis, instead of opioids, to treat their postoperative pain,” adding, “I have a lot of patients who say they prefer it.”

The downside is that according to a study published last year in the journal Patient Safety in Surgery, patients of joint replacement surgery who’ve used marijuana reported feeling greater pain and consumed more opioids in the hospital after vehicle crash injuries compared with nonusers. 

“The hypothesis is that chronic marijuana users develop a tolerance to pain medications, and since they do not receive marijuana while in the hospital, they require a higher replacement dose of opioids," said Dr. David Bar-Or, who directs trauma research at Swedish Medical Center in Englewood, Colorado. Currently, Bar-Or is studying dronabinol, a synthetic form of THC, as an alternative to opioids.

As with so many studies involving cannabis, further research and greater information is required.