In recent years, there has been a growing number of cannabis users across the United States. Some of these users consume all day long: when they wake up, when it’s time to eat, when they run errands, and even before heading out for surgery. And while the potential benefits of cannabis for managing chronic pain and other medical conditions have been widely discussed, there is less understanding of how cannabis use may impact the surgical experience for these cannabis using patients.
As the number of patients presenting with cannabis use continues to grow, it is important to consider the potential effects on surgery, including anesthesia, pain management, and post-operative care.
New Rules for Anesthesiologists
In January of 2023 the American Society of Regional Anesthesia and Pain Medicine released a new guideline for anesthesiologists regarding patient’s cannabis use. This is the first guideline of its kind regarding cannabis in the US. The new guidelines state that all patients should be screened for cannabis before having surgery. They also encourage healthcare workers to inform frequent users of the potentially poor response to pain control their cannabis use can cause.
Why the Need for New Rules?
The new guidelines have come in response to the increased use of cannabis across adults as more states legalize medical and recreational cannabis. Medical professions have watched the increased usage and are concerned that it potentially can interact with anesthesia and lead to complications.
While cannabis education is being implemented in medical schools, most practicing doctors have received little to no information on the plant and how it interacts with the body during their training. The recent guidelines look to educate and instruct healthcare workers how to navigate their patients and cannabis use.
Anesthesia and Adverse Effects
According to Dr. Samer Narouze, the president of the American Society of Regional Anesthesia and Pain Medicine, regular and heavy cannabis use can leave patients experiencing more pain than usual after surgery. Furthermore, consuming cannabis immediately prior to an operation can increase the risk of heart problems, including heart attacks.
Dr. Samer Narouze has also noted that heavy marijuana users may require higher doses of anesthesia to induce and maintain sleep during surgery. In addition, heavy cannabis use can leave patients feeling more agitated during the recovery period. Furthermore, acute cannabis intoxication can lead to confusion, rapid heart rate, panic episodes, and impaired ability to provide informed consent for the surgery to take place.
Practicing physicians have noticed an increase in interactions during anesthesia along with more patients having a different, and difficult, outcome in the recovery room. Patients have been experiencing more pain, more violence, and more vomiting. These difficult cases are assumed to be caused by cannabis use, but most physicians are unsure. The new guidelines will allow the physicians to put all the puzzle pieces together and treat the patient’s post-op state in the correct manner.
When Will the Guidelines be Implemented?
For institutions that already have cannabis and surgical guidelines in place the new rules set out by the American Society of Regional Anesthesia and Pain Medicine are nothing new to be implemented in their practice. However, there does not seem to be a set date that all hospitals and medical institutions are required to implement the new regulations by.
There is hope the guidelines will be universally adopted as soon as possible to make sure all patients and cannabis users are as safe as possible moving forward.
How Will New Guidelines be Implemented?
The group of medical professionals who worked together to create the guidelines have identified three subsets of patients who may not have optimal outcomes from anesthesia during surgery.
The first group is composed of patients who arrive at the hospital while acutely intoxicated with cannabis. In this state, patients may experience delusions or paranoia, or they may not be able to provide informed consent. In such cases, the guidelines recommend postponing surgery until the patient can be re-evaluated.
The second group includes patients with cannabis use disorder who are heavy users and have developed tolerance to the drug. These patients may experience more pain during recovery, even after minor procedures. To manage their pain, a multi-modal approach including nerve blocks or regional anesthesia may be recommended.
The third group consists of patients who have smoked cannabis recently. Research has shown that in the two hours following smoking, these patients may experience an increased heart rate, which can be a risk factor for heart attacks during surgery. To mitigate this risk, the guidelines recommend delaying surgery for at least two hours after smoking cannabis.
Pre-op Drug Testing
All the talk around cannabis use and surgery may have users wondering if drug testing will become a part of the pre-surgery routine. However, this is not the plan as long as truthful answers are given to the direct questions about cannabis use. Even as the guidelines are reviewed and updated, drug testing is likely to not be implemented as the results cannot reveal anything about the amount of usage and the fact that cannabis stays in the body weeks after usage.
Recommendations for Pre-Op Weaning
Readers may be wondering if these guidelines will lead to recommendations and requirements on when to stop smoking before surgery takes place. Physicians are hesitant to create and implement these types of recommendations at this time due to the lack of data surrounding the issue. As more data is collected the writers of the guidelines may choose to update them if they see a need to. Currently, as stated above, the only recommendation is to postpone elective surgeries for patients who show up even acutely intoxicated.
What About CBD?
The new guidelines do not touch on CBD, but users should be aware of how it can also affect surgery. It is generally recommended that patients do not use CBD before surgery without first consulting with their healthcare provider. Although CBD is generally considered safe and non-psychoactive, it can potentially interact with anesthesia and other medications used during surgery.
CBD can affect the way certain medications are metabolized in the liver, which can increase the risk of adverse reactions or alter the effectiveness of anesthesia. Therefore, it is important for patients to disclose their CBD use to their healthcare provider and follow their instructions before undergoing surgery.
Additionally, CBD can have blood-thinning effects, which can increase the risk of bleeding during surgery. Therefore, patients who are scheduled for surgery should inform their healthcare provider if they are taking CBD or any other supplements, to ensure safe and effective treatment.
As both the public and medical professionals learn more about cannabis and how it affects the body, we may see more guidelines regarding cannabis use and medical procedures.
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