Like It Or Not, All Patients In The US May Now Have To Undergo Screening For Cannabis Use Before Surgery
New guidelines that have just been published by the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) recommend that all individuals who are set to undergo surgery that requires the use of anesthesia be screened about their marijuana consumption.
ASRA Pain Medicine is one of the biggest medical organizations focusing on anesthesiology, which was founded back in 1975. They currently have over 5,000 members across 6 continents.
These are the first-ever guidelines to be released in the United States making such recommendations. Doctors and physicians state that regular cannabis use can actually result in increased risk for nausea and pain following surgery, causing patients to require the use of opioids.
ASRA Pain Medicine explains that the guidelines were released due to the growing use of cannabis throughout the last 20 years, though there are valid concerns that cannabis can have unwanted interactions with anesthesia. “Before surgery, anesthesiologists should ask patients if they use cannabis – whether medicinally or recreationally – and be prepared to possibly change the anesthesia plan or delay the procedure in certain situations,” explains Samer Narouze, MD, Ph.D., ASRA Pain Medicine’s president and the senior author of the guidelines.
This is not news, as there have been numerous studies in the past pointing towards the possible hazards and risks of cannabis use, when not abstained before surgery. More on this below.
So is it fair for patients to be screened about their cannabis consumption before surgery? This may be a valid point, and one of those situations wherein it may be for the benefit of patients to actually abstain from it, as it may do more harm than good.
“They also need to counsel patients about the possible risks and effects of cannabis. For example, even though some people use cannabis therapeutically to help relieve pain, studies have shown regular users may have more pain and nausea after surgery, not less, and may need more medications, including opioids to manage the discomfort,” reads the guidelines. “We hope the guidelines will serve as a roadmap to help better care for patients who use cannabis and need surgery,” it continues.
What Studies Say
Current studies point towards risks and dangers that marijuana consumers face during surgery. That’s why it’s recommended to abstain before you are due to go under the knife.
In a 2022 study, whose findings were presented during the Anesthesiology 2022 yearly meeting, cannabis users tend to experience more pain following surgery. The researchers analyzed medical records from 34,521 adult patients, 1,681 of whom were marijuana consumers, all of whom had surgeries conducted at the Cleveland Clinic from January 2010 to December 2020. They found that marijuana users who consumed the drug within one month before surgery were found to suffer from 14% more pain within 24 hours after surgery compared to non-cannabis consuming patients.
Furthermore, cannabis consuming patients required 7% more opioids after surgery.
“The association between cannabis use, pain scores and opioid consumption had been reported before in smaller studies, but they’ve had conflicting results,” notes Dr. Elyad Ekrami, MD, the study’s lead author and a clinical research fellow from the Cleveland Clinic’s Anesthesiology Institute. “Our study has a much larger sample size and does not include patients with chronic pain diagnosis or those who received regional anesthesia, which would have seriously conflicted our results. Furthermore, our study groups were balanced by confounding factors including age, sex, tobacco and other illicit drug use, as well as depression and psychological disorders,” he said.
Dr. Ekrami adds that physicians need to take note of patients who consume cannabis it has an impact on their outcomes, especially because they may require more painkillers or opioids post-surgery. “Physicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control,” Dr. Ekrami says.
Meanwhile, another study from 2019 demonstrated another impact of cannabis on surgery: requiring more anesthesia. Dr. Mark Twardowski of Colorado’s Western Medical Associates, the lead author of the study, explains that consuming cannabis before surgery will have an impact on patients’ medical care. Dr. Twardowski and his team analyzed 250 patients who had to undergo minimally invasive procedures which required anesthesia in the state, where cannabis has long been legal for recreational use.
Ten percent of the patients reported being regular cannabis users. These individuals needed more than double the amount of propofol, an anesthetic. In addition, cannabis users also needed 14% more fentanyl for the pain, and midazolam for sedation.
“Cannabis users cannot assume that their use will have no effects on their medical care,” Dr. Twardowski explains. “Clearly the fact that use affects the effectiveness of these three medicines certainly raises myriad questions about potential effects on other medications (pain medicines, anxiety medicines etc),” he told Reuters via email.
He also explains that since cannabis stays so long in the human body, it could actually take months for its effects to no longer affect surgical outcomes. “Patients absolutely need to inform their providers about cannabis use prior to any procedure,” he advises.
If you are due for any kind of procedure requiring anesthesia, it’s critical to be upfront with your healthcare provider about your marijuana consumption. Not doing so may result in an extremely unpleasant experience as you may still feel the pain without adequate anesthesia.