Weed and Procedure Complications

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I live in Colorado, which was one of the first states to legalize recreational marijuana (MJ). One of the trends we’ve seen for years is that marijuana products increase the amount of anesthesia it takes to get someone to sleep. Now there’s research showing that there is a relationship between these products and problems with anesthesia. Let’s dig in.

My Position on MJ

I have no issues with people choosing to use CBD or other marijuana products to help with pain, nausea, or other issues. So my position on MJ products and anesthesia is based solely on what I see and what’s now being reported. Hence, everyone just needs to know that like any substance, there are benefits and risks.

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Our Experience with MJ and Anesthesia

For most procedures, I perform my own anesthesia. I began to notice several years ago that we had certain people whose anesthesia requirement was MUCH higher than the next person. While I was used to seeing this in chronic pain patients that took narcotics, these patients were on no medications. As I tried to investigate why one commonality stood out, they were all on MJ products.

The Research Begins to Clarify

At that time, I looked for anything on this topic in the research literature, but there was nothing. That made sense since Colorado and Oregon were the only places in the US where a large volume of MJ products was being sold for recreational use. However, eventually, more research appeared.

Several studies support that cannabis users require more medications for anesthesia (to get to the point of being unconscious) (1,2). This fits exactly with my experience in the O.R. However, the anesthesia itself only becomes more dangerous when the patient is abusing cannabis (3).

The New Research

A new MJ research paper was published this month that was spine surgery specific. Given that we have patients that are considering that procedure, I thought it would be good to review (4). The authors looked at records on more than four hundred thousand patients. Their focus was on patients who had a medical diagnosis of cannabis abuse.

After controlling for other variables, these patients were twice as likely to get a serious blood clot and respiratory complications. They were three times as likely to get a serious neurologic complication like a stroke. They also spent more time in the hospital and cost more while there.

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Moving from Perscriptions to Cannabis

Again, I have no issue with the idea that patients who are in pain want to ditch the scripts and take a cannabis product instead. However, it is my job as a physician to work hard to keep my patients safe. Hence, I suspect as more states allow recreational use, that spine surgeons and interventional pain providers need to know that about these effects.

The upshot? Abusing any drug, whether it’s a prescription or something you can buy at the liquor store or dispensary is a problem. So if you’re considering spine surgery and are a heavy cannabis user, you may want to find alternative non-surgical ways to manage your pain.

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References:

(1) Kraft B, Stromer W. Der Einfluss von Cannabis und Cannabinoiden auf Anästhesie und Analgesie in der perioperativen Phase [The effects of cannabis and cannabinoids on anesthesia and analgesia during the perioperative period]. Schmerz. 2020 Aug;34(4):314-318. German. doi: 10.1007/s00482-020-00449-x. PMID: 32125500.

(2) Lynn RSR, Galinkin JL. Cannabis, e-cigarettes and anesthesia. Curr Opin Anaesthesiol. 2020 Jun;33(3):318-326. doi: 10.1097/ACO.0000000000000872. PMID: 32371642.

(3) Goel A, McGuinness B, Jivraj NK, Wijeysundera DN, Mittleman MA, Bateman BT, Clarke H, Kotra LP, Ladha KS. Cannabis Use Disorder and Perioperative Outcomes in Major Elective Surgeries: A Retrospective Cohort Analysis. Anesthesiology. 2020 Apr;132(4):625-635. doi: 10.1097/ALN.0000000000003067. PMID: 31789638.

(4) Chiu RG, Patel S, Siddiqui N, Nunna RS, Mehta AI. Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States. Spine (Phila Pa 1976). 2021 Jun 1;46(11):734-743. doi: 10.1097/BRS.0000000000004035. PMID: 33769411.

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