New Guidelines Recommend Screening All Surgery Candidates for Cannabis Use
New guidelines from the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) say doctors should ask all people scheduled for surgery with anesthesia about whether they use cannabis, including its frequency and the type of product they use.
The guidelines were published online on Jan. 3, 2023, by the journal Regional Anesthesia & Pain Medicine. Read the abstract of “ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids.”
The ASRA Pain Medicine is an international anesthesiology medical society.
About cannabis
Cannabis refers to a family of plants that includes marijuana and hemp. In the past, marijuana was viewed as a recreational drug. But in the past 25 years, interest in medical use of marijuana has increased dramatically and a number of states have legalized it for both medical and recreational use. According to federal statistics from 2018, about 10% of people in the United States — 27.6 million people — report using cannabis monthly.
The most common ways to consume cannabis are:
eating products infused with cannabis, such as gummies, mints, cookies, and suckers
inhaling cannabis smoke or vapor
Many people diagnosed with cancer report that cannabis products help to manage their symptoms and treatment side effects.
But because cannabis is federally illegal in the United States, research on cannabis is limited, including research on how cannabis interacts with other medicines and substances.
Still, we do know that cannabis may:
increase the sedating effects of opioids, alcohol, antihistamines, and benzodiazepines such as Xanax (chemical name: alprazolam), Valium (chemical name: diazepam), and Ativan (chemical name: lorazepam)
increase the risk of tachycardia — abnormally rapid heart rate — when combined with antidepressants, such as Tofranil (chemical name: imipramine) and Prozac (chemical name: fluoxetine), and sinus medicines, such as Sudafed (chemical name: pseudoephedrine)
increase the effects of direct-acting oral anticoagulants, such as Eliquis (chemical name: apixaban) and Xarelto (chemical name: rivaroxaban), as well as older vitamin K antagonist anticoagulants, such as warfarin
increase the effects of antiplatelet medicines, such as Plavix (chemical name: clopidogrel)
increase the amount of acetaminophen, ibuprofen, and other analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) in your system
decrease the effects of digoxin, which is used to treat heart failure
decrease the effects of Imodium (chemical name: loperamide)
Cannabis and surgery
There have been no randomized, controlled research studies on cannabis use and surgery because of federal law. But observational studies, which are considered less rigorous, have shown some clear patterns between cannabis use and complications after surgery, including:
more pain
more nausea and vomiting
more heart problems
more problems with blood flow in the brain
It is unclear how cannabis may interact with anesthesia drugs used during surgery.
About the guidelines
To help anesthesiologists and other doctors safely manage surgery for people who use cannabis, a panel of ASRA Pain Medicine experts developed guidelines that include the following recommendations:
Doctors should ask all people scheduled for surgery with anesthesia about their cannabis use, including:
type of product used
whether it is smoked or ingested
amount used
how recently it was used
frequency of use
Doctors should counsel anyone scheduled for surgery about the risks of continuing to use cannabis before surgery. People having elective surgery should postpone the surgery if their mental state or decision-making capacity is impaired because of cannabis use.
Doctors should tell people who use cannabis frequently about the potential effects on post-operative pain control. People using a low dose of cannabis under a doctor’s supervision are less likely to have problems with pain control after surgery.
Doctors should counsel pregnant women about the risks of cannabis use on the developing baby and discourage pregnant women from using cannabis.
Anesthesiologists should be prepared to change the drugs used for sedation during surgery, depending on when a patient last used cannabis.
The expert panel is going to continue to review new research as it is published and update the guidelines as necessary.
What this means for you
If you’re scheduled for breast cancer surgery, these guidelines underscore the importance of telling your doctor about any cannabis products you might use.
Although research is limited, we do know that cannabis may lead to more pain and nausea after surgery and also alter the effects of a number of medicines used to control pain and swelling after surgery. Depending on when you last used cannabis, it also may enhance the effects of anesthesia used during surgery.
To make sure you get the best care possible, it makes sense to tell your doctor about any and all drugs and supplements you use, including cannabis, and discuss all the risks and benefits, including any interactions that may happen.
Learn more about medical cannabis.
— Last updated on February 22, 2023 at 7:12 PM