According to research published in the Journal of the American Osteopathic Association, more than the usual level of sedation in medical procedures is required for regular cannabis users.
Researchers in Colorado examined medical records of 250 patients who received endoscopic procedures after 2012, when the state legalised recreational cannabis. They found regular cannabis users, patients who smoked or ingested cannabis on a daily or weekly basis, required 14% more fentanyl, 20% more midazolam, and 220% more propofol to achieve optimum sedation in medical procedures.
What do you know about sedation in medical procedures?
“Some of the sedative medications have dose-dependent side effects, meaning the higher the dose, the greater likelihood for problems,” says lead researcher Mark Twardowski, DO, an osteopathic internal medicine physician.
“That becomes particularly dangerous when suppressed respiratory function is a known side effect.”
A lack of research, due to cannabis’s status as a schedule 1 drug, combined with its sudden widespread legalisation, makes Dr Twardowski concerned about other unforeseen issues.
Regular cannabis users and the uncertainty of use
Cannabis use in the United States increased 43% between 2007 and 2015. According to the study, an estimated 13.5% of the adult population used cannabis during this period, with the greatest increase recorded among people 26 and older.
As more states legalise medical and recreational cannabis, there is also greater potential for meaningful data collection. Not only are there more regular cannabis users and more patients using cannabis, but more are also now willing to admit cannabis use in the past, which increases the likelihood that they will be forthcoming when questioned by a medical professional.
“Cannabis has some metabolic effects we don’t understand, and patients need to know that their cannabis use might make other medications less effective. We’re seeing some problematic trends anecdotally, and there is virtually no formal data to provide a sense of scale or suggest any evidence-based protocols,” adds Twardowski.
The requirement of higher sedation in medical procedures
Twardowski says colleagues in nearby emergency departments have noticed more patients reporting with complaints of chronic nausea, a symptom that can occur from regular cannabis use. He also says that colleagues in anaesthesiology have noted patients requiring much higher dosages for general anaesthesia and higher rates of post-op seizures.
Moreover, according to the researchers, adding specific questions regarding cannabis use to patient intake forms is the first step to acquiring useful information that influences patient care.
“This study really marks a small first step,” says Dr. Twardowski. “We still don’t understand the mechanism behind the need for higher dosages, which is important to finding better care management solutions.”