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Regular cannabis users require higher sedation dosages for surgery

New research from the American Osteopathic Association has revealed that patients who use cannabis regularly may require more than twice the typical level of sedation for medical procedures.

The investigation was focused on the medical records of 250 patients who received endoscopic procedures in Colorado after 2012, which is the year that recreational cannabis was legalized in the state. The researchers discovered that patients who used cannabis on a daily or weekly basis needed 14 percent more fentanyl, 20 percent more midazolam, and 220 percent more propofol to be sedated.

“Some of the sedative medications have dose-dependent side effects, meaning the higher the dose, the greater likelihood for problems,” said study lead author Dr. Mark Twardowski. “That becomes particularly dangerous when suppressed respiratory function is a known side effect.”

Dr. Twardowski explained that due to cannabis’s status as a schedule 1 drug, a lack of research combined with its sudden widespread legalization raises concerns about other unforeseen issues.

“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.”

Dr. Twardowski said that some doctors have noticed an increase in the number of patients complaining of chronic nausea, which is often caused by cannabis use. In addition, anesthesiologists have found that patients are requiring much higher dosages for general anesthesia and have noted higher rates of post-op seizures.

This information prompted an investigation by Dr. Twardowski and his colleagues. Their study revealed that cannabis use in the United States increased by 43 percent between 2007 and 2015, with the greatest increase documented among people 26 and older.

As recreational cannabis is legalized in more and more states, many individuals will become more honest about their cannabis use and there is the potential for meaningful data collection. 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,” said Dr. Twardowski. “We still don’t understand the mechanism behind the need for higher dosages, which is important to finding better care management solutions.”

The study is published in The Journal of the American Osteopathic Association.

By Chrissy Sexton,  Staff Writer

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