According to a small study, cannabis users needed twice as much sedation as medical procedures

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With "the continued increase in the legalization and use of cannabis, the field of anesthesia and sedation requires further study," wrote the authors of the study. , published Monday in the Journal of the American Osteopathic Association.

Marijuana has gained popularity around the world in recent years, partly because of changing laws. According to a United Nations report, between 2007 and 2015, marijuana use increased by 43% in the United States, where about 13.5% of adults consume cannabis. In 2015, it was estimated that 183 million people, nearly 4% of the adult population, had used cannabis worldwide.

How is the growing use of cannabis affecting medical care? Researchers at the Grand Junction, Colorado, community hospital have explored a small area of ​​medical care: sedation. They reviewed the medical records of 250 patients who underwent endoscopic surgery between January 1, 2016 and December 31, 2017 – years after the state had legalized marijuana for recreational purposes in 2012.

Comparing cannabis users to non-users, they found that patients who reported smoking or consuming food every day or week required 14% more fentanyl, 20% midazolam and 220% more propofol. obtain optimal sedation during routine procedures, including colonoscopies. For example, it took an average of 13.83 milligrams of propofol to 225 non-users to lose consciousness, compared to an average of 44.81 milligrams for 25 cannabis users.

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The authors of the study note that some sedatives have side effects and that the higher the dose, the greater the probability of problems. Asking questions about cannabis use during consumption "can be an important tool for planning patient care and assessing both drug needs and possible risks during endoscopic procedures," they wrote.

Too few participants in the study

Dr. Roderic Eckenhoff, professor of anesthesia at the University of Pennsylvania, said the study was interesting but lacked rigor. "I would consider this as a pilot study on which perhaps one should embark on and do a more comprehensive test," said Eckenhoff, who did not participate in the research.
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One of the factors that bothered him was that the study was retrospective: the researchers simply looked at the medical records and compared the amount of sedation used for each patient instead of controlling the exact amounts of sedation and comparing the effects.

What is considered "sufficient" depends a lot on the providers and surgeons involved, said Eckenhoff. This "uncertainty", combined with a small number – only 25 – of cannabis users, makes the results "really precarious at best," he said.

Similar results have not been observed in previous research. He said: "Even if you give propofol to a person for a long time, it becomes a little tolerant, but not 200%." Although a 200% "upward" resistance may be "possible, I would be surprised if this is retained as part of a larger study," he said.

Finally, he noted that patients are not always reliable and do not necessarily tell their doctor "everything they take," which may have influenced the results: "Some people who consume marijuana also take other drugs for recreational purposes ".

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