Regular users of cannabis need a higher dosage of 220% for sedation during medical procedures

CHICAGO – April 15, 2019 – Patients who consume cannabis regularly may need more than twice the usual sedation level during the medical procedure, according to a study published in the Journal of the American Osteopathic Association.

Colorado researchers reviewed the medical records of 250 patients who underwent endoscopic surgery after 2012, when the state had legalized cannabis for recreational purposes. They found that patients who smoked or ingested cannabis daily or weekly needed 14% more fentanyl, 20% more midazolam, and 220% more propofol to achieve optimal sedation during badfeeding procedures. routine, including colonoscopy.

"Some sedative medications have dose-related side effects, which means that the higher the dose, the more likely it is that problems will occur," said lead researcher Mark Twardowski, DO, a physician in osteopathy in internal medicine. "It becomes especially dangerous when the suppression of the respiratory function is a known side effect."

A lack of research, due to the status of cannabis as a Schedule 1 drug, combined with its widespread widespread legalization, makes Dr. Twardowski concerned about other unforeseen problems.

"Cannabis has metabolic effects that we do not understand and patients need to know that their use of cannabis can affect the effectiveness of certain medications." We observe problematic trends in anecdotal way and it practically does not exist. no formal data to give a sense of scale or to suggest evidence-based protocols, "said Dr. Twardowski.

He added that colleagues from nearby emergency departments have noticed that more and more patients are complaining of chronic nausea, a symptom that can result from regular cannabis use. He also stated that colleagues in anesthesiology had noted patients requiring much higher doses for general anesthesia and higher rates of postoperative convulsions.

These types of recurring stories prompted Dr. Twardowski and his colleagues to gather real data.

Potential for more insight

In the United States, cannabis use increased by 43% between 2007 and 2015. An estimated 13.5% of the adult population reportedly used cannabis during this period, with the largest increase among cannabis users. 26 years and over.

As more and more states legalize cannabis for medical and recreational purposes, the potential for useful data collection is also greater. Not only are more patients consuming cannabis, but more people are now willing to admit it, which increases the chances that they will be considerate when they are interviewed by a health professional.

According to the researchers, adding specific questions regarding the use of cannabis to patient intake forms is the first step to obtain useful information that influences patient care.

"This study really marks a modest first step," said Dr. Twardowski. "We still do not understand the mechanism behind the need for higher doses, which is important for finding better care management solutions."

Dr. Twardowski's team is currently developing a follow-up study on the differences between sedation and anesthesia requirements, as well as post-procedure pain treatment among regular cannabis users compared to to non-consumers.

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the Journal of the American Osteopathic Association (JAOA) is the official scientific publication of the American Osteopathic Association. Edited by Robert Orenstein, DO, it is the first scholarly publication of the osteopathic and peer-reviewed medical profession. JAOA's mission is to advance medicine through the publication of peer-reviewed osteopathic research.

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