Regular marijuana users may need more sedatives during medical procedures

A growing number of Americans are consuming marijuana. In some states, getting marijuana is as easy as going to a store and picking what's in a shop window. Even though states legalize cannabis for recreational and medical purposes, it remains a taboo subject even in doctors' offices.

A new study now suggests that keeping the secret of marijuana use among health professionals is probably not a good idea. A team of Colorado researchers has found that people who regularly use marijuana need more than a few sedatives and anesthetics commonly used before routine medical procedures.

The study, published in The journal of the American Association of Osteopathy, analyzed the medical records of 250 people who underwent endoscopy, that is, a doctor's surgery that inserts a camera into a person's body to see what's going on inside. Of the 25 people who reported smoking marijuana or consuming edible cannabis products daily or weekly, the researchers said they needed higher doses of drugs and anesthesia to achieve optimal sedation.

On average, cannabis users needed 14% more fentanyl, 20% midazolam and 220% propofol before colonoscopy and other routine medical procedures. The researchers say this finding is important because higher doses often involve a higher probability of negative – and potentially dangerous – side effects.

"Some sedative medications have dose-related side effects, which means that the higher the dose, the greater the likelihood of problems. This becomes particularly dangerous when the suppression of respiratory function is a known side effect, "said lead researcher Mark Twardowski, a specialist in osteopathy in internal medicine in Grand Junction, Colorado, in a statement.

In colonoscopies, which constituted the majority of cases investigated by researchers, midazolam and propofol are the most commonly used sedatives, and fentanyl is a commonly used analgesic. Since researchers have only studied the impact of marijuana on these three drugs, it is not known if marijuana would interact with other sedatives on the market.

Medicine of nature?

The interaction of marijuana with the three drugs studied is not entirely clear. The researchers believe that this may be related to the way tetrahydrocannabiol (THC), the main psychoactive chemical compound in marijuana, interacts with the body's endocannabinoid and opioid systems. These are two interdependent neurotransmitter systems that intervene in the treatment of addiction, pain, etc. THC can bind to these receptors and alter the metabolism of other drugs. People who consume cannabis frequently may need higher doses of certain sedatives to be effective, as this study has shown.

However, further research is needed to understand how marijuana, which contains at least 85 cannabinoids and 27 terpenes, affects the processes of the human body and how its chemical compounds interact with other drugs. Marijuana is still illegal at the federal level in the United States, where policies and regulations limit research.

While research is lagging behind, the consumption of the drug is booming. The study found that between 2007 and 2015, marijuana use in the United States increased by 43%. It is estimated that 13.5% of adult adults used marijuana during this period, with the largest increases occurring in those 26 years of age and older.

Even though marijuana is becoming more prevalent, cannabis users may want to keep in mind that it is still new in the medical world.

"Cannabis has metabolic effects that we do not understand and patients should know that their use of cannabis could affect the effectiveness of other drugs. We observe problematic trends anecdotally, and there is virtually no formal data to give an idea of ​​scale or to suggest evidence-based protocols, "said Twardowski.