Not only does cannabis use increase post-procedure pain, but users are more likely to require opioid treatment.
A new study presented at the American Society of Anesthesiologists annual meeting in New Orleans suggests that regular marijuana use tends to make patients experience more post-surgery pain than those who avoid using. Because of this, users also tend to require treatment with opioids more often than nonusers. This is big news as the legalization of marijuana has caused it to spike in popularity in recent years. So far, it has been approved for recreational use in 19 states and medical use in 37 states, according to the National Conference of State Legislatures.
“It’s not an enormous amount of additional pain compared to non-users, we found, but we can’t say don’t worry about it because it’s not too much,” said lead researcher Dr. Elyad Ekrami who’s also a clinical research fellow with the Cleveland Clinic’s Anesthesiology Institute. He added, “They needed more opioids to cure their pain, so this is something that is meaningful.”
Dr. Qian Cece Chen, an anesthesiologist with NYU Langone Health in New York City, explained, “When a patient is using marijuana, the moment when I start inducing – giving them medications to have them go to sleep – that’s when I see the difference. Even in full anesthesia, we see the difference.”
Ekrami and his team reviewed data from more than “34,500 patients who had a surgery lasting more than an hour at the Cleveland Clinic between 2010 and 2020,” and who required at least a full day’s stay at the iclinic post-surgery. Of these, nearly “1,700 had used marijuana” within a month prior to surgery, the researchers said.
The team found that marijuana users reported “14% more pain during the first 24 hours following surgery compared to non-users.” This group also ingested “7% more opioids after surgery” for pain management.
But why does marijuana worsen pain levels? Experts cite many reasons for this.
Marijuana impacts brain receptors that respond to chemical present in both weed and opioids, Ekrami said, adding, “Regular marijuana use could desensitize those receptors, making opioid painkillers less effective during and after surgery.”
“The fact that fully sedated marijuana-using patients need more opioids to keep them anesthetized is evidence that these brain receptors likely are being jumbled by regular marijuana exposure,” Chen added. “Under anesthesia, with the suppression of brain activity, that shouldn’t be a component. They shouldn’t be processing any of that surgical stimulation, but they do respond do it.” She explained further, {It’s also possible that some are using marijuana to self-medicate and cope with anxiety or emotional problems. In pain management, we know anxiety contributes to pain.”
Whether marijuana users are coping with mental pain, physical pain or both, the team doesn’t believe they have enough information to advise patients to eliminate use prior to surgery. They feel this would only heighten symptoms, leaving patients feeling even more anxious and prone to experiencing high levels of pain.
“It’s hard to give any recommendations at this point with the current evidence we have on whether to continue using or to stop using prior,” said Dr. Shalini Shah, chief of pain medicine at the University of California, Irvine. “I think the bottom line really comes down to giving guidance to physicians and clinicians in terms of trying to risk-mitigate (their) patients from adverse events postoperatively, for those who are on cannabis.”
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