March 2020

Yes. The expression of CB1 receptors and CB2 receptors is up-regulated during the progression of liver disease. For example, cannabinoid receptor expression is increased on myofibroblasts and vascular endothelial cells in individuals with liver disease. Thus, patients with liver disease may have a different reaction to cannabinoid based products than patients with a healthier liver.

Studies have shown that nabilone and intravenous THC do not ameliorate or prevent postoperative nausea and vomiting.

Chronic pain is the most commonly cited condition. In fact, according to studies and observational reports, greater than 80% of patients with a medical marijuana card indicate “severe pain” as the reason for use of medical marijuana.

Yes. According to a double blind randomized controlled study of human volunteers, gastric emptying of solid food was slowed due to THC administration from an average of 30 minutes to 120 minutes. This, in turn, may impact the administration of anesthesia and increase the risk of aspiration.

Hypertension and tachycardia are commonly associated with marijuana withdrawal. These hemodynamic changes may lead to a mismatch in cardiac oxygen supply and demand. This oxygen supply and demand mismatch, coupled with the increased cardiovascular oxygen demands during surgery, may lead to an increased perioperative risk of acute myocardial infarction among patients with cannabis use disorder.

Yes. Lynch and Ware published 2 systematic reviews. One SR evaluated trials from 2003 to2010 and the other SR evaluated trials from 2010 to 2014. Of the 29 RCTs evaluated in the 2 SRs, 22 of them demonstrated that cannabinoids have a modest analgesic effect and are safe in the management of chronic pain. The modes of administration explored in these 29 SRs included: smoking, oromucosal and oral. All 6 smoked cannabis trials showed a positive analgesic response.

No. RCTs involving the post-operative period or induced acute pain in healthy volunteers did not indicate that cannabinoids were effective analgesic agents for acute pain.

According to literature reviews, the use of marijuana is associated with an increased risk of thromboembolism. However, there is evidence that cannabinoids have an anticoagulant effect, as well. In addition, some cannabinoids (including THC and CBD) interact with anticoagulant agents such as warfarin, and increase the INR. These factors should be considered prior to performing neuroaxial blocks and placing invasive lines in patients who use marijuana.

According to the 2016 to 2017 National Survey on Drug Use and Health, more than 39 million people smoke marijuana, and according to data from the U.S. Department of Health and Human Services, 34.3 million people smoke tobacco cigarettes. Recent trends show that the number of marijuana smokers is rising while the number of cigarette smokers is declining.