First U.S. Surgery, Cannabis Guidance Released

First U.S. Surgery, Cannabis Guidance Released
High Times

Finally detailed and informed advice on the potential interactions between cannabis and anesthetic medications before, during, and after surgery is taking shape.  The first guidelines on cannabis use and the surgery timeline were published on Jan. 3 by the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine), who acknowledged that up until now there  is “no single document” that summarizes all of these concerns. The guidance is based on known data and recommendations from the Perioperative Use of Cannabis and Cannabinoids Guidelines Committee—a group composed of 13 anesthesiologists, chronic pain physicians, experts, and patient advocates. The committee answered nine questions and made 21 recommendations using a modified Delphi consensus method. They arrived at an over 75% agreement required for recommendation, and all 21 recommendations achieved full consensus. Recommendations include screening all patients before surgery; postponing elective surgery in patients who have altered mental status or impaired decision-making capacity at the time of surgery; Counseling frequent users on the potentially negative effects of cannabis use on postoperative pain control; Counseling pregnant patients on the potential risks of cannabis use to the unborn child. Addressing Surgery and Cannabis Concerns “While many of the perioperative risks and challenges related to perioperative cannabis, such as how to advise patients preoperatively, the effects of cannabis on anesthetic medications, and the interaction between cannabis, opioids, and pain, have been described in the literature, there is no single document that summarizes all of these concerns and provides evidence-based recommendations,” the document reads. The document continues, “Flexibility in this clinical practice guideline is intended to enable person-centered decision-making that takes into account an individual’s expected health outcomes and well-being within the context of various regulatory environments.”  No recommendations were made for the reduction of cannabis administered by other non-smoking routes before surgery “due to current…

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