In a TikTok video posted on March 10, influencer and doctor Kunal Sood M.D. warned that people who need anesthesia and who smoke pot should disclose that information because of real interactions that can occur. A higher dose of medication may be required for people who smoke regularly, and it’s in the patient’s best interest to plan accordingly.

LAD Bible reports that one doctor is trying to bring light to an issue related to cannabis consumers that has basis in fact—not just a typical scare tactic you may hear from other sources.

“Did you know if you do cannabis (marijuana) long term you will require a higher dose of anaesthesia to achieve the same effect,” his TikTok video reads. “Make sure you tell your anaesthesiologist if you smoke or consume cannabis.”

It’s a simple five-second video, and the doctor simply nods his head in approval, but the video gained over 10 million views at the time of writing. Sood is a double-certified pain doctor and CMO of Avenir Nutrition. He uses comedy and facts to inform people about health issues.

Simply discussing cannabis use with a doctor can make a big difference in their decision for your dose of medicine. The doctor is not suggesting the people quit completely, but simply be honest with their doctors.

In a nutshell, if you consume cannabis regularly, then you will probably need to have a larger dose of anesthesia than someone else in order to be unconscious for your operation and stay unconscious. In the worst case scenario, that could mean not fully knocking out. Waking up during surgery sounds genuinely like one of the all-time worst experiences that a person could have.

It turns out that most experienced anesthesiologists say the same thing. Sometimes it’s recommended to abstain from cannabis for a certain amount of days prior to surgery based on these potential interactions.

Harvard David Hepner, MD, MPH, issued a similar plea in 2020, saying that he’s seeing more people who need different amounts of anesthesia because they consume cannabis.

“The way(s) you use marijuana (smoking, edibles, etc.), how often you use, and how much all can affect how your body responds to anesthesia,” Hepner wrote. “Since marijuana and anesthesia both affect the central nervous system, people who use marijuana regularly may need different amounts of anesthesia medicines. In order to know which medicines and how much to use, your doctor needs to know ahead of time how much and how often you use marijuana.”

The American Society of Anesthesiologists (ASA) has a list of eight things that you should tell your physician and anesthesiologist before surgery, and the use of marijuana is one of them.

Recently, detailed and informed advice on the potential interactions between cannabis and anesthetic medications before, during, and after surgery was released. 

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.

“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.

You might want to listen to what anesthesiologists are saying about cannabis.

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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 lack of evidence;” the routine tapering of cannabis and cannabinoids before, during, or after surgery; the use of intraoperative electroencephalogram (EEG) in patients who have taken cannabinoids; nor adjusting opioid prescriptions afterward in surgical patients who use cannabinoids.

Authors noted the wide range of recommendations for pre-op patients, but cautioned that surgery should be postponed for a minimum of two hours after smoking cannabis. People who rely on medical cannabis are advised to taper off before surgery in some cases.

Most current recommendations, however, advise patients to abstain from cannabis a few to 10 days prior to surgery. “A recent consensus-based guideline recommended reducing cannabinoid use 7 days prior to surgery (to less than 1.5 g/day of smoked cannabis, 300 mg/day of CBD oil, 20 mg/day of THC oil) while cautioning not to attempt any tapering strategies within 6 days of elective surgery and not to attempt tapering a day prior to surgery.”

The document continues with the range of guidance, “Contrary to this recommendation, recent reviews of perioperative cannabinoids recommended cessation 72 hours prior to surgery. An even more conservative recommendation was recently provided, in which the authors recommended up to 10 days of cessation of oral cannabis consumption.”

Does Cannabis Impact An Anesthesia?

Research has a long way to go, however there is a growing body of evidence showing potential interactions and effects of cannabis before or after surgery.

One study published in Baylor University Medical Proceedings in 2019 shows that cannabis consumers may require higher doses of anesthesia than non-consumers, as well as a slew of other potential interactions, while another study found no significant difference before surgery in the gastrointestinal tract.

Cannabis might be an issue at the dentist as well. There is a strong belief that cannabis interacts with novocaine and local anesthetics like lidocaine. In one study dating back to 1976, THC interacted undesirably with anesthetic medications.

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Evidently, so many cannabis users have embraced this strategy before their dental appointments that the American Dental Association (ADA) is speaking out, suggesting patients refrain from cannabis use before their visits. Additionally, a recent survey found that more than half of dentists (52%) reported patients arriving to appointments high on cannabis or another drug.

The findings were uncovered in two surveys: One surveyed 557 dentists; the second was a nationally representative survey of 1,006 consumers. Each survey was conducted as part of trend research by the ADA, which suggests the trend is due to increasing recreational and medicinal cannabis use across the nation. 

As dentists talk through patients’ health histories, Dr. Tricia Quartey, a New York dentist and ADA spokesperson, said that more have disclosed their use of cannabis since it became legal.

“Unfortunately, sometimes having marijuana in your system results in needing an additional visit,” Dr. Quartey said in an ADA media release. According to researchers, showing up for a dental appointment while high can limit the care dentists are able to deliver. 

The survey of dentists found that 56% had to limit treatment to high patients. Another 46% of surveyed dentists said they sometimes had to increase anesthesia to patients who needed care, due to the way cannabis and anesthesia impact the central nervous system.

“Marijuana can lead to increased anxiety, paranoia and hyperactivity, which could make the visit more stressful. It can also increase heart rate and has unwanted respiratory side effects, which increases the risk of using local anesthetics for pain control,” Dr. Quartey said. “Plus, the best treatment options are always ones a dentist and patient decide on together. A clear head is essential for that.”

The ADA also notes that cannabis users are more likely to have “significantly more” cavities than non-users, particularly due to the foods consumers often crave after a smoke sesh.

“The active ingredient in marijuana, THC, makes you hungry, and people don’t always make healthy food choices under its influence,” Dr. Quartey said. “Medically speaking, munchies are real.”

The ADA generally cites the “strong indications” that smoking cannabis is harmful to oral, and overall, health. (Regarding the relationship between oral health and edible and topical use, research is still catching up.)

Quartey said that smoking cannabis is associated with gum disease and dry mouth, which can lead to other oral health issues. She added smoking cannabis also puts folks at an increased risk of mouth and neck cancers.

Among the consumers surveyed in the second poll, 39% reportedly used cannabis, with smoking as the most common form of use. A separate 25% of respondents vaped, and 51% vaped cannabis. 

The survey also found that 67% of patients said they were comfortable talking to their dentist about cannabis, as the ADA recommends dentists discuss cannabis use while they review health history with patients during their appointments. 

“If we ask, it’s because we’re here to keep you in the best health we can,” Dr. Quartey said. “If you use it medicinally, we can work with your prescribing physician as part of your personal healthcare team.”

The ADA has also called for further research around cannabis and oral health, affirming its intent to continue monitoring the science and providing clinical recommendations for both dentists and patients. 

For cannabis users who want to stay on top of their oral health, the ADA recommends a strong daily hygiene routine of twice-daily brushing with fluoride toothpaste, daily flossing, routine dental visits, and healthy snack choices.

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