Marijuana and Surgery

Did you know that marijuana use can impact your surgery and post-surgery success?

Marijuana affects many parts of the body. These effects can impact your surgery through the following ways:

• Respiration: Marijuana affects the airways making it harder to place a breathing tube for anesthesia. Marijuana also affects the lungs and can cause wheezing, coughing, and chronic bronchitis.
• Cardiac effects: Marijuana affects heart rate and blood pressure and has the potential to increase risks of a heart attack and/or stroke.
• Pain management: Marijuana may interfere with pain control and the amount of pain medication needed to provide relief following an operation. 

You should discuss with your surgical team if you are using any form of marijuana or cannabis products. It can affect the outcome of your surgery. It is recommended to stop using marijuana products 72 hours before surgery.

What breathing problems are caused by smoking marijuana?

Smoking marijuana increases your risk of breathing problems. Marijuana cigarettes are unfiltered. Users take deep breaths and hold their breath. This increases the amount of harmful chemicals like tar that are absorbed in the airways. Marijuana burns at a higher temperature than tobacco, thus the smoke causes more thermal (heat) injury to the throat and airway as well. Marijuana smokers can have wheezing, coughing and chronic bronchitis. These are the same symptoms you see with tobacco smokers but can happen up to 10 years sooner in marijuana smokers.¹

Did You Know?

One study estimated that 3–4 cannabis cigarettes daily have the same effect of about 20 tobacco cigarettes in terms of bronchial tissue damage.²  

What can happen if your airway is swollen?

Smoking marijuana can cause swelling of the uvula (uvulitis). The uvula is the small, teardrop-shaped piece of soft tissue that hangs from the center of your soft palate. Uvular swelling can last 12 to 24 hours after smoking marijuana.³

If your uvula is swollen: 

• You can have trouble breathing.
• You can choke or gag – which can lead to aspiration of your secretions (instead of going down the esophagus, they may go down the trachea) and pneumonia.
• It is harder to place a breathing tube in your airway as part of your anesthesia. 
• You may need larger amounts of medications when placing a breathing tube. 
• You may have to stay on a breathing machine after surgery because it will be harder to remove the tube. 

What are the effects of vaping? 

Vaping marijuana is not safer than smoking marijuana. When vaping or “dabbing,” the concentrate is inhaled all at once—in a single breath. As a result, large amounts of THC are delivered to the body quickly, causing a high and affecting judgment and motor skills. Chronic marijuana vaping can damage the cells in the lungs. This can cause inflammation (swelling), and increased chances of respiratory infections. Chronic marijuana use can lead to a substance use disorder, and over the long-term, addiction.

In 2019, there were increased emergency room visits and deaths after vaping THC. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have recommended not using THC-containing e-cigarettes.⁴

What effect does marijuana have on heart rate and circulation?

Marijuana can cause your heart rate and blood pressure to increase or decrease depending on how much you take. 

Marijuana causes: 

• Increased heart rate (tachycardia) and increased blood pressure at low and moderate dosages.⁵ These changes in heart rate can last from 1-4 hours. 
• Slower heart rate and decreased blood pressure at high dosages. 

• Irregular heartbeats and increased risk of a heart attack.  The risk is up to five times higher compared to non-smokers in the first hour after you smoke.⁶
• Reduced amounts of oxygen in the blood. This decreased amount of oxygen may mean your surgical wounds will not heal or take longer to heal.

Can marijuana affect pain control after surgery?

• Patients with previous injuries who used marijuana before surgery reported higher amounts of pain. Higher dosages of opioids were used for a longer time after surgery to control pain, when compared to those who did not use marijuana. ⁷ Chronic marijuana use was associated with higher opioid use for pain relief compared with occasional marijuana users.⁷
• CBD gel patches applied to the skin can reduce pain and itching in patients with peripheral neuropathy (pain at the nerve site).⁸ Gels containing CBD and a combination of CBD and THC had mixed results in decreasing pain in patients with cancer. 
• Patients with cancer reported decreased neuropathic (nerve) pain after using cannabis compared with patients who did not use marijuana.⁹

When should I stop using marijuana before surgery? 

The effects of marijuana peak at approximately 1 hour and can last 2–4 hours.¹⁰

Marijuana:

• Increases stress on the heart, and the chance for heart attacks and strokes in young, chronic users.
• It can cause lung complications such as airway obstruction and the need for higher doses of anesthesia. 

If you are having surgery, you should not use cannabis products within 72 hours of general anesthesia.¹⁰

Let your surgeon know if you are having difficulty stopping marijuana. You may be irritable, angry, nervous, and sleep deprived. You may have less appetite, feel depressed or moody, and have tremors, sweating, fever, chills, and headache. 

If you feel you are addicted to marijuana: 

• Work with your surgical team to meet with an addiction counselor.
• Call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Addiction Hotline for help at 1-800-662-HELP (4357). The call is free, confidential, and someone is available 24 hours per day. 
• If you are having an emergency procedure, make sure you or a family member informs your healthcare team about your marijuana use. 

Summary

Patients are strongly encouraged to talk with their doctors about their marijuana/cannabis use. This helps with your safe treatment plans prior to surgery. The American College of Surgeons (ACS) has not taken a position on legalization of marijuana for medical use. The ACS does not support the smoking or vaping of marijuana and other cannabinoids as smoking poses numerous health risks to the surgical patient. For questions, contact surgicalpatienteducation@facs.org.

Talk to Your Doctor

Fill in the table below with your doctor to have a conversation about how use could impact your surgery and health. This form may also be printed and taken to your appointment.

References

1. Moore BA, Augustson EM, Moser RP, Budney AJ. Respiratory effects of marijuana and tobacco use in a U.S. sample. J Gen Intern Med. 2005;20(1):33-37.
2. Wu TC, Tashkin DP, Djahed B. Pulmonary hazards of smoking marijuana as compared with tobacco.  Engl. J. Med. 1988; 318:347–351.
3. Rawal SY, Tatakis DN, Tipton DA. Periodontal l manifestations of marijuana use. J Tenn Dent Assoc. 2012;92(2):26-32.
4. Outbreak of lung injury associated with the use of e-cigarette, or vaping products. Centers for Disease Control. Accessed November 1, 2021. Available at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
5. Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol. 2002 Nov;42(S1):64S-70S. doi: 10.1002/j.1552-4604. 2002.tb06005. x. PMID: 12412838.
6. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103(23):2805-2809.
7. Bhashyam AR, Heng M, Harris MB, Vrahas MS, et al. Self-reported marijuana use is associated with increased use of prescription opioids following traumatic musculoskeletal injury. J Bone Joint Surg Am. 2018 Dec 19;100(24):2095-2102. doi: 10.2106/JBJS.17.01400. PMID: 30562289.
8. Xu D.H., Cullen B.D., Tang M., Fang Y. The effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities.  Pharm. Biotechnol. 2019; 21:390–402. doi: 10.2174/138920102066619120211153428.
9. D’Andre S, McAllister S, Nagi J, Girdhar KV, Ruiz-Macias E, Loprinzi C. Topical cannabinoids for treating chemotherapy-induced neuropathy: a case series. Integr Cancer Ther. 2021;20:1-8. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8646190/pdf/10.1177_15347354211061739.pdf
10. Huson HB, Granados TM, Rasko Y. Surgical considerations of marijuana use in elective procedures. Heliyon. 2018;4(9): e00779. Published 2018 Sep 15. doi: 10.1016/j.heliyon. 2018.e00779.