Wbuilding up in the middle of surgery is the stuff of nightmares. Your eyes will be open while a surgeon digs his scalpel into your abdomen. The operations team goes wild; anesthesiologist rushes to give a stronger dose. Although some of these horror stories have made headlines, thanks to modern medicine such conditions are rare. But the risk of it happening may be rising and anesthesiologists are taking note. The culprit is not an attack on bad doctors or bad drugs, but the increase in Americans’ casual use of a substance that many consider harmless: marijuana.
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A study published in 2019 found that patients who used marijuana daily or weekly needed up to three times the usual dose of anesthesia to stay under while they were in the theater. Smoking weed before surgery can leave patients confused, irritable and sometimes even violent when they wake up. But the problems do not end there. A working paper published in October, which has not yet been peer-reviewed, suggests that herbs can also interfere with recovery. Of the nearly 35,000 Cleveland Clinic patients evaluated, those who used marijuana within 30 days of their operation experienced 14% more pain the day after surgery and took 7% more prescription opioids to make it easier. Why this might be, like anesthesia itself, is a mystery.
The problem is compounded by an increasing number of Americans getting older. This past November Maryland and Missouri joined 19 states and Washington, DC, in legalizing recreational marijuana. New York recently issued its first cannabis sales licenses; in January Connecticut stores got the green light to start selling it. The share of Americans who report smoking weed jumped from 7% in 2013 – the year before legal sales began in Colorado, the original state – to 16% in 2022. that spike was at least partially driven by the change in laws: a study of couples living in different states found that legalization led to a 20% increase in use.
Meanwhile, federal regulation remains strict, making marijuana difficult to control. The Controlled Substances Act of 1970 classified weed as a Schedule One drug, just like heroin. Back then it was considered to have a “high potential for abuse” and no established medical use. Studies from around the world have since shown that marijuana can relieve chronic pain, excruciating chemotherapy-induced nausea and help treat epilepsy. Even though the World Health Organization proposed in 2019 to renew the classification, in America this was not done. That makes it difficult to conduct clinical trials. Labs must be equipped with elaborate safety equipment for the Drug Enforcement Administration to give the stamp of approval and funding is scarce. As more and more Americans light up joints, other grim side effects could be lurking.
For clinicians, the downsides of surgery are clear enough to change medical protocols—even before more studies come in. In January, the American Society of Regional Anesthesia and Pain Medicine issued guidelines on how to screen patients for marijuana use before surgery. Pregnant women should be discouraged from smoking weed, the group said, and non-urgent surgeries should be postponed for at least two hours if the patient becomes blitzed in. Several other new reports are warning anesthesiologists about the growing risks.
The common belief that marijuana relaxes nerves works against doctors. Some people seem to get stoned before they get to the hospital to calm themselves down. New users may be particularly likely to smoke for such a reason. For a better experience, patients should forget about the parking lot. economist readers will now know better. ■
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