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How Marijuana Can Affect Your Surgery

Scott Sundick, MD, is a board-certified vascular and endovascular surgeon. He currently practices in Westfield, New Jersey.

If you smoke marijuana and are planning to have surgery you may be wondering if you need to stop smoking before your procedure. Like smoking cigarettes, the short answer is this: Yes, quitting today may improve your surgical outcome, how quickly you get out of the hospital, and how quickly you heal after surgery.

Marijuana Before Surgery

Like nicotine, marijuana can complicate surgery and should be avoided in the weeks and even months prior to your procedure. Much like smoking cigarettes, abstaining from marijuana in the weeks before surgery can decrease the likelihood of complications during and after surgery.

Unfortunately, research on the topic of marijuana use and the effects during surgery is limited. It should become more plentiful in the future as medicinal marijuana has been legalized in multiple states (and recreational use in a growing number), making it easier to gather scientific data on the topic.

We do know that marijuana, while effective for decreasing nausea and some other health-related benefits, has the potential to interact with anesthesia.  

Risks of Smoking Marijuana

Contrary to popular wisdom, marijuana smoking is not a healthier option than cigarettes. It can lead to lung cancer and other respiratory problems.  

The process of inhaling large amounts of marijuana, then holding it in the lungs for extended periods of time to increase the amount absorbed, leads to increased exposure to cancer-causing chemicals.

The chronic coughing, wheezing and difficulty breathing that long-term cigarette smokers experience also occur in marijuana users.  

Types of Marijuana

When talking about surgery anesthesia and marijuana, all types of marijuana should be avoided. That means smoking marijuana, edibles, and synthetic marijuana.

Synthetic marijuana, in particular, is poorly understood, unregulated, and highly variable in content. For this reason, it is impossible to predict the reaction that might occur with exposure to anesthesia. Synthetic marijuana should not be used in the days, or even weeks, prior to surgery.

Marijuana and Anesthesia

Smoking marijuana regularly leads to the same risks of complications faced by patients who smoke cigarettes. This means that marijuana smokers are more likely than non-smokers to be on the ventilator longer, have a higher risk of developing pneumonia after surgery, and greater scarring of incisions.

The use of marijuana, especially immediately prior to surgery, can change the doses needed for sedation.   One commonly used medication, propofol, requires substantially higher doses for the patient who routinely uses marijuana.

One study looked at the doses of propofol required to intubate patients who routinely smoked marijuana with non-marijuana using patients.   The individuals who used marijuana required a dramatic increase in sedation.

One patient who smoked marijuana 4 hours prior to surgery was the topic of a case study, after experiencing an airway obstruction during the procedure.   This is a very serious complication that can lead to death, and is believed to have been caused by airway hyperreactivity, a condition known in cigarette smokers but previously unidentified in marijuana users.

It is also believed that regular users of marijuana—whether it is smoked or eaten—are more likely to experience agitation.

Marijuana Effects During Surgery

The use of marijuana the day before surgery, and especially in the hours prior to the procedure, can cause more dramatic effects.   While some people are tempted to use marijuana prior to surgery in an effort to relax or be less stressed before the procedure, this is a very bad idea and can cause problems.

Marijuana causes the blood vessels of the body to relax, a process called vasodilation. This process can cause the blood pressure to fall and the heart rate to increase. These, in turn, can complicate matters if the patient’s blood pressure is falling due to issues with the surgery, and can change the way the body responds to anesthesia.

Tell the Truth About Marijuana Use

It is very important that you are candid with the anesthesia provider about your personal use of marijuana. This means giving an accurate report of how much and how often you use marijuana, whether you eat it or smoke it, and when you last did so.

It is unlikely that your use will delay your surgery, but it is important that the anesthesia provider understands the potential for your body to need more anesthetic than is typical.

The anesthesia provider also needs to be prepared for any airway issues that may arise, which are more common in smokers of all types compared to non-smokers.

After Surgery

Regular marijuana use, like cigarette and cigar use, can increase the length of time it takes to be removed from the ventilator after surgery.   The risk of being on the ventilator long term is decreased by quitting smoking before surgery, and that risk is decreased further with every day that passes between the last day of smoking and the day of surgery.

A Word From Verywell

It may seem like a drag—pardon the pun—to stop smoking marijuana before surgery and to not smoke during your recovery from surgery, but you will heal faster, return to your normal activities more quickly, have less scarring and fewer complications if you refrain.

It is true that most people would have quit smoking long ago if it were easy, but surgery offers a real incentive to back away from the marijuana (and nicotine) in order to have the best possible outcome after surgery.

Every day you go without smoking prior to surgery will decrease your chances of being on the ventilator longer than the average patient, and will decrease the length of your stay in the hospital.

Smoking pot before surgery can cause problems during and after your procedure, find out why you should avoid marijuana before surgery.

Is Smoking Cannabis Before or After Surgery Safe?

Most would agree that preparing for surgery is an anxiety-laden task, and with fair reason—whether elective or not, surgery is a serious matter. For the cannabis lover, it may seem obvious to turn to a toke to soothe the nerves in preparation for the big event, but is it wise to do so? Are there any contraindications to smoking before surgery? How about smoking after surgery, and does cannabis make a good post-op medicine?

To find out, Leafly reached out to Dr. David Bearman, a leader in cannabinoid medicine with a long career in drug abuse treatment and prevention, as well as author of the book Drugs Are Not The Devil’s Tools. Dr. Bearman’s credentials are extensive, ranging from his time serving the U.S. Public Health Service, to co-founding the American Academy of Cannabinoid Medicine, and much more.

The top question on the list: Is it safe to consume cannabis before a surgery? The answer, as one may expect, is not a simple yes or no, but instead relies on a few variables.

Note: Although Dr. Bearman is providing his expert opinion, as with all medical concerns, please consult with your doctor or surgeon about consuming cannabis before or after a surgical procedure. For more information, please refer to Leafly’s Terms of Service.

How long before surgery should one stop smoking cannabis, if necessary?

Bearman: The therapeutic and recreational effects of smoking cannabis usually last from 1.5 to 2.5 hours. For most surgeries, patients arrive at the hospital more than three hours prior to the surgery.

However, smoking can cause increased sputum production; for that reason, I would recommend not smoking cannabis for several hours prior to the surgery.

In terms of people who are using oral administration, the effects are going to last 3-6 hours. The night before surgery you are instructed not to eat anything after 10:00 p.m., so if you follow pre-op instructions, any effect from oral use would be gone well before the surgery.

There is some speculation that cannabis may affect the heart adversely. Are there any contraindications that heart patients should be aware of?

Bearman: I don’t want to glorify it by calling it a study, but a “study” was done on the East Coast a few years ago suggesting that people who smoke cannabis have an increased chance of having a heart attack. This was a retrospective study, never reproduced, and highly criticized, so I don’t think that I have seen any strong evidence that would suggest that cannabis has adverse cardiac effects.

The effects of cannabis on the heart are, how can I say, not very large and are variable. According to the 1999 Institute of Medicine report, the effects on blood pressure is that it may make it go up or down by five milligrams. That’s not an enormous amount; it’s basically the same as saying it doesn’t have much effect.

Now what I’ve noticed in a very small number of patients who have severe hypertension, is that cannabis can be amazingly successful in lowering their blood pressure to the normal range. I think that for people who have severe hypertension, I would suggest avoiding cannabis use before surgery, just because we don’t know what the effects of it are going to be. It’s possible that they might actually end up with hypotension—the combination of the cannabis and the anti-hypertension medication might be confusing to the anesthesiologist, who needs to know all the medications they’re on.

It’s very important that if a person is regularly using cannabis that they make sure they let the anesthesiologist know, so the anesthesiologist is aware of all of the medications they’re taking, including cannabis.

Now, in addition, there is supposed to be a fleeting effect [by cannabis] on pulse; it may cause it to increase. Frankly, I don’t know how fleeting it is, but I’ve seen thousands of patients and I don’t think the pulse rate of my patients is any more abnormal or higher than the average patient. So, I don’t think it’s a big deal, because it’s unlikely [your doctors] are going to let you smoke marijuana a half hour before your surgery.

What’s the best method of consumption before surgery?

Bearman: As mentioned, when cannabis is smoked it does cause an increase in cough and an increase in sputum production, so it’s probably not a great idea to smoke it prior to a surgery. If a patient is going to use it before surgery they’re going to want to choose a method other than smoking. Since vaporizing has 70% [fewer] irritants than smoking, if a patient wants to use the respiratory method, they should vaporize.

Alternatively, a patient may want to use an oral administration such as a tincture or edibles.

Is cannabis a beneficial choice as a post-op medicine?

Bearman: Yes, I think using it post-op is fine. Again, I wouldn’t smoke it. Particularly after abdominal surgery—that would be a contraindication. With abdominal surgery, doctors don’t want to see you coughing or vomiting. When a surgeon cuts into a person’s abdominal, sutures everything up, and then they start coughing or they start vomiting, the sutures start to come undone because of an increase in the inner abdominal pressure.

So, I would certainly think that cannabis is very useful for treating pain post-operatively, but in particular with abdominal surgery I wouldn’t smoke because of the possibility of coughing. If a patient wants to use the respiratory route they may want to try vaporizing, or it may be more prudent to use an under-the-tongue spray or other routes of oral administration.

Interestingly enough, historically if you go back to the 19th century, and certainly before that, cannabis was used as a childbirth anesthetic. One of the things we know about the cannabinoids is that many of them have analgesic properties, and THC has the most. It may decrease the dosage of pain medication that the person requires post-operatively.

Leafly asked Dr. David Bearman, a leader in cannabinoid medicine, if it’s safe to smoke or consume cannabis before and after a surgical procedure. ]]>