A small-scale study finds people who regularly use cannabis may need two times the level of sedation required by nonusers when undergoing medical procedures. Midazolam, fentanyl and propofol, three sedation drugs commonly used during endoscopic procedures, were compared in the research. Marijuana has gained popularity around the globe in recent years due, in part, to changing laws. According to a United Nations report, between 2007 and 2015, use of marijuana increased 43% in the United States, where an estimated 13.5% of adults use cannabis. Meanwhile, cannabis use around the world was estimated to include 183 million people in 2015.
Comparing cannabis users to nonusers, research found that patients who reported smoking or using edibles on a daily or weekly basis required 14% more fentanyl, 20% more midazolam and 220% more propofol to achieve optimum sedation for routine procedures. For example, it took 13.83 milligrams of propofol, on average, for 225 nonusers to float into unconsciousness, compared with 44.81 milligrams needed, on average, by 25 cannabis users. Dr. Roderic Eckenhoff, a professor of anesthesia at the University of Pennsylvania, said the study is interesting but lacked rigor. “I would consider this a pilot study that maybe somebody should pick up on and do a more complete trial,” said Eckenhoff, who was not involved in the research.
One factor that bothered Dr. Eckenhoff was that the researchers simply examined medical records and compared whatever amount of sedation was used for each patient instead of controlling exact amounts of sedation and comparing the effects. What is considered “enough” depends a lot on the individual providers and surgeons involved, “Even if you give someone propofol for a long time, they get a little tolerant to it, but not by 200%.” Although upward of 200% “resistance” may be “possible, I’d be surprised if that held up in a bigger study,” Eckenhoff said. Finally, he noted that patients are not always reliable and don’t necessarily tell their doctors about “everything else that they take,” and this may have influenced the results: “Some people who use marijuana also take other drugs recreationally.”
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