Trending Clinical Topic: Cannabis Screening

Ryan Syrek


January 27, 2023

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Cannabis use has been steadily rising worldwide, with nearly 150 million people estimated to use the drug each year. This increase in consumption has led to various health consequences and considerations. Of note, the American Society of Regional Anesthesia and Pain Medicine (ASRA) issued guidelines on cannabis screening for patients undergoing procedures that require regional or general anesthesia (see Infographic). This, combined with other key recent findings, resulted in the week's top trending clinical topic.

The ASRA's recommendations are the first guidelines in the United States to cover cannabis use as it relates to surgery. The recommendations were created by 13 experts, including chronic pain specialists, anesthesiologists, and a patient advocate. Studies in support included one that showed long-term cannabis use was linked to a 20% increase in postoperative nausea and vomiting incidence. Beyond the four grade A recommendations, additional suggestions include delaying elective surgery for at least 2 hours after a patient has smoked cannabis owing to an increased risk for heart attack and considering adjustment of ventilation settings during surgery for patients who regularly smoke cannabis. However, the guidelines state that doctors should not conduct universal toxicology screenings, given a lack of evidence supporting this practice.

Part of the impetus for the guidelines was increased cannabis consumption. A recent study broke down that increase within the United States. During the pandemic, states in which all cannabis use is illegal and states in which medical marijuana is legal both saw jumps in consumption. However, states that allow recreational cannabis use saw no significant change. In states where cannabis use is prohibited, adult use increased from 14.5% before the COVID pandemic to 18.1%. In states where only medical marijuana is legal, use rose from 16.3% to 18.9%. In states that allow recreational cannabis use, around 28% of adults reported use both before and during the pandemic. The data included 178,824 adults with an average age of 51 years.

Part of the changes in use involves some patients with chronic pain switching from opioids to cannabis. Almost one third of patients with chronic pain now report using medical cannabis, with more than half subsequently decreasing use of other pain relivers, including opioids. The survey included 1724 US adults aged 18 years or older with chronic noncancer pain. Just over 96% of respondents completed the full survey (57% female; mean age, 52.3 years). Among study participants, 31% (95% CI, 28.2%-34.1%) reported having used cannabis for pain, 25.9% (95% CI, 23.2%-28.8%) reported use within 12 months, and 23.2% (95% CI, 20.6%-26%) reported use within 30 days. As for nonpharmacologic treatments, 38.7% reported that cannabis use led to decreased physical therapy, 19.1% to lower meditation use, and 26% to less cognitive-behavioral therapy (CBT). However, 5.9%, 23.7%, and 17.1% reported increased use of physical therapy, meditation, and CBT, respectively.

Increased cannabis use has also had serious unintended consequences. Poison control centers in the United States now receive more calls about adolescents abusing cannabis than about any other substance. In 2000, alcohol was the most commonly involved substance (1318, or 9.8% of all calls). Through 2013, alcohol abuse cases exceeded cannabis cases annually. However, in 2014, cannabis overtook alcohol. Over the 20-year study period, calls about exposure to cannabis increased 245%, from 510 in 2000 to 1761 in 2020.

Edibles played a key role. The number of children aged 5 years or younger exposed to edible cannabis in the United States jumped 1375% from 2017 to 2021, rising from 207 reports to 3054. A recent study found that about 97% of exposures occurred in residences, with 90% at the child's home. Around half of all cases involved children aged 2 and 3 years. During the 5-year period, children younger than 6 years had 7043 edible cannabis exposures. In 2.2% of cases, the exposure was either life-threatening or caused residual disability. In 21.9% of cases, the effect was moderate. About 8% of children were admitted to critical care units; 14.6% were admitted to noncritical care units. Of the 4827 cases for which information about clinical effects of exposure was available, 70% involved central nervous system depression. Patients also experienced ataxia (7.4%), agitation (7.1%), confusion (6.1%), tremor (2%), and seizures (1.6%). Other common symptoms included tachycardia (11.4%), vomiting (9.5%), mydriasis (5.9%), and respiratory depression (3.1%).

As the risks and potential benefits of cannabis use continue to be investigated, findings related to health concerns help to inform clinicians and patients. This week, screening recommendations reflecting increases in use were of great interest and resulted in the top trending clinical topic.

Learn more about cannabis-related disorders.


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