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All Surgical Patients in the US are Now Required to Come Clean about Their Cannabis Usage
New rules are in place so doctors and nurses can adjust your anesthesia for surgeries
Like It Or Not, All Patients In The US May Now Have To Undergo Screening For Cannabis Use Before Surgery
New guidelines that have just been published by the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) recommend that all individuals who are set to undergo surgery that requires the use of anesthesia be screened about their marijuana consumption.
ASRA Pain Medicine is one of the biggest medical organizations focusing on anesthesiology, which was founded back in 1975. They currently have over 5,000 members across 6 continents.
These are the first-ever guidelines to be released in the United States making such recommendations. Doctors and physicians state that regular cannabis use can actually result in increased risk for nausea and pain following surgery, causing patients to require the use of opioids.
ASRA Pain Medicine explains that the guidelines were released due to the growing use of cannabis throughout the last 20 years, though there are valid concerns that cannabis can have unwanted interactions with anesthesia. “Before surgery, anesthesiologists should ask patients if they use cannabis – whether medicinally or recreationally – and be prepared to possibly change the anesthesia plan or delay the procedure in certain situations,” explains Samer Narouze, MD, Ph.D., ASRA Pain Medicine’s president and the senior author of the guidelines.
This is not news, as there have been numerous studies in the past pointing towards the possible hazards and risks of cannabis use, when not abstained before surgery. More on this below.
So is it fair for patients to be screened about their cannabis consumption before surgery? This may be a valid point, and one of those situations wherein it may be for the benefit of patients to actually abstain from it, as it may do more harm than good.
“They also need to counsel patients about the possible risks and effects of cannabis. For example, even though some people use cannabis therapeutically to help relieve pain, studies have shown regular users may have more pain and nausea after surgery, not less, and may need more medications, including opioids to manage the discomfort,” reads the guidelines. “We hope the guidelines will serve as a roadmap to help better care for patients who use cannabis and need surgery,” it continues.
What Studies Say
Current studies point towards risks and dangers that marijuana consumers face during surgery. That’s why it’s recommended to abstain before you are due to go under the knife.
In a 2022 study, whose findings were presented during the Anesthesiology 2022 yearly meeting, cannabis users tend to experience more pain following surgery. The researchers analyzed medical records from 34,521 adult patients, 1,681 of whom were marijuana consumers, all of whom had surgeries conducted at the Cleveland Clinic from January 2010 to December 2020. They found that marijuana users who consumed the drug within one month before surgery were found to suffer from 14% more pain within 24 hours after surgery compared to non-cannabis consuming patients.
Furthermore, cannabis consuming patients required 7% more opioids after surgery.
“The association between cannabis use, pain scores and opioid consumption had been reported before in smaller studies, but they’ve had conflicting results,” notes Dr. Elyad Ekrami, MD, the study’s lead author and a clinical research fellow from the Cleveland Clinic’s Anesthesiology Institute. “Our study has a much larger sample size and does not include patients with chronic pain diagnosis or those who received regional anesthesia, which would have seriously conflicted our results. Furthermore, our study groups were balanced by confounding factors including age, sex, tobacco and other illicit drug use, as well as depression and psychological disorders,” he said.
Dr. Ekrami adds that physicians need to take note of patients who consume cannabis it has an impact on their outcomes, especially because they may require more painkillers or opioids post-surgery. “Physicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control,” Dr. Ekrami says.
Meanwhile, another study from 2019 demonstrated another impact of cannabis on surgery: requiring more anesthesia. Dr. Mark Twardowski of Colorado’s Western Medical Associates, the lead author of the study, explains that consuming cannabis before surgery will have an impact on patients’ medical care. Dr. Twardowski and his team analyzed 250 patients who had to undergo minimally invasive procedures which required anesthesia in the state, where cannabis has long been legal for recreational use.
Ten percent of the patients reported being regular cannabis users. These individuals needed more than double the amount of propofol, an anesthetic. In addition, cannabis users also needed 14% more fentanyl for the pain, and midazolam for sedation.
“Cannabis users cannot assume that their use will have no effects on their medical care,” Dr. Twardowski explains. “Clearly the fact that use affects the effectiveness of these three medicines certainly raises myriad questions about potential effects on other medications (pain medicines, anxiety medicines etc),” he told Reuters via email.
He also explains that since cannabis stays so long in the human body, it could actually take months for its effects to no longer affect surgical outcomes. “Patients absolutely need to inform their providers about cannabis use prior to any procedure,” he advises.
Conclusion
If you are due for any kind of procedure requiring anesthesia, it’s critical to be upfront with your healthcare provider about your marijuana consumption. Not doing so may result in an extremely unpleasant experience as you may still feel the pain without adequate anesthesia.
New Mexico regulators fined a cannabis operator nearly $300,000 and revoked its license after the company allegedly created fake reports in the state’s traceability software.
The New Mexico Cannabis Control Division (CCD) accused marijuana manufacturer and retailer Golden Roots of 11 violations, according to Albuquerque Business First.
Golden Roots operates the The Cannabis Revolution Dispensary.
The majority of the violations are related to the Albuquerque company’s improper use of BioTrack, which has been New Mexico’s track-and-trace vendor since 2015.
The CCD alleges Golden Roots reported marijuana production only two months after it had received its vertically integrated license, according to Albuquerque Business First.
Because cannabis takes longer than two months to be cultivated, the CCD was suspicious of the report.
After inspecting the company’s premises, the CCD alleged Golden Roots reported cultivation, transportation and sales in BioTrack but wasn’t able to provide officers who inspected the site evidence that the operator was cultivating cannabis.
In April, the CCD revoked Golden Roots’ license and issued a $10,000 fine, according to the news outlet.
The company requested a hearing, which the regulator scheduled for Sept. 1.
At the hearing, the CCD testified that the company’s dried-cannabis weights in BioTrack were suspicious because they didn’t seem to accurately reflect how much weight marijuana loses as it dries.
Company employees also poorly accounted for why they were making adjustments in the system of up to 24 pounds of cannabis, making comments such as “bad” or “mistake” in the software, Albuquerque Business First reported.
Golden Roots was fined $298,972.05 – the amount regulators allege the company made selling products that weren’t properly accounted for in BioTrack.
The CCD has been cracking down on cannabis operators accused of selling products procured from out-of-state or not grown legally:
- Regulators alleged in August that Albuquerque dispensary Sawmill Sweet Leaf sold out-of-state products and didn’t have a license for extraction.
- Paradise Exotics Distro lost its license in July after regulators alleged the company sold products made in California.
Golden Roots was the first alleged rulebreaker in New Mexico to be asked to pay a large fine.
Source: https://mjbizdaily.com/new-mexico-cannabis-operator-fined-loses-license-for-alleged-biotrack-fraud/
Four marijuana companies, including a multistate operator, have filed a lawsuit against U.S. Attorney General Merrick Garland in which they allege the federal MJ prohibition under the Controlled Substances Act is no longer constitutional.
According to the complaint, filed Thursday in U.S. District Court in Massachusetts, retailer Canna Provisions, Treevit delivery service CEO Gyasi Sellers, cultivator Wiseacre Farm and MSO Verano Holdings Corp. are all harmed by “the federal government’s unconstitutional ban on cultivating, manufacturing, distributing, or possessing intrastate marijuana.”
Verano is headquartered in Chicago but has operations in Massachusetts; the other three operators are based in Massachusetts.
The lawsuit seeks a ruling that the “Controlled Substances Act is unconstitutional as applied to the intrastate cultivation, manufacture, possession, and distribution of marijuana pursuant to state law.”
The companies want the case to go before the U.S. Supreme Court.
They hired prominent law firm Boies Schiller Flexner to represent them.
The New York-based firm’s principal is David Boies, whose former clients include Microsoft, former presidential candidate Al Gore and Elizabeth Holmes’ disgraced startup Theranos.
Similar challenges to the federal Controlled Substances Act (CSA) have failed.
One such challenge led to a landmark Supreme Court decision in 2005.
In Gonzalez vs. Raich, the highest court in the United States ruled in a 6-3 decision that the commerce clause of the U.S. Constitution gave Congress the power to outlaw marijuana federally, even though state laws allow the cultivation and sale of cannabis.
In the 18 years since that ruling, 23 states and the District of Columbia have legalized adult-use marijuana and the federal government has allowed a multibillion-dollar cannabis industry to thrive.
Since both Congress and the U.S. Department of Justice, currently headed by Garland, have declined to intervene in state-licensed marijuana markets, the key facts that led to the Supreme Court’s 2005 ruling “no longer apply,” Boies said in a statement Thursday.
“The Supreme Court has since made clear that the federal government lacks the authority to regulate purely intrastate commerce,” Boies said.
“Moreover, the facts on which those precedents are based are no longer true.”
Verano President Darren Weiss said in a statement the company is “prepared to bring this case all the way to the Supreme Court in order to align federal law with how Congress has acted for years.”
While the Biden administration’s push to reschedule marijuana would help solve marijuana operators’ federal tax woes, neither rescheduling nor modest Congressional reforms such as the SAFER Banking Act “solve the fundamental issue,” Weiss added.
“The application of the CSA to lawful state-run cannabis business is an unconstitutional overreach on state sovereignty that has led to decades of harm, failed businesses, lost jobs, and unsafe working conditions.”
Alabama regulators are targeting Dec. 1 to award the first batch of medical cannabis business licenses after the agency’s first two attempts were scrapped because of scoring errors and litigation.
The first licenses will be awarded to individual cultivators, delivery providers, processors, dispensaries and state testing labs, according to the Alabama Medical Cannabis Commission (AMCC).
Then, on Dec. 12, the AMCC will award licenses for vertically integrated operations, a designation set primarily for multistate operators.
Licenses are expected to be handed out 28 days after they have been awarded, so MMJ production could begin in early January, according to the Alabama Daily News.
That means MMJ products could be available for patients around early March, an AMCC spokesperson told the media outlet.
Regulators initially awarded 21 business licenses in June, only to void them after applicants alleged inconsistencies with how the applications were scored.
Then, in August, the state awarded 24 different licenses – 19 went to June recipients – only to reverse themselves again and scratch those licenses after spurned applicants filed lawsuits.
A state judge dismissed a lawsuit filed by Chicago-based MSO Verano Holdings Corp., but another lawsuit is pending.
Source: https://mjbizdaily.com/alabama-plans-to-award-medical-cannabis-licenses-dec-1/
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