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All Surgical Patients in the US are Now Required to Come Clean about Their Cannabis Usage

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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.

Source: https://cannabis.net/blog/medical/all-surgical-patients-in-the-us-are-now-required-to-come-clean-about-their-cannabis-usage

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Alleged Crores Pharma Scam Mastermind Arrested from Surat

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After evading law enforcement for nearly 13 years, an accused linked to a large-scale pharmaceutical fraud case has been arrested by Delhi Police from Surat, Gujarat. The suspect is alleged to have orchestrated a series of financial scams involving fake identities, forged documents, and dishonoured cheques used to procure high-value pharmaceutical raw materials.

Authorities say the accused, identified as Himmat Singh Lodha, is believed to have defrauded multiple pharmaceutical companies in Delhi of goods worth approximately ₹98 lakh before disappearing and remaining underground for years.

Fake Business Deals and Dishonoured Cheques Used in Fraud

Investigators claim the accused posed as a legitimate pharmaceutical trader and placed bulk orders for expensive drug ingredients, offering post-dated cheques as payment security.

In one documented case from 2013, he allegedly obtained around 550 kilograms of Gliclazide, a diabetes-related pharmaceutical ingredient, valued at over ₹26 lakh. When suppliers attempted to encash the cheques, they were reportedly returned with the remark “account closed.”

Following the transaction, the accused allegedly vacated his office and rented residence and disappeared without settling payments. He was later declared a proclaimed offender in 2016 after repeatedly failing to appear before court proceedings. Authorities had also issued a reward for information leading to his arrest.

Multiple Identities and Repeated Fraud Pattern

Police investigations further link the accused to another cheating case dating back to 2012, where he allegedly used a fake identity, “Kailash Jain,” to obtain a large consignment of Ambroxol HCL, a pharmaceutical compound used in cough medications. The value of that consignment was estimated at around ₹72 lakh.

Officials believe the accused followed a consistent modus operandi—posing as a credible businessman, securing high-value goods on deferred payment terms, and then disappearing after delivery while shutting down business operations.

Investigators suspect that forged business records, fake company credentials, and fabricated financial histories were used to build trust with suppliers and gain access to expensive raw materials.

Multi-State Surveillance Leads to Arrest in Surat

A special Crime Branch team tracked the accused through coordinated surveillance efforts across multiple cities, including Mumbai, Ahmedabad, and Surat. After nearly a month of technical monitoring and intelligence gathering, officials located and arrested him from a residential area in Surat.

Authorities also revealed that the accused had been involved in property-related activities while staying under the radar to avoid detection.

Growing Threat of Corporate Identity Fraud

The case highlights a rising trend of organised financial fraud targeting industries that rely heavily on trust-based transactions and deferred payments. Experts note that criminals increasingly exploit gaps in corporate verification systems by using fake GST registrations, temporary offices, and forged documentation to appear legitimate.

Cybercrime and financial fraud specialists warn that such schemes are becoming more complex with the widespread availability of digital business tools, making it easier to create convincing but fraudulent corporate identities.

Experts Urge Stronger Due Diligence in High-Value Transactions

Experts, including former IPS officer and cybercrime specialist Prof. Triveni Singh, emphasize the need for stricter verification procedures in commercial dealings. He noted that relying solely on paperwork or digital business profiles can expose companies to significant financial risk.

Authorities and industry experts recommend physical verification of business operations, bank account validation, and detailed background checks before engaging in high-value or deferred-payment transactions—particularly in sectors like pharmaceuticals, where single consignments can involve transactions worth crores.

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EU Pressure Builds on Google as Regulators Face Calls for Massive Fine Over Search Practices

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A growing coalition of European industry groups is intensifying pressure on regulators to take decisive action against Google over allegations of unfair search practices that could reshape competition rules across the region’s digital economy.

Investigation Under Digital Markets Act Gains Momentum

The case is being examined by the European Commission under the European Union’s landmark Digital Markets Act (DMA), introduced to curb the dominance of major technology platforms and ensure fair competition.

Launched in March 2024, the investigation focuses on whether Google has been prioritising its own services in search results, potentially disadvantaging rival businesses that rely on online visibility to reach customers.

Industry Groups Demand Swift Action

Several prominent European organizations have jointly urged regulators to conclude the probe without further delay. They argue that prolonged investigations allow alleged anti-competitive practices to continue, putting European companies—especially startups—at a disadvantage.

Signatories include the European Publishers Council, the European Magazine Media Association, the European Tech Alliance, and EU Travel Tech.

In a joint statement, these groups warned that delays in enforcement are affecting innovation, profitability, and growth prospects for regional businesses competing in digital markets.

Google Denies Allegations

Google has rejected claims of bias, stating that its search algorithms are designed to deliver the most relevant and useful results to users. The company has also proposed adjustments to address regulatory concerns.

However, critics argue that these changes are insufficient and fail to address the core issue of market dominance.

Potential Billion-Euro Penalties

If found in violation of the DMA, Google could face significant financial penalties. Under EU rules, fines can reach a substantial percentage of a company’s global turnover, potentially amounting to billions of euros.

Regulators may also impose corrective measures requiring changes to business practices, which could have long-term implications for how digital platforms operate in Europe.

Wider Implications for Big Tech

The case highlights ongoing tensions between European regulators and major U.S. technology firms. In recent years, the EU has taken a more aggressive stance in enforcing competition laws, aiming to create a level playing field for local businesses.

A final ruling against Google could set a major precedent, influencing future enforcement actions and shaping the regulatory landscape for global tech companies operating within Europe.

As scrutiny intensifies, the outcome of the investigation is expected to play a critical role in defining the future of digital competition across the European Union.

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Amazon Faces Potential Criminal Trial in Italy Over €1.2 Billion Tax Evasion Allegations

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Milan: U.S. tech giant Amazon is facing the prospect of a major legal showdown in Italy, after prosecutors in Milan formally requested a court to move forward with criminal proceedings over alleged tax evasion totaling approximately ₹12,500 crore (€1.2 billion).

The case targets Amazon’s European division along with four senior executives, marking one of the most significant tax-related investigations involving a global e-commerce platform in Europe.

Trial Push Despite Multi-Million Euro Settlement

The move comes even after Amazon reached a financial settlement with Italian tax authorities in December, agreeing to pay around ₹5,500 crore (€527 million), including interest, to resolve part of the dispute.

Typically, such settlements lead to the closure of criminal investigations. However, Milan prosecutors have opted to proceed, signaling a tougher stance on alleged corporate tax violations.

A preliminary hearing is expected in the coming months, where a judge will decide whether to formally indict the company and its executives or dismiss the case.

Allegations of VAT Evasion Through Marketplace Sellers

At the center of the investigation are claims that Amazon’s platform enabled non-European Union sellers to avoid paying value-added tax (VAT) on goods sold to Italian consumers between 2019 and 2021.

Prosecutors allege that the company’s marketplace structure allowed thousands of foreign vendors—many reportedly based in China—to operate without fully disclosing their identities or tax obligations. This, authorities argue, led to substantial VAT losses for the Italian government.

Under Italian law, online platforms facilitating sales can be held partially liable if third-party sellers fail to comply with tax requirements, a key point in the prosecution’s case.

Italian Government Named as Affected Party

In their filing, prosecutors identified Italy’s Economy Ministry as the injured party, citing significant financial damage resulting from the alleged tax evasion.

Legal experts say the outcome of the case could have wide-ranging implications across the European Union, where VAT systems are harmonized and similar compliance rules apply to digital marketplaces.

Multiple Investigations Add to Pressure

The VAT probe is just one of several legal challenges facing Amazon in Italy. The European Public Prosecutor’s Office is reportedly examining additional tax-related issues covering more recent years.

Meanwhile, Milan authorities are pursuing separate investigations into alleged customs fraud linked to imports from China and whether Amazon maintained an undeclared “permanent establishment” in Italy—potentially exposing it to higher tax liabilities.

In a separate regulatory action, Italy’s data protection authority recently ordered an Amazon unit to stop using personal data from over 1,800 employees at a warehouse near Rome.

Amazon Denies Allegations

Amazon has consistently denied wrongdoing and indicated it will strongly contest the allegations in court if the case proceeds. The company has also warned that prolonged legal uncertainty could impact investor confidence and Italy’s appeal as a destination for international business.

Broader Impact on Europe’s Digital Economy

If the case moves to trial, it could become a landmark moment for the regulation of global e-commerce platforms in Europe. Governments across the region are increasingly scrutinizing how digital marketplaces handle tax compliance, especially in cross-border transactions.

With online retail continuing to expand, regulators are under mounting pressure to ensure that multinational platforms and third-party sellers adhere to the same tax rules as traditional businesses.

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