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Preoperative Considerations: One of the primary concerns in treating cannabis users is preoperative counselling. Patients are often advised to taper their cannabis use before surgery to minimise the risk of adverse effects. Increased cannabis use is associated with higher rates of myocardial ischemia and a greater tolerance to standard anaesthesia doses, which can complicate surgical procedures. Therefore, thorough preoperative evaluations are essential to identify and mitigate potential risks associated with cannabis use.
Intraoperative Challenges: During surgery, cannabis can influence anaesthesia management. Patients using cannabis may require higher doses of anaesthetics due to increased tolerance, leading to prolonged sedation and recovery times. These factors necessitate heightened vigilance and potentially adjusted anaesthetic protocols to ensure patient safety.
Postoperative Care and Cannabis: Postoperative care for cannabis users presents additional challenges. While studies offer mixed results, some suggest a correlation between cannabis use and increased incidences of postoperative pain, nausea, and vomiting. Conversely, topical cannabinoids may enhance wound healing, presenting a nuanced picture of cannabis’s role in recovery.
Drug Interactions and Cannabis Use Disorder: Cannabis also poses significant drug-drug interaction concerns, particularly with anticoagulant medications commonly used in postoperative care. These interactions require careful management to avoid complications. Additionally, the prevalence of cannabis use disorder among patients underscores the importance of screening. Short screening tools can help identify patients at risk, providing an opportunity to address potential complications proactively. (Source: JAMA)
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Review of the oral toxicity of cannabidiol (CBD)
A B S T R A C T: Information in the published literature indicates that consumption of CBD can result in developmental and reproductive toxicity and hepatotoxicity outcomes in animal models. The trend of CBD-induced male reproductive toxicity has been observed in phylogenetically disparate organisms, from invertebrates to non-human primates. CBD has also been shown to inhibit various cytocahrome P450 enzymes and certain efflux transporters, resulting in the potential for drug-drug interactions and cellular accumulation of xenobiotics that are normally transported out of the cell. The mechanisms of CBD-mediated toxicity are not fully understood, but they may involve disruption of critical metabolic pathways and liver enzyme functions, receptor-specific binding activity, disruption of testosterone steroidogenesis, inhibition of reuptake and degradation of endocannabinoids, and the triggering of oxidative stress. The toxicological profile of CBD raises safety concerns, especially for long term consumption by the general population. (Click Here for Complete Research)
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Cannabis use and its potential health risks have become a topic of increasing relevance as its legalisation and social acceptance grow. A pivotal study published in JAMA Otolaryngology–Head & Neck Surgery explores the potential link between cannabis use and head and neck cancer, drawing parallels with historical patterns seen in tobacco use and cancer.
Historical Context: Tobacco and Cancer
In the mid-20th century, tobacco was widely marketed as not only safe but beneficial for one’s health. The tobacco industry’s influence was significant in the suppression of early research linking smoking to cancer. It took decades of comprehensive research to establish smoking as the leading cause of preventable deaths in the United States, highlighting the dangers of industry influence overshadowing public health priorities. This historical narrative serves as a crucial backdrop as society begins to grapple with the potential risks of cannabis.
Current Research Findings on Cannabis
Study Overview: The study by Gallagher et al. investigates the association between cannabis use and head and neck cancer. Conducted with a focus on whether the expanding acceptance of cannabis might mirror the historical underestimation of tobacco risks, the study raises critical questions about cannabis’s carcinogenic potential.
Biological Comparisons: Tobacco vs. Cannabis - Cannabis and tobacco share similarities in that both are often consumed through smoking, exposing users to a spectrum of harmful compounds. However, the carcinogens in cannabis, compared to those in tobacco, are not as well documented, and further research is needed to clarify the specific cancer risks associated with cannabis use.
Industry Influence and Public Perception: The cannabis industry’s growth, bolstered by legislative support and public enthusiasm, mirrors the rise of the tobacco industry in its earlier days. The study underscores the importance of prioritising public health and scientific research over commercial interests, cautioning against allowing industry influence to delay necessary health warnings and regulations.
Public Health Implications: The potential connection between cannabis use and cancer necessitates comprehensive research and informed public health strategies. The study stresses the importance of addressing these issues proactively, echoing concerns that without due diligence, society might confront a public health crisis reminiscent of the tobacco era’s legacy.
Research and Policy Recommendations: The study advocates for extensive research into the health effects of cannabis, particularly its association with cancer. Key research areas should include the biological mechanisms of cannabis on cellular health and the long-term health outcomes of its use. Additionally, public health policies must be informed by robust science to effectively mitigate potential risks.
(Source: JAMA Otolaryngology)
Also see
- Heavy Cannabis Use Tied to Increased Head and Neck Cancer Risk
- Epidemiological overview of multidimensional chromosomal and genome toxicity of cannabis exposure in congenital anomalies and cancer development
- Cannabis Causing Cancer
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Following a tragic crash that killed six high school girls in Oklahoma, the head of the U.S. National Transportation Safety Board (NTSB) is urging parents to warn their teenagers about the dangers of driving under the influence of marijuana. The NTSB has released its final report on the March 22, 2022 collision, which provides detailed insights into the causes and implications of the accident.
Background of the Crash
The collision occurred in Tishomingo, Oklahoma, involving a Chevrolet Spark hatchback and a gravel-hauling semi. The investigation revealed that the 16-year-old driver slowed for an intersection but then accelerated through a stop sign. The NTSB concluded that she was likely impaired by recent marijuana use and distracted by having five other teenagers in the car.
NTSB Findings and Recommendations
Impairment from Marijuana
The NTSB report highlights several key impairments caused by marijuana:
- Decreased Motor Coordination: Marijuana use can significantly impair motor skills necessary for driving.
- Slowed Reaction Time: Users may react more slowly in critical driving situations.
- Impaired Judgement of Time and Distance: Accurate perception of time and spatial relationships is crucial for safe driving.
Broader Concerns: Chairwoman Jennifer Homendy pointed out that the issue of cannabis impairment while driving extends beyond teenagers. With more states legalising recreational marijuana, both teens and adults tend to underestimate its risks when driving.
Legal Status of Marijuana: As of now, marijuana is legal for recreational use in 24 states and Washington, D.C., for individuals aged 21 and older. However, driving while impaired by marijuana is illegal across all states and Washington, D.C. In Oklahoma, recreational use is not permitted, although medical use is allowed.
Safety Alert and Parental Guidance: The NTSB has issued a safety alert urging parents to discuss with their children the dangers of driving under the influence of marijuana. The board emphasised the importance of educating young drivers on making responsible choices to avoid impaired driving and not riding with impaired drivers.
Broader Implications: The NTSB’s findings underscore the critical need for increased awareness and education around the risks of driving under the influence of marijuana. As legalisation expands, understanding how marijuana affects driving abilities becomes increasingly important to prevent similar tragedies.
(Source: AP News)
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Recent research highlights that abstaining from cannabis for 28 days can lead to significant cognitive improvements and changes in brain activation among people with multiple sclerosis (MS). This study, presented by Omar Iqbal Khan, MD, emphasises the potential benefits of cannabis abstinence on the default mode network (DMN), which plays a crucial role in modulating cognition.
Key Findings
Cognitive Improvements: The cannabis withdrawal group exhibited significant improvements in multiple cognitive domains by the end of the 28-day period. These improvements underscore the potential cognitive benefits of abstaining from cannabis for individuals with MS.
Day 28 Differences:
- CW Group vs. CC Group: By day 28, the CW group showed increased activation in the left posterior cingulate and right angular gyrus (p < 0.05 for both, TFCE).
- Within CW Group: The CW group exhibited increased activation at day 28 versus baseline in the left posterior cingulate, right angular gyrus, left hippocampus (BA 36), and right medial prefrontal cortex (p < 0.05).
Implications for the Default Mode Network (DMN): The DMN is known to modulate cognition, and the study revealed enhanced DMN activity following cannabis abstinence. This finding provides objective evidence supporting the cognitive benefits of abstaining from cannabis for individuals with MS.
Summary: The study concluded that abstaining from cannabis for 28 days can reverse the activation of DMN activity and lead to improved cognition across several domains in people with MS. These findings offer valuable insights for counselling patients with MS and cognitive complaints about the potential benefits of cannabis abstinence.
Source: PracticeUpdate