Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Jonathan Kaplan, MD, MPH, a board-certified plasic surgeon based in San Francisco, California. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
Regardless of your personal bent on the topic, marijuana use for medicinal purposes is now legal in 29 states plus the District of Columbia. That's a lot of places where patients can legally be prescribed and purchase medical marijuana for an assortment of ailments, including recovery after surgery. Before dismissing the idea because of the perceived stigma, warranted or not, with marijuana use, consider these 5 reasons why your postop patient should consider rolling a joint after surgery:
1. Avoid opioid overdose and addiction
The current opioid crisis has contributed to over $55 billion in health and social costs. Could marijuana use after surgery ironically be the answer to the opioid crisis in America?
FURTHER READING: America's self-inflicted opioid crisis
When you consider the following facts, it's not such an unreasonable conclusion. In this recent study, most consumers try opioids (Percocet, Vicodin, etc.) for the first time after undergoing surgery. Of those, 6% continue using opioids for at least three months after surgery. So, what if those patients were never offered opioids in the first place? What if their doctors gave them a prescription for marijuana instead?
There's reason to believe the replacement of opioids with marijuana can reduce dependency on opioids. According to this study in JAMA Internal Medicine, "Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates." The article goes on to say, "In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20% after one year, 25% by two years and up to 33% by years five and six compared to what would have been expected..."
And it's not just the risk of dependency that's concerning. There's also the risk of an accidental overdose. I prescribe Percocet for all of my postop patients. Usually there's not a problem with dependency or overdose but an overdose occurred once, and once is enough. Instead of taking their Percocet "prn pain," the patient took their pain medication around the clock. When combined with the fact that the patient was opioid naive, their respiratory rate dropped and the patient had to go to the hospital. The patient recovered without any need for reversal medications like Narcan but obviously it was a scary, avoidable situation for the patient and family (and me).
In contrast to opioids, the risk of overdose with marijuana is impossible because according to the National Cancer Institute, “cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration.” In other words, my patient whose respirations slowed from Percocet would not have had the same experience with marijuana.