I Wanna Be Sedated

With an ever-growing number of cannabis users attending medical services, Mark Twardowski and colleagues were interested in the effect cannabis use might have on patient response to sedatives – THC binds to the body’s cannabinoid receptors, which can interact with opioid and benzodiazepine receptors.

The researchers studied the medical records of 250 patients undergoing an endoscopic procedure in Colorado, 25 of whom were daily or weekly cannabis users and 225 of whom were non-users (1). The sample was reviewed in terms of age, sex, alcohol habits, and receipt of benzodiazepines and opiates. The amount of sedation required in cannabis users versus non-users was assessed using the t-test and Mann-Whitney U test.

In this group, cannabis users required 14 percent more fentanyl, 20 percent more midazolam and 220 percent more propofol than non-users to achieve optimum sedation for their procedure. The numbers demonstrate a clear trend, but what implications do these findings have for the treatment of cannabis users in everyday clinical practice?

As cannabis users were more likely to receive close to the maximum recommended dose of each drug than non-users, they may be more likely to experience dose-dependent adverse effects. There is particular concern that the increased sedative dose may increase the risk of suppressed respiratory function.

The authors suggest that healthcare providers consider specifically asking patients about cannabis use prior to administering sedation: “Determining cannabis use before procedural sedation can be an important tool for planning patient care and assessing both medication needs and possible risks related to increased dosage requirements during endoscopic procedures.”