Marijuana is increasingly available. We as plastic surgeons hate smoking- it I has a clear affect on surgery, particularly any surgery dependent on blood supply to heal, like breast reductions, breast lifts, abdominplasty, and facelifts. But pot can be taken in many forms: gummies, brownies, vaping, smoking, oils.
So is it okay?
This is a new area being rapidly studied. There is a 2018 article which looked at, “A Systematic Review of the Complex Effects of Cannabinoids on Cerebral and Peripheral Circulation in Animal Models.” This was a collation of studies done on animal models to try to answer that exact question.
Pearls from the article:
Cannabis is a drug and not fully understood.
- There are many studies linking it and the synthetic forms (like spice) to strokes and ischemic effects in the brain, particularly in young users.
- Animal models have been used. They show different effects, depending on the amount use, mode of giving, and the type of animal model. The authors of the review state rodent models in particular are poor comparisons, and we need to do studies in larger mammals with vasculature closer to that of humans.
- They conclude:
- Evidence has been accumulating with both vasodilation and constriction.
- Clinical data suggest that cannabinoid uptake may play a role in strokes, but the mechanism is not clear
- Vasoconstriction may be the common endpoint
- “It seems licit to consider these results and their potentially dangerous consequences in the ongoing discussions on marijuana legalization. Constituents of cannabis undoubtedly have complex regulatory effects on peripheral and cerebral vasculature. Psychotropic and medical benefits of cannabis in chronic pain, spasticity, and sedation should not be evaluated independently of these side effects.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986896/
What do I think?
I think anytime you take any kind of medication, herbal, or vitamin, there are the effects you are aiming for and effects you aren’t aware of. Your body is a complex system. I may take Advil for a headache or knee pain, not considering how it may give me tummy upset or make me bleed more easily. There are interactions between medications. Does it affect the anesthetic? Pain medication? Are there effects on healing and blood supply? Is it processed by the liver or the kidney? How long does it stay in the system? Can you reverse it?
It is frustrating we do not understand yet how best to use cannabis. There have been positive effects noted: anti-anxiety, anti-inflammatory, and pain reduction among others. But until we know more – the dosage, THC vs CBD, the route of administration, if it has interactions with anesthetics and medications, if it affects blood supply and tissue healing- I will not endorse its use for my patients around surgery.