Summary: Cannabis users undergoing gastric endoscopy procedures generally require more sedation than non-cannabis users, researchers report.
Source: American Gastroenterology Association
Patients who use cannabis required higher levels of sedation during gastric endoscopies than non-users, according to research presented at Digestive Disease Week (DDW) 2022.
As legalization expands and cannabis use becomes more common, this observational research highlights a practical consideration for gastroenterology teams: routine pre-procedure assessment should include questions about cannabis use so clinicians can anticipate potential increases in sedative requirements and plan monitoring and recovery accordingly.
“Patients did not report greater awareness or discomfort during the procedures, but they did require higher doses of sedative medications,” said Yasmin Nasser, MD, Ph.D., the lead investigator and assistant professor at the Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary.
The investigators performed a prospective cohort study that enrolled 419 adult outpatients scheduled for endoscopic procedures at three Canadian centers. All procedures were performed under conscious sedation — a sedation approach intended to keep patients relaxed and comfortable while allowing them to remain partially conscious and breathe independently.
Participants completed two brief questionnaires: one before the procedure, which asked about baseline cannabis use, and one after the procedure, which asked about intra-procedural awareness and comfort. The research team combined these self-reported data with clinical records of sedative administration, focusing on the commonly used agents midazolam, fentanyl and diphenhydramine.
The primary finding was that cannabis use was associated with increased odds of needing higher total sedation for gastroscopy. In this study higher total sedation was defined clinically as receiving more than 5 mg of midazolam, more than 100 mcg of fentanyl, or the administration of diphenhydramine during the procedure. Gastroscopy — an upper endoscopic exam that involves passing a flexible scope through the mouth and throat into the upper gastrointestinal tract — tends to require more sedation than colonoscopy because manipulation of the oropharynx and esophagus often stimulates gagging and discomfort.
Cannabis use was not associated with increased sedative requirements for colonoscopy in this cohort. The investigators also found that baseline cannabinoid use was not independently linked to higher fentanyl use alone, nor was it associated with increased intra-procedural awareness, reported discomfort, or a higher rate of adverse events during the conscious sedation procedures studied.
Importantly, the study categorized patients simply as cannabis users or non-users and did not collect detailed data on timing, quantity, frequency, or route of cannabis consumption prior to the procedure — for example whether cannabis had been inhaled, vaporized, ingested, or administered by another route. The authors note that these variables could influence sedative interaction and are appropriate targets for future research.
The research focused on procedures performed with conscious sedation and did not assess the interaction between cannabis use and propofol-based sedation techniques, which are more commonly used in some settings. As a result, these findings are most directly applicable to centers that employ midazolam- and opioid-based conscious sedation.
Clinical implications from this study suggest that pre-procedural screening for cannabis use can inform staffing, dosing considerations and post-procedure monitoring to ensure patient safety and comfort. Clinicians and endoscopy units may wish to include standardized questions about cannabis in pre-procedure intake forms and consider the potential need for incremental sedative dosing while maintaining vigilance for respiratory and hemodynamic effects associated with higher sedative use.
Further research is needed to clarify whether the timing of last cannabis use, cumulative exposure, method of administration, or specific cannabinoid content (such as tetrahydrocannabinol versus cannabidiol) modifies sedation requirements or procedural safety. Randomized or pharmacokinetic studies could help determine mechanisms and best practices for peri-procedural management of patients who use cannabis.
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Author: Press Office
Source: American Gastroenterology Association
Contact: Press Office – American Gastroenterology Association
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Original Research: The findings were presented at Digestive Disease Week 2022