New research has emerged that suggests that cannabis users require higher levels of sedation for gastric endoscopies in comparison to non-users. ¹

This emerging information has found itself to be extremely important in terms of clinician and patient communication. For if cannabis patients need more sedation, chances are those that don’t inform their doctors of their cannabis habits aren’t receiving the proper treatment they need.

It’s understandable if some patients remain hesitant about telling doctors they consume cannabis. Especially due to the fact that it remains illegal in most U.S. states.

But in accordance with this new study, it’s looking as though patients will need to be more open with their physicians as it’s likely a cannabis habit affects other forms of treatment in medicinal practices.

What is Endoscopy and Why is it Performed?

Simply put, a gastric endoscopy is a flexible fiberoptic scope that’s inserted down your esophagus in order to observe problems that may be occurring with internal organs. This procedure is often suggested when a patient experiences unexplained symptoms, such as: ²

• Bleeding in the upper GI tract
• Continuous vomiting (intractable vomiting)
• Difficulty swallowing
• Upper stomach pain or chest pain not related to the heart
• Unexplained weight loss

While an endoscopy procedure can’t always identify a condition, it usually picks up the following:

• Blockages or narrowing strictures
• Celiac disease
• Chron’s disease (in the upper GI tract)
• Damaged caused by swallowing harmful objects
• Esophageal varices (larger than normal veins)
• Infections (in the upper GI tract)
• Inflammation and sores
• Gastroesophageal reflux disease (GERD)
• Hiatal hernia (stomach moving upwards)
• Tumors

Furthermore, a GI endoscopy may be used in certain operations, such as controlling problematic bleeding or removing a tumor.

In order to perform this operation, a patient needs to be sedated. Usually, very high doses of a medication called propofol are used which has a general anesthesia effect.

What Does the Study Reveal About Cannabis and Endoscopy Sedation?

Within the above-mentioned study, 419 adult outpatients who underwent endoscopic procedures at three Canadian centers were observed. All procedures required conscious sedation which means patients were somewhat aware of their surroundings but very relaxed and comfortable.

Each patient was required to complete two questionnaires - one before the procedure concerning their cannabis use and one afterward about how aware and comfortable they were during the procedure.

Throughout all procedures, a number of sedatives were used, including midazolam, fentanyl, and diphenhydramine.

In accordance with the data collected, cannabis use was found to require higher levels of sedation in comparison to patients who didn’t use cannabis. As defined by the procedures, this means more than 5mg of midazolam and more than 100mcg of fentanyl.

Due to these findings, some speculate that cannabis users may require more sedation for all medical procedures. However, there is some conflicting evidence for this. For example, it was found that cannabis users undergoing a colonoscopy didn’t require more sedation than non-cannabis users.

This is likely due to the fact that endoscopy requires the tool to be inserted into the upper part of the gastrointestinal tract. Beyond the irritation it may cause, many patients experience the triggering of the gag reflex.

Problems with the Study

While the findings of this study are very important to further research on cannabis’s relation to medical procedures, it only details a single procedure. Being the findings, chances are there are likely other procedures that require more sedation among cannabis users, we just don’t have the research to properly understand this.

However, more specifically, the research didn’t examine specific traits of cannabis users. This includes when they consume cannabis, how often they consume it, and the method of consumption (i.e. smoking, ingesting, etc.).

Furthermore, certain medications commonly used for these procedures (including propofol) were not observed within the study.

There’s no denying that the results of this research have given us insight into an area of cannabis we don’t often consider. Still, this only opened the doors to the necessity for further research concerning both cannabis and endoscopy as well as cannabis and other medical procedures that require sedation.

How Does Cannabis Effect Sedation?

In order to understand cannabis’s effect on sedation, we must first develop a comprehension of how sedation works in the brain.

Simply put, sedative medication modifies specific nerve communications within the central nervous system (CNS). More so, the neurotransmitters gamma-aminobutyric acid (GABA) is increased, causing a slow down in brain activity. ³

Cannabis, on the other hand, works a bit differently as it doesn’t directly affect GABA. Instead, tetrahydrocannabinol (THC) and other cannabinoids work directly with cannabinoid receptors in our endocannabinoid system (ECS). By specifically targeting CB1 receptors, cannabis is able to induce sleep and drowsiness. ⁴

While more research is required, it’s been found that CB1 inhibits GABA within the brain. If true, this means THC’s link to CB1 receptors will inhibit the effects of sedative medication. ⁵

It should be noted that this has not been identified within the research discussed earlier in the article. Rather, this is what we found based on our own personal research.

However, if true, this would align properly with the research concerning endoscopy sedation. It would also bring up the argument that it's likely cannabis will inhibit the effects of other sedative medication used in medical procedures - especially if it’s consumed prior to a procedure.

Final Word

The difficulty with this argument is the fact that cannabis research remains in the very early stages. Therefore, we’re not even 100% sure how it affects the body, especially in the long term.

The evidence put forth by the endoscopy study reveals that cannabis does have deeper impacts than we may consider. And that there are likely a number of medical procedures currently occurring that overlook cannabis’s impact on the said procedure.

Since we can only garner more knowledge through further research, we simply have to wait and see what comes about in the future. However, the demand for this research has never been so high.

With so many places legalizing cannabis, its use among the general population is soaring at heights previously unseen. ⁶ Therefore, more and more people aren’t just consuming cannabis, but going about daily life with little knowledge about how it’s playing a role in their lives.

This knowledge is increasingly important - not just to ensure proper medical procedures, but to better understand our relationship with this plant.

Reference Sources

¹ Neuroscience News: Cannabis Users Require More Sedation for Endoscopy: https://neurosciencenews.com/cannabis-endoscopy-sedation-20634/

² Johns Hopkins Medicine: Upper GI Endoscopy: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/upper-gi-endoscopy

³ UC Davis: Student Health and Counseling Services: Sedatives, also known as depressants: https://shcs.ucdavis.edu/health-topic/sedatives-also-known-depressants

⁴ Progress in Neuro-Psychopharmacology & Biological Psychiatry: The role of the CB1 receptor in the regulation of sleep: https://pubmed.ncbi.nlm.nih.gov/18514375/

⁵ National Institute on Drug Abuse (NIDA): Why Marijuana Displeases: https://nida.nih.gov/news-events/nida-notes/2018/03/why-marijuana-displeases

⁶ Columbia: Mailman School of Public Health: Recreational Cannabis Legalization Leads to Higher Use in Some Demographics: https://www.publichealth.columbia.edu/public-health-now/news/recreational-cannabis-legalization-leads-higher-use-some-demographics