How long before a colonoscopy should cannabis tincture be stopped?

Cannabis Tincture Cessation Before Colonoscopy

Cannabis tincture should be stopped at least 7 days before a colonoscopy if the patient uses significant amounts (>300 mg/day CBD oil or >20 mg/day THC oil), while continuing use until 24 hours before the procedure is acceptable for lower doses. 1

Understanding Cannabis Use Before Colonoscopy

Significant Cannabis Use Thresholds

According to the 2021 British Journal of Anaesthesia guidelines, significant cannabis consumption that warrants consideration for weaning before procedures includes:

• 1.5 g/day of inhaled cannabis

• 300 mg/day CBD oil

• 20 mg/day THC oil

• Unknown cannabis products used more than 2-3 times per day 1

Timing Recommendations for Cannabis Cessation

For patients meeting the above thresholds:

• >7 days before procedure: Consider weaning or stopping cannabis 1
• 1-6 days before procedure: No consensus recommendation exists 1
• <24 hours before procedure: Do NOT wean or stop cannabis (could trigger withdrawal) 1

For patients using lower doses than the thresholds above, continuing until standard pre-colonoscopy fasting guidelines is acceptable.

Rationale and Considerations

Procedural Concerns

1. Sedation Requirements: Cannabis users require significantly higher amounts of sedation during endoscopic procedures 2, 3. A 2024 study found marijuana users needed higher doses of fentanyl, midazolam, and propofol during endoscopy 3.

2. Bowel Preparation Timing: For optimal colonoscopy preparation, patients should:

   • Complete the final dose of bowel preparation at least 2 hours before the procedure 1
   • Begin the second portion of split-dose preparation 4-6 hours before colonoscopy 1

3. Cannabis Withdrawal Syndrome (CWS): Abrupt cessation within 24 hours of surgery may increase risk of withdrawal symptoms 1

Practical Approach

For cannabis tincture users:

1. High-dose users (>300 mg/day CBD or >20 mg/day THC):

   • Begin weaning at least 7 days before colonoscopy
   • Target reducing to below threshold amounts
   • Do not abruptly stop within 24 hours of procedure

2. Low-dose users (below threshold amounts):

   • Can continue until standard pre-procedure fasting guidelines
   • Follow the 2-hour clear liquid cutoff rule before sedation

3. Unknown dosage users:

   • If using more than 2-3 times daily, treat as high-dose user
   • If using less frequently, follow low-dose user guidelines

Special Considerations

• Therapeutic users: Involve the cannabis authorizer in discussions about weaning 1
• Sedation planning: Inform anesthesia providers about cannabis use, as they may need to adjust sedation dosages 2, 3
• Bowel preparation: Follow standard guidelines for timing of bowel preparation regardless of cannabis use 1

Caveats and Pitfalls

• Do not abruptly stop high-dose cannabis within 24 hours of the procedure as this may trigger withdrawal symptoms 1
• Patients using cannabis may require higher sedation doses, so disclosure to the endoscopy team is important 3
• Never delay colonoscopy solely for cannabis weaning if the procedure is medically necessary 1