Stopping Marijuana One Week Before Hip Surgery: Risk Assessment
Stopping marijuana only one week before hip surgery falls into a gray zone where expert consensus could not be reached, but the evidence suggests this timeframe may pose risks of cannabis withdrawal syndrome without sufficient time to realize the full benefits of cessation. 1
The Critical Timing Problem
The British Journal of Anaesthesia guidelines explicitly state that for the 1-6 day window before surgery, there is no consensus recommendation on whether to wean or stop cannabis. 1, 2 This one-week timeframe sits at the edge of this uncertain zone, creating a clinical dilemma.
Why One Week May Be Problematic
Cannabis withdrawal syndrome (CWS) typically peaks within the first week after cessation, with symptoms including irritability, anxiety, sleep disturbances, and potentially exacerbation of chronic pain. 1, 3
The expert panel specifically warned that tapering or cessation within a day of surgery increases the risk of CWS, which could complicate the perioperative period by worsening underlying conditions like chronic pain and anxiety. 1
Withdrawal symptoms onset within 24-72 hours and peak in the first week, meaning a patient stopping one week before surgery may be experiencing peak withdrawal symptoms at the time of surgery. 3
What the Guidelines Actually Recommend
For Optimal Timing
If surgery is more than 7 days away, consider weaning or stopping cannabis to potentially reduce risks of analgesic tolerance, interference with EEG-based anesthesia monitoring, and postoperative nausea/vomiting. 1, 4, 2
Ideally, a 2-week abstinence period is preferred to reduce airway irritability in smokers and allow sufficient time for withdrawal symptoms to resolve before surgery. 4, 2
For Immediate Surgery
- If surgery is within 24 hours, do not attempt to wean or stop cannabis due to the increased risk of precipitating acute withdrawal during the perioperative period. 1, 4, 2
Practical Management for the One-Week Scenario
Since your patient has already stopped one week prior, here's how to manage the situation:
Preoperative Vigilance
Screen for cannabis withdrawal symptoms including irritability, restlessness, anxiety, sleep disturbances, appetite changes, and abdominal pain. 3
Assess the patient's baseline cannabis consumption to determine if they were a significant user (>1.5 g/day smoked cannabis, >300 mg/day CBD oil, or >20 mg/day THC oil). 1, 4, 2
Intraoperative Considerations
Give extra consideration to processed EEG monitoring (bispectral index or entropy) as cannabis may interfere with readings. 1, 4
Consider additional PONV prophylaxis as cannabis users may have altered risk profiles. 1, 4
Plan for potentially greater depth of anesthesia during induction and maintenance. 1, 4
Postoperative Management
Maintain heightened vigilance for cannabis withdrawal syndrome in the immediate postoperative period. 1, 4, 2
Consider acute pain service referral as increased postoperative analgesia may be required due to potential analgesic tolerance. 1, 4
Cannabis use is not a contraindication to NSAIDs, opioids, regional anesthesia, ketamine, gabapentinoids, dexmedetomidine, or acetaminophen. 1
Important Caveats
Surgery Should Never Be Delayed
- The most critical principle: surgery should never be delayed for cannabis weaning or re-evaluation. 1, 3, 4, 2 The risks of delaying necessary surgery outweigh concerns about cannabis use timing.
Actual Perioperative Risk Data
Recent research shows conflicting evidence on actual complication rates. One study found no increased risk of major or minor complications after hip arthroplasty in cannabis users 5, while another found increased risk of myocardial infarction (adjusted OR 1.88) 6 and a third found modestly increased overall morbidity and mortality (adjusted OR 1.19). 7
The increased myocardial infarction risk appears to be the most consistent finding across studies, warranting particular attention to cardiac monitoring. 6