Cannabis users need more sedation medication for gastroscopy

Patients who reported using some sort of cannabinoids had a marked higher likelihood of needing higher doses of midazolam or any diphenhydramine while undergoing a diagnostic esophagogastroduodenoscopy (EGD). For those receiving colonoscopies, no significant difference in dosing requirement was established.

Endoscopist-directed conscious sedation (EDCS) is widely used for endoscopic procedures such as gastroscopy and colonoscopy. While efficient and cost-effective, EDCS can be limited by failure to achieve sufficient levels of sedation that enable safe endoscopy. “It is important to be able to predict which patients require higher doses of EDCS or are at a high likelihood of sedation failure,” Prof. Yasmin Nasser (University of Calgary, Canada) explained the motivation for the presented study [1]. In light of the rising number of states/countries that legalise some sort of cannabis, with a resulting larger population of users, Prof. Nasser pointed out that medical practitioners will increasingly encounter patients with baseline cannabinoid use. In these patients, the possibility of drug interactions between cannabinoids and medications routinely used for sedation during endoscopy might be expected, but there is a lack of data on this matter.

A total of 419 adults who underwent either colonoscopy or gastroscopy (EGD) were included in the study. The participating outpatients gave information on topics like cannabinoid use, alcohol, and comorbidities prior to the diagnostic procedure. Also, a questionnaire to assess their endoscopy tolerability experience (PRO-STEP) was filled in before going home after endoscopy. By multiple logistic regression, differences between cannabinoid users and non-users were evaluated with variables including age, sex, alcohol use, anxiety, and depression.

The results demonstrated that participants undergoing EGD who had stated use of cannabinoids were nearly 3 times more likely to need ≥5 mg of midazolam (adjusted odds ratio [aOR] 2.89) and require diphenhydramine (aOR 3.04). For colonoscopies, these 2 outcomes were not significant. Furthermore, cannabinoid use was not an independent risk factor for intra-procedural adverse events nor fentanyl use.

The need for high sedation with a combination of midazolam ≥5 mg, fentanyl ≥100 µg, or any diphenhydramine during EGD was also significantly more likely in cannabis users (aOR 3.72). In terms of intra-procedural awareness, pain, or discomfort, there were no significant differences for cannabinoid users for either procedure.

“Overall, our findings could suggest the following: first, that baseline cannabinoid users undergoing endoscopic procedures require increased doses of benzodiazepines relative to opioids; and second, that the overall tolerability of outpatient endoscopy is similar between cannabinoid users and non-users,” Prof. Nasser concluded.

1. Nasser Y. Baseline Cannabinoid Use is Associated with Increased Sedation Requirements for Outpatient Endoscopy. Poster Sa1022, Digestive Disease Week 2022, 21–24 May, San Diego, CA, USA.

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Posted on 14 June 202226 July 2024