Cannabidiol (CBD) is a compound derived from the cannabis plant often used for managing conditions like pain and anxiety. Unlike tetrahydrocannabinol (THC), CBD is non-intoxicating. Despite its generally safe profile, using CBD around the time of surgery introduces medical risks. Patients must disclose CBD use to their care team, as its presence can interfere with the precise medical control required during and after an operation, potentially leading to complications.
How CBD Interacts with Surgical Medications
The primary concern regarding CBD use before surgery is its interference with the liver’s drug-processing system, specifically the cytochrome P450 (CYP450) enzymes. These enzymes metabolize approximately 60% of all prescribed medications, including many anesthetics and pain relievers. CBD acts as a competitive inhibitor, slowing the rate at which the body processes other drugs by occupying the CYP450 enzymes’ active sites. Medications are then not cleared from the bloodstream as quickly as expected. This delayed metabolism can lead to high concentrations of certain drugs, resulting in increased potency and prolonged effects of anesthetic agents, sedatives, and post-surgical pain medications.
Primary Medical Risks During Surgery
The interference of CBD with drug metabolism translates directly into several medical risks during the perioperative period. One danger is the unpredictable potentiation of general anesthesia and sedatives. CBD has sedative properties, and when combined with the delayed clearance of anesthetic drugs, it can lead to excessive and prolonged sedation. This makes it challenging for the anesthesiologist to precisely dose medications and can result in a delayed or difficult emergence from anesthesia.
Another complication is the increased risk of excessive bleeding during and after the operation. Cannabidiol possesses mild anticoagulant, or blood-thinning, properties. When a patient is also receiving blood thinners, the combined effect can significantly raise the likelihood of hemorrhage. Uncontrolled bleeding may necessitate a second procedure to correct the issue.
CBD use can also affect the cardiovascular system, leading to instability that complicates anesthesia management. It may cause hypotension, a drop in blood pressure, which is hazardous when combined with anesthetic agents that suppress the cardiovascular system. Precise control of heart rate and blood pressure is necessary for patient safety, and CBD’s presence introduces variables that undermine this control.
Establishing a Pre-Surgical Cessation Schedule
To mitigate the risks of drug interaction and cardiovascular instability, patients should immediately inform their entire medical team, including the surgeon and anesthesiologist, about any CBD use. This communication is essential for surgical planning and patient safety. The team must know the form, dose, and frequency of use to make informed decisions about medication management.
Medical professionals generally recommend stopping all forms of CBD—including oils, edibles, and topicals—at least one to two weeks before any scheduled procedure. A two-week cessation period is often advised, particularly for regular users, to ensure the compound is fully cleared from the system. The exact required timeline can vary depending on the patient’s individual metabolism, dosage, and frequency of use.
This pre-surgical abstinence allows the liver’s CYP450 enzyme system to return to its normal function, ensuring that surgical and pain medications can be metabolized predictably. If a patient is using CBD for a medical condition, the care team should work with them to find alternative pain or anxiety management strategies for the pre- and post-operative periods. The goal of this cessation schedule is to eliminate variables that could compromise the balance of anesthesia and recovery.