Marijuana and Medication Reconciliation Be sure to capture all the details of your patients’ use BY ROBERT KURTZ


n 2012, Colorado and Washington became the first states to legalize marijuana for recreational purposes. Since then, the number of states where the drug has been legalized for medi- cal and/or recreational purposes has increased. One in seven Americans used marijuana in 2017, according to an Annals of Internal Medicine report. For the staff at Harmony Surgery Center in Fort Collins, Colorado, ask- ing patients if they consume marijuana as part of the ASC’s medication rec- onciliation process is no different than asking if they drink alcohol or smoke cigarettes, says Catherine Seiler, RN, director of clinical operations. “We have patients coming in with prescriptions for marijuana to help man- age their epilepsy, chronic pain, glau- coma, Crohn’s disease—the list goes on,” Seiler says. “Then there are those patients who use it recreationally. We consider it imperative to capture details on our patients’ marijuana use because of the drug’s pharmacologic effects.” These effects are potentially sig- nificant, says Sheldon Sones, presi- dent of Sheldon S. Sones and Associ- ates of Newington, Connecticut, and a pharmacy consultant to ASCs. “Areas of concern include increased risk of bleeding, lower blood pressure and elevated risk of aspiration,” he says. “To me, the name of the game is col- lecting as much information about a patient’s marijuana use as possible. This will help ensure accurate medica- tion reconciliation records are handed to anesthesia providers who can then adjust therapies as they see fit.” Capture several details about a

patient’s marijuana use, Seiler advises. “We first ask whether the use is for medical purposes, recreational pur- poses or both. Then we inquire about

I would love to see [ASCs] advising patients who acknowledge recreational drug use to abstain from consuming marijuana or any recreational drugs on the day of surgery and preferably within 24 hours of the procedure.”

— Sheldon Sones, Sheldon S. Sones and Associates

the route. Is the marijuana smoked, eaten, applied topically or consumed in another way? We ask about quan- tity consumed, as there is a significant difference between someone who uses marijuana all day versus once a week. Finally, we discuss and note the effects of the marijuana use.”

ASCs in states where marijuana

is legalized are likely to treat patients more willing to speak candidly about their marijuana use, Sones says, but even patients legally using the drug may still hesitate to discuss their hab- its openly. “Try to use verbiage during inter-

views that encourages patients to be revealing,” Sones says. “Emphasize the importance of sharing all details about their use because it can affect how much anesthesia is provided and the level of monitoring required. Also remind patients that the information you collect about their medications,


including any legal or illegal drugs, is kept in a confidential record. This may encourage more data coming back.” Seiler says she has seen how the

wording of questions can have a sig- nificant effect on patients. “We used to ask a question along the lines of, ‘Do you use any illegal or recreational drugs?’ This covered marijuana. Some patients took offense to our continuing to include the drug with this question once marijuana was legalized, so we altered our wording.” As ASCs work to effectively account for increasing marijuana use by patients, Sones says “I would love to see them advising patients who acknowledge recreational drug use to abstain from consuming marijuana or any recreational drugs on the day of surgery and preferably within 24 hours of the procedure. I believe this should become a standard practice as it will help in the delivery of safer care.”

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