Marijuana Use

Marijuana and marijuana-infused products are legal within Washington state, however, the use of such products is not without risk.

We ask that you notify us of the use of any marijuana or marijuana-infused products. As potential interactions between marijuana and medications are not well-studied, our recommendation is to avoid all marijuana products prior to and after surgery to minimize the risk of complications. If you elect to continue with the use of such products, we consider this to be an educated decision on your part after weighing the risks and benefits, with acknowledgment of the potential for increased risks or complications from surgery or any prescribed medications.

Regardless of how marijuana is used (smoking, vaping, ingesting), like most other drugs or medications, THC and CBD (the most well-known cannabinoids in marijuana) are both metabolized by the liver. Therefore, even though marijuana is a plant, it can interact with a number of other drugs or medications. If you take prescription medications and use marijuana, it would be wise to discuss this with your care providers and pharmacist for your safety.

Since 1964, when the Surgeon General's report exposed the negative impacts of smoking on public health, there have been tremendous efforts to decrease tobacco use¹. Nonetheless, smoking remains the leading preventable cause of morbidity (disease) and mortality (death) in the United States², accounting for 480,000 premature deaths and 289 billion dollars in healthcare-associated costs each year³. Complications related to tobacco use before and after total joint replacement are well established⁴. In a systemic review of 21 studies, current smokers were significantly more likely to have a complication or die following total joint replacement compared to nonsmokers⁵. Smoking and tobacco use is associated with delayed wound healing⁶, surgical site infections⁷ requiring further surgery including removal of prosthetic implants, early revision⁸,⁹, and death¹⁰.

We want you to have the best possible outcome for your surgery. Therefore, we require you to quit smoking and tobacco products AND be off all nicotine replacement therapy (i.e. patches, gum, lozenges, ect.) a MINIMUM of 6 weeks prior to surgery. We will help you with the necessary resources to quit. You will have urine and/or/ blood tests to confirm you have quit, and surgery will be delayed if you do not pass the tests. We firmly believe this is in your best interest.

References:

1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238e45.
2. Centers for Disease C, Prevention. Smoking-attributable mortality, years of potential life lost, and productivity losses-United States, 2000-2004. MMWR Morbidity Mortality Weekly Rep 2008;57:1226e8.
3. Springer BD. Modifying risk factors for total joint arthroplasty: strategies that work nicotine. J Arthroplasty 2016;31:1628e30.
4. Moller AM, Pedersen T, Villebro N, Munksgaard A. Effect of smoking on early complications after elective orthopaedic surgery. J Bone Jt Surg Br 2003;85: 178e81.
5. Benowitz NL. Nicotine addiction. New Engl J Med 2010;362:2295e303.
6. Maradit Kremers H, Kremers WK, Berry DJ, Lewallen DG. Social and behavioral factors in total knee and hip arthroplasty. J Arthroplasty 2015;30:1852e4.
7. Kee JR, Mears SC, Edwards PK, Barnes CL. Modifiable risk factors are common in early revision hip and knee arthroplasty. J Arthroplasty 2017;32: 3689e92.
8. Lim CT, Goodman SB, Huddleston 3rd JI, Harris AHS, Bhowmick S, Maloney WJ, et al. Smoking is associated with earlier time to revision of total knee arthroplasty. Knee 2017;24:1182e6.
9. Duchman KR, Gao Y, Pugely AJ, Martin CT, Noiseux NO, Callaghan JJ. The effect of smoking on short-term complications following total hip and knee arthroplasty. J Bone Jt Surg Am 2015;97:1049e58.
10. Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol 2011;38:1824e34.