Perioperative Cannabis Use: A Framework for Surgical Teams

Cannabis use among surgical patients is increasingly recognized in perioperative literature, yet many institutions still lack structured approaches to screening, documentation, and team communication around it. This article outlines a practical framework surgical and anesthesia teams can use to reduce variability in how cannabis-using patients are identified and managed — without replacing institutional protocols or individual clinical judgment.

Why structured screening matters

Unstructured social history taking produces unstructured results. When cannabis use is captured inconsistently — asked on some forms but not others, documented in free text without standard fields, or omitted from handoffs — perioperative teams operate with incomplete information. The consequences are not abstract: anesthesia planning, coagulation considerations, and postoperative pain strategies all benefit from knowing a patient's use pattern before the day of surgery.

[VERIFY] Survey and registry data suggest cannabis use is prevalent among adult surgical populations and that underdisclosure is common when screening is not standardized. A structured framework does not mandate specific clinical responses — it ensures the question is asked, documented, and communicated consistently so that clinical teams can apply their own protocols with better information.

Three domains of perioperative relevance

A useful framework organizes cannabis-related perioperative considerations into three domains that map to common clinical workflows:

• Bleeding and coagulation: [VERIFY] Cannabis use — particularly via inhalation and with regular frequency — has been explored in relation to platelet function and coagulation pathways. Clinical significance varies by patient and procedure; teams should align screening findings with institutional coagulation protocols rather than applying universal testing rules.
• Anesthesia planning: [VERIFY] Regular cannabis use has been associated in the literature with altered anesthetic requirements and emergence characteristics. Evidence does not support a single adjustment algorithm; the value of screening is informing anesthesiologist awareness and individualized titration.
• Postoperative pain management: Cannabis use history may influence pain thresholds and analgesic requirements. Early identification allows acute pain services and surgical teams to set expectations and design multimodal plans proactively.

Minimum viable screening fields

A perioperative cannabis screening framework should capture, at minimum:

• Frequency of use (daily, weekly, occasional, none, unknown)
• Route of administration (inhaled, oral/edible, topical, other)
• Relative timing of last use (document as reported; avoid converting to policy thresholds in the intake form itself)
• THC vs. CBD vs. both (as reported by patient)
• Concurrent substances (alcohol, opioids, benzodiazepines, other)

Standardized fields improve handoff quality between preoperative clinic, day-of-surgery nursing, anesthesia, and the surgical team. Free-text documentation alone makes aggregation and quality review difficult.

Workflow integration points

Consider where cannabis screening fits in existing perioperative pathways rather than creating a parallel process:

• Preoperative clinic: Capture use history at the first surgical visit, when there is time for patient education and follow-up questions.
• Electronic health record: Structured fields that populate the anesthesia preoperative evaluation and surgical consent workflow.
• Day-of-surgery verification: Confirm whether use history has changed since the preoperative visit — patients may disclose more readily when asked again in a non-judgmental way.
• Postoperative handoff: Include cannabis use history in pain management handoffs to floor nursing and acute pain services.

Communication and non-judgmental inquiry

Screening only works if patients answer honestly. Training preoperative staff to ask about cannabis use in the same direct, clinical tone used for tobacco and alcohol — without hedging language that signals judgment — improves disclosure rates. [VERIFY] Studies on substance use disclosure in perioperative settings have noted that question framing and clinician comfort level significantly affect patient responses.

Document what the patient reports. Avoid converting intake data into automated clinical recommendations without physician review — the screening framework identifies patients who warrant team discussion; it does not replace that discussion.

Decision support tools and next steps

Structured screening generates data; decision support tools help teams organize considerations across the three domains above. Reference tools that categorize considerations by use pattern — rather than asserting fixed clinical thresholds — support consistent team communication without overriding institutional protocols.

For a deeper look at implementing screening at the department level, read Building a Cannabis Use Disclosure Protocol for Your Surgical Department.