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Medical Professionals: would answering "yes" to marijuana use on a medical questionnaire affect my friend's chances of being selected for DBS surgery?
January 20, 2011 12:06 PM   Subscribe

Medical Professionals: would answering "yes" to marijuana use on a medical questionnaire affect my friend's chances of being selected for DBS surgery?

My friend is being pre-certified for DBS surgery for Parkinsons. On the pre-surgery questionnaire there is a question about previous drug use. She has self medicated with pot for a couple of years. She's afraid that if she answers the question honestly that she will be denied the surgery. What advice would you give her? What are the risks?
posted by spakto to Health & Fitness (16 answers total) 1 user marked this as a favorite
 
They probably do not care whether she did or did not from a legal standpoint, it might just be as a control to better ensure a successful procedure.

That being said lying about her past drug use would be unethical.
posted by BobbyDigital at 12:45 PM on January 20, 2011


ALWAYS be truthful with your physician. If they're not allowing the surgery for previous users of pot, it's not because they're just the man holding you down. More likely, it's because pot users have been determined to present an unacceptable risk of a negative outcome for that particular kind of surgery. I understand that there are potential corporate insurance complications in the US that come with being truthful with your doctor about drug use, but they've GOT to do it anyway.
posted by deadmessenger at 12:47 PM on January 20, 2011 [4 favorites]


I understand that there are potential corporate insurance complications in the US that come with being truthful with your doctor about drug use

that's pretty much "the man holding you down." i agree that almost always you have to be completely truthful about all drug use with doctors - but i do think in some cases it's worth weighing the probability that marijuana will screw things up and the probability that you'll be treated like an addict and denied the surgery.
posted by nadawi at 12:59 PM on January 20, 2011 [3 favorites]


Note that the question is not about marijuana use as such, it's about previous drug use. That includes the harder stuff, e.g. cocaine, crack, heroin, methamphetamines, all of which can do a total number on your body and pose significant risks during surgery. If you've completely shot all your veins, they need to know that before they need to give you an emergency IV, etc. That's what they're really looking for.

Answer truthfully--they're your doctors and need to know--but the question is almost certainly being asked to get a complete medical history, not as some sort of screening or selection rubric.
posted by valkyryn at 1:01 PM on January 20, 2011


The key thing they're considering is how to dose you for anaesthesia. I had a friend go through a minor procedure earlier this year, the key thing they pressured her on was that even small amounts of marijuana use can affect how your body metabolizes anaesthetic.
posted by Oktober at 1:03 PM on January 20, 2011 [1 favorite]


Oktober's 100% correct, according to my anesthesiologist friend. It's the only thing in a surgery that is affected by marijuana use, but it's a really important factor in that.
posted by General Malaise at 1:09 PM on January 20, 2011 [1 favorite]


Don't lie. This IS brain surgery.

Past self-medication may impact the prognosis on DBS. Your friend wouldn't want to lie, only to find out that the surgery doesn't have the expected outcome, due to the drugs.
posted by supercres at 1:09 PM on January 20, 2011


Great answers! Thanks everyone. I will pass this info along.
posted by spakto at 1:12 PM on January 20, 2011


You might want to look at this AskMe. Although it sounds like your friend's questionaire is from the insurance company, not a physican, in which case you might want to be wary of them looking for reasons to deny coverage; whether lying on the form or disclosing drug use is more likely to result in this I don't know. I do know that as an anesthesiologist, worrying about whether a person has smoked pot is pretty much at the bottom of the list of things I worry about, but I would rather they be truthful as a rule. I don't know how their surgeon might feel, though. All in all thiere is unfortunately no good answer to this question in most cases.
posted by TedW at 1:21 PM on January 20, 2011 [1 favorite]


DH is a smoker. All I cared about when he went in for spine surgery was his usage impacting anethesia. But this is brain surgery. You can ask the physician to talk in confidence and not put it on a medical record. Then at least verbally he can say thumbs up or down for the surgery knowing the risks.

But overall, I don't think he will get denied medically. Insurance-wise though, he could. That's why I say if he has a good relationship with the physician, ask for it to be held in confidence as a yea or nay to surgery, not insurance based cost/ethics.
posted by stormpooper at 2:01 PM on January 20, 2011 [2 favorites]


If you lie about the drugs (legal/illegal) that you are taking vis a vis surgery and other medical interventions you could die.
posted by MsKim at 3:00 PM on January 20, 2011


I can't find anything indicating that marijuana use has any impact on anaesthesia. I've found one article that suggest inhaling marijuana right before surgery might result in acute uvular oedema, but the patient was described as really fucking high.

Can anyone find any literature backing this up? Given that marijuana acts on its own and doesn't have any narcotic effects that you'd see with things like benzodiazepine or opiates, I doubt there's any risk there.

Given the prevalence of marijuana use and the lack of literature suggesting otherwise, I really only see that marijuana would be used to deny you care. I'm not a doctor obviously, and would love for someone to show me how wrong I am.
posted by geoff. at 4:19 PM on January 20, 2011


That's why I say if he has a good relationship with the physician, ask for it to be held in confidence as a yea or nay to surgery, not insurance based cost/ethics.

And not right before the surgery. If you ever read Andrew Sullivan's Cannabis Closet or similar AskMes, some doctors really, really flip out when marijuana use is discussed ... even doctor's who should know better. I really think you should be open to your doctor about using marijuana, but make sure you realize you might not get the most open minded treatment and should be willing to switch doctors if that arises.
posted by geoff. at 4:21 PM on January 20, 2011


Cannabis can raise heart rate and decrease blood pressure while under the influence of the drug. But the effects are minor and transient, and both are monitored during surgery, and how many people really puff on a joint right before undergoing surgery? I would also love to see some literature citations indicating previous marijuana use has any relevance whatsoever to the use of anesthesia.
posted by Thoughtcrime at 6:26 PM on January 20, 2011


Yeah, I want to raise a caution here, too. There is massive discrimination against drug users, even marijuana users, that has very little to do with science. There could be insurance complications and denial of coverage related to this as well.

If the person is a daily user and cannot abstain for a few weeks prior to surgery, that needs to be mentioned for other reasons. One of the big ones being that DBS can sometimes produce addictive behavior in Parkinson's patients so if there is a pre-existing addiction, this could be a reason to not proceed.
posted by Maias at 6:57 PM on January 20, 2011


IANAD, but I, too, would be interested to see any research showing that this could affect the surgery/anesthesia. I have no doubt that it could, but being a doctor doesn't make you immune to believing BS.

FWIW, I'd have the keep-this-out-of-the-medical-record conversation with the anesthesia team or some Parkinsons expert. Surgeons are experts in cutting people, not drugs.
posted by pjaust at 5:19 AM on January 21, 2011


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