Is marijuana use something a surgeon needs to know about?

October 11, 2016 9:15 PM

(Asking for a friend). A friend smokes weed a couple of times a year. They just smoked (for the first time in a year or two) yesterday, and are going in for a hernia surgery in three days. The hospital intake paperwork asks whether they use illegal drugs. The privacy statement specifically retains the right to share information with the police. So they'd rather not admit to the marijuana unless it's actually medically relevant. Is it possible that a couple of joints could have lasting effects four days later that a surgeon would need to know about?
posted by anonymous to Health & Fitness (18 answers total)

Just checked with the ER doctor sitting on the couch with me. The drug use will be completely covered by patient-provider confidentiality/HIPAA. Also, as long as the weed use is irregular/not something that would cause withdrawal, they should be fine, but they should be honest with the docs. She doesn't think there are any negative interactions (just did a v quick doc review), but it's better for the docs to know.
posted by protocoach at 9:34 PM on October 11, 2016 [6 favorites]

The drug use will be completely covered by patient-provider confidentiality/HIPAA.

True so far as it goes, but it's not a HIPAA violation to submit diagnoses to insurers on a claim; in fact it's a requirement of doing business. And hospitals naturally keep and retain their own records of all of their patients' diagnoses. There is indeed a diagnosis code for cannabis use (F12.90). No guarantee that this would actually make it through the coding and abstracting process to make it onto a claim, but if it did, your friend could end up in a database with their insurer and in the hospital's EMR system as an officially recorded User of Marijuana.

Not something they would or could share with the police, but I could see it affecting treatment decisions if they, say, were considering whether to prescribe painkillers or other drugs with possible recreational uses down the line.
posted by strangely stunted trees at 10:03 PM on October 11, 2016 [8 favorites]

My understanding is that the surgeon probably doesn't need to know, but if you are going to be sedated your anesthesiologist should be aware of recent smoking and/or marijuana use.
posted by HMSSM at 10:07 PM on October 11, 2016 [4 favorites]

I suspect the risks on both sides--records being shared or health impacts--are exceedingly low but there are apparently some potential drug-drug interactions with cannabis. I don't think internet advice from people who don't know the surgery, anesthesia or follow up treatments is going to lower the health risk to zero. And being a wimp I'd make the decision based on the fact the impact of an health event, if it happens, is worse than the impact of a note that you smoke a joint once in a while.

What about leave the form blank and ask the doctor/surgeon/anesthesiologist directly if it's a hypothetical problem?
posted by mark k at 11:15 PM on October 11, 2016 [1 favorite]

The health risks are incredibly low, and the chances of this getting to insurers and having dire consequences (financial and otherwise) is not insignificant. And if you're in America, you should always be worried about your insurance. I would not risk divulging this information. I know it's not the "right" or "proper" thing to say, but seriously, I'd recommend just omitting this.
posted by naju at 11:59 PM on October 11, 2016 [18 favorites]

Former OR nurse here: the marijuana is likely irrelevant to surgery, but useful for the anesthesiologist to know about. Given the (in)frequency of your friend's use, it's unlikely to cause any troubles (if it is as infrequent as stated). But, people who smoke (marijuana or cigarettes) can have airways that are more difficult to manage, and marijuana smokers respond differently to sedation, so it's better for the OR team to be prepared with that background!

The "right to share information with the police" is a caveat included, by law, in all HIPAA disclosures. What it means is that, if the police are looking for your friend as a suspect in a burglary, for example, the healthcare team is required to disclose your friend's presence at the hospital. It is still illegal for the team to tell the police that your friend reported smoking marijuana, or that he has a family history of high cholesterol, or anything else that's not relevant to their burglary investigation. Any further disclosure of protected health information would require court orders. Also, in my years of billing, we never coded anyone as "marijuana user." There are likely sub-codes that might come up (e.g., "complicated case, including obesity, asthma, smoking) but it's highly unlikely that "marijuana use" would be coded, unless your friend is a heavy smoker and that pertains specifically to the billing charges--which in the case of a hernia surgery is highly unlikely.

In short, it's always best to let your healthcare team know your complete and honest medical history, including any illegal/legal drugs, vitamins, supplements, herbs, etc. Don't worry about the hospital telling the police about marijuana use. Good luck to your friend with the surgery.
posted by stillmoving at 12:51 AM on October 12, 2016 [33 favorites]

Regarding legality, maybe your friend was recently in Colorado where marijuana is legal. It's probably a lie but not a terrible one (if plausible.)
posted by Jason and Laszlo at 3:40 AM on October 12, 2016 [3 favorites]

I would definitely NOT disclose this. Not worth it.
posted by pintapicasso at 5:15 AM on October 12, 2016 [6 favorites]

Another vote for do not disclose, don’t see how it could be medically relevant in this case. Four days after an occasional joint every two years? it’s the same as someone who never smokes pot! Your friend practically never smokes pot!
Even people who do smoke pot more regularly than every two years or so would take a few days off it to prepare for surgery, it wouldn’t even be an issue then, they wouldn’t even mention it unless it was daily heavy use.
Tell your friend not to worry and best of luck with the surgery!
posted by bitteschoen at 5:51 AM on October 12, 2016 [1 favorite]

If it's literally just "Do you use illegal drugs?" I would have zero qualms about lying in the face of such a broad and judgemental query. Your friend can always tell the anesthesiologist privately, as suggested above. Most likely scenario, they'll say they'd only be concerned about much heavier use of much harder drugs.
posted by teremala at 5:55 AM on October 12, 2016

Depends on the interpretation of the meaning of "use" is. "Use", to me, implies an ongoing act. If they asked, "Have you used illegal drugs", I would disclose 1 time in the last 2 years, but they did not. Feel free to not disclose. I wouldn't.
posted by AugustWest at 7:19 AM on October 12, 2016

We are getting closer and closer to a day to universal health care records, even among separate HC systems. I personally wouldn't want it on there as it may reemerge in the future. I wonder what your friend's field of work is? Is this likely to be a disqualifier for current or future employment?
posted by rubster at 8:42 AM on October 12, 2016 [1 favorite]

My friend discloses their (much more regular) use verbally and requests that the health care provider not add it to the record. Most providers have understood and are just happy to know as much information as possible.
posted by juliplease at 10:20 AM on October 12, 2016

I disclosed my use decades ago and it still follows me everywhere. Apparently it is on one of the first windows that pops up when they open my file on their computer. I don't use it anymore and haven't for a long time. I wish that I had never disclosed.
posted by futz at 10:58 AM on October 12, 2016 [6 favorites]

My dad is a doctor. He works on patients in an operating room setting. He told me once that he considers pot smokers to be "pre-medicated." On the off chance that there could be an interaction with your friend's anesthesia, it's prudent to disclose. Perhaps your friend could remind his doctor that marijuana is legal in certain places and therefore he's not sure whether it falls under the category of "illegal" drugs.
posted by Mr. Fig at 2:29 PM on October 12, 2016 [2 favorites]

Anesthesia student here: Surgery doesn't need to know, but anesthesia likes to know when people are regular users of substances because it can affect how much anesthetic they will need. I wouldn't worry too much about this though. Doesn't sound like this person is a regular user, so it shouldn't really affect anything. Also, the main drug that I worry about is cocaine, which can have some serious interactions with certain drugs.
posted by brevator at 4:47 PM on October 12, 2016 [3 favorites]

My sister recently went for surgery and was asked by the anesthesiologist in pre-op. He said they need to know because it can affect how much anesthesia she might need, as marijuana use might make it less effective.
posted by slogger at 7:27 AM on October 13, 2016

I really wouldn't - it won't make any difference to anaesthesia, and will stick on your medical records forever visible to both medical insurers and life insurers.

As a doctor I would pretend I hadn't heard you, and wouldn't write it down. If you were smoking crack or using heroin that would be different, as would heavy marijuana use causing psychiatrists symptoms, but I don't want to know about a twice-a-year joint habit.
posted by tinkletown at 11:24 AM on October 13, 2016 [1 favorite]