HJAR Jan/Feb 2020

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2020 43 and discomfort associated with cancer and cancer treatment. However, my neurosur- gical practice has encountered many other instances of marijuana’s negative impacts on a patient’s brain. Marijuana is known to cause increased blood flow. In some rare patients it causes a massive increase in blood flow, to the point that circulation in the brain may become overloaded, disrupting barriers that separate blood from the brain. In one instance, we were preparing to op- erate on a patient suffering from a condition that already causes an increase in blood flow in the brain. When the time came for surgery, we opened their skull but could not oper- ate. The brain was tense, the arteries were very angry, and the brain was swollen to the point that we found it too risky. We told the patient the situation was unusual, and that we attempted all measures to relax the brain. We could not explain why this occurred until something clicked and we decided to check their blood for anything else. That’s when we discovered the patient had used marijuana the night before surgery. Unfortunately, cases like this have be- come quite common, especially in situations where marijuana is combined with other il- legal substances. There is not a week or two that passes without admitting a patient with a brain bleed because they had been using marijuana and methamphetamine together. That combination proves particularly risky, and many of these are younger patients who don’t have bad vessels or the wear and tear commonly associated with a bleed. What happens is this: the blood vessels in the brain are made in a way that they auto regulate pressure, dilating to decrease pres- sure, or constricting to increase pressure when needed. They regulate because if you have too little blood, you have a stroke. If you have too much, you have a bleed. By mixing marijuana with something like methamphet- amine, arteries lose their ability to auto regu- late or react to pressure and instead, operate as a wide open pipe, inviting problems. Over the last four to five years, we have seen an epidemic of brain bleeds caused by just such a combination, but the potential for a reaction with illegal substances isn’t the only challenge. In my experience, if you have a patient who already has high blood pressure and they mix even a mild, over the counter methamphetamine, like certain cold medicines, with marijuana, they are creat- ing a cocktail for catastrophe. Until there are further studies on how marijuana interacts with other medications, we simply do not know how a patient is going to react, or which populations may be at higher risk. Until then, every practice needs to oper- ate as an observer, logging and exploring things they encounter, but cannot explain. As these encounters have grown, my prac- tice now regularly utilizes a tox screen be- fore surgery, and if a patient has been us- ing marijuana, we do not operate because experience has shown the risk is too high. We also need patients to realize they cannot use marijuana following surgery because the ensuing brain bleed could cause a whole new storm of trouble. As the prevalence and use of medical mari- juana grows in society, we will undoubtedly learn more. Could there be other benefits we have yet to discover? That’s certainly possible. We will also learn more about po- tentially deadly drug interactions and other side effects we remain ignorant of today. It is important for all medical professionals to realize we are traversing truly undiscovered territory. We don’t know where we’ll have a smooth ride, where we may encounter an ambush, or where we’ll face a mountain to climb. We will see and learn a lot during the journey. n Ali Krisht, MD, FACS Director Arkansas Neuroscience Institute at CHI St. Vincent “It is time for medical professionals across the state to prepare ourselves for everything we don’t know about this drug and how it interacts with other medications, illegal substances, and even specific types of patients.”

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