CBD Surgery Facts You Should Not Ignore
Loving your cannabidiol (CBD) especially for its anxiolytic and anti-inflammatory properties? Great. Can you safely take it before surgery to help you through the ordeal? Well, as usual, the answer is not straightforward, and those in the know don’t seem to agree 100 percent, either. But that’s not a problem.
With CBD, hospital stays can definitely be more positive, but you need to see the whole picture before making a choice. Surgery involves a lot more than meets the eye, obviously. So, you and your doctor will need to work together closely if you want to include CBD in your arsenal against anxiety, pain, and inflammation.
CBD Surgery—always Do This First
Let’s lead with one important piece of advice, though: always disclose your CBD and/or cannabis use (including weed) to the surgeon and anesthesiologist or any medical staff responsible for your hospital intake. Also, ask the presiding surgical doctor if you should be ingesting any cannabinoid at all, and take that advice seriously. Read on for the basic guidelines, but sticking to what the doctor says will be the best course of action.
Are there any guidelines as to who should really avoid taking CBD before surgery, though? Yup, and they’re pretty simple—if you are on any anticoagulant, you should completely avoid taking CBD or any cannabis-related product long before getting operated on.
Here’s why, according to Dr. Alaa Abd-Elsayed, writing for ASRA News. Abd-Elsayed is a pain physician and anesthesiologist:
“Blood coagulation studies indicate that . CBD showed mild anticoagulating effects. Furthermore, the authors demonstrated that 50% clotting times in obese and lean rats treated with cannabis extracts were 1.5- to 2.0-fold greater than their controls (rats not treated with cannabis extracts). The authors also suggested that cannabis may be used in the setting of hypercoagulable states as may exist in patients with diabetes type 2.5. In other studies, CBD oil was found to affect platelets and anticoagulants by suppressing their production and thereby potentially increasing bleeding tendencies.” 
In simpler terms—research shows that CBD is a mild blood thinner. It could potentially exacerbate bleeding after surgery and slow down wound healing, especially if you suffer from any clotting disorder.
Cannabidiol furthermore gets metabolized via the same liver pathways as most prescription anti-coagulants. This effect is dose dependent, but it can affect the potency of the drug. (Research has shown that CBD increases serum warfarin, which could prove fatal.) 
Therefore, if you’re taking prescription blood thinners, always consult with your doctor before starting on any CBD regimen. They should insist on regular blood checks, as CBD and cannabis can decrease the degradation of especially warfarin in your body, and doses should be adjusted accordingly. If not, it could cause serious complications that would put your health—even your life—at risk.
If you are taking CBD together with any chronic medicine (especially those with a risk of drug-drug interaction), the rule of thumb should be to consult with your doctor for guidance days before uptake for surgery or any other hospital procedure.
Anesthesia is no joke. Your body literally gets paralyzed by powerful drugs (ergo the need for ventilators, because you cannot breathe by yourself while “under!”) before the surgeon takes to it with their blade. You don’t want to mess with this procedure.
For this reason, patients are always advised to disclose any chronic supplements and medication they take well before surgery, including cannabis and related products.
From a patient education pamphlet distributed by the Royal Victoria Regional Health Care Centre, Ontario:
“Anesthetic risk has many variables and is often related to your unique medical issues and specific surgery. Individuals who use cannabis do so in many ways, forms and amounts. Therefore, its effect on the body is difficult to predict when combined with a wide variety of anesthetic agents and techniques.
Currently, we do not have enough evidence to say that cannabis alone will increase your anesthetic risk when stopped at an appropriate time.” 
CBD Surgery—when Should You Stop Taking CBD?
If you’re not taking chronic medication, it gets somewhat easier.
At the Royal Victoria, patients are advised to stick to the following times for stopping any cannabis product:
Another doctor responder for the HelloMD forum sends this notice to her patients:
“If you ever do end up with surgery, you must discontinue your CBDs and your vitamin D3 approximately 48 hours before surgery. Both CBD and vitamin D thin the blood so typically surgeons would like to have you off anything that thins your blood for 48 hours before surgery. You may start in both medications again after surgery, typically when you’re released from the hospital.” 
Yet another doctor, the Chief Medical Officer of HelloMD, says this on the same forum:
“There should be no issue with you taking CBD the day before surgery, unless you are on blood thinners. CBD could perhaps prolong your bleeding time. As an anti-inflammatory it may even help with your wound healing. Depending on the time of your surgery, I would make sure that if you are taking a capsule that you observe the instructions by whoever calls you from the hospital regarding what time to stop eating and drinking fluids. You should not take the CBD after that time either. For post operative pain, you might want to consider using a 1:1 CBD:THC ratio tincture instead of an opioid, if one is prescribed by your surgeon. I would also let them know that you are taking it as well.” 
Get the idea? Cannabis, CBD, hospitals, and surgery are not simple and easy companions—and research is lacking, so there are no formal guidelines. Therefore, the safest route would always be to consult with your physician and disclose what you ingested well before surgery.
With CBD, hospital stays can surely be more positive, but is it safe to take CBD before surgery to help you through the ordeal? Get the whole picture here.
CBD Oil Before / After Surgery Safe?
While some states are slowly adopting more lenient laws regarding the recreational use of marijuana, it is a byproduct of this plant that seems to be taking the country by storm. Whether it is tinctures to manage physical pain and anxiety, or topical creams and smokeable “joints,” CBD appears to be the latest “cure-all” craze—and users are flocking to pharmacies and pop-up dispensaries in droves.
CBD is considered to be generally safe by many, but the popularity of the product has far surpassed current regulation. Unregulated, synthetic products should be avoided entirely and even regulated CBD should not be taken immediately before or after surgery.
As a physician, I must weigh the popularity vs. the published research for medical and health-related products. While CBD oil does appear to have potential as an effective treatment for some people, it’s important to know the possible risks before using or consuming CBD.
I have recently had some patients ask about using CBD oil before and after elective surgery, and I want to clear a few things up to ensure that patients have a safe surgery and recovery.
What is CBD?
Cannabidiol (CBD) is one of the main extracts of the marijuana plant, second only to tetrahydrocannabinol (THC, the psychoactive component of marijuana). While it has experienced a boom in popularity over the last few years, this derivative from the hemp plant has a long history, with documentation of therapeutic use dating back to 2737 BC.
There are a number of studies that suggest that CBD can be a powerful alternative for managing epilepsy, insomnia, and mental health disorders, however, the popularity of the product has far surpassed current research on its effectiveness.
Is CBD legal in Texas?
Earlier this summer, Governor Greg Abbott signed a bill making the production of hemp and hemp-derived CBD legal in Texas. While producing and purchasing CBD products is now technically legal, many available products are still unregulated and could contain more or less CBD than advertised, have undisclosed ingredients, or could be concocted with synthetic cannabinoids. Commonly found in gas stations and convenience stores, synthetic cannabinoids are completely unregulated and pose significant risks.
CBD may now be legal, but that doesn’t mean it’s safe: the FDA has issued a warning about synthetic, contaminated CBD products.
Just because a product is legal does not mean it is guaranteed to be safe. The FDA released a warning last year about the health risks of synthetic cannabinoid products, which were found to be contaminated with the rat poison brodifacoum. After ingesting these products, many people experienced vomiting, increased heart rate and blood pressure, and even violent behavior and suicidal thoughts. Synthetic cannabinoids have now been linked to severe, uncontrolled bleeding and death. Hundreds of people across several states have been affected negatively by CBD products.
Should I stop taking CBD before cosmetic surgery?
CBD is used widely in the self-management of pain and anxiety, so many patients wonder if they can ingest CBD oil drops or tinctures before their cosmetic procedure and during their recovery. CBD products should not be taken in the days before or after surgery.
We have an incomplete understanding of how CBD interacts with other medications and how it may impact our body systems, but research has found that it has an anticoagulant effect, which puts patients at risk for increased bleeding during and after surgery. Abundant or easy bleeding after surgery can result in the need to return for another, unanticipated surgery to correct the bleeding problems, asymmetry, and tissue death after surgery.
Just as I ask patients to stop taking herbal supplements, vitamins, and nicotine (and even seemingly harmless beverages like green tea) to ensure there are no problems with anesthesia or increased bleeding, CBD products should be stopped two weeks prior to surgery.
CBD products also have a potent reaction with an enzyme system in the liver that can prevent other medications—such as anesthesia medications or prescription pain killers—from using the same system, leading to a build-up in your system and preventing the medications from doing their job.
The unregulated nature of CBD means that dosing has not been defined and that different brands offer a wide variety of strengths available for purchase. The current state of the CBD industry is like the wild west of supplements, and without truly scientific data, we must err on the side of caution.
Can I smoke weed before surgery?
I encourage patients not to smoke anything before a procedure. Many patients falsely believe that smoking marijuana is a safer choice than cigarettes, which is not true—particularly when it comes to surgery. Smoke of any kind in the lungs can lead to respiratory distress, and marijuana itself can interfere with anesthesia, leading to a higher risk of pneumonia after surgery and a higher risk of airway emergencies. Much like nicotine, smoking marijuana before or after surgery delays the healing process and causes poor scarring of your surgical sites. If you live somewhere where marijuana is legal, edibles are a better choice for eliminating the respiratory problems, however, be sure not to eat past the allowed time before surgery.
It’s crucial to be transparent with your physician; we’re not here to judge, but rather to keep you safe
Before any procedure, it’s important that you share any medications, herbal supplements, or vitamins you take regularly with your surgeon, in addition to information about lifestyle habits like drinking, smoking, and drug use.
As a board certified plastic surgeon, my job is not to pass judgment on your personal decisions or lecture you. However, once you are in my operating room, my ability to perform your procedure safely is very much affected by what you put in your body and whether or not you share that information with me. Something as seemingly innocent as CBD oil drops can lead to surgical complications that can, in turn, impact your wellbeing and your results.
If you are ever unsure about what you can or cannot take prior to surgery, please contact your surgeon for their specific pre-op and post-op instructions.
Wondering if CBD is safe to use before & after surgery? Board certified plastic surgeon Dr. Emily Kirby explains why you may need to rethink this popular product.