I'm having open heart surgery soon and I want to reduce my use of opioids post surgery. Is the use of cannabis safe?

"if OK, is smoking or vaping OK?"

I think that’s an excellent idea. Studies have shown that cannabis use with opioids can decrease your opioid use up to 25%.. However, there are several things to consider. After your surgery for several week, your medications may be changed, added or discontinued by your cardiologist or surgeon. These changes can affect your blood pressure and heart rate, so both should be stable before starting cannabis since it can sometimes cause changes in both.

During this time you might need to take some narcotics that the surgeon has prescribed. Everyone’s reaction to the chest wall pain after open-heart surgery is different and you may find that your pain is minimal by the time your medications, blood pressure, and heart rate are stabilized.

When all is stable I would suggest speaking with the surgeon and cardiologist to tell them that you would like to take cannabis for pain, if in fact, it is still there, to decrease your use of narcotics. Cardiac surgery patients usually begin cardiac rehabilitation 2-4 weeks after uncomplicated cardiac surgery, but this depends on your physical condition prior to surgery and other factors such as any difficulties during or after surgery.

When cardiac rehab does begin you may experience chest wall pain from the deeper breathing that you get from the exercise program to strengthen the heart muscle that you get from rehabilitation. It is this chest wall discomfort or pain that you might need to use cannabis for if anti-inflammatories do not work (which sometimes is all that is needed at this point).

Now to finally answer your question. Since its usually the chest incision that causes the most discomfort after open hear surgery (verses minimally invasive cardiac surgery that can be performed if possible), I would avoid both smoking and vaping cannabis. The reason being, though both give the fastest effect, is that they both can cause irritation to your lungs if your not used to inhaling them, which can cause coughing. This of course can be painful with a fresh chest wall incision.

I would tend to use a tincture that can start to take effect within 15-30 minutes. A capsule is another option. I would tend to avoid edibles, except perhaps in the evening for sleep, only for the reason that the effect can take 1-2 hours and you would like pain relief faster then that.

Speaking of cardiac rehab, it has been shown to significantly decrease your chances of another cardiac event and I would highly recommendation beginning it as soon as possible after your surgery. If you need cannabis to help tolerate it instead of narcotics, then go for it!

Perry Solomon, MD

I love Dr Solomon’s answer and would add that the problem I have met is when the patient has a stent and has to be on blood thinners for that reason or for other heart reasons, then the cannabis does add to thinning the blood and the dose of blood thinner may need to be adjusted to accommodate the cannabis.

Many doctors will tell you to stop the cannabis but because it has such profound pain relief without the addiction risk of narcotics I would encourage that you pursue talking with your doctor about your choices rather than their choices.

One of the major reasons for conflict in medicine is when doctors forced their choices on patients, and the patient suffers a bad outcome, then the patient is angry and takes action against the doctor. Sometimes it’s up to the patient to teach the doctor to learn to listen. Good luck, we all want to be seen and heard, so be well centered and express your wishes with kindness but you can be firm and repetitive in order to be heard.

Dr Olson

I agree, but do think the short-term opiates have their place in the immediate post-operative period. THC is not the best for acute pain and CBD works best for inflammatory and neuropathic pain.

CBD competes for metabolic enzymes at the cytochrome P450 level so one must be cautious when using it with medications (Coumadin) that rely on those enzymes for metabolism. So if high CBD strains are used, be sure to dose it at least a couple of hours apart from your other medication – most especially Coumadin.

Dr Frye

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