New research has revealed that plastic surgery patients who use marijuana often have elevated nicotine levels, even when they deny using nicotine-containing products. The study, conducted by Dr. Joseph A. Ricci and colleagues from Hofstra University School of Medicine in Hempstead, N.Y., was published in the September issue of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons.
In a press release, Dr. Ricci expressed concern about these findings: "This raises concerns that unsuspected nicotine exposure might lead to an increased risk of postoperative complications." Nicotine is known to cause vasoconstriction, reducing blood flow and potentially impairing wound healing, which is particularly concerning for plastic surgery patients, Dr. Ricci said. He added that elevated nicotine levels in marijuana users who deny nicotine use also present a "concern for unrecognized surgical risk."
The study included 135 consecutive patients seeking cosmetic plastic surgery consultations; 92% of patients were women with an average age of 38 years.
The researchers found that:
20% of patients reported marijuana use, with 7% using marijuana alone and 13% using both marijuana and nicotine;
Marijuana users showed significantly elevated urine nicotine and cotinine levels compared to non-users; and
Patients who reported marijuana use but denied nicotine use still had elevated nicotine levels (average nicotine 23.1±13.5 ng/mL, p=0.00007, and cotinine 221.2±141.8 ng/mL, p=0.0002).
The study found that less than one-third of active marijuana and/or nicotine users reported their use during clinical visits.
The study authors recommend healthcare providers develop an increased awareness about potential nicotine exposure in marijuana users that could include more thorough patient screening and education about the risks associated with marijuana and nicotine use in the perioperative period. They also advise clinicians to consider urine nicotine/cotinine testing for patients who report use of marijuana.
"In real clinical settings, under-reporting of nicotine-containing product use, including marijuana, remains a concern for unrecognized surgical risk and affects decisions on offering elective procedures," Dr. Ricci said.
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