Patterns of Marijuana Use and Nicotine Exposure in Patients Seeking Elective Aesthetic Procedures
Lakshmi Mahajan*2, Yi-Hsueh Lu1, Joseph A. Ricci1
1Division of Plastic Surgery, Montefiore Medical Center, Bronx, NY; 2Albert Einstein College of Medicine, Bronx, NY
With the legalization of marijuana and increasing popularity of various nicotine products, it is challenging for clinicians to identify nicotine exposure preoperatively, a well-known risk factor for complications. Co-use of marijuana and nicotine is common yet unrecognized. This study aims to establish normative data on marijuana and nicotine use in plastic surgery patients and correlate their self-reported use with urine cotinine (a nicotine metabolite) levels.
After IRB approval, patients seeking elective plastic surgery procedures were identified and asked to complete a survey on marijuana and nicotine use. Urine samples were collected. The survey answers, urine cotinine levels, and clinical outcomes were followed.
A total of 135 patients were included with 94 patients (70%) self-identified as Hispanic and 39 patients (29%) completed the survey in Spanish. Average age was 37.8 years (range 18-67 years). Use patterns were categorized as non-users (50%), active nicotine users (19%), active marijuana users (7%), active users of both nicotine and marijuana (13%), and past use (11%). Active marijuana users (while denied nicotine use) showed significantly elevated levels compared with non-users (cotinine levels 7.5±4.1 vs 221.2±141.8 ng/mL, p=0.0002; TABLE1). Less than a third of active marijuana and/or nicotine users reported active use of these products during their reported as such during actual clinical encounters. Among those patients whose active substance use were not reported, both groups had elevated urine nicotine (active marijuana users 169±143 ng/mL and active nicotine users 416±194 ng/mL; TABLE 2), which would be considered as active smoker based on reference values. There was no difference in urine levels, reported use, or other patient characteristics in patients with and without postoperative complications.
This is the first descriptive study to document elevated urine nicotine levels in self-reported marijuana users in an urban, diverse patient population seeking elective plastic surgery procedures.
TABLE1. Survey-reported use pattern of marijuana and nicotine and urine nicotine and cotinine levels
TABLE2. Survey-reported use pattern of marijuana and nicotine versus clinical-reported use
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