Patterns of Marijuana Use and Nicotine Exposure in Patients Seeking Elective Aesthetic Procedures

Abstract

Introduction: With the increasing legalization and popularity of marijuana, it is frequently and sometimes unintentionally combined with nicotine-containing products. Consequently, patients may fail to accurately report usage during preoperative exams or remain unaware of the inclusion of nicotine. This poses a challenge for clinicians in identifying preoperative nicotine exposure. This study aims to establish normative data on the use of marijuana and nicotine in plastic surgery patients and correlate it with urine nicotine/cotinine levels. Methods: All consecutive patients presenting to our clinic seeking elective procedures were identified. Patients were surveyed on marijuana and nicotine use and provided a urine sample for analysis. The survey responses, urine results, surgical treatments, and clinical outcomes were followed prospectively. Results: A total of 135 patients completed the survey and were categorized as non-users (50%), active nicotine users (19%), active marijuana users (7%), active users of both (13%), and past users (11%). Marijuana users (who actively denied nicotine use) showed significantly elevated levels compared with non-users (average nicotine 23.1±13.5 ng/mL, p=0.00007, and cotinine 221.2±141.8 ng/mL, p=0.0002). 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. There was no difference in urine levels, reported use, or other patient characteristics in patients with and without postoperative complications. Conclusion: 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.