Introduction: Chronic cannabis use is increasingly prevalent among surgical patients, yet its effects on anesthetic drug requirements remain unclear. This systematic review and meta-analysis evaluated whether chronic cannabis users require higher doses of propofol or intraoperative opioids compared with non-users undergoing procedural sedation or general anesthesia.

Methods: A systematic search of PubMed was performed from January 1, 2000 to January 1, 2025. Eligible studies included adult chronic cannabis users undergoing procedural sedation or general anesthesia and reported total intraoperative propofol dose or opioid administration convertible to morphine milligram equivalents (MME). Two reviewers independently extracted data and assessed risk of bias using the Cochrane Risk of Bias tool. Mean differences with 95% confidence intervals were pooled using a fixed-effects model. A prespecified subgroup analysis stratified studies by propofol outcome definition (induction dose vs. total intraoperative dose).

Results: Four studies (617 patients) reported propofol dosing and three studies (557 patients) reported intraoperative opioid administration. Cannabis users required significantly more propofol than non-users (mean difference 35.30 mg, 95% CI 17.25–53.35; I² = 0%). In subgroup analysis, the three studies reporting total intraoperative propofol dose demonstrated a mean difference of 32.53 mg (95% CI 12.94–52.13; p = 0.001; I² = 0%), and the test for subgroup differences was non-significant (χ² = 0.51, p = 0.48). Cannabis users also required higher intraoperative opioid doses (mean difference 1.48 mg MME, 95% CI 0.69–2.27; I² = 0%).

Conclusions: Chronic cannabis use is associated with increased propofol requirements and modestly increased intraoperative opioid administration. These findings were robust across subgroup analyses stratifying by propofol outcome definition, supporting the importance of preoperative cannabis use assessment and individualized anesthetic management.