I got my medical marijuana card!

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F0nzie

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Anybody else frustrated with the medical marijuana docs that are prescribing to our patients? Often these patients are just getting it for anxiety or sleep and do not have any medical problems that warrant its use ie. cancer, rare seizures, severe movement disorders, etc. Just the other day I was referred a patient with borderline pd and no medical problems on Oxycodone, Xanax, and medical marijuana. Wow what a winning combo!

There is this public misperception that weed is harmless. This misperception is further reinforced by medical professionals running the marijuana mills.The THC content today is about 10-15x higher than weed smoked in the 70s. Higher THC % in marijuana is known to result in worsening depression, anxiety/panic, paranoia...etc. Now I have to deal with all these patients arguing that marijuana is "all natural" with the smug looks on their faces displaying their cards like they are members of an exclusive club. Seriously?

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[ Now I have to deal with all these patients arguing that marijuana is "all natural" with the smug looks on their faces displaying their cards like they are members of an exclusive club. Seriously?[/quote]

Hemlock and Arsenic are natural last time I checked.
I had a patient tell me he was given a THC card for his asthma.
 
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Why the hell don't these doctors get investigated by the medical board?! I have a patient who got a card, and I talked to him about his evaluation to get the card -- the doctor talked to him for a few minutes, supposedly reviewed his extensive medical records (yeah, right) and didn't touch him at all, which seems inappropriate because he was asking for the card for chronic MSK pain. Of course he had to pay $200 for this oh so thorough evaluation. I've never heard of anyone not getting approved for their card.

Anyway, I prefer legalization to this medical marijuana stuff because medical marijuana just validates what is potentially an addictive or substance misuse issue.
 
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What I don't understand is why so many of us seem to think the modern for profit prison system in less scary for mental health than the use of a recreational substance that is but one of many. Sure. We should remove the medical licenses of people who write weed scripts for everything or much of anything for that matter. But I think tacit support for crimilization of weed possession or use is as ridiculous as it is unconscionable. How's anal rape and acculturation into organized violence for one's mental health profile.
 
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Anybody else frustrated with the medical marijuana docs that are prescribing to our patients? Often these patients are just getting it for anxiety or sleep and do not have any medical problems that warrant its use ie. cancer, rare seizures, severe movement disorders, etc. Just the other day I was referred a patient with borderline pd and no medical problems on Oxycodone, Xanax, and medical marijuana. Wow what a winning combo!

There is this public misperception that weed is harmless. This misperception is further reinforced by medical professionals running the marijuana mills.The THC content today is about 10-15x higher than weed smoked in the 70s. Higher THC % in marijuana is known to result in worsening depression, anxiety/panic, paranoia...etc. Now I have to deal with all these patients arguing that marijuana is "all natural" with the smug looks on their faces displaying their cards like they are members of an exclusive club. Seriously?
Win! I've got a butt load of those in my PP and I'm slowly expelling them or converting them into appropriate management strategies...
 
I like when patients ask me about prescribing them medical marijuana .... at the VA. I tell them no, because it's not indicated for their condition, and that even if I wanted to, do you really think the VA is going to on board with it already? They give me trouble for even trying to prescribe Seroquel (which I only did twice, I swear!).
 
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I like when patients ask me about prescribing them medical marijuana .... at the VA. I tell them no, because it's not indicated for their condition, and that even if I wanted to, do you really think the VA is going to on board with it already? They give me trouble for even trying to prescribe Seroquel (which I only did twice, I swear!).

But did you inhale?
 
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I'm wondering how the psychiatrists in Colorado are dealing with all this "medical marijuana" craziness… I don't usually confront patients about this but my answer is simple: "It's still illegal in the United States of America, on a federal level. I don't care that certain states have 'legalized' it." Boom, end of discussion.
 
Why the hell don't these doctors get investigated by the medical board?!

Yeah well why doesn't the pill-mill opioid doctor get investigated? Why did the doctor that was accused of giving a rectal exam unnecessarily only have his license taken away after the 50th investigation?

http://humanrightsalert.wordpress.com/2007/12/19/psychiatrist-accused-of-molesting-boys/
http://psychsex.wordpress.com/page/10/

By the way, I know people that know the above guy. He did eventually get his license taken away but only after several years and several several accusations of sexual assaults and he worked in several institutions, being fired by several of them but then just going on to the next one and continuing poor work.

IMHO there is a place for medical marijuana but it should be close to last-line. Of all the patients I've ever had, maybe 5 fit this need. So if I ever had the power to prescribe it, we're talking just 1 patient I got now that might need it, and this is a guy who's OCD is so bad and treatment-resistant he needs psychosurgery. And pretty much no one with psychosis should ever take it.

As for the illegality on a federal level, Obama has issued orders to the law-enforcement branches of the federal government not to pursue arrests of marijuana users. So at least for the next few years "medical" marijuana use within a state that's legal within that state could continue. With the next administration this could change.....

Though I speculate that what will happen is by then the acceptance of it will grow to the degree eventually the federal government may drop it as an illegal substance. It'll go through phases, e.g. the next President may too chose to ignore it, and then after years (few to several) it'll become legal.

IMHO, on a cultural level, we psychiatrists need to educate patients that marijuana can make someone psychotic-permanently. Almost everyone these days at least experiments with it, even if they have a close relative with schizophrenia on a false impression that marijuana will do no harm.
 
Whopper,

Interesting thought.

There are some members from the SUDS side who believe that cannabis is not that big of a deal as only 1% can only penetrate the BBB and believe the research was a bit contrived. Others through annecdotal experience, pharmcokinetics and schizophrenia research believe that it can unleash permanent psychosis.
 
Medical mj is a huge pain. I've never rxd it and I don't typically rx bdz's or stims to someone using mj medical or otherwise.

That being said, imagine if one studied the effect of cannabis on depr or anx via using phq-9 or gad-7. Would potentially outperform ssri's. Think about it (sleep, appetite, interests, guilt,
Just sayin ;)
 
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What if the schizophrenogenicity (idk if that's a word) becomes firmly established? What then? As Whopper indicated--weed is headed for wider use and has made the transition from illegality in a way that will be impossible to reverse. A few posters seem to dilberately ingnore that in Colorado you don't need a card--you just walk in and buy some weed like you buy a beer. So here we go, this is what we face.

I agree with whopper that we should take a public health and education role.

And I have to say I find it disturbingly egg-headed and myopic that as a profession we are able to pretend the effects of maintaining the largest prison population in the world is somehow insconseqeutial and beyond our purvey as mental health professionals. Particularly when these policies are destroying the fabric of minority communities. All just to be scientifically right in our distaste for stoners and their culture. If this is our main position, then I'm sorry, but we're the ones who are engaging in mass delusion and mental illness.
 
The trouble with Psychiatrists trying to educate users about the inherent dangers of Marijuana is the fact that many of the most vocal advocates for medical Marijuana et al, at least those I've come across, is this inherent 'grown in the ground, gift from God' attitude that behoves them not to listen to the 'Big Pharma' pill pushing Doc behind the ivory tower desk. You just want to out law marijuana use, they'll say, because eventually it will take over and replace your dangerous pills, making the evil corporatisation of medicine through the Pharmaceutical companies obsolete. I should know, I used to be one of these people. No one, but no one could tell me the dangers of marijuana. So blinded was I by this idea that marijuana was this innocent gift of nature, and therefore vastly superior to all the pills manufactured in giant factories for ridiculous profits, that I would argue 'till I was blue in the face with anyone who thought differently and could provide the evidence to back up their statements. I just didn't want to listen, not until I had the extreme mispleasure of developing Cannabis psychosis (or at least having Cannabis trigger off an already underlying Psychotic condition) and that's pretty much when I learnt the hard way to shut my damn mouth, because oh how wrong I had been.

Mind you at the time I was railing against the pharmaceutical companies, with their factories and profits and how dare they stand in the way of humankind's progress towards the wonderful world of weed, I was also taking any number of other drugs - manufactured in illicit factories, for profit. Hypocrisy, yay. :yeahright:
 
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Refreshingly honest Ceke.

What I think it will take is some well-publicized, well-controlled, quantitative performance data showing impairment in reaction time, academic performance, etc. Unfortunately what we're likely to get is an uptick in highway carnage in CO and WA. Folks don't care so much about the risk of psychosis--just like the risk of cancer never seemed to motivate people to quit smoking.

We were just discussing this issue in a GME meeting this AM re: impaired residents. How do the consequences of having a THC+ urine screen change now in states where weed is legal? Do we have to demonstrate a different standard of impaired performance?
 
So I agree with all of this dismantling of the mythology of weed as panacea. Or even as harmless. But criminalization is not the solution. I wonder, ceke, if you'd been popped for possession with intent to distribute during your days of canibus use--orders of magnitude more likely if you're the wrong skin color--if time in a state prison would've helped you--psychotic or not? Rhetorically, of course. But this seems to be a perfectly uncriticized position in our profession. You can just state that it should be illegal and wash your hands of a generation of brown kids and be considered perfectly rational and civililized. And the only public to be lamented over are white kids whose parents can afford a shrink to fret over it.
 
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So I agree with all of this dismantling of the mythology of weed as panacea. Or even as harmless. But criminalization is not the solution. I wonder, ceke, if you'd been popped for possession with intent to distribute during your days of canibus use--orders of magnitude more likely if you're the wrong skin color--if time in a state prison would've helped you--psychotic or not? Rhetorically, of course. But this seems to be a perfectly uncriticized position in our profession. You can just state that it should be illegal and wash your hands of a generation of brown kids and be considered perfectly rational and civililized. And the only public to be lamented over are white kids whose parents can afford a shrink to fret over it.

Where I live marijuana is decriminalised. More than 2o years ago our Government saw the futility in prosecuting and locking up people for the 'crime' of smoking what is essentially a weed, so they decriminalised it and replaced prosecution with on the spot fines and confiscation. Interestingly enough since decriminalising marijuana the peer pressure to smoke, among teenagers especially, fell considerably compared to other states. It was practically legal, so it was seen as not that big a deal and therefore not 'rebellious' enough. Having marijuana decriminalised here hasn't led to some huge upswing in nefarious pushers trying to lure the innocent onto the dangers of ganga, quite the opposite in fact. Most people think 'it's just dope, there's plenty of it, take it or leave it'. Even when I was smoking, the every day, glued to the couch, no motivation, risk of psychosis type smoker wasn't exactly the norm. Despite my experiences with marijuana and psychosis I actually do believe in legalisation and regulation. I agree totally that jail in these circumstances is far more detrimental than any amount of marijuana could be, psychosis, cancer, or not. I had a friend who was caught, not with weed but with a small amount of recreational use LSD tabs. He was behind the 8 ball from the start, because class wise he came from a lower socio-economic background, he was part indigenous, and he struck a judge who decided to make an example of him. He went into jail a fairly innocent, recreational drug user, he came out a hardened criminal with serious mental health issues.
 
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Unfortunately what we're likely to get is an uptick in highway carnage in CO and WA.
I did some research on this for a talk I gave. It's pretty interesting. Small quantities of weed had little impact on driver performance when tested, and folks performed substantially better on weed than alcohol. But when the two were combined, even a little alcohol on top of weed or a little weed on top of alcohol had some very bad performance outcomes.

This brings up the better question: how come I never saw fliers looking for subjects for studies like THIS when I was in college?
 
[ Now I have to deal with all these patients arguing that marijuana is "all natural" with the smug looks on their faces displaying their cards like they are members of an exclusive club. Seriously?

Hemlock and Arsenic are natural last time I checked.
I had a patient tell me he was given a THC card for his asthma.[/quote]

So is dog poop and cyanide. All natural.
 
Medical mj is a huge pain. I've never rxd it and I don't typically rx bdz's or stims to someone using mj medical or otherwise.

That being said, imagine if one studied the effect of cannabis on depr or anx via using phq-9 or gad-7. Would potentially outperform ssri's. Think about it (sleep, appetite, interests, guilt,
Just sayin ;)

And motivation too eh?
 
Sounding like there's two of me.

I do think medical marijuana should be made available to patients, but not to psychotic ones. And for the ones that could benefit-e.g. chronic pain, treatment resistant anxiety, treatment resistant nausea, treatment resistant anorexia (of a physiological type) it could only be prescribed after several conventional treatments have been tried and failed, and that if it's given the prescribing doc has to emphasize that more data is needed, and that it's being offered as a type of "grasping at straws" approach. Like I said, I've had very few that would've truly fit this category but if it were legal I would've told them to use it.

As for my psychosurgery candidate patient, he started using it months ago (and he is not drug-seeking). It does help him tremendously but he's still far from what I'd say is remission. His GAF went from a 35 to about a 48 on it. He's still doing very bad. He went from only being able to sleep at max 5 hours a night to 8 hours a night, chronic nausea to almost none, PTSD nightmares often to barely any, OCD that was severe that went to moderate, and his agoraphobia is still very bad. He still has several problems.

It's not legal in Ohio, but it is helping this guy and if it became legal I'd prescribe it to him, but he would be the only one out of all the patients I have.

The problem is that like all meds, some docs will prescribe it like it's candy. IMHO that is not the fault of marijuana the lack of enforcement of doctors in general that needs to be fixed.

Any patient I got that has a chronic psychotic disorder other than dementia with psychotic features that I've had for more than just a one-time PES visit, and actually have a decent cognition, I usually ask if them if they have any relatives below the age of 30, and if they say yes, I tell them and their families that NO ONE, I mean NO ONE < 30 years can use marijuana because it can increase the risk of psychosis, possibly schizophrenia, and that they should all take fish oil.

While one could reasonably argue that more data needs to be obtained, IMHO enough is out there for me to believe there's a significant risk with marijuana on it being potentially schizophrenogenic.
 
there is no evidence that cannabis use after the age of 18 increases the risk of schizophrenia, and the greatest risk is in those who use heavily before the age of 15, and even then there is only a four-fold increase (two-fold for 15-18), which compares to 20-40 fold increase risk of lung cancer with smoking tobacco for example.
 
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Wow. You called it. We need to figure out how to test drivers so that we use the current DUI laws.
Most states you already do. Many states you're under the same laws as DUIs. Other's have specific laws pertaining to drugs. Google "Drug Recognition Expert" for more information about how states are starting to handle this.
 
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And motivation too eh?

Interesting how motivation is not measured in either phq-9 or gad-7. Probably in part because antidepressants can at times exacerbate amotivation as well. If motivation were a core symptom of depressive and anxiety disorders I bet therapies would seem more effective when studied using tools such as phq9.
 
Most states you already do. Many states you're under the same laws as DUIs. Other's have specific laws pertaining to drugs. Google "Drug Recognition Expert" for more information about how states are starting to handle this.

Interesting. Here's what I bet happens. Defendant #1 with the quid to bankroll a big time attorney makes mincemeat of the report. Whereas no tengo dinero defendant #2 gets advised to take the rap by Joey the Public defender whether the tests are performed by hacks with a redneck agenda or not.

Same as it ever mf'n was.

Urine tox screen in step 15 or whatever is useless because those are degraded metabolites that don't indicate current intoxication. And from what the web tells me the cops internal studies comprise the majority of the evidence for the efficacy of the tests.

Could be the psychological test are legit. As a repository of past pan-psychopharmacpoeial experimentation myself, my instinct is these test could be spot on for detecting a stoned individual. But training and enough qualified people in the field seems a stretch. Cops f@ck up a breathylizer on the reg. Seems like we need a molecular test for current intoxication to be street level effective to me.

We'll see. I'm impressed OPD called the uptick in traffic accidents a while back, I remember us having the pot discussion sometime ago, before Colorado went full legal. The studies you mention about synergistic effects of alcohol and MJ are interesting.
 
For full disclosure, I'm personally a constitutional libertarian and I believe that drugs should be decriminalized and people should be allowed to do what they want in the privacy of their homes, though any harm/impact they have on others outside of their homes is on them. The pure application of this would be tough in the USA, but at last decriminalizing certain drugs and tightly controlling distribution could be the realistic (albeit still limited) compromise.

Professionally I believe there is definitely a place for medical marijuana, though the dx's that should qualify for use should be short and supported by the research. I was working in Michigan when they first started allowing medical marijuana and I saw it quite frequently in the chronic pain clinic and with a number of my out-pt SCI patients. The former group were the typical mix of mostly psychiatric, so it was hard to justify how most were using MM. However, my SCI patients (primarily C-level) appeared much more appropriate for use. Most were on high levels of opiates, anxiety meds (a good % benzos), anti-nausea, etc. and really struggled day to day w. pain management with anxiety being a significant moderating factor. The pts I saw that used MM were able to d/c the anti-nausea meds, significantly cut down on their opiates, and curb the need for anxiety PRN meds. I didn't have time to pull together a set of case studies or a small study, but I think that could be one area where MM use may actually benefit. MM isn't perfect, but to side-step issues of constant constipation, n/v, and increased pain due to increased anxiety….that really helped w. quality of life issues.

Could be the psychological test are legit. As a repository of past pan-psychopharmacpoeial experimentation myself, my instinct is these test could be spot on for detecting a stoned individual.

I'm not sure if traditional psych assessment would have enough reliability, sensitivity, etc….though I'd be interested in neurocognitive assessment. There isn't much in the literature about performance while stoned, though I have seen some studies that found no significant long-term impact (after cessation from marijuana) on cognitive performance. I'm not sure how "in the moment" would looking on testing, but it'd be worth exploring.
 
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there is no evidence that cannabis use after the age of 18 increases the risk of schizophrenia, and the greatest risk is in those who use heavily before the age of 15, and even then there is only a four-fold increase (two-fold for 15-18), which compares to 20-40 fold increase risk of lung cancer with smoking tobacco for example.

Didn't know about the age 18 vs age 15 years thing. Everything else, however, I did know about.
A 4-fold increase is something where I dont' think the world "only" should apply if there already are risk factors for schizophrenia in the particular individual such as a biological relative with schizophrenia.

That's a reason why I emphasize marijuana must be avoided in those who have a relative with schizophrenia. I do tell patients in general marijuana may pose some risk for psychosis and schizophrenia, but with an already existing significant risk factor, the morbidity of the disorder is just too much of a risk to consider using it for recreational purposes. Medical? That depends on the specific person and their current condition though psychosis or a family member with it IMHO warrants a contraindication.
 
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I feel yall after inhaling, say in a car while riding up to a store, you get this feeling/mindstate as if you are in your ownprivate eggshell from what others are feeling. You kind of get a feeling of anxiety as if you don't want anyone to find out or that the police is out there to get you. Upon graduation, I will prescribe herb in moderation as it may help some muscle contraction patients more than even a flexeril. But yeah psych patients with anxiety should not be smoking the herb.
 
I feel yall after inhaling, say in a car while riding up to a store, you get this feeling/mindstate as if you are in your ownprivate eggshell from what others are feeling. You kind of get a feeling of anxiety as if you don't want anyone to find out or that the police is out there to get you. Upon graduation, I will prescribe herb in moderation as it may help some muscle contraction patients more than even a flexeril. But yeah psych patients with anxiety should not be smoking the herb.

Does that go along with pill popping of BZD for PTSD?
 
Higher THC % in marijuana is known to result in worsening depression, anxiety/panic, paranoia...etc.
But don't anti-depressants, anti-anxieties, and anti-psychotics have side effects that worsen the symptoms you listed as well?
 
i am very proud to say that i will retire from the field of medcine and leave this country immediately, before i ever prescribe medical marijuana to anyone. it is absolutely devastating hearing that physicians can be so hungry for wealth that they can go to these levels. completely disgusting and devasating.
 
i am very proud to say that i will retire from the field of medcine and leave this country immediately, before i ever prescribe medical marijuana to anyone. it is absolutely devastating hearing that physicians can be so hungry for wealth that they can go to these levels. completely disgusting and devasating.

Hahaha. Let me see...some agency says to me your career and your citizenship or this weed script which is less toxic than koolaide, ummmm my humungous pride aside...they're getting the script.

But your moral outrage against a plant is hilarious.
 
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i am very proud to say that i will retire from the field of medcine and leave this country immediately, before i ever prescribe medical marijuana to anyone. it is absolutely devastating hearing that physicians can be so hungry for wealth that they can go to these levels. completely disgusting and devasating.
I disagree strongly with how many folks are prescribing weed, but I also disagree with how many folks are prescribing stimulants and benzos. Demonizing cannabis is exactly why we're in the mess that we are in.
 
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THC needs to be properly researched rather than blindly saying, please go ahead and blaze away and be sure to try one of each variety out there. Equivalent to saying try some jack vs bud vs tequila vs Chianti to see what works best for you.
 
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Hahaha. Let me see...some agency says to me your career and your citizenship or this weed script which is less toxic than koolaide, ummmm my humungous pride aside...they're getting the script.

But your moral outrage against a plant is hilarious.

you may find it hilarious, but i have seen so much potential wasted with cannabis abuse. families completely destroyed. maybe it has to do with the strict upbringing i was brought up in.
 
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Time mag came out with an article a year ago about mj study over 20 years. The findings-helped lung function, did not cause cancer, and overall was not harmful. This was of thousands of people of diff ages. I agree that it should not be something inhaled by kids for growth and dev considerations but what about psychotropic drugs? Do they have studies like that regarding psychotropic drugs? Maybe some but not many. Weed is not for everyone. Some know its not for them, but others claim it helps them and some have touching stories to prove that. If it helps them then they should get it. Side effects are fewer, and slowly weed is becoming accepted more and more by society. The old conservative docs will never understand, but who cares they will soon retire anyway and the new open minded psychiatrists and doctors and psychiatric nurse practitioners will fill their spot with a new, more open minded agenda.
 
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troll harder people...
 
the meds used are basically to f#ck you up so you don't think about the traumatic episode.
No.

Weed is completely diff it does not have the side effects like the pills do and it helps some people that like it. Some people don't need it and that's fine, they should not take it and they will tell you. Others believe it is the answer to their problems and as long as they think that then why should we keep them from getting it.
Weed should be treated no differently than any other chemical. It should be tested, and if it is shown to have efficacy and a favorable risk/benefit profile, then we should prescribe it when appropriate. Until then, there's no place for marijuana being prescribed.

If people want to smoke marijuana, then they should work on getting it legalized. Trying to backdoor it through medicalization is a bastardization of medicine.
 
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It has been tested over 20 years, it has been legalized in 3 states and prescribed in many more for cancer pts and many diff things (muscle contractions, pain and even its anti cancer properties). I have talked to pts while at work or at clinicals of the benefits and it's all good. They all said that the countless meds have not helped. (Don't get me wrong, I do believe in medications that target specific illness, talking about the side effects of the cancer meds compared to weed). Game, set, match.
 
It has been tested over 20 years, it has been legalized in 3 states and prescribed in many more
Ok, so for which psychiatric conditions has MJ been tested and I should be prescribing it for? Before you edited your other post, it seems like you were suggesting PTSD?
 
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I'd like to know what peer reviewed research there is in which compound has been isolated for FDA approval of a diagnosis.
 
That's a gray area. You are the doc, so you make your choice. I can't say what to do as nothing is black or white in mental health. I would do cog and group psychotherapy for ptsd and the most appropriate med. I was talking about benzos as being minor tranquilizers and i believe may not work best for some ptsd pts. You have to play around do some tests, everyone is diff. Take conservative approaches. Weed is even a more gray area, it helps some but not everyone. Weed has been shown to have positive outcomes for cancer pts (more like uplifting sensation and quality of life and for some muscle spasm pts and diet stimulant not so much i think) before entering psychiatry, i tried many drugs on myself so i know what i'm going to be prescribing. So use your judgement i'm not trying to tell anyone what to do but sharing my insight.
 
Concrete declarations with insults to rapidly reversing course wanting to hedge the bet.

Sounds like addictions to me.
 
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i tried many drugs on myself so i know what i'm going to be prescribing. So use your judgement i'm not trying to tell anyone what to do but sharing my insight.

You tried a full 6-8 week course of an SSRI to see how it worked? You are aware that the feeling is completely different for patients after enough time has passed by?
 
Dudes, i dont think this is a real person. It's scripted to be provocative. With a 3 post count on the topic of weed.
 
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