Let's talk about Marijuana!

[LoudBark]

Every drug screen I have ever seen tests for marijuana.
As an ER doc, is there ever, ever a value of knowing if someone has smoked / ingested marijuana?

If someone is obtunded and unresponsive on arrival to your ER.......and they test positive for marijuana......well you certainly should be entertaining another cause of the mental status change.

If someone is acting all psychotic and out of touch with reality.......think primary psych disorder or other drugs or another metabolic process....not the marijuana.......etc, etc, etc......

Any reason at all marijuana remains on a drug screen?

Any value that an ER doc has knowing that someone has marijuana in their system?????

Can anyone name any acute organ or systemic damage done by marijuana for someone who presents to an ER?
Lungs, liver, skin, kidneys, heart, pituitary, adrenals......anything?

Any chronic organ damage by marijuana that would be significant knowing if someone takes it? Can't think of any.

Why not just eliminate it from the drug screen and save the health system just a few more dollars?
(Unless of course any of you can think of any good reasons why it is needed.)

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[RustedFox]

THC is not on our drug screens at my shop.

 

[Apollyon]

Every drug screen I have ever seen tests for marijuana.
As an ER doc, is there ever, ever a value of knowing if someone has smoked / ingested marijuana?

If someone is obtunded and unresponsive on arrival to your ER.......and they test positive for marijuana......well you certainly should be entertaining another cause of the mental status change.

If someone is acting all psychotic and out of touch with reality.......think primary psych disorder or other drugs or another metabolic process....not the marijuana.......etc, etc, etc......

Any reason at all marijuana remains on a drug screen?

Any value that an ER doc has knowing that someone has marijuana in their system?????

Can anyone name any acute organ or systemic damage done by marijuana for someone who presents to an ER?
Lungs, liver, skin, kidneys, heart, pituitary, adrenals......anything?

Any chronic organ damage by marijuana that would be significant knowing if someone takes it? Can't think of any.

Why not just eliminate it from the drug screen and save the health system just a few more dollars?
(Unless of course any of you can think of any good reasons why it is needed.)

Because people mix adulterants into their marihuana (see what I did there? Used the archaic, "governmental" spelling!), such as a "General Sherman" or "dip". It gives a little more information (including if we suspect something else that the screen did not detect, possibly by being below detection limits, but not physiologic effect), and I believe the money savings would be negligible.

Now, if this is an academic question, fine. HOWEVER, if you are a pro-MJ adherent (which, by the way, is called "marie-jeanne" in France, colloquially), and you are itching to argue why it's so good, I'm checking out.

 

[gman33]

i'm not sure any parts of the drug screen ever helped with anything except getting a patient admitted by psych.

An ETOH level can help at times because it tells you some current info.
The UDS has a lot of flaws and just tells you they used something over some time range.
Too many false positives and false negatives.
We wouldn't accept this kind of garbage test in most other areas.
It is designed for employment screening, not clinical medicine.

 

[doctorFred]

i'm not sure any parts of the drug screen ever helped with anything except getting a patient admitted by psych.

An ETOH level can help at times because it tells you some current info.
The UDS has a lot of flaws and just tells you they used something over some time range.
Too many false positives and false negatives.
We wouldn't accept this kind of garbage test in most other areas.
It is designed for employment screening, not clinical medicine.

mostly agree. occasionally, +benzos may steer your workup of an obtunded patient (though with diligence, so as not to foreclose on anything.) also, +marijuana/+PCP on the guy i can't put down with an elephant dart reassures me that he was smoking wet and will be relatively normal in couple of hours. and finally, as mentioned before, when you're going to pass that patient on to someone else (vs the metabolize to freedom crowd), your psych/MICU/floor consultant will want a UDS, and it's not totally unreasonable.

 

[WilcoWorld]

It does help me explain perioral cheetosis, but otherwise it's never helped me in the ED. In fact, for the lab that currently runs our UDS's THC is a special order.

 

[BADMD]

Any reason at all marijuana remains on a drug screen?

The major reason is that it is part of the SAMHSA-5 and required for DOT physicals. Any lab that looks for contracts will want the capability to do it.

 

[The White Coat Investor]

If I'm concerned about Spice, those folks almost always smoke marijuana too, and I don't have a test for spice....

 

[Arcan57]

F$@& Spice ....

 

[DeadCactus]

Marijuana Hyperemesis Syndrome in a patient denying marijuana use. The entire UDS seems useless except for helping cobble together weak validations of clinically based decisions...

 

[WilcoWorld]

Dead Cactus and WCI make good points (and I think the synthetic cannabinoids are one of the worst drugs out there), but the fact is that my practice won't be changed much in either case. When evaluating altered mental status or refractory vomiting I'm still more concerned about ruling things out than I am with ruling cannabis in. If I think someone needs a head CT, I'm not going to let a + UDS stop me, and if I don't think someone needs a head CT I'm not going to let a - UDS force my hand.

 

[Janders]

I love to diagnose cannaboid hyperemesis. I do it a couple times a year. 50% of the time the patient doesn't believe me, but the other half seem to believe that I could be onto something. One DID stop smoking, and on a later un-related visit thanked me.

Other than that... psych likes it purely to see if the patients are telling them the truth (i.e. did they admit to MJ use during their intake history?). They don't seem to mind much when I worked at a different nearby ED which DOESN'T test for MJ...

 

[inspirationmd]

THC is not on our drug screens at my shop.

This

 

[F0nzie]

THC testing is helpful for inpatient or outpatient psychiatrists receiving the ED paperwork!

Clinically, patients may have worsening symptoms of depression, anxiety/panic, paranoia, disinhibition, and exacerbation of impulsive tendencies.

The THC content of todays marijuana is about 10x more potent than the weed smoked in the 70s. The higher the THC content the greater the risk for psychiatric symptoms.

In an ER setting the most you can do with a THC reading is provide brief psychoeducation to high risk individuals or those who are symptomatic.

 

[Car-rX]

Many drug screens measure the inactive metabolite carboxy-THC, which is detectable for many weeks after use but doesn't indicate current intoxication. For EDs that screen, does your lab test THC, THC-COOH, or both?

Some statistics claim that "marijuana emergency room visits" number in the hundreds of thousands annually. Hyperemesis has been mentioned; what other physical conditions come up with these cases? Are they more numerous and burdensome than the narcotic seekers?

 

[RustedFox]

Many drug screens measure the inactive metabolite carboxy-THC, which is detectable for many weeks after use but doesn't indicate current intoxication. For EDs that screen, does your lab test THC, THC-COOH, or both?

Some statistics claim that "marijuana emergency room visits" number in the hundreds of thousands annually. Hyperemesis has been mentioned; what other physical conditions come up with these cases? Are they more numerous and burdensome than the narcotic seekers?

No.

 

[Rendar5]

Many drug screens measure the inactive metabolite carboxy-THC, which is detectable for many weeks after use but doesn't indicate current intoxication. For EDs that screen, does your lab test THC, THC-COOH, or both?

Some statistics claim that "marijuana emergency room visits" number in the hundreds of thousands annually. Hyperemesis has been mentioned; what other physical conditions come up with these cases? Are they more numerous and burdensome than the narcotic seekers?

I see at most 1 marijuana related complaint every several months, which consists of either a parent requesting a drug screen (no, get your own damn drug screen) or once or twice I've seens omeone call the cops because they thought they were too stoned. I have never seen cannabinoid hyperemesis syndrome, though I suspected it at times it never panned out.

Marijuana is not an important ED drug, and I do not know if it shows up on drug screens because i never order drug screens on altered patients. There's no real benefit in a non-seizing, non-chest pain, non-stroke patent who's not being admitted to a psych facility. And if they are being admitted to a psych facility, I order it, but never really pay attention to the results.

 

[Rendar5]

I see at most 1 marijuana related complaint every several months, which consists of either a parent requesting a drug screen (no, get your own damn drug screen) or once or twice I've seens omeone call the cops because they thought they were too stoned. I have never seen cannabinoid hyperemesis syndrome, though I suspected it at times it never panned out.

Marijuana is not an important ED drug, and I do not know if it shows up on drug screens because i never order drug screens on altered patients. There's no real benefit in a non-seizing, non-chest pain, non-stroke patent who's not being admitted to a psych facility. And if they are being admitted to a psych facility, I order it, but never really pay attention to the results.

since my computer is not letting me edit properly. I meant I do not know what form of it shows up on our drug screens because I have no need to know the answer, so never asked my lab.

 

[deleted547339]

I actually had the UDD be relevant recently. A pretty young kid came in "altered." He wouldn't respond except to painful stimuli, but his response to painful stimuli was entirely appropriate. Ended up getting a full work up, urine was the only thing positive....my little kid got into momma's stash. Mind you, it didn't change what was done so some would argue against it, but it gave us a pretty compelling reason for the kid to be altered.