Question for dual opioid/cannabis prescribers...

[drusso]

I don't prescribe opioids for patients using illicit or "medical" cannabis. I do have interventional-only patients who receive dual opioids and cannabis from other prescribers. Recently, one of those patients landed in the ER with K-2 "Spice" toxicity after "smoking bad weed." The prescriber called me and wanted to know if there is a "community standard" for dealing with opioid/pot patients who suddenly pop positive for synthetic cannabis. I didn't know....does anyone?

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[101N]

The problem with synthetic weed is that it's potentancy and chemical structure are both moving targets. It's difficult to identify via SDS/UDS and will often be missed entirely. NMS is the 'go to' national lab: http://nmslabs.com/services-forensic-K2-testing

"Community standard" would be stopping Rx'ing opioid if the patient is persistently positive for either THC or synthetic THC.

 

[Ducttape]

im sorry, not to be glib... is there a federal "community standard" for marijuana, with the exception being Marinol? the other provider is up a creek without a paddle, regardless of the local laws on this one, imho.

 

[emd123]

Considering we prescribe 95% of the worlds opiates in this country, and have an off-the-rails opiate abuse epidemic, I'd say whatever the "community standard" is, is in need of serious redefining.

I know what the community standard should be. It's to not prescribe abusable drugs to people known to abuse drugs (legal or not), because the risks outweigh the gains.

Opiates are not oxygen.

People that can't handle addictive substances (legal or not), can't handle addictive substances.

People that abuse substances (legal or not) to get high, will abuse your substances to get high.

How long will we refuse to see that,

"The definition of insanity is doing something over and over again and expecting a different result"?

To prescribe opiates to people that get high on spice, legal drugs or illegal drugs is not the compassionate thing to do, despite what the Founding Fathers of the Opiate Epidemic might try to lead us to believe.

 

[H2H]

K-2 'Spice'. I was surprised to see how easily they can be purchased from your local grocery store near the cash register with gum, AAA batteries, and tabloid magazines...
http://time.com/57167/rise-of-fake-pot/

 

[drusso]

I just like the idea of there being a "community standard" for being outside the community standard...what do you do when your cannabis-dependent/opioid dependent patient starts using **other** illicit or quasi-illegal substances...beisdes the illicit or quasi-illegal substances you already *know* they're using but are ignoring...is THAT a problem?

 

[Ducttape]

I just like the idea of there being a "community standard" for being outside the community standard...what do you do when your cannabis-dependent/opioid dependent patient starts using **other** illicit or quasi-illegal substances...beisdes the illicit or quasi-illegal substances you already *know* they're using but are ignoring...is THAT a problem?

Ignorance is not bliss. We've already eaten the red pill, we know what lies waiting down the rabbit hole for these patients.

Not knowing is poor care. Deliberate ignorance by these dual prescribers should be criminal.