controlled substances prescribing with medical MJ card

[linguistafeliz]

I was wondering if anyone has any take on this. I trained in a state where there was no medical MJ law and if a patient was found to be on MJ on UDS, their controlled substance contract was "terminated" (no more controlled substances from the clinic). Currently I live in a state where medical MJ is legal and very common. If you prescribe controlled substances (e.g. chronic opioids, benzodiazepines) would you suspend these prescriptions if a patient has MJ show up on a urine drug screen, or do you ask for proof of medical MJ card and document that you advised of risks of taking both medications?

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[VA Hopeful Dr]

I was wondering if anyone has any take on this. I trained in a state where there was no medical MJ law and if a patient was found to be on MJ on UDS, their controlled substance contract was "terminated" (no more controlled substances from the clinic). Currently I live in a state where medical MJ is legal and very common. If you prescribe controlled substances (e.g. chronic opioids, benzodiazepines) would you suspend these prescriptions if a patient has MJ show up on a urine drug screen, or do you ask for proof of medical MJ card and document that you advised of risks of taking both medications?

Marijuana is still Schedule 1 per the DEA. Until that changes, I personally would consider testing positive to be breaking a controlled substance contract.

 

[Sushirolls]

Medical marijuana is a farce.
Contract was broken.
Make sure there is an extra blurp in contract that draws attention to no cannabis, or even "medical cannabis."

 

[hallowmann]

Depends on what's in the contract. If the contract stipulates no substance use, in most cases that would include marijuana as a substance regardless of legality in a state.

To be honest, this probably should be a more nuanced question about what should be in a controlled substance contract. A lot of people develop controlled substance contracts with a specific goal in mind. "Punishment," titration, harm reduction, decreasing medicolegal liability, decreasing diversion, etc. It just depends based on the goal the contract might be different. For a patient getting Suboxone that tests positive for THC, the safest thing (for them, society, and fiscally) would be to keep them on Suboxone. A patient with mild-moderate ADHD that tests positive for THC might need to be on a shorter leash, especially if they continue taking something that will directly affect attention.

I will also say that I am also very skeptical about the "medicinal" benefits of marijuana outside of some very specific, terminal or treatment refractory conditions.