Medical marijuana and OMS-3/4

[MaryJaneGanja]

Long time SDN user, but I created this throwaway account for anonymity. I was diagnosed with Hodgkins Lymphoma during OMS-1 in 2020. Took a leave of absence for treatment and praise God I’m in remission now. I still have residual pain (and all the oncologists and pain doctors have informed me this is extremely unusual with my diagnosis and chemo regimen). I take tramadol, medical marijuana and am about to start some kind of patch because with students returning to campus I know I will have an increase in pain.

Anyway, the point is that no one knows if my pain will go away. There is a chance I may still need pain medicine once I start OMS-3/4. I don’t really want my school to know I’m on MJ unless I have to disclose, so I am coming here for advice. I read my school’s clinical manual and it said students are drug tested for 10 substances and I’m guessing MJ is one of them, but I’m not positive. Is it acceptable to be on medical MJ? Can I just show the clinical sites my MJ card and that’s fine? Are there stipulations on taking it only at night (ie don’t come to clinical impaired)?How about in residency and beyond? Thanks for any insight you can give me!

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[calivianya]

I definitely wouldn’t disclose. Even with a card, you’re not going to be allowed to use it.

Can’t speak for schools in particular, but as someone who’s worked in healthcare for a while before going to med school, testing positive for MJ would have been career-ending at any of the places I’ve ever worked, even with a prescription. Even if you know you’re not altered, there’s no way to 100% prove that since you test positive for so long after due to THC’s lipid solubility. You will absolutely need to have a negative test for MJ (by whatever means necessary) before clinical rotations. Even if the school decided to let you through with a positive test for whatever reason, the ultimate decision to allow you in is going to be up to the hospital, and I’d bet nearly every dollar I have that every hospital in the country would turn you away if you came back positive for THC.

Does CBD by itself control your pain at all? I know some companies that lab test their CBD products, and they can give you the exact lab test results for each batch so you know if it’s truly THC-free or not. A lot of the “THC-free” CBD just has a certain threshold of THC they’re allowed to have, and you can still test positive using them if you take enough.

 

[MaryJaneGanja]

I definitely wouldn’t disclose. Even with a card, you’re not going to be allowed to use it.

Can’t speak for schools in particular, but as someone who’s worked in healthcare for a while before going to med school, testing positive for MJ would have been career-ending at any of the places I’ve ever worked, even with a prescription. Even if you know you’re not altered, there’s no way to 100% prove that since you test positive for so long after due to THC’s lipid solubility. You will absolutely need to have a negative test for MJ (by whatever means necessary) before clinical rotations. Even if the school decided to let you through with a positive test for whatever reason, the ultimate decision to allow you in is going to be up to the hospital, and I’d bet nearly every dollar I have that every hospital in the country would turn you away if you came back positive for THC.

Does CBD by itself control your pain at all? I know some companies that lab test their CBD products, and they can give you the exact lab test results for each batch so you know if it’s truly THC-free or not. A lot of the “THC-free” CBD just has a certain threshold of THC they’re allowed to have, and you can still test positive using them if you take enough.

Thanks for the response. I was hoping for more liberal mindsets about medical use, but from the hospital’s perspective, I understand not wanting an impaired physician. To answer your question, no CBD alone doesn’t help. I tried that well before agreeing to medical marijuana. But my pain is improving (extremely slowly) so I may try to switch to CBD.

 

[ciestar]

Every year there are threads here or Reddit of people being kicked out of their residency programs for THC. It’s risky.

 

[calvinhobbes]

Do NOT do this. For residency, some programs want a drug test a week after you match (in March) while others will test you a week before you start. Either way, it’s illegal at the Federal level, and because hospitals receive CMS money from Medicare, you cannot work if you test positive, since GME is funded by the federal government (in addition to various state laws). Even if legal in the state you match in, it’s still illegal federally. Even if you have a medical exemption (which is not legal in all states anyway), you will lose your spot. Do yourself a favor and quit now, so it’s not in your system before you give a test. Save yourself the stress and headache about this. Until it’s legal on the federal level, you should never disclose it and never give a testing sample if you’re been using any recent (?) form of THC.

 

[calvinhobbes]

And do not use CBD oil either. A fellow was kicked out and her medical license revoked because she was using it for anxiety, and admitted that, but still lost her position because her testing (I think urine) found THC. Not all CBD oil is made the same.

 

[Neopolymath]

This is ruthlessly simple. Choose between this career path and weed. It's unfortunately the only answer in 2021.

 

[MaryJaneGanja]

Thanks for the replies. I’ll def spend the year weaning off and getting off well before 3rd year.

 

[calvinhobbes]

Also wanted to add I wish you all the best and happy you’re in remission. Sorry if my post sounded stern, didn’t mean for it to come out that way, just have seen SO many med students and residents lose their dreams of becoming a doctor because of a stupid urine test for THC, so, just wanted to give you the heads up that it would never be accepted if you tested positive. Continue to do if after testing negative? That’s a diff story, but the VA can randomly test (although I doubt it), and in my residency no one ever tested again after orientation. Be careful but also don’t risk it. Good luck and wish you all the very best health.

 

[Neopolymath]

Also wanted to add I wish you all the best and happy you’re in remission. Sorry if my post sounded stern, didn’t mean for it to come out that way, just have seen SO many med students and residents lose their dreams of becoming a doctor because of a stupid urine test for THC, so, just wanted to give you the heads up that it would never be accepted if you tested positive. Continue to do if after testing negative? That’s a diff story, but the VA can randomly test (although I doubt it), and in my residency no one ever tested again after orientation. Be careful but also don’t risk it. Good luck and wish you all the very best health.

If you get an accidental needlestick the first thing HR is gonna do is make you piss in a cup before you even go get fixed up with prophylactic treatment, if needed. Just something to think about with smoking after testing.

 

[TragicalDrFaust]

Really sorry you have to deal with this and hope the laws change soon. Just to add more context to anyone who reads this thread, I live in a state where marijuana is legal for recreational use and there's even a law that went into effect 01/01/2020:

"Employers cannot fail or refuse to hire prospective employees because of marijuana metabolites in a drug test"

However, this law does not apply if the job involves people's safety so healthcare workers who use marijuana are generally not protected under the law.

 

[wholeheartedly]

If you get an accidental needlestick the first thing HR is gonna do is make you piss in a cup before you even go get fixed up with prophylactic treatment, if needed. Just something to think about with smoking after testing.

I’m in charge of our facility’s needle stick program. I’ve never requested a urine on someone who got a needle stick. I’m not aware of any other places that do this either.

They might do a pregnancy test and will do blood work before prophylaxis.


Now if you’re in a work related car accident or something yes.

 

[hallowmann]

To be completely honest, the first time I was drug tested, I think was before med school and the next time was before residency. Theoretically they can do it at literally any time, and some schools do.

Medical marijuana is not federally legal. In addition, as far as I'm aware, all states that have legalized marijuana or medical marijuana have statutes in place that actually explicitly exclude healthcare workers/physicians. It is a mind-altering substance and unlike alcohol, there are not great ways to "measure" level of impairment. Because of this, blanket laws are applied, and the truth is having positive THC testing will like end or significantly damage a career in medicine at this time. As odd as it may sound, you'll be in less trouble if you were found with opioids in your systems (e.g. tramadol) than marijuana. It is obviously in your best interest to wean off of all controlled substances.

 

[Neopolymath]

I’m in charge of our facility’s needle stick program. I’ve never requested a urine on someone who got a needle stick. I’m not aware of any other places that do this either.

They might do a pregnancy test and will do blood work before prophylaxis.


Now if you’re in a work related car accident or something yes.

Anecdata but in my region I know of at least 5 hospitals where everyone gets a UDS for any workplace event like needlestick.

This is very typical corporate policy in general anyways.

 

[wholeheartedly]

Anecdata but in my region I know of at least 5 hospitals where everyone gets a UDS for any workplace event like needlestick.

This is very typical corporate policy in general anyways.

Seems like a waste of resources and low yield. Most of our facility needle sticks were because the patient did something unexpected suddenly or someone stocked the wrong insulin pen needles in the cart at the nursing home (home use not safety) and someone stuck themselves recapping. Most of our workplace injuries were parking lot falls on the ice (because maint couldn’t be bothered to clear snow before 10 or 11 a.m.)

 

[Schwifty]

Defiantly don’t risk it. You will be tested for MJ and you never know when your school might drop a surprise test on you (yes this happens). It’s unfortunate, but for now it’s federal law

 

[Dantes]

This is so dumb. Can't believe it's still an issue in 2021. That said, I agree with everyone else. Better safe than sorry OP, especially given your school's testing policy.

 

[Neopolymath]

Seems like a waste of resources and low yield. Most of our facility needle sticks were because the patient did something unexpected suddenly or someone stocked the wrong insulin pen needles in the cart at the nursing home (home use not safety) and someone stuck themselves recapping. Most of our workplace injuries were parking lot falls on the ice (because maint couldn’t be bothered to clear snow before 10 or 11 a.m.)

I agree but it doesn't change that it exists some places unfortunately.

 

[NotAProgDirector]

Many employers will drug test during an occ med claim because, if positive, they can claim that the injury was due to intoxication and/or they can fire you for cause before your occ med process plays out -- either way saving them lots of $$$. This may be less likely at health care facilities where occ med visits are for needlesticks rather than "slip and fall" But heathcare also has slip and fall claims, some frivolous, and if they want to test those people they need to test everyone.

 

[KirksvilleKrunk]

Many employers will drug test during an occ med claim because, if positive, they can claim that the injury was due to intoxication and/or they can fire you for cause before your occ med process plays out -- either way saving them lots of $$$. This may be less likely at health care facilities where occ med visits are for needlesticks rather than "slip and fall" But heathcare also has slip and fall claims, some frivolous, and if they want to test those people they need to test everyone.

Exactly, I got bit by a psych patient and first thing the nurse had me do was pee in a cup before I got any ppx shots.

 

[LimpSpatula]

Exactly, I got bit by a psych patient and first thing the nurse had me do was pee in a cup before I got any ppx shots.

Lol what? Can you tell this story, from start to finish, in detail?

 

[KirksvilleKrunk]

Lol what? Can you tell this story, from start to finish, in detail?

Was with another med student while we interviewed an inpatient psychotic adult. Had to break the news that patient couldn't be in communal meals for the day because they were verbally belligerent with others. Patient lunged at me, I put an arm out and patient took a bite out of me. Took about a year to heal completely. Anyways an example of the random slip and fall accidents that can happen and you'll be in a real bad place if you self medicate in any way.

 

[LimpSpatula]

Was with another med student while we interviewed an inpatient psychotic adult. Had to break the news that patient couldn't be in communal meals for the day because they were verbally belligerent with others. Patient lunged at me, I put an arm out and patient took a bite out of me. Took about a year to heal completely. Anyways an example of the random slip and fall accidents that can happen and you'll be in a real bad place if you self medicate in any way.

Well I meant the nurse asking you to pee part. You getting bit makes me think the doctors and nurses on your rotations are ****ty. I’m sorry they put you in that position.

 

[KirksvilleKrunk]

Well I meant the nurse asking you to pee part. You getting bit makes me think the doctors and nurses on your rotations are ****ty. I’m sorry they put you in that position.

Well, soon as I got into the exam room at ER a nurse came in with a cup asking for a urine sample. Not sure how else to elaborate. I provided that and then a doc looked at the wound and gave me some shots. If you pee dirty, bet your arse the school would be notified (and you'd have to foot the ER bill).

 

[LimpSpatula]

Well, soon as I got into the exam room at ER a nurse came in with a cup asking for a urine sample. Not sure how else to elaborate. I provided that and then a doc looked at the wound and gave me some shots. If you pee dirty, bet your arse the school would be notified (and you'd have to foot the ER bill).

I’m not so sure about that. For one, you’re not forced to do anything with Occ Health at a hospital, especially as a medical student.

 

[DO2015CA]

I think even medical marijuana is prohibited in such places. They always do drug tests, so it's a little chance they won't know what you use. I honestly find it quite weird because some people NEED med. marijuana and it's prescribed by the doctors...but...

Change your avatar to anything but your face

 

[ortnakas]

Unfortunately medical marijuana is still federally illegal even if you have a card, even in a state where it’s legal. Schools and medical licensing boards frown on that.

 

[scoopdaboop]

Jeez. So there is no exception in cases like this? Just seems inhumane.

 

[VA Hopeful Dr]

Jeez. So there is no exception in cases like this? Just seems inhumane.

There might be. That's the issue, if you don't know then its almost always better to play it safe.

 

[Lawpy]

This is so dumb. Can't believe it's still an issue in 2021. That said, I agree with everyone else. Better safe than sorry OP, especially given your school's testing policy.

It sucks i know. The federal government is way behind the times, and hospitals and medical boards are risk averse and are concerned about liability. I’m hoping exemptions will be granted but knowing the state of bureaucracy, I doubt it. It just sucks

 

[Neopolymath]

Hmm, I think you can replace marijuana with CBD products. I think it will be even better, because you won't be breathing smoke while smoking marijuana.

Many CBD products that say pure CBD or THC free have been found to have THC and cause positive drug screens. Do not do this.

 

[coffeebythelake]

Many CBD products that say pure CBD or THC free have been found to have THC and cause positive drug screens. Do not do this.

How accurate do you think these companies are when they say xyz milligrams of THC or CBD. It's not regulated by FDA, probably more like supplements so I assume they can just put nonsense down?

 

[Mass Effect]

This is an old thread that's been bumped, but if the OP is still reading, contact a lawyer. MJ is (and should be) outlawed for healthcare professionals, but there's a case to be made regarding appropriate accomodations under ADA. Doctors are sometimes on prescribed benzos and opiates, both of which are mind-altering drugs as well. I don't know what hoops they've jumped through, but it happens. Find out from a lawyer what your rights are in this case. I wouldn't give up medicine due to this without exploring all your options and rights.

 

[sloop]

This is an old thread that's been bumped, but if the OP is still reading, contact a lawyer. MJ is (and should be) outlawed for healthcare professionals, but there's a case to be made regarding appropriate accomodations under ADA. Doctors are sometimes on prescribed benzos and opiates, both of which are mind-altering drugs as well. I don't know what hoops they've jumped through, but it happens. Find out from a lawyer what your rights are in this case. I wouldn't give up medicine due to this without exploring all your options and rights.

Please elaborate on how you think someone could successfully sue in federal court referencing a federal law on the basis that their employer did not accommodate a practice that is federally illegal.

The difference with benzos, opiates, stimulants, etc. is that those are Schedule II drugs, meaning that the federal government acknowledges that there are legitimate medical uses for them. Cannabis is Schedule I, meaning that the federal government does not acknowledge or allow for its medical use.

 

[Neopolymath]

How accurate do you think these companies are when they say xyz milligrams of THC or CBD. It's not regulated by FDA, probably more like supplements so I assume they can just put nonsense down?

Yep! It's very likely inaccurate or at the very least has mistakes while manufacturing because it just doesn't matter. I forget where I read this but it's basically like those male sexual performance supplements found at gas stations. Many of them actually included some type of PDE-5 inhibitor despite not being advertised as such.

 

[Mass Effect]

Please elaborate on how you think someone could successfully sue in federal court referencing a federal law on the basis that their employer did not accommodate a practice that is federally illegal.

The difference with benzos, opiates, stimulants, etc. is that those are Schedule II drugs, meaning that the federal government acknowledges that there are legitimate medical uses for them. Cannabis is Schedule I, meaning that the federal government does not acknowledge or allow for its medical use.

Medicinal marijuana is legal in 37 states. If the OP lives in one of those 37 states and is not working at a VA or other federal agency, then I think a lawyer would be appropriate to explore the option. The lawyer may say there's no case, but no one on this forum has the legal expertise to do so.

 

[sloop]

Medicinal marijuana is legal in 37 states. If the OP lives in one of those 37 states and is not working at a VA or other federal agency, then I think a lawyer would be appropriate to explore the option. The lawyer may say there's no case, but no one on this forum has the legal expertise to do so.

What option? Federal courts do not apply state law, except in the case of a state law claim under diversity jurisdiction but that is not what this would be. They apply federal law. They also have original subject matter jurisdiction over federal laws like the ADA. It doesn’t matter where you work. A federal court is not going to say that your employer is compelled to allow you to violate federal law, nor are they going to say that your medical marijuana prescription is protected by the ADA when it is considered a Schedule I drug that by definition has no legitimate medical use.

I mean, sure, he can cold call a bunch of attorneys but it’s a waste of time. There is no ADA case here, almost by definition.

 

[Mass Effect]

What option? Federal courts do not apply state law, except in the case of a state law claim under diversity jurisdiction but that is not what this would be. They apply federal law. They also have original subject matter jurisdiction over federal laws like the ADA. It doesn’t matter where you work. A federal court is not going to say that your employer is compelled to allow you to violate federal law, nor are they going to say that your medical marijuana prescription is protected by the ADA when it is considered a Schedule I drug that by definition has no legitimate medical use.

I mean, sure, he can cold call a bunch of attorneys but it’s a waste of time. There is no ADA case here, almost by definition.

After seeing your take on the law surrounding patient autonomy and capacity, I think I'll defer to legal experts. OP, I'd get a free consultation and just review your concerns.

 

[sloop]

After seeing your take on the law surrounding patient autonomy and capacity, I think I'll defer to legal experts. OP, I'd get a free consultation and just review your concerns.

That’s fine. It turns out that your opinion here doesn’t change the fact that an ADA claim to compel an employer to let you smoke marijuana is absolute nonsense.

 

[Neopolymath]

That’s fine. It turns out that your opinion here doesn’t change the fact that an ADA claim to compel an employer to let you smoke marijuana is absolute nonsense.

I'm glad to see at least one other person remembers middle school social studies. Supremacy Clause ring any bells lol?

 

[Mass Effect]

That’s fine. It turns out that your opinion here doesn’t change the fact that an ADA claim to compel an employer to let you smoke marijuana is absolute nonsense.

Thank you. Now hop down off your throne. Your interpretation of law is terrifying and should not be taken seriously by anyone here.

 

[Mass Effect]

I'm glad to see at least one other person remembers middle school social studies. Supremacy Clause ring any bells lol?

I did some quick research and you are correct about the ADA, but this was determined through a court case and since then, several states have supposedly drafted their own anti-discrimination legislation for medicinal marijuana.

"Patients who use prescription medications often have recourse under the Americans with Disabilities Act (ADA) if they are discriminated against for using their medicine. However, courts have found that ADA protections do not apply to medical cannabis since it is federally illegal. Several of the more recent medical cannabis laws include language intended to prevent discrimination against medical cannabis patients in housing, child custody cases, organ transplants, college enrollment, or employment, with some limitations. In states without strong language preventing such discrimination, court decisions have been mixed, though the recent trend has been more favorable. In 17 of the 36 medical marijuana states, either the laws include some explicit employment protections or courts have ruled in favor of employees — Arizona, Arkansas, Connecticut, Delaware, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Utah, and West Virginia."

Medical Cannabis Laws and Anti-Discrimination Provisions

We Change Laws!

www.mpp.org

I don't think anyone here is qualified to tell the OP whether or not he has options here.

 

[sloop]

I did some quick research and you are correct about the ADA, but this was determined through a court case and since then, several states have supposedly drafted their own anti-discrimination legislation for medicinal marijuana.

"Patients who use prescription medications often have recourse under the Americans with Disabilities Act (ADA) if they are discriminated against for using their medicine. However, courts have found that ADA protections do not apply to medical cannabis since it is federally illegal. Several of the more recent medical cannabis laws include language intended to prevent discrimination against medical cannabis patients in housing, child custody cases, organ transplants, college enrollment, or employment, with some limitations. In states without strong language preventing such discrimination, court decisions have been mixed, though the recent trend has been more favorable. In 17 of the 36 medical marijuana states, either the laws include some explicit employment protections or courts have ruled in favor of employees — Arizona, Arkansas, Connecticut, Delaware, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Utah, and West Virginia."

Medical Cannabis Laws and Anti-Discrimination Provisions

We Change Laws!

www.mpp.org

I don't think anyone here is qualified to tell the OP whether or not he has options here.

Yes, there may be a case in certain limited circumstances based on state law. Your initial post was talking about an ADA claim, and I was only responding to that.

 

[Mass Effect]

Yes, there may be a case in certain limited circumstances based on state law. Your initial post was talking about an ADA claim, and I was only responding to that.

Yes I mentioned ADA, but the point of my post was very clearly the OP should consult an attorney to explore his rights. None of us are qualified to inform him of those rights, whatever they may be. ADA doesn't work, fine. But there are other anti-discrimination laws out there that may protect his employment.

 

[VA Hopeful Dr]

I did some quick research and you are correct about the ADA, but this was determined through a court case and since then, several states have supposedly drafted their own anti-discrimination legislation for medicinal marijuana.

"Patients who use prescription medications often have recourse under the Americans with Disabilities Act (ADA) if they are discriminated against for using their medicine. However, courts have found that ADA protections do not apply to medical cannabis since it is federally illegal. Several of the more recent medical cannabis laws include language intended to prevent discrimination against medical cannabis patients in housing, child custody cases, organ transplants, college enrollment, or employment, with some limitations. In states without strong language preventing such discrimination, court decisions have been mixed, though the recent trend has been more favorable. In 17 of the 36 medical marijuana states, either the laws include some explicit employment protections or courts have ruled in favor of employees — Arizona, Arkansas, Connecticut, Delaware, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Utah, and West Virginia."

Medical Cannabis Laws and Anti-Discrimination Provisions

We Change Laws!

www.mpp.org

I don't think anyone here is qualified to tell the OP whether or not he has options here.

That website is interesting. It seems that state courts are more friendly towards this issue than Federal ones, which isn't a surprise.

Most of those states listed in the paragraph you posted have employer protections but also have carve outs for "if being high on the job would be malpractice, you're not protected".

 

[Mass Effect]

That website is interesting. It seems that state courts are more friendly towards this issue than Federal ones, which isn't a surprise.

Most of those states listed in the paragraph you posted have employer protections but also have carve outs for "if being high on the job would be malpractice, you're not protected".

That's to be expected. The same is true of benzos and opiates. If your medical treatment impairs your thinking, you won't be allowed to work. My point was just that it's not as clear cut as previous replies would have you believe. The only reason I even replied to this thread given that it's from last summer is the poster who said it's "simple" and the OP just has to choose between marijuana for a legitimate medical reason and being a doctor.

 

[VA Hopeful Dr]

That's to be expected. The same is true of benzos and opiates. If your medical treatment impairs your thinking, you won't be allowed to work. My point was just that it's not as clear cut as previous replies would have you believe. The only reason I even replied to this thread given that it's from last summer is the poster who said it's "simple" and the OP just has to choose between marijuana for a legitimate medical reason and being a doctor.

Sure, and I said similar earlier up as well. I honestly did just think the website was interesting, especially since this isn't an area I've ever really looked in to. Wasn't trying to refute anything you'd said.

 

[Mass Effect]

Sure, and I said similar earlier up as well. I honestly did just think the website was interesting, especially since this isn't an area I've ever really looked in to. Wasn't trying to refute anything you'd said.

No I understand. That post wasn't meant to be argumentative. I was just explaining why I replied to this in the first place and repeating that it isn't so simple and those who think they have all the answers actually don't. The OP needs legal consultation before giving up medicine.

 

[Goro]

Hey @MaryJaneGanja, your concerns about medical marijuana usage while in medical school are totally understandable. Given that you're studying medicine, I'd recommend talking with a medical ethics advisor or a legal consultant who specializes in healthcare issues. This area tends to be complex and varies by jurisdiction.

OP was last seen in 7/21.

 

[Bacchus]

And Goro had to reply to the 2 year gap 6 hours later. Just let it die.