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Medical marijuana and OMS-3/4

MaryJaneGanja

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Jul 20, 2021
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    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

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      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.
       
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      MaryJaneGanja

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        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.
         
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        calvinhobbes

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          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.
           
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          calvinhobbes

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            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.
             
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            calvinhobbes

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              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.
               
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              Neopolymath

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                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.
                 
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                TragicalDrFaust

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                  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.
                   

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                  Epi Geek
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                    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.
                     
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                    hallowmann

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                      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.
                       
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                      Neopolymath

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                        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.
                         

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                        Epi Geek
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                          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.)
                           
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                          Dantes

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                            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.
                             
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                            Neopolymath

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                              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

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                                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.
                                 
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                                Seabasstian

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                                  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.
                                   
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                                  Seabasstian

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                                    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

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                                      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.
                                       
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                                      Seabasstian

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                                        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

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                                          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.
                                           
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