Medical marijuana and opioids

[Yo GabbaPentin]

What is your policy on medical marijuana and opioids? Every clinic around me will continue opioids while on it.

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[Sushirolls]

As a psychiatrist / addictionologist I counsel every patient to stop and that it doesn't help with functional improvement. It worsens mood, anxiety, sleep, and appetite to varying degrees. Opioids and cannabis both also carry serotonin syndrome risk; which compounded by the likely use of various mental health meds adds more potential risk. Y'all should be telling people no.

"medical" marijuana is a farce.

*some data supports use in cancer pain and certain child subtype seizure disorders

 

[painfree23]

As a psychiatrist / addictionologist I counsel every patient to stop and that it doesn't help with functional improvement. It worsens mood, anxiety, sleep, and appetite to varying degrees. Opioids and cannabis both also carry serotonin syndrome risk; which compounded by the likely use of various mental health meds adds more potential risk. Y'all should be telling people no.

"medical" marijuana is a farce.

*some data supports use in cancer pain and certain child subtype seizure disorders

*telling people he11 no!

 

[lobelsteve]

Ok with the DEA? Nope.
Nonstarter.

 

[Agast]

You’re lucky, since your colleagues will continue prescribing you can refer your THC patients to those people for a second opinion.

 

[Ferrismonk]

This has been largely discussed in other threads, but my answer is an emphatic "No."

Here's my template:

Patient has been identified as a user of marijuana products. While legal at the state level for both medial and recreational use, marijuana is still considered by the federal government to be a Schedule-1 controlled substance. Schedule-1 substances are defined as drugs with no accepted medical use and high potential for abuse, potentially leading to severe psychological or physical dependence.
Marijuana use has also been associated with impaired body movement, difficulty thinking and problem-solving, impaired memory, anxiety, depression, hallucinations, early-onset psychosis, paranoia, poor school performance, and decreased IQ. In addition, users of marijuana have been shown to have lower life satisfaction, poorer physical and mental health, less academic and career success, and more job absences, accidents, and injuries. Additionally, people who use marijuana have been shown to be more likely to use prescription drugs for both medical and nonmedical purposes. I recommend the patient stop using marijuana products.
Drug Fact sheet from the NIH has been given to the patient regarding marijuana. (Marijuana DrugFacts | National Institute on Drug Abuse)

 

[Yo GabbaPentin]

Ok good. I just wanted to check since I seem to be the only one saying no.

 

[painfree23]

Ok good. I just wanted to check since I seem to be the only one saying no.

Saying “no”costs $ bc u miss out on some patients. I can’t believe some docs exclude thc from the UDS…likely bc they r worried about getting + and needing to respond to that (fire the patient$)

 

[painfree23]

The answer from people who aren’t quaking in terror of the federal government, or old school boomers who fear the “reefer madness” is don’t prescribe but don’t worry about it either. This is the future. Maybe it helps, maybe it doesn’t. Not enough legitimate research at this point to decide. But definitely shouldn’t care one way or the other.

Wat happens when ur patient ODs and they do a tox screen and their positive for opiates and thc? And u knew about it and said it’s coo, here r more narcs?

 

[drusso]

As a psychiatrist / addictionologist I counsel every patient to stop and that it doesn't help with functional improvement. It worsens mood, anxiety, sleep, and appetite to varying degrees. Opioids and cannabis both also carry serotonin syndrome risk; which compounded by the likely use of various mental health meds adds more potential risk. Y'all should be telling people no.

"medical" marijuana is a farce.

*some data supports use in cancer pain and certain child subtype seizure disorders

My daughter carpools to ballet and gymnastics with a family that owns 8 dispensaries and one of the largest commercial cannabis farms in the Pacific Northwest. We go round and round on this topic. There seems to be a problem with selection bias. If you study cannabinoids and opioids in pain clinics you get a different answer than if you study the topic in dispensaries.

I gave a talk to a group of "bud-tenders" about the topic. Their company spent about $200K on a very extensive survey of cannabis users and found most want to use cannabis INSTEAD of opioids. In pain clinics, it seems that patients want to use BOTH. I think that the people in dispensaries versus pain clinics are fruit from different trees.

 

[Ferrismonk]

My daughter carpools to ballet and gymnastics with a family that owns 8 dispensaries and one of the largest commercial cannabis farms in the Pacific Northwest. We go round and round on this topic. There seems to be a problem with selection bias. If you study cannabinoids and opioids in pain clinics you get a different answer than if you study the topic in dispensaries.

I gave a talk to a group of "bud-tenders" about the topic. Their company spent about $200K on a very extensive survey of cannabis users and found most want to use cannabis INSTEAD of opioids. In pain clinics, it seems that patients want to use BOTH. I think that the people in dispensaries versus pain clinics are fruit from different trees.

View attachment 339304

People in dispensaries are looking to get high. Marijuana is easier to get than opioids now, thus less requests for opioids.
People in pain clinics who get opioids aren't interested in giving them up but want to get high too.

It's not exactly rocket science.

 

[drusso]

People in dispensaries are looking to get high. Marijuana is easier to get than opioids now, thus less requests for opioids.
People in pain clinics who get opioids aren't interested in giving them up but want to get high too.

It's not exactly rocket science.

What about the data on psilocybin?

 

[specepic]

I have seen many pts be able to d/c opioids via cannabis. Pretty much a either/or scenario in our practice

 

[Ferrismonk]

What about the data on psilocybin?

"Psilocybin is a Schedule I substance under the Controlled Substances Act, meaning that it has a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision"

https://www.dea.gov/sites/default/files/2020-06/Psilocybin-2020.pdf

 

[Ducttape]

I have seen many pts be able to d/c opioids via cannabis. Pretty much a either/or scenario in our practice

i have too.

when i tell them they arent getting any opioids from their PCP and dont expect any from here.

 

[Agast]

Part of me thinks that as soon as it becomes legal in Texas I should close down my clinic and open a marijuana and fudge shop, heavily marketing my MD. I could probably retire after a year.

 

[Pain Applicant1]

"Psilocybin is a Schedule I substance under the Controlled Substances Act, meaning that it has a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision"

https://www.dea.gov/sites/default/files/2020-06/Psilocybin-2020.pdf

Psilocybin is in no way addictive and is considered to have a high potential for abuse mainly because it's misunderstood. What does it mean to be abused anyway? I can understand it for ETOH, weed, opioids, etc but psilocybin is different. Psychedelics have been used since the beginning of time and are very spiritual for many people and cultures. There's no currently accepted medical use because it's a schedule I and is too difficult to study. Now that the foolish and wasteful war on drugs is finally coming to an end and there are US centers studying psilocybin there will be medical indications. Check out some of the research at Johns Hopkins and NYU and get back to me. I'd like to discuss this further.

 

[bedrock]

"Psilocybin is a Schedule I substance under the Controlled Substances Act, meaning that it has a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision"

https://www.dea.gov/sites/default/files/2020-06/Psilocybin-2020.pdf

I have seen many pts be able to d/c opioids via cannabis. Pretty much a either/or scenario in our practice

doesn't matter if it is legal on a state level while the federal government controls the DEA.

Agree with specpic. It's an either or. I don't mind if patients take MJ, unless I'm prescribing a controlled substance, at which point MJ is a no go.

They have to choose. Those who "must" have both are by definition chemical copers.

 

[painfree23]

What is your policy on medical marijuana and opioids? Every clinic around me will continue opioids while on it.

Nope

 

[drrosenrosen]

Agree with others - even in CA where it is legal by state, I still said no, because as long as the DEA considers it a schedule I, I don't really see any grey area at all.