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Thoughts on patients who are on low dose scheduled II and started on or wanting to start medical marijuana? Are you ok with patients being on both?
 

emd123

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For context, I’m in a weed-illegal state. The Feds, i.e. the guys who allow me to have a DEA license at all, still consider MJ schedule I and illegal in all states. To them, it’s right there with heroin & LSD so I treat a positive as such. Don’t think for a minute that the Feds will cut you legal slack because your patients (or you or anyone else) tries to claim “weed is no big deal.” Even if you’re right, the Fed don’t agree, so it doesn’t matter. If they ever do agree, I’ll see proof of that when they legalize Federally. Until then, “Sorry, it sucks but, Feds’ rules not mine. Sorry.” Bye.

Plus, I think it’s bulls**t that people claim they smoke cannabis for their pain, but then they all still want opiates. Argues to me, that medical cannabis (for pain, at least) is likely a fraud. Plus, the Feds will be glad to make an example of you by claiming you knew or should have known they sold your pills to buy pot, which again, according to all their laws is 100% illegal in a 50 states.

In 2019 we should be looking for reasons to discontinue opiates, not looking for reasons to rationalize continuing them. When you find such a reason, act on it.
 
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soccrwz

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Just listened to a lecture from ASRA from Wilson Compton, who is the deputy director, of the national institute on drug abuse.

"Cannabis has been linked to misuse of prescription pain meds and opioid addiction" M olfson et al 2019

1994 Anthony JC et al: "9% of time MJ will develop dependence"

Also the DEA guy they had there mentioned if you have THC and opioids in UDS you are not in compliance and may be prosecuted.

So proceed with caution...

P.S. I do not have an opinion either way on this, but thought I'd pass on the information
 
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if you have THC and opioids in UDS you are not in compliance and may be prosecuted.
This is my bottom line, and the reason I DC all scheduled meds on any pt with THC in the UDS. I told a guy today I don't care if he uses CBD oil but a dirty UDS is a dirty UDS and he's a work comp guy I'm trying to wean off Percocet. If he pops for THC it is DC with no wean...baclofen, clonidine, Zofran...

To be legal, CBD oil must be less than 0.3% THC but you can still pop for it, and I have a fear of dudes using CBD just so they can blame their failed urine on it when they are actually smoking weed.
 
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Ferrismonk

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I don't allow both, but I'll give them a warning and a chance to stop before discharge off opiates. Other drugs is one and done from office.

I don't get where people think that marijuana is "safe". There is a ton of evidence that it causes real harm. Here's my template and the packet I give patients.

Patient has been identified as a user of marijuana products. While legal at the state level under certain circumstances, 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. In addition, 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

If they insist on marijuana use, I don't stop treating them (I'm in a recreational "legal" state), just no opiates from me.
 

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emd123

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To be legal, CBD oil must be less than 0.3% THC but you can still pop for it, and I have a fear of dudes using CBD just so they can blame their failed urine on it when they are actually smoking weed.

Exactly. And the DEAs response to those blowing off a THC + UDS based on CBD oil is going to be, "Sorry. You ignored THC. THC is schedule I and illegal per Federal law. Period."
 

smarterchild

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for those of you who manage opioid dependency, do you apply the same rules with marijuana and Suboxone?
 

Ferrismonk

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for those of you who manage opioid dependency, do you apply the same rules with marijuana and Suboxone?
I don't manage opiate dependency/abuse, however from what I understand, there is more tolerance to "slip ups" in that patient population since the goal is to control their addiction, not treat pain.
 

lobelsteve

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Fun study. But beyond useless. They had 25 self reported marijuana users out of 250 patients undergoing colonoscopy. Self reported use. Not tested for. And percent additional meds used was less than 20%. Lots of potential confounders. But fun to postulate. Not worthy of publication in a peer reviewed journal.
 

Ducttape

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useless maybe, but it is more evidence of potential ill effects of marijuana than positive evidence showing benefit of marijuana for chronic pain.