Medical Marijuana

[Sushirolls]

---

Members don't see this ad.

Just saw "medical marijuana" show up on the controlled substance database report with pharmacies for a patient. First time seen that. This one was prescribed by an EM physician. [shakes head]

[put long rant here]

[put demoralization and feelings of defeat summary here]

 

[clozareal]

Medical marijuana means a bunch of things, including FDA approved medications such as cannabidiol (Epidiolex) to synthetic cannabinoids such as dronabinol and nabilone, all of which you take orally rather than smoking it. However, the public mainly knows the latter which is not how many of the studies on the effectiveness medical marijuana for certain conditions (chemotherapy induced nausea/vomiting, appetite inducer, seizures, spasticity pain as a result of MS, etc) were conducted.

 

[calvnandhobbs68]

Just saw "medical marijuana" show up on the controlled substance database report with pharmacies for a patient. First time seen that. This one was prescribed by an EM physician. [shakes head]

[put long rant here]

[put demoralization and feelings of defeat summary here]

Yeah it showed up in the controlled substance database in the last state I was in as well, not my current state though, think it's a state to state thing. I actually prefer that because I can actually quantify how much the patient is going through (or should be going through) looking at their fills rather than asking them and getting answers like "idk 5 hits of my vape every night?". I think it also shows you the THC:CBD ratio for a lot of them too which is kind of helpful.

 

[comp1]

I'm guessing dronabinol would show up differently than medical marijuana in a state controlled substance database. I concur with the above poster saying it's nice to be able to quantify. That said, I also agree with the OP that it is sad an EM provider did this.

 

[Merovinge]

No wonder the field of EM is going down the tubes when they are prescribing medical marijuana... I don't envy EM docs, they have a very tough job, but good God Lemon.

 

[annoyedpsychiatrist]

Epidiolex is an amazing seizure medication for LGS and dravets. I remember seeing it work wonders in kids


But yeah, i have a patient here who works for a plastic surgeon who owns a medical marijuana clinic on the side.

 

[calvnandhobbs68]

I'm guessing dronabinol would show up differently than medical marijuana in a state controlled substance database. I concur with the above poster saying it's nice to be able to quantify. That said, I also agree with the OP that it is sad an EM provider did this.

No wonder the field of EM is going down the tubes when they are prescribing medical marijuana... I don't envy EM docs, they have a very tough job, but good God Lemon.

Nah this isn't that atypical. It's probably someone who does EM and then sells med marijuana cards on the side. It doesn't mean they're doing this from the ER. We all know whole "medical marijuana" process is a pay to play joke anyway.

 

[WisNeuro]

Compared to the medication messes I see in a lot of my patients, MJ is one of the least of my worries.

 

[comp1]

Not for me. I see THC induced psychosis pretty regularly and it is a mess. They literally soak the buds in acetone to extract the THC then boil the solvent off to leave shatter and consume it directly.

 

[WisNeuro]

Not for me. I see THC induced psychosis pretty regularly and it is a mess. They literally soak the buds in acetone to extract the THC then boil the solvent off to leave shatter and consume it directly.

The most consistent work I've seen is that there may be an association in early use, but still rare, but that link becomes tenuous in adult use. Is there newer, quality work on this topic that would bolster an argument about an explosion in cases? At least for those using something as prescribed?

 

[calvnandhobbs68]

At least for those using something as prescribed?

Can you elaborate on this, considering there's basically no evidence for any type of dosing of THC? Here's some interesting advice from one of the "clinics" in Florida, which is one of the few states that actually requires people to "prescribe" some sort of dosing:

"When you visit MMTCFL, your physician will provide you with a recommended dose of medical marijuana that he or she believes will suit your needs. You should view this dose as a starting point and feel free to raise or lower the dose as you see fit. If you have any questions about dosing, contact your MMTCFL physician, and they will be happy to help guide you."

Anyways:

Meta-analysis of the Association Between the Level of Cannabis Use and Risk of Psychosis - PMC

Cannabis use has been reported to induce long-lasting psychotic disorders and a dose-response relationship has been observed. We performed a systematic review of studies that investigate the association between the degree of cannabis consumption and ...

www.ncbi.nlm.nih.gov

Development Over Time of the Population-Attributable Risk Fraction for Cannabis Use Disorder in Schizophrenia in Denmark - PubMed

The results from these longitudinal analyses show the proportion of cases of schizophrenia associated with cannabis use disorder has increased 3- to 4-fold during the past 2 decades, which is expected given previously described increases in the use and potency of cannabis. This finding has...

pubmed.ncbi.nlm.nih.gov

The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study - PubMed

Medical Research Council, the European Community's Seventh Framework Program grant, São Paulo Research Foundation, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London and the NIHR BRC at...

pubmed.ncbi.nlm.nih.gov

I could keep going

 

[allantois]

Lol DEA licenses marijuana facilities

 

[allantois]

You can’t “prescribe” marijuana. Physicians whor** certify that the patient has a qualifying condition, which they usually don’t

 

[annoyedpsychiatrist]

You can’t “prescribe” marijuana. Physicians whor** certify that the patient has a qualifying condition, which they usually don’t

ive yet to see a condition that doesnt qualify for it. Insomnia? MM. Pain? MM. Depression? MM. Bad day? MM. Girlfriend dumped you? MM

 

[Stagg737]

The most consistent work I've seen is that there may be an association in early use, but still rare, but that link becomes tenuous in adult use. Is there newer, quality work on this topic that would bolster an argument about an explosion in cases? At least for those using something as prescribed?

In the ER and see it all the time, at least 3-4x per month. Saw one yesterday that was 100% THC-induced as patient was using a home-grown source. Not necessarily chronic psychosis, but patients using some form of THC or Delta-whatever who come in with really bizarre behaviors and delusions. Sometimes they clear up in a day or two and other times they spend a week or so in our psych unit clearing up. Occasionally family will bring them in after the symptoms are there for a couple weeks and they end up going to the state hospital. Idk if I'd say there's an "explosion" in cases, but it's certainly not uncommon where I'm at.

 

[annoyedpsychiatrist]

As the world grows sicker and more chaotic, people start to want an escape more than learning coping skills and life improvement.

 

[Stagg737]

In the ER and see it all the time, at least 3-4x per month. Saw one yesterday that was 100% THC-induced as patient was using a home-grown source. Not necessarily chronic psychosis, but patients using some form of THC or Delta-whatever who come in with really bizarre behaviors and delusions. Sometimes they clear up in a day or two and other times they spend a week or so in our psych unit clearing up. Occasionally family will bring them in after the symptoms are there for a couple weeks and they end up going to the state hospital. Idk if I'd say there's an "explosion" in cases, but it's certainly not uncommon where I'm at.

Update, saw another one this morning. Patient started using a new dispensary a few weeks ago and per SO has been psychotic for the past week, hallucinating, bizarre behaviors, very guarded/paranoid, etc. Been in our ER for ~36 hours and wasn't seen by psych yesterday because EMS gave ketamine in the field and patient had to be sedated due to agitation and aggression. Today was linear and pleasant and actually pretty insightful about their substance use. Only other psychotic history was as a teenager and when using K2. SO provided collateral, pretty straightforward.

 

[Sushirolls]

ive yet to see a condition that doesnt qualify for it. Insomnia? MM. Pain? MM. Depression? MM. Bad day? MM. Girlfriend dumped you? MM

Before cannabis there was tobacco. And this song captures the sentiment. If you jump to 2:04 you'll hear everything it cures.

 

[PsyDr]

If I can see such "professional" terms as "Purple Haze Tincture" on lists of controlled medications, why can't every medication have a fun name?

 

[clausewitz2]

If I can see such "professional" terms as "Purple Haze Tincture" on lists of controlled medications, why can't every medication have a fun name?

Toreupirone

 

[B52slinger]

Lol DEA licenses marijuana facilities

I wonder what the liability is like for the physicians working there full-time. Doing hundreds of marijuana certifications per month with the expectation for every patient to be certified and for none to be denied....

 

[Merovinge]

I wonder what the liability is like for the physicians working there full-time. Doing hundreds of marijuana certifications per month with the expectation for every patient to be certified and for none to be denied....

The same as the doctors "overseeing" 100 NPs prescribing Adderall IR to 95% of the patients they see.

 

[allantois]

Any patient with family history of addiction/SMI should stay far away from marijuana

 

[Merovinge]

Any patient with family history of addiction/SMI should stay far away from marijuana

Yes AND anyone who is using on a regular basis, particularly high quantities/amounts, should expect for increased glutamate firing actively worsening anxiety anytime they are not acutely intoxicated. This is not any better than using benzos on a daily basis. People somehow are trying to argue that they are solving their problem by using "natural" THC, you know the THC that grew around 5% in concentration in the wild, is now 20% in all the plant matter and 80-100% pure in carts/dabs/edibles. The fix to your problem is not just ingesting a substance, I'm not sure how the US population came to be this way to believe otherwise (I say as someone prescribing psychotropics all day long).

 

[MacDonaldTriad]

I hate the term "medical" marijuana. I don't care what you smoke, just don't put doctors in the loop of approving it. You will find some doctors are willing, but they are generally sleaze balls that you wouldn't want to treat a real illness if you had one. I had a patient who went to a THC doctor and he said his indication was asthma. So smoking pot is a treatment for asthma now.

 

[Candidate2017]

Yes AND anyone who is using on a regular basis, particularly high quantities/amounts, should expect for increased glutamate firing actively worsening anxiety anytime they are not acutely intoxicated. This is not any better than using benzos on a daily basis.

Shut up, that's absolutely nonsense [according to my patients].