Patients using non-THC composed cannabinoids...

[drusso]

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How are people dealing with the situation where patients are using non-THC cannabinoids: CBD, CBG, CBN, etc. They screen POS for cannabinoids by CLASS on immunoassay, but negative for THC-COOH on Mass Spec? Tends to be common in the creams/tinctures/ointment preparations or when patients are using dispensaries from outside the USA. Some dispensaries in my area using non-sterile compounding pharmacy techniques including chromatography-based methods to prepare various concoctions for a whole host of health conditions...

Are you considering this a violation of a pain treatment agreement? Is it the presence of the THC molecule or cannabinoid class that's your trigger for action?

 

[emd123]

I no longer waste time on pos UDS due to these clinically irrelevant false positives. Skip straight to mass spec and problem solved. Why waste the time, money and invite confusion by even doing the in office tests if you're going to ultimately ignore them?

I dont

 

[101N]

Until I hear otherwise from either the state Board - my malpractice carrier - or my state's board consultants
a MS confirmed THC is a non-started for opioids.

 

[willabeast]

got to relate a story i heard ...in about 1981 or so the USNavy started urine testing everyone. urine testing then counted poppy seed bagels as positive for opioids, and a bunch of people got general discharges from the Navy as a result.
took them a long time to figure it out. perhaps these hemp based products should carry a warning on them, because a + THC drug test could very adversely affect one's career.

 

[drusso]

Until I hear otherwise from either the state Board - my malpractice carrier - or my state's board consultants
a MS confirmed THC is a non-started for opioids.

That's the problem: POS on the screen for cannabinoids by class--NEG on the MS for THC-carboylate. The patient admits to using non-THC cannabinoid unguents from an out-of-country compounding pharmacy.

 

[emd123]

Until I hear otherwise from either the state Board - my malpractice carrier - or my state's board consultants
a MS confirmed THC is a non-started for opioids.

Of course. It's illegal under federal law which trumps state law. If the Feds wanted us to ignore THC they'd make it legal federally. They haven't. They fact that a large percentage of the population thinks THC is "no big deal" is irrelevant. The guys that let me work (the federal DEA) think it is a big deal, so I'm not going to be cavalier about it.

If you want weed and opiates, too bad. Not my problem.

 

[emd123]

Why do an in office UDS at all? There's no reason to, if you don't write an rx on visit #1 and you're not going to act on an in-office UDS until confirmation. Why waste time and get confused with the worthless in office screens?

 

[drusso]

I think as we see the quasi-legal dispensaries become more sophisticated with separation, purification, and non-sterile compounding techniques--this stuff is going to be popping up all over. So, perhaps cannabinoid as a CLASS is the way to go. I just wonder how the driving while intoxicated issues are going to be adjudicated--they will be NEG for THC. I'm not sure that the forensic labs are going to be looking at all cannabinoid compounds by MS methods.

 

[emd123]

I just wonder how the driving while intoxicated issues are going to be adjudicated--they will be NEG for THC. I'm not sure that the forensic labs are going to be looking at all cannabinoid compounds by MS methods.

And this is the primary reason I think MJ legalization is a bad idea. And for the people that say it makes you drive slower and more careful, I call BS. Nothing that gets you high makes you drive better. People just want to get high and they're willing to risk the effects on self and others. They don't care, they just want to escape and get buzzed.

 

[willabeast]

Of course. It's illegal under federal law which trumps state law. If the Feds wanted us to ignore THC they'd make it legal federally. They haven't. They fact that a large percentage of the population thinks THC is "no big deal" is irrelevant. The guys that let me work (the federal DEA) think it is a big deal, so I'm not going to be cavalier about it.

If you want weed and opiates, too bad. Not my problem.

for those few libertarians among us, it IS a problem. because if the Feds can restrict what some people put in their own bodies, then they can restrict a whole lot of other things as well.
it is a limit on our freedoms.

It is true that classical libertarian thought is opposed to state intervention in social life, as a consequence of deeper assumptions about the human need for liberty, diversity, and free association.

Noam Chomsky


Read more at http://www.brainyquote.com/quotes/quotes/n/noamchomsk635960.html#CQmYwjRci1SScWY1.99

 

[emd123]

for those few libertarians among us, it IS a problem. because if the Feds can restrict what some people put in their own bodies, then they can restrict a whole lot of other things as well.
it is a limit on our freedoms.

It is true that classical libertarian thought is opposed to state intervention in social life, as a consequence of deeper assumptions about the human need for liberty, diversity, and free association.

Noam Chomsky


Read more at http://www.brainyquote.com/quotes/quotes/n/noamchomsk635960.html#CQmYwjRci1SScWY1.99

I tend to lean libertarian also, but we live in a a society where people want to ride motorcycles without helmets and inject drugs and when their brain is smashed or no longer functional and life goes to sht, you and I have to pay for it as a tax payer. So I agree, in a vacuum. But in an ideal libertarian world, where people demand ultimate freedom they need to accept total self responsibility. Yet we have the total opposite. People want the right to get stoned, inject drugs, have kids, ride motorcycles helmet-less and take major risks with their freedoms, yet want society to pick up the pieces when it all goes to sht. Then we end up paying for their kids to be in foster care, end up finding rehab, end up paying for their welfare when they can't work , clean up after riots and looting, and so on, due to their catastrophic levels of dysfunction.

I support anyone's right to do anything else, so long as it doesn't hurt others OR end up in them demanding that society or the taxpayers pick up the pieces from their disastrous life choices. In a country where the majority are unwilling to take responsibility, those ideals must be tempered.

So, yes: Ideal if people accepted responsibility for their actions, but that ship has sailed.

 

[willabeast]

I tend to lean libertarian also, but we live in a a society where people want to ride motorcycles without helmets and inject drugs and when their brain is smashed or no longer functional and life goes to sht, you and I have to pay for it as a tax payer. So I agree, in a vacuum. But in an ideal libertarian world, where people demand ultimate freedom they need to accept total self responsibility. Yet we have the total opposite. People want the right to get stoned, inject drugs, have kids, ride motorcycles helmet-less and take major risks with their freedoms, yet want society to pick up the pieces when it all goes to sht. Then we end up paying for their kids to be in foster care, end up finding rehab, end up paying for their welfare when they can't work , clean up after riots and looting, and so on, due to their catastrophic levels of dysfunction.

I support anyone's right to do anything else, so long as it doesn't hurt others OR end up in them demanding that society or the taxpayers pick up the pieces from their disastrous life choices. In a country where the majority are unwilling to take responsibility, those ideals must be tempered.

So, yes: Ideal if people accepted responsibility for their actions, but that ship has sailed.

if enough people vote libertarian that ship will sink after being nuked.

 

[ERK123]

if enough people vote libertarian that ship will sink after being nuked.

And this is one of the main reasons why I am opposed to libertarians and all other utopian ideals.

 

[willabeast]

And this is one of the main reasons why I am opposed to libertarians and all other utopian ideals.[/QUOTE

"I think that in no country in the civilized world is less attention paid to philosophy than in the United States... Nevertheless it is easy to perceive that almost all the inhabitants of the United States conduct their understanding in the same manner, and govern it by the same rules; that is to say, that without ever having taken the trouble to define the rules of a philosophical method, they are in possession of one, common to the whole people. To evade the bondage of system and habit, of family maxims, class opinions, and, in some degree, of national prejudices; to accept tradition only as a means of information, and existing facts only as a lesson used in doing otherwise, and doing better; to seek the reason of things for one's self, and in one's self alone; to tend to results without being bound to means, and to aim at the substance through the form; – such are the principal characteristics of what I shall call the philosophical method of the Americans...[In] most of the operations of the mind, each American appeals to the individual exercise of his own understanding alone." Alexis De Tocqueville

 

[ERK123]

Tocqueville lived in such a different America that it is difficult to fully evaluate the complexity of his viewpoints to modern society. I do not have a problem with the libertarian ideal. I would be fine with living in such a world. I just cannot envision a just pathway to such a dramatically different society and I am not willing to undergo such radical change. We can blame the generations before us for creating such an unjust society that make such ideals unattainable. There are certainly breaking points that shake the foundation that we are given, but I do not think that we have reached such a point. Tocquerville lived in a time of much more political and societal instability within the civilized world. He lived in a different time as is evident from another one of his quotes,

"The first who attracts the eye, the first in enlightenment, in power and in happiness, is the white man, the European, man par excellence; below him appear the Negro and the Indian. These two unfortunate races have neither birth, nor face, nor language, nor mores in common; only their misfortunes look alike. Both occupy an equally inferior position in the country that they inhabit; both experience the effects of tyranny; and if their miseries are different, they can accuse the same author for them".

 

[willabeast]

Tocqueville lived in such a different America that it is difficult to fully evaluate the complexity of his viewpoints to modern society. I do not have a problem with the libertarian ideal. I would be fine with living in such a world. I just cannot envision a just pathway to such a dramatically different society and I am not willing to undergo such radical change. We can blame the generations before us for creating such an unjust society that make such ideals unattainable. There are certainly breaking points that shake the foundation that we are given, but I do not think that we have reached such a point. Tocquerville lived in a time of much more political and societal instability within the civilized world. He lived in a different time as is evident from another one of his quotes,

"The first who attracts the eye, the first in enlightenment, in power and in happiness, is the white man, the European, man par excellence; below him appear the Negro and the Indian. These two unfortunate races have neither birth, nor face, nor language, nor mores in common; only their misfortunes look alike. Both occupy an equally inferior position in the country that they inhabit; both experience the effects of tyranny; and if their miseries are different, they can accuse the same author for them".

They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.
Benjamin Franklin

Rightful liberty is unobstructed action according to our will within limits drawn around us by the equal rights of others. I do not add 'within the limits of the law' because law is often but the tyrant's will, and always so when it violates the rights of the individual.
Thomas Jefferson

Democracy and socialism have nothing in common but one word, equality. But notice the difference: while democracy seeks equality in liberty, socialism seeks equality in restraint and servitude.
Alexis de Tocqueville

The truth is that men are tired of liberty.
Benito Mussolini

 

[ERK123]

They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.
Benjamin Franklin

I said absolutely nothing about giving up liberty for safety

Rightful liberty is unobstructed action according to our will within limits drawn around us by the equal rights of others. I do not add 'within the limits of the law' because law is often but the tyrant's will, and always so when it violates the rights of the individual.
Thomas Jefferson

Thomas Jefferson can write about equal rights and the rights of the individual all he wants from his study in his plantation house.

Democracy and socialism have nothing in common but one word, equality. But notice the difference: while democracy seeks equality in liberty, socialism seeks equality in restraint and servitude.

I gave no comparison or mention of democracy or socialism.

So I guess I should ask... what is your point?

 

[emd123]

A huge portion of this country does not want the responsibility that goes with freedom. They want freedom and to be taken care of, too. It's a big problem. The horse wants to be pulled by the cart.

 

[drrosenrosen]

I think as we see the quasi-legal dispensaries become more sophisticated with separation, purification, and non-sterile compounding techniques--this stuff is going to be popping up all over. So, perhaps cannabinoid as a CLASS is the way to go. I just wonder how the driving while intoxicated issues are going to be adjudicated--they will be NEG for THC. I'm not sure that the forensic labs are going to be looking at all cannabinoid compounds by MS methods.

If the THC compounds are the ones primarily responsible for the psychogenic effects of cannabis, then taking CBD oil, for example, shouldn't result in impairment.

 

[drusso]

If the THC compounds are the ones primarily responsible for the psychogenic effects of cannabis, then taking CBD oil, for example, shouldn't result in impairment.

Right.

Except the manufacturing standards being used in the dispensaries in my area are unclear: The dispensaries involved in making the stuff seem to be using imported food science standards and modified non-sterile compounding standards--not pharmaceutical manufacturing standards. It's not Six Sigma reliability standards. So, again, administratively speaking, it comes down to the CANNABINOID class of molecules not THC specifically that is the trigger for discontinuation of opioid therapy.

I'm hearing a consensus on this thread, that most clinicians focus on the CANNABINOID class not specific molecules in the class (THC, etc) as the cause for action (stopping opioid therapy). Hopefully, I'm not misrepresenting anyone's view on the matter.

 

[lobelsteve]

THC is active drug of abuse.
CBD may be therapeutic and ruins the THC.
Manipulating ratios of THC/CBD has been ongoing for 50+ years to make marijuana several times more potent as far as euphoria/high effect.
If we want to do this right then we regulate the heck out marijuana exactly like alcohol and standards before sale would include putting ratios on the bottle just like they do for proof on booze. Dose standards are important if we want to tax/regulate and reduce harms. If this were to occur we could stop UDS for THC/CBD and warn patients on opiates like we do for ETOH, BZD, etc.

 

[Ducttape]

your point is why THC cannot be downgraded from a Schedule 1 substance. we have no idea what the active ingredient and the amounts of such.

I am sure that none here would stop opioid prescribing in a patient taking dronabinol, a schedule III substance, if it were being prescribed for an FDA approved indication.