recreational drug use in psychology

[AcronymAllergy]

I believe traces of marijuana can stay in your body for up to 60 days depending upon individual differences. People on probation try to beat the urine test but now they have hair folical test. Some folks have started using synthetic marijuana K2 or something called bath salts so they won't have a positive UA. Unfortunately, these synthetic drugs may cause psychotic episodes and there have been cases where they have become so paranoid that they have killed or murdered someone or a person they love because they thought the loved one was the devil chasing them.

Moral of the story...stay away from drugs! This is the right thing to do and the responsible thing to do especially if you are in a helping profession. The ethical concerns when a court ordered client is required to see a psychologist for help with their drug abuse. You would be a fraud if you are using drugs or abusing alcohol when treating others having abuse/dependency concerns.

I of course wouldn't support or recommend those behaviors, but I also wouldn't say they'd make you a fraud. As psychologists, we don't have to "practice what we preach" in order to help our clients, much in the same way that research supports our being able to help others without having experienced various adverse events first-hand. It's akin to a physician who smokes yet tells his patients to stop smoking. Hypocritical? Sure, but not fraudulent, unless you're actually self-disclosing to your clients and saying, "I don't drink or use drugs, so you shouldn't, either."

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[AnnoyedByFreud]

.

 

[AnnoyedByFreud]

Being "high" may be independent from impairment d/t use. Which really brings up how one draws the line as to "impairment." Plenty of evidence that effects are chronic not acute, though.

http://www.ncbi.nlm.nih.gov/pubmed/7776840
http://www.ncbi.nlm.nih.gov/pubmed/20217055
http://www.ncbi.nlm.nih.gov/pubmed/18519827
http://www.ncbi.nlm.nih.gov/pubmed/15925403

Really not trying to turn this into a pro/con THC war. I'm fairly impartial except when you walk into my clinic actively psychotic. Just pointing out that there is evidence to consider.

Yeah, but I'd guess that regular usage of alcohol (or any drug) leaves long term effects as well. Marijuana isn't special in that way. My point was that the earlier poster seemed to be suggesting that because marijuana metabolites remain in one's system for days/weeks, that this could somehow indicate prolonged intoxication. I don't think anyone would deny that long term usage of marijuana can have lasting effects. Of course, that's true for alcohol, cocaine, etc, etc.

 

[deleted176373]

I believe traces of marijuana can stay in your body for up to 60 days depending upon individual differences. People on probation try to beat the urine test but now they have hair folical test. Some folks have started using synthetic marijuana K2 or something called bath salts so they won't have a positive UA. Unfortunately, these synthetic drugs may cause psychotic episodes and there have been cases where they have become so paranoid that they have killed or murdered someone or a person they love because they thought the loved one was the devil chasing them.

Moral of the story...stay away from drugs! This is the right thing to do and the responsible thing to do especially if you are in a helping profession. The ethical concerns when a court ordered client is required to see a psychologist for help with their drug abuse. You would be a fraud if you are using drugs or abusing alcohol when treating others having abuse/dependency concerns.

The synthetic you speak of (popularly know as Spice or K2) is a brand name of "incense" that people have taken to smoking, it usually contains one of the many JWH synthentic cannabinoids (naphthoylindole family of compounds) invented for use on laboratory rats in medical research. The creator of these compounds was reported as saying, "It's like playing russian roulette because we don't have toxicity data, we don't know the metabolites, and we don't know the pharmacokinetics."

I don't know about others, but after seeing a number of people hospitalized in our psych ward following exposure to this stuff, I'm pretty sure that ingesting this stuff is not entirely bright. Risk vs reward. If someone thinks the risk of hospitalization (or worse) is worth the reward of getting high, then it's not my business to stop them.

 

[4410]

The synthetic you speak of (popularly know as Spice or K2) is a brand name of "incense" that people have taken to smoking, it usually contains one of the many JWH synthentic cannabinoids (naphthoylindole family of compounds) invented for use on laboratory rats in medical research. The creator of these compounds was reported as saying, "It's like playing russian roulette because we don’t have toxicity data, we don’t know the metabolites, and we don’t know the pharmacokinetics."

I don't know about others, but after seeing a number of people hospitalized in our psych ward following exposure to this stuff, I'm pretty sure that ingesting this stuff is not entirely bright. Risk vs reward. If someone thinks the risk of hospitalization (or worse) is worth the reward of getting high, then it's not my business to stop them.

People believe it is safe because it is synthetic but most of our most severe cases of acute psychosis has been traced back to use of these synthetics. Psychiatrist are having to use older antipsychotics on these folks and it is taking two to three months for them to remotely clear. It is extremely sad as some of these folks were very high functioning but now they are hearing voices and telling us they were just smoking marijuana and they woke up in jail a week later.

 

[Plathebo]

Ugh.

It will continually amaze me that despite our field’s lofty ideals and educational goals to address our preconceptions and biases (and the APA’s constant need to pat itself on the back), we all remain biased and hypocritical. We SHOULD strive for congruence. We SHOULD strive to live our ideals, not just pay them with lip service. Yet…I encounter more physically and psychologically unhealthy practitioners than healthy ones, and more bias in supposedly “open” (read: “woke”) therapists than in conservative ones.

How are people arguing for the long term detrimental effects of THC use but not at all discussing the long term effects of regularly prescribed pharma?? Or noting that it’s o.k. to have a glass of wine, but not a quick little snoot on a one hitter??Because despite our best efforts, we are all still victims of our very human brain. They’ve either never smoked, had bad experiences, or are guided by weed stigma . Hypocrites. Biased.

To any who read this who smoke cannabis, you’re probably not funding a cartel. No more than our government is. And only you know how much it affects you and your ability to be conscientious and responsible. The bottom line is legality: at least right now, it’s illegal. You’ll be tested at some point if you work for the government, usually in the hiring process. Private institutions have their own policy and you’ll have to research that. It’s a risk. Bottom line.

 

[Cam_Chai19]

Ugh.

It will continually amaze me that despite our field’s lofty ideals and educational goals to address our preconceptions and biases (and the APA’s constant need to pat itself on the back), we all remain biased and hypocritical. We SHOULD strive for congruence. We SHOULD strive to live our ideals, not just pay them with lip service. Yet…I encounter more physically and psychologically unhealthy practitioners than healthy ones, and more bias in supposedly “open” (read: “woke”) therapists than in conservative ones.

How are people arguing for the long term detrimental effects of THC use but not at all discussing the long term effects of regularly prescribed pharma?? Or noting that it’s o.k. to have a glass of wine, but not a quick little snoot on a one hitter??Because despite our best efforts, we are all still victims of our very human brain. They’ve either never smoked, had bad experiences, or are guided by weed stigma . Hypocrites. Biased.

To any who read this who smoke cannabis, you’re probably not funding a cartel. No more than our government is. And only you know how much it affects you and your ability to be conscientious and responsible. The bottom line is legality: at least right now, it’s illegal. You’ll be tested at some point if you work for the government, usually in the hiring process. Private institutions have their own policy and you’ll have to research that. It’s a risk. Bottom line.

It's worth noting that this thread is from 10 years ago. Recreational marijuana was only legal in two states by 2012. A lot has changed since then regarding the legal implications of marijuana use (although still not at the federal level), where marijuana is sourced from, and how it's perceived socially. That being said, many of the legal implications for our field remain the same as you noted.

 

[WisNeuro]

It's worth noting that this thread is from 10 years ago. Recreational marijuana was only legal in two states by 2012. A lot has changed since then regarding the legal implications of marijuana use (although still not at the federal level), where marijuana is sourced from, and how it's perceived socially. That being said, many of the legal implications for our field remain the same as you noted.

Don't dissuade the rant! We haven't had a good self aware wolf in a while.

 

[BuckeyeLove]

Approx 50% of the psychologists I know have their card and use daily, and that's only the ones I know, honestly the number is likely higher. Many I know have said they are worried about people finding out that they have it, that a "psychologist uses marijuana." However, they are all doing fine from what I can tell. The demonization of substance use in the United States (and our field in general) is hilariously sad. And don't get me started on employment drug testing.

 

[WisNeuro]

Most HC professionals I know support legalization federally. Many of them also favor continuing to study the known risks of chronic use, which many people like to discount or hand wave about.

 

[calimich]

I imagine many pearls would be clutched if the Friday thread discussed weed in the same way as booze

 

[futureapppsy2]

I imagine many pearls would be clutched if the Friday thread discussed weed in the same way as booze

Honestly, when I taught Intro to Addiction, which included an overview of the major classes of abusable substances, I found that there really isn't that much that can be said to demonize marijuana as that harmful, beyond it making some people less productive (and being a trigger for psychosis in a subset of young people). Alcohol, on the other hand... whoo boy. (Also, fun fact: prohibition worked much better at curbing alcohol use and alcohol-related medical consequences than we give it credit for, surprisingly ). That said, I don't think its worth risking someone's career to smoke recreationally.

 

[WisNeuro]

I imagine many pearls would be clutched if the Friday thread discussed weed in the same way as booze

I doubt it, actually. I don't think there are many here who are opposed to legalization and use all that much.

 

[Therapist4Chnge]

It's interesting to see this bumped 10 years later (and ~13 from the original post). While this post wasn't specifically about cannabis, a lot has changed with it since 2009. I remember being on fellowship (10ish yrs ago) when medicinal cannabis was legalized in the state where I practiced. I remember talking with my mentors and the attendings on my in-patient units and the general consensus was "We are XXXX....and we will not prescribe cannabis." It wasn't 100% across the board, as there were a couple of younger attendings and a couple of MD/PhD fellows who were more willing to consider the impact on our patients and talk about possible implications. No one was doing research into it and it wasn't something that our institution would have approved at the time, but it was at least some consideration. It ended up that none of the providers I worked with wanted to deal with it, so they mostly treated their portion and tried to make it work. To be fair to those providers, most of the community providers writing for medicinal cards were pop-up shops. Collaborating was likely not possible, but there was still a clear bias and mistrust. It'd be interesting to see if that has changed since then.

What I found funny was that we had some (oncology) providers at the institution who had previously written for Marinol (dronabinol)....but stopped bc patients reported it wasn't very helpful. I'm interested to see what some of these larger and more recent studies on medicinal cannabis discover, as dronabinol was a giant fail from a treatment and revenue perspective for pharma companies.

ps. I'm still supportive of legalization, though for individual, social, and fiscal reasons. Individual for adults making an informed choice, social because of how the "war on drugs" unfairly targeted minority populations, and fiscal for the tax dollars cannabis sales can bring a state to fund education/sub abuse/related areas. It's not perfect, but the blueprint for states is out there, especially for the tax $$ allocations that could really make a difference in many (poorly resourced) states.

 

[WisNeuro]

It's interesting to see this bumped 10 years later (and ~13 from the original post). While this post wasn't specifically about cannabis, a lot has changed with it since 2009. I remember being on fellowship (10ish yrs ago) when medicinal cannabis was legalized in the state where I practiced. I remember talking with my mentors and the attendings on my in-patient units and the general consensus was "We are XXXX....and we will not prescribe cannabis." It wasn't 100% across the board, as there were a couple of younger attendings and a couple of MD/PhD fellows who were more willing to consider the impact on our patients and talk about possible implications. No one was doing research into it and it wasn't something that our institution would have approved at the time, but it was at least some consideration. It ended up that none of the providers I worked with wanted to deal with it, so they mostly treated their portion and tried to make it work. To be fair to those providers, most of the community providers writing for medicinal cards were pop-up shops. Collaborating was likely not possible, but there was still a clear bias and mistrust. It'd be interesting to see if that has changed since then.

What I found funny was that we had some (oncology) providers at the institution who had previously written for Marinol (dronabinol)....but stopped bc patients reported it wasn't very helpful. I'm interested to see what some of these larger and more recent studies on medicinal cannabis discover, as dronabinol was a giant fail from a treatment and revenue perspective for pharma companies.

ps. I'm still supportive of legalization, though for individual, social, and fiscal reasons. Individual for adults making an informed choice, social because of how the "war on drugs" unfairly targeted minority populations, and fiscal for the tax dollars cannabis sales can bring a state to fund education/sub abuse/related areas. It's not perfect, but the blueprint for states is out there, especially for the tax $$ allocations that could really make a difference in many (poorly resourced) states.

I still don't support prescribing it in many cases. Not because I'm against its use, but because the data doesn't suggest it is helpful for most of the conditions that people are having it prescribed for. There are a lot of claims out there that are not backed by any compelling data. I'd like to see it legalized to make research easier, but so far, it's use for medicinal purposes is quite limited.

 

[erg923]

Is there really no longer a difference between getting a little "tight" from a glass or 2 or 3 of wine VS smoking/snorting/vaping unknown substances/chemicals that may or may not have been specifically grown and engineered for the express purpose of getting people all kinds of ****ed up?

There is a world of difference here, to me...

 

[Therapist4Chnge]

I still don't support prescribing it in many cases. Not because I'm against its use, but because the data doesn't suggest it is helpful for most of the conditions that people are having it prescribed for. There are a lot of claims out there that are not backed by any compelling data. I'd like to see it legalized to make research easier, but so far, it's use for medicinal purposes is quite limited.

I definitely hear that. Unfortunately states are regulating it w/o enough data, and many of their decisions have nothing to do with science. Blanket use for unspecified anxiety, depression, PTSD, etc....definitely suspect because I haven't seen solid data on it yet. I'm most interested in its use for chronic pain, as there have been a couple/few papers in the past 5-10 years looking at possible synergistic effects with opioids. This Abrams et al. (2011) article (see below) touches on possible synergistic effects, though it was a pretty small sample size (N=21). There was also a promising tidbit that it didn't raise levels of the opioid in the blood, which was a concern of some that it could cause problems with clearance and complicate dosing.

In the past few years I've seen some chronic pain docs work with patients on lowering their opioid intake if they are active users of cannabis. I support this approach in most cases because between the s/e profile (i.e. constipation in 25%-75%+ opioid users...depending on which study you read) and risk of abuse and/or dependence would theoretically go down, it's almost its own harm reduction approach. There will always be a % of patients who don't use it correctly and/or effectively, but I'd feel a lot better about considering broader use if there were more data.

I don't know if there are data on use of cannabis for chronic pain patients nationally, but I know locally it is quite high (no pun intended), so I have tried to learn as much as I can about it. Cooper et al. (2018) extended upon some of the earlier work in their study, though they also had a small sample (N=18) and some other limitations. I think these studies are going in the right direction, but it's been a few years since I've looked at current studies or findings. In the Cooper et al. (2018) study they also used smoked cannabis, which would likely have some health concerns, but I still view that as "better" than higher dosing of opioids. They also only looked at low-dosing, so I'm interested in seeing what kind of results (if any) they would get at more "real life" use of opioids for chronic pain patients.

Abrams DI, Couey P, Shade SB, Kelly ME, Benowitz NL. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther. 2011 Dec;90(6):844-51. doi: 10.1038/clpt.2011.188. Epub 2011 Nov 2. PMID: 22048225.

Cooper, Z.D., Bedi, G., Ramesh, D. et al. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacol 43, 2046–2055 (2018). https://doi.org/10.1038/s41386-018-0011-2

 

[msc545]

I live in California where cannabis is legal in almost all forms and widely used. It is an open and unresolved question as to whether or not one can be terminated from a job or penalized in some way for testing positive for THC. The general position of the VA here seems to be essentially "don't ask - don't tell" at least relative to veteran's benefits or so I have been told. Probably, people who work for TSA or the FBI, etc will have a very different experience, California residents or not.

 

[JustNoticing]

It's not an unresolved question. State supreme court in Colorado (where pot is also legal) have upheld firings of employees due to cannabis use even when prescribed by a doctor. Without a separate statute making this practice illegal in your state, it is safe to assume that anyone can be fired for it if that is a part of their employment arrangement.

 

[msc545]

It's not an unresolved question. State supreme court in Colorado (where pot is also legal) have upheld firings of employees due to cannabis use even when prescribed by a doctor. Without a separate statute making this practice illegal in your state, it is safe to assume that anyone can be fired for it if that is a part of their employment arrangement.

Decisions in Colorado courts (unless it was a federal court) do not apply in California and are not considered in California courts. It is most certainly NOT safe to assume that anyone can be fired for it in California until a case that is on point is adjudicated here in California.

 

[WisNeuro]

Decisions in Colorado courts (unless it was a federal court) do not apply in California and are not considered in California courts. It is most certainly NOT safe to assume that anyone can be fired for it in California until a case that is on point is adjudicated here in California.

I think you can still say it is safe to assume that the possibility exists, and that most people don't want to be the test case. Furthermore, you do now have established precedent. We still use rulings and precedents in other states to make legal arguments in out states. We do it commonly with things like TPO in IMEs.

 

[hhhzzzaaa]

I'm a fifth year in a clinical psychology PhD program in a major city. I've had 5 practica at a wide range of settings and have never been drug tested. My program also has never required drug testing. I am, however, going to be drug tested for internship that begins this summer. Months of advanced notice was provided to me about this.

 

[PsySeeker]

Ugh.

It will continually amaze me that despite our field’s lofty ideals and educational goals to address our preconceptions and biases (and the APA’s constant need to pat itself on the back), we all remain biased and hypocritical. We SHOULD strive for congruence. We SHOULD strive to live our ideals, not just pay them with lip service. Yet…I encounter more physically and psychologically unhealthy practitioners than healthy ones, and more bias in supposedly “open” (read: “woke”) therapists than in conservative ones.

How are people arguing for the long term detrimental effects of THC use but not at all discussing the long term effects of regularly prescribed pharma?? Or noting that it’s o.k. to have a glass of wine, but not a quick little snoot on a one hitter??Because despite our best efforts, we are all still victims of our very human brain. They’ve either never smoked, had bad experiences, or are guided by weed stigma . Hypocrites. Biased.

To any who read this who smoke cannabis, you’re probably not funding a cartel. No more than our government is. And only you know how much it affects you and your ability to be conscientious and responsible. The bottom line is legality: at least right now, it’s illegal. You’ll be tested at some point if you work for the government, usually in the hiring process. Private institutions have their own policy and you’ll have to research that. It’s a risk. Bottom line.

This is hilarious.

 

[PsySeeker]

I still don't support prescribing it in many cases. Not because I'm against its use, but because the data doesn't suggest it is helpful for most of the conditions that people are having it prescribed for. There are a lot of claims out there that are not backed by any compelling data. I'd like to see it legalized to make research easier, but so far, it's use for medicinal purposes is quite limited.

Absolutely. In PA the medical model really is a total joke. Cash only MD’s often just do brief phone call “assessments” for $250 bucks a pop. Most places advertise a guarantee that you will get diagnosed with anxiety or whatever and then can get your card or you get your money back! Sometimes they even run BOGO assessment deals for you and a friend on radio spots!

It’s really too often just pseudo-recreational legalization cloaked as medical because that’s acceptable to the Pennsyltucky Republicans that dominate the legislature here, perhaps that’s especially because sometimes their friends and donors get to own the very limited number of “dispensaries.” Ah yes, the beauty of pay for play prescriptions for an understudied psychoactive substance that one is then welcome to take in relatively any form, unrestricted, as often as they feel like. My college student patients love it. I bet they’d love a stimulant card and dispensary too though, and how about an opiate card and dispensary? You could buy fentanyl lollipops and opium suppositories to treat your boredom and anxiety at your leisure as you see fit with your opiate doctor’s blessing.

Kidding aside, it’s a mockery of a medical system that leads to a bunch of my clients (I mean, really, maybe 10% or more of them at times) seriously over using and rationalizing their use and it’s many negative impacts because it’s prescribed by a doctor. Should just be fully recreationally legal, but you know, Jesus, morals, and guns and stuff still requires that it be called medicine otherwise people that use it must be branded criminals and sinners and their lives subsequently occasionally ruined. 🤷‍♂️

 

[deleted1100659]

In most places where CBD/THC/whatever is sold, it is so loosely regulated, product wise, that how do you know the real amount of THC in what you're smoking/ingesting/etc?

It's a well known and accepted fact that THC in itself has multiple negative effects.

CBD, in some instances, has some medical value in specific circumstances. Epidiolex is a very powerful AED for dravets syndrome and a few other seizure disorders. But this is way different than the stuff regular people are using.

 

[Therapist4Chnge]

In most places where CBD/THC/whatever is sold, it is so loosely regulated, product wise, that how do you know the real amount of THC in what you're smoking/ingesting/etc?

This is absurdly not accurate. For instance, here are the CA laws and statutes related to cannabis sales. It is *highly* (no pun intended) regulated and under constant scrutiny. They requires testing, tracking, labeling, audits, and piles of paperwork before a single package can be sold.

Codes: Code Search

 

[AbnormalPsych]

I have direct knowledge of clinics in legal states doing urine lab testing for pts using CBD and pretty much always finding THC at varying levels. Now, who knows whether that is the pts not reporting their usage accurately or CBD being regularly tainted with THC, counter to claims and what pts are aware they are taking.

 

[deleted1100659]

This is absurdly not accurate. For instance, here are the CA laws and statutes related to cannabis sales. It is *highly* (no pun intended) regulated and under constant scrutiny. They requires testing, tracking, labeling, audits, and piles of paperwork before a single package can be sold.

Codes: Code Search

I have direct knowledge of clinics in legal states doing urine lab testing for pts using CBD and pretty much always finding THC at varying levels. Now, who knows whether that is the pts not reporting their usage accurately or CBD being regularly tainted with THC, counter to claims and what pts are aware they are taking.

Im talking about most places, in my state for example edibles arent even supposed to be legal yet somehow some places are still selling them, which I believe is based upon how they market it. CA is a lot different than most areas in my region. These CBD shops pop up everywhere and are selling all kinds of various things.

Totally agree with second statement, I am often very skeptical the accuracy of the reported amounts of THC.

 

[texanpsychdoc]

I'm a psychologist, not a politician, a lawyer, or some self-righteous, overly-idealistic crusader against drug use. My focus is on the individual, not on what else society is doing, the rest of the U.S. is not in my office for 45 minutes. When I have a patient seeing me because they struggle with substance use, whether it be alcohol, marijuana, etc., I personally don't give two ****s about the legality of the substance, or any geo-political, highly-charged controversial debate on what is or is not being directly or indirectly funded by their substance use. My focus is on the function of their behavior and their quality of life. If they use it as a means to destress and cope, we are going to look at other options that don't require chemical dependence. If their substance use is getting them in trouble with the law, which then affects their family/personal life and/or job, we are certainly going to address that. CNN and Fox News are not in my office, so any tirade about the unfairness of how our country decides on what substances should or should not be legal is a moot point I shut down fast as I do not have time for that.

 

[smalltownpsych]

I'm a psychologist, not a politician, a lawyer, or some self-righteous, overly-idealistic crusader against drug use. My focus is on the individual, not on what else society is doing, the rest of the U.S. is not in my office for 45 minutes. When I have a patient seeing me because they struggle with substance use, whether it be alcohol, marijuana, etc., I personally don't give two ****s about the legality of the substance, or any geo-political, highly-charged controversial debate on what is or is not being directly or indirectly funded by their substance use. My focus is on the function of their behavior and their quality of life. If they use it as a means to destress and cope, we are going to look at other options that don't require chemical dependence. If their substance use is getting them in trouble with the law, which then affects their family/personal life and/or job, we are certainly going to address that. CNN and Fox News are not in my office, so any tirade about the unfairness of how our country decides on what substances should or should not be legal is a moot point I shut down fast as I do not have time for that.

Completely agree. There is a cost benefit analysis for all medications and it is up to the patient to determine the choices they want to make. My job is to help them examine those choices from as objective a stance as possible. Sometimes these medications help and sometimes they can make things worse. If they don’t really want to examine this, then they are wasting my time anyway. The first step in Motivational Interviewing from my perspective is to stop the argument the patient is having with everyone else from continuing in the room. i definitely don’t want to just reenact the same pattern that they already have. I have a number of ways of addressing this. I tend to be pretty upfront and direct about it. “I’m not here to argue with you or pick a side. It’s up to you to make the decisions about what makes sense in your life.” “It sounds like you’re defending yourself right now. Why? Against who?” ”why does it matter what they think, they’re not here right now, what do you think?” What is funny is how quickly the patient will often shift to the other side having good points once we stop the automatic arguing.

It is only the first step in the change process and that is one bias I clearly have. Change and growth is going to happen in the relationship, I don’t like to waste my time or their time. What that change and growth will look like is somewhat unpredictable, but often patients will identify that some of their behavioral patterns are impeding their values and goals and begin making changes.

I also practice what I preach so I examine my own behaviors and try to grow, improve, and learn. Lost some weight about five years ago because of that and also made a shift to a primarily plant-based diet a couple of years after that. Nicotine went away when I started my internship and maybe someday caffeine will. Not today though. For me, the drugs that get you high had to go away before I even started this journey of growth because my own use and lack of ability to regulate or moderate that use was incompatible with life. Simple as that.

 

[msc545]

I think you can still say it is safe to assume that the possibility exists, and that most people don't want to be the test case. Furthermore, you do now have established precedent. We still use rulings and precedents in other states to make legal arguments in out states. We do it commonly with things like TPO in IMEs.

Assumptions are never safe as you should know by now. That said, I concur based on my clinical experience that most (but not all) people would be unwilling to test it. That is always the outlier.

I think you can still say it is safe to assume that the possibility exists, and that most people don't want to be the test case. Furthermore, you do now have established precedent. We still use rulings and precedents in other states to make legal arguments in out states. We do it commonly with things like TPO in IMEs.

Assumptions are never safe as you should know by now. That said, I concur based on my clinical experience that most (but not all) people would be unwilling to test it. There is always the outlier. I am unaware of any established precedent in California, so if there is one, I would appreciate a link to it. Finally, at least in our courts, we do not use precedents established in administrative law courts in our own state, much less in others.

 

[WisNeuro]

Assumptions are never safe as you should know by now. That said, I concur based on my clinical experience that most (but not all) people would be unwilling to test it. That is always the outlier.

Assumptions are never safe as you should know by now. That said, I concur based on my clinical experience that most (but not all) people would be unwilling to test it. There is always the outlier. I am unaware of any established precedent in California, so if there is one, I would appreciate a link to it. Finally, at least in our courts, we do not use precedents established in administrative law courts in our own state, much less in others.

Legal precedent from other jurisdictions are commonly used in cases in which a state does not currently have a statute in place. This isn't a theoretical, this is how things operate in practice. I've been involved in affadavits and court proceedings personally in several states that have done just this. CA is its bag in a lot of ways, at least for neuropsych. I know the courts there are quite permissive on things like TPO.

 

[Therapist4Chnge]

I've only had one instance where TPO was ignored, which was..... frustrating. I've practiced on three states and that was a first for me, but it was settled before I got involved. I filed an affidavit with all of the expected citations anyway, but once a judge makes a ruling, they are usually not gonna change it.

 

[WisNeuro]

I've only had one instance where TPO was ignored, which was..... frustrating. I've practiced on three states and that was a first for me, but it was settled before I got involved. I filed an affidavit with all of the expected citations anyway, but once a judge makes a ruling, they are usually not gonna change it.

I recently had one where we used legal examples from two different states and the judge upheld our opposition and compelled the exam without TPO.