THC & Schedule II's: Yea or Nay

[101N]

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My policy is 'Nay'. It's either or but not both. If I find THC in a UTS there will be serial studies demonstrating abstinence or we are done with opioids.

Epidemiol Rev. 2011 Oct 4. [Epub ahead of print]
Marijuana Use and Motor Vehicle Crashes.
Li MC, Brady JE, Dimaggio CJ, Lusardi AR, Tzong KY, Li G.

Abstract
Since 1996, 16 states and the District of Columbia in the United States have enacted legislation to decriminalize marijuana for medical use. Although marijuana is the most commonly detected nonalcohol drug in drivers, its role in crash causation remains unsettled. To assess the association between marijuana use and crash risk, the authors performed a meta-analysis of 9 epidemiologic studies published in English in the past 2 decades identified through a systematic search of bibliographic databases. Estimated odds ratios relating marijuana use to crash risk reported in these studies ranged from 0.85 to 7.16. Pooled analysis based on the random-effects model yielded a summary odds ratio of 2.66 (95% confidence interval: 2.07, 3.41). Analysis of individual studies indicated that the heightened risk of crash involvement associated with marijuana use persisted after adjustment for confounding variables and that the risk of crash involvement increased in a dose-response fashion with the concentration of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol detected in the urine and the frequency of self-reported marijuana use. The results of this meta-analysis suggest that marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.

 

[facets]

No way. Unfortunately AZ is one one the states that has legalized medical thc I don't care it is illlegal at a federal level and aberrant behavior goes way up if the patient is on THC. BTW, this is where universal precautions come into play. Remember all the potheads from the 60's? They are all sweet LOL and LOM who you would never believe are dirty till you test them. Test EVERYONE, I don't care if the president comes in, he is peeing in a cup.

 

[lobelsteve]

Simple.

The DEA feels strongly that marijuana is an illegal drug. A pattern of ongoing Rx'ing opiates to patients testing + THC will get your registration yanked.

 

[Jcm800]

double post. sorry

 

[Jcm800]

nay. but to both THC AND opiates...

 

[Tenesma]

THC is Class I controlled substance - I think it is irresponsible (legally) to prescribe controlled substances to somebody on a federally illegal drug...

furthermore, narcotics have a very good street value but are cheap at the pharmacy - so how do you know that they aren't selling your narcotics in order to purchase marijuana --- marijuana has become quite expensive in my neck of the woods (despite it being ok to have medical marijuana in my state)

 

[epidural man]

It's not a question in my practice - can't do mary jane.

Although I think if I were in private practice, I wouldn't care if they were doing it, but I wouldn't give them opioids if they were, as some have mentioned.

I would much rather them smoking pot than doing oxycontin. My guess is that if you were prescribing pot - you would never have the pot smokers call in and say they lost it - or they need more, or it stopped working, or all the other crap stories we have posted on the other thread. Opioids are strange, strange drugs.

Anecdotally, I have had several people (not my patients) tell me that pot allowed them to get off tons of anxiety meds and opioids. If that were true, that's pretty cool.

 

[deleted185747]

Cannabis and Its Derivatives
Lawrence Leung, MBBChir, MFM(Clin)
Posted: 08/30/2011; J Am Board Fam Med. 2011;24(4):452-462. © 2011 American Board of Family Medicine
http://www.medscape.com/viewarticle/746571_print

Cannabis has level A evidence for use in neuropathic pain in HIV patients and spasticity in MS patients.

Nabilone has level A evidence for use in spasticity in SCI patients and pain in fibromyalgia patients.

Sativex has level A evidence for bladder dysfunction and central pain in patients with MS, and any patient with peripheral neuropathy.

-------------------

Does anyone Rx Nabilone or Sativex?

 

[lobelsteve]

Cannabis and Its Derivatives
Lawrence Leung, MBBChir, MFM(Clin)
Posted: 08/30/2011; J Am Board Fam Med. 2011;24(4):452-462. © 2011 American Board of Family Medicine
http://www.medscape.com/viewarticle/746571_print

Cannabis has level A evidence for use in neuropathic pain in HIV patients and spasticity in MS patients.

Nabilone has level A evidence for use in spasticity in SCI patients and pain in fibromyalgia patients.

Sativex has level A evidence for bladder dysfunction and central pain in patients with MS, and any patient with peripheral neuropathy.

-------------------

Does anyone Rx Nabilone or Sativex?

Poorly designed and controlled studies. But it's something. It just seems that anything other than illicit THC doesn't work. Marinol can't relieve my pain. So smoke pot and I can stop prescribing opiates. Bu-bye.

DEA and law triumphs clinical data and patient self reported outcomes.

 

[epidural man]

DEA and law triumphs clinical data and patient self reported outcomes.

👍

 

[Apollyon]

Isn't right now right about time for someone to sign up for SDN expressly to comment on this thread, stating exactly above, namely, that pot is what keeps them going, and nothing else, and that we suck suck suck as doctors and MJ should be as legal as air?

(And, considering it's 3pm on the east coast, it's also right about time for such folks to be getting up.)

 

[101N]

Isn't right now right about time for someone to sign up for SDN expressly to comment on this thread, stating exactly above, namely, that pot is what keeps them going, and nothing else, and that we suck suck suck as doctors and MJ should be as legal as air?

(And, considering it's 3pm on the east coast, it's also right about time for such folks to be getting up.)

Well, I think a lot of folks that would do just that are busy at Occupy Main Street right about now.

 

[PMR 4 MSK]

Marijuana is not recognized as medicinal. It has Purported medicinal qualities. It has well-established side effects, including intoxication, hallucinations, delusions and risk-behaviors after use. Long-term risk may be associated with lower mental acuity.

It is not prescribable under federal law and physicians endanger their DEA license to prescribe it.

Even when prescribed, the doctor does not prescribe a specific drug, but rather the patient chooses among many. There is no dosing, you smoke or vaporize as much as you want. Their is no dose frequency, you use it as omen as you want. There is no amount prescribed - you buy as much as you want, within legal boundaries. There are no refills prescribed - you buy again as often as you want, again within legal boundaries.

 

[lobelsteve]

Marijuana is not recognized as medicinal. It has Purported medicinal qualities. It has well-established side effects, including intoxication, hallucinations, delusions and risk-behaviors after use. Long-term risk may be associated with lower mental acuity.

It is not prescribable under federal law and physicians endanger their DEA license to prescribe it.

Even when prescribed, the doctor does not prescribe a specific drug, but rather the patient chooses among many. There is no dosing, you smoke or vaporize as much as you want. Their is no dose frequency, you use it as omen as you want. There is no amount prescribed - you buy as much as you want, within legal boundaries. There are no refills prescribed - you buy again as often as you want, again within legal boundaries.

Make opiates C-I and do the same. No more lost Rx's. Just go to the dispensary and choose among the brands....As a doc we can write opiate trial warranted and then they go elsewhere. Would eliminate a ton of headaches for us- not so sure this would be good for the general public...

 

[101N]

"There is no amount prescribed - you buy as much as you want, within legal boundaries."

This is part of the rub. The laws in my state are so liberal on how many ounces/plants that a 'patient' can have in their possession that it has lead to an enormous oversupply. Because those physicians that do authorize cards DO NOT perform random UTS - or make any other reasonable effort to quantify what they prescribe - the enormous over-suppy is ending up sold illegally. I think our medical boards should mandate REMS all medical TCH patients/clinics: treatment agreement, material risks, and random UTS with TCH quantification.

Most of the public does not realize that 'medical marijuana' is an enormous sham effort to get pot legalized through a back door.

 

[ghost dog]

Poorly designed and controlled studies. But it's something. It just seems that anything other than illicit THC doesn't work. Marinol can't relieve my pain. So smoke pot and I can stop prescribing opiates. Bu-bye.

DEA and law triumphs clinical data and patient self reported outcomes.

These are crap studies.

I have yet to see a FM pt respond in a meaninful manner to Nabilone. I have had a few LBP pts respond.

Someone described opioids in such a manner: this class of drugs allows a pt to enjoy their springers and tie their shoes , but not increase their function significantly. Is this how we should measure a functionally significant response? I have become cynical. 🙁

As to +THC, and opioids. This is an opioid contract violation. A pt gets a warning, and a subsequent (random) re-test. If they are + THC again = opioid taper.

 

[pretenda]

Most of the public does not realize that 'medical marijuana' is an enormous sham effort to get pot legalized through a back door.

Really? I think its pretty obvious...Cant blame them though. Weed is certainly less dangerous than booze, cigs, or even opioids.

No matter what my personal opinions are, I dont have a DEA number but I wouldn't be able to justify prescribing a federally banned drug and script opioids at the same time. Just completely unfeasable no matter how many studies are done.

 

[mille125]

My policy is 'Nay'. It's either or but not both. If I find THC in a UTS there will be serial studies demonstrating abstinence or we are done with opioids.

Epidemiol Rev. 2011 Oct 4. [Epub ahead of print]
Marijuana Use and Motor Vehicle Crashes.
Li MC, Brady JE, Dimaggio CJ, Lusardi AR, Tzong KY, Li G.

Abstract
Since 1996, 16 states and the District of Columbia in the United States have enacted legislation to decriminalize marijuana for medical use. Although marijuana is the most commonly detected nonalcohol drug in drivers, its role in crash causation remains unsettled. To assess the association between marijuana use and crash risk, the authors performed a meta-analysis of 9 epidemiologic studies published in English in the past 2 decades identified through a systematic search of bibliographic databases. Estimated odds ratios relating marijuana use to crash risk reported in these studies ranged from 0.85 to 7.16. Pooled analysis based on the random-effects model yielded a summary odds ratio of 2.66 (95% confidence interval: 2.07, 3.41). Analysis of individual studies indicated that the heightened risk of crash involvement associated with marijuana use persisted after adjustment for confounding variables and that the risk of crash involvement increased in a dose-response fashion with the concentration of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol detected in the urine and the frequency of self-reported marijuana use. The results of this meta-analysis suggest that marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.

Why is this even a question?

 

[101N]

Why is this even a question?

Let's say you are asked to give an evidence based defense of your opinion to a committee of primary providers who are creating policy for the largest multi-specialty group in your home state. Bould pronounements don't fly in some venues.

 

[Ligament]

Let's say you are asked to give an evidence based defense of your opinion to a committee of primary providers who are creating policy for the largest multi-specialty group in your home state. Bould pronounements don't fly in some venues.

It is federally illegal should really be enough of a recommendation. Ask them what other federally illegal activities the group knowingly participates in!