Pain Profile - Marijuana

[GoodVibes1313]

I apologize, but this question is naive. I'm just not sure what the answer is. Will second hand smoke of marijuana show up positive on pain profile?

[philllyvee]

I apologize, but this question is naive. I'm just not sure what the answer is. Will second hand smoke of marijuana show up positive on pain profile?

Unless you are spending your time in hotboxes, no.


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[Reality Check 2]

Our lab 20 yrs ago told us that they tested by basically putting people in the equivalent of a phone booth and pumping in ganja smoke and serially testing their blood levels and it did not ring positive until something like 12+ hours of constant exposure in the tiny ventless box.

The lab said that unless confined and unventilated and smoking continuously for hours - no way for a positive on second hand smoke.

We also got questions about semen containing cocaine being swallowed, poppy seed muffins, etc.

Very little in the way of second hand anything would ever ring positive was the consensus.

[MCHAD]

Haha, I was going to say it depends on how high their friends were getting, how small the room was, and how good the ventilation in the room is!

[GoodVibes1313]

Thanks! Had a patient today who argued that if his urine comes back positive, it was due to second hand smoke. Had to get the manager involved because he was relentless. Of course, didn't help me that the doc who provided him the Norcos (10-325mg 2tabs p.o. bid!) didn't put him on a pain contract nor do urine checks. Ugh.

[MCHAD]

1 hour ago, GoodVibes1313 said:

Thanks! Had a patient today who argued that if his urine comes back positive, it was due to second hand smoke. Had to get the manager involved because he was relentless. Of course, didn't help me that the doc who provided him the Norcos (10-325mg 2tabs p.o. bid!) didn't put him on a pain contract nor do urine checks. Ugh.

It's stories like this that make me grateful our clinic policy is no pain management for chronic pain. 

[Reality Check 2]

Pot is legal in Washington where I am. Still federally illegal.

Some medical offices stopped caring about pot on drug screens and others kept it as a major no-no terminating offense.

Unlike alcohol, marijuana can be smoked, eaten, vaped, oiled, etc. It's concentration doesn't map like etoh in the human body and cannot be tested rapidly.

Employers don't want employees coming to work drunk or stoned but pot has proven to be a difficult substance.

It is a controversial and unstudied drug with a lot of nuances. We have no federal support in a legal state.

I believe that like etoh, it is easily abused and potentially dangerous with other drugs, alcohol and prescription drugs. I wish we had more guidance for drug screens, med mgmt and restrictions.

[MaggieMay3]

This is actually one of the things we studied in forensic toxicology - the case of Ross Rebagliati, a Canadian snowboarder whose Olympic gold medal was in jeopardy after testing positive for marijuana. His defense was that he did not partake in smoking, but was in the vicinity as others smoked.
The conclusion in our class is that passive inhalation is usually not enough to give significant blood THC concentrations - one study reporting blood THC levels of 1 - 6 ng/mL right after exposure (to give context: with normal inhalation, blood THC rises to above 100 ng/mL in the minutes immediately after, and settles to about 30 ng/mL in about 20 minutes, in a typical user). And even obtaining that level required extreme exposure - high concentration of smoke and limited volume ("hot-boxing"). Subjects complained of such severe eye irritation that they requested sealed goggles. So my toxicology professor is adamant passive inhalation does next to nothing, physiologically.

"I believe that like etoh, it is easily abused and potentially dangerous with other drugs, alcohol and prescription drugs." - Disagree.

That a pill has one compound when there are more than one “ ingredients “ for pills , for example generic vs name brand pills use different ingredients because of this. How synthetic meds have less side effects than cannabis or is somehow safer. Cannabis has zero recorded deaths due to overdoses. When I sit through pharmacist “ inservices”, it drives me crazy to see them discuss the effects, properties of cannabis with no personal experience, professionally or personally of medical use. Such as perpetuating the myth that all flower smells bad as a reason to pop a pill instead when 1. not all flower smells bad 2.using flower is the best way to obtain all the effects since it utilizes terpenes, etc.. and 3. there are many non-smoking ways to medicate. They try to Make people feel safer with what big pharma says, without providing valid education. Folks can’t make an educated decision without being educated. Many find it hard to understand a medicine that patients can take control of managing symptoms and even grow it if they wish. It’s new and scary. cbd has gained more acceptance as people feel safer with a product without thc. I recommend that folks start with cbd because it may be enough to help. Thc is not the enemy though, a touch of it often works better with neurological symptoms. What's bad about smoking marijuana is that it involves inhaling combusted plant matter that absolutely WILL form tar in your lungs.

Just check out the bong that stoner you know never cleans. See how muddy and brown it is? I guarantee that guy's lungs look about the same or worse.

Now, it does seem like marijuana is associated with less negative health outcomes than smoking Tobacco and that is likely due to a variety of reasons, I'll try to list some here:

People don't smoke weed in the same quantity as Tobacco. You might have anecdotal stories of that one Snoop Dog level friend that smokes every day all the time, but a regular weed user might smoke 1-3 times a day. A regular cigarette user might smoke a dozen times or more per day.

Smoking is not the only way to consume marijuana. There are healthier alternatives that can bypass the lungs entirely.

Cost and accessibility. While this varies from person to person, pound for pound marijuana is much more expensive than Tobacco. This leads to less consumption by weight. Less consumption by weight leads to better health outcomes. I don't find it particularly destructive. I have mild anxiety as well as insomnia. I have medical marijuana card and smoke sometimes. Much better than the sleeping pills I was using. At least this way I don't feel groggy or notice side effects like mood swings. 

Edited December 25, 2019 by MaggieMay3

[ventana]

I am in primary care

 

I contract my inherited patients for opiates and benzos

I specifically state that MJ/Cannabis is not allowed and if they test positive it will be treated like any other inappropriate positive.

there is just not enough data out there (beside peds seizures) that MJ has  any benefit.  Until there is more data I consider it a drug that should not be used by someone under contract, irrelevant to legal status of the drug.  The whole "it's legal" argument doesn't wash with me - norco and vic's are legal but we exclude people from getting them from another provider if on contract so nope, no MJ for them

[Cideous]

Not that it matters, but this article is pretty damn scary..

 

 

https://www.usatoday.com/story/news/nation/2019/12/15/weed-psychosis-high-thc-cause-suicide-schizophrenia/4168315002/

[ventana]

13 hours ago, Cideous said:

Not that it matters, but this article is pretty damn scary..

 

 

https://www.usatoday.com/story/news/nation/2019/12/15/weed-psychosis-high-thc-cause-suicide-schizophrenia/4168315002/

clinically have already seen this three times

 

I think this is a HUGE issue and one that we are going to hear more about.....  

and once you go down that rabbit hole you NEVER come out.....