Is It Alright For Pain Doctors To Terminate Patients For Using Medical Marijuana?
When an individual sees a pain physician, that individual may receive narcotics. Especially if that individual is dealing with chronic pain and no operative solution exists, narcotics may be part of the long term plan.
There are significant potential side effects with opiate medications. This may include constipation, depression, sedation, euphoria, dizziness, fatigue, anxiousness, clammy skin, confusion, respiratory depression, and a slew of others.
One of the most prevalent issues seen with narcotics is tolerance and/or addiction. Tolerance is when the equivalent amount of pain medication does not provide sufficient pain relief any longer, despite the patient's painful condition staying the same.
One of the current pain treatment options that exists in 16 states plus DC now is medical marijuana. Treatment with medical marijuana doctors in Arizona may offer substantial relief that may decrease the need for increased opiate dosing or in some cases provide pain relief where narcotics have not worked.
For example, opiate meds are not a great choice for peripheral neuropathy treatment. The pain is not modulated really well, whereas, medical marijuana az works better for neuropathy.
Medical marijuana does not preclude the need for interventional pain management. With a disc herniation or a focal problem where a pain management injection would help, medical marijuana is not the answer.
When individuals are taking chronic pain medications with a pain doctor, usually a pain contract is signed. This agreement usually states that while an individual is receiving treatment, that person will not use illicit drugs.
Unfortunately, marijuana is still federally illegal despite the fact it is now legal in 16 states. And most pain doctors perform drug screening on their patients. So if a patient is under a contract, gets tested, and turns up positive for THC (the active component of marijuana), is it appropriate for the pain doctor to terminate the patient?
It's a simple answer as to whether or not the pain doctor has the right to terminate the patient, but not a simple answer as to whether it's appropriate. If the pain agreement states that the doctor has the right to terminate a patient if the drug test turns up positive for narcotics not being prescribed, then that is difficult to refute. If the patient is given the opportunity to rectify their termination by ceasing the marijuana use and re-testing in a few weeks, once again that is the doctor's prerogative.
Ethically, the situation is not so simple. Patients deserve effective pain management, and there is a big push in American not to undertreat. Medical marijuana with an Arizona medical marijuana card has shown effectiveness in a number of chronic pain conditions and numerous other conditions such as severe nausea/vomiting and cancer.
Having marijuana continue to be federally illegal and placed into the illicit category puts pain doctors in a very difficult situation. If they test patients for THC and then don't terminate patients who test positive, is it showing bias with regard to other illicit substances?
Some pain doctors do not view marijuana as an illicit substance due to its medicinal value, therefore, they do not test for it with screening. If a patient discloses the use of marijuana to the doctor, the issue becomes the same.
The point here is there really is no clear cut right and wrong answer for the pain doctor to follow. Guidelines need to be individualized. Hopefully once federal views on marijuana change then these ethical issues will become moot.

