Should Pain Doctors Terminate Patients When They Use Medical Marijuana?

When a person sees a pain doctor, that person may receive narcotics. Especially if that person is experiencing chronic pain and no there is no operative answer, opiates may be part of a long pain relief plan.

Multiple important side effects can occur with narcotic medications. This can include sedation, dizziness, constipation, euphoria, fatigue, anxiousness, clammy skin, respiratory depression, and a number of others.

One of the largest seen with opiates is addiction and/or tolerance. Tolerance is when the same amount of pain meds no longer provide adequate pain relief, despite the person’s chronic pain condition does not change.

One of the current pain treatment options that exists in 16 states plus DC now is medical marijuana. Treatment with medical marijuana 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, marijuana 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 people are on chronic pain medications with a pain management physician, usually a pain agreement is signed. This “contract” typically states that while a person is under his or her care, that individual will stay away from illicit drugs.

Marijuana is still federally illegal, even for medicinal purposes, despite it being legal in 16 states. A large amount of pain doctors have urine drug testing as standard for patients under care. So if a person is under contract, gets tested, and shows positive for THC (the active marijuana component), is it the right thing to do to terminate the person?

It’s a simple answer as to the pain doctor’s prerogative to “fire” the patient, but not so simple as to whether or not it’s appropriate. If the pain contract says the physician has the right to fire a patient with a positive drug test for narcotics not being prescribed, then that is difficult to argue against. If the individual is given the opportunity to fix their firing by stopping the marijuana use and re-taking the test in a few weeks, once again that is the doctor’s choice.

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 has shown effectiveness in a number of chronic pain conditions and numerous other conditions such as severe nausea/vomiting and cancer.

With marijuana remaining federally illegal and in an illicit category it places pain management doctors in a very difficult situation. If patients are tested and test positive for marijuana and then are not terminated, does it represent bias when placed in the context of other illicit substances.

Some pain physicians don’t look at marijuana as illicit because of its medicinal value, so they do not screen for it. If an individual discloses his or her marijuana use to the doctor, the issue becomes the same.

There really is no clear cut answer that the pain doctor can follow in this situation. Guidelines for management should be individualized. Hopefully as federal laws on medical marijuana change then this issue will become moot.

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