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 biggest issues seen is tolerance and/or addiction with opiates. Tolerance is when the patient's chronic pain condition doesn't change, but the same amount of pain medication doesn't quite provide adequate pain relief any longer.
One of the newer options in 16 states plus the District of Columbia is medicinal marijuana. Treatment with marijuana may offer substantial relief that may decrease the need for high doses of opiates or in some cases provide relief where opiates do not work well.
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 obviate the need or utility for interventional pain management. When dealing with a herniated disc or a focal medical problem where a pain injection would help, medical marijuana is not the end all 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 remains federally illegal, even medicinally, despite it being legal in 16 states. A significant amount of pain doctors perform urine drug screening on their patients. So if an individual is under contract, undergoes a test, and then tests positive for THC (marijuana's active component), is it proper for the pain doctor to fire 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 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 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.
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.
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 biggest issues seen is tolerance and/or addiction with opiates. Tolerance is when the patient's chronic pain condition doesn't change, but the same amount of pain medication doesn't quite provide adequate pain relief any longer.
One of the newer options in 16 states plus the District of Columbia is medicinal marijuana. Treatment with marijuana may offer substantial relief that may decrease the need for high doses of opiates or in some cases provide relief where opiates do not work well.
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 obviate the need or utility for interventional pain management. When dealing with a herniated disc or a focal medical problem where a pain injection would help, medical marijuana is not the end all 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 remains federally illegal, even medicinally, despite it being legal in 16 states. A significant amount of pain doctors perform urine drug screening on their patients. So if an individual is under contract, undergoes a test, and then tests positive for THC (marijuana's active component), is it proper for the pain doctor to fire 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 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 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.
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.
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