Is It Acceptable for Pain Main Management Physicians to Fire 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 more recent pain management options in DC plus sixteen states is medical marijuana. Marijuana treatment can provide significant relief that can reduce the need for higher narcotic dosing or in certain cases give pain relief where opiates have not worked.

For instance, opiate medications are not a great choice for peripheral neuropathies. They just don’t modulate the pain well, whereas, medical marijuana works very well for these issues.

Medicinal marijuana doesn’t negate the need or utility for interventional pain management. With a focal medical problem or disk herniation where a pain management injection would help, medical marijuana is not the answer.

When patients are on chronic pain medications with a pain doctor, typically a pain contract is signed. The “contract” usually states that while a patient is under his or her care, the patient will not use 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.

With marijuana being federally illegal, and in an illicit status, it puts pain doctors in a difficult situation. If individuals are tested and show up positive for THC and are then not fired, does it show bias when put into context with additional 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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