Only recently has "medical" marijuana begun to directly impact my psychiatric practice. When the drug was simply illegal I could deal with patients who admitted to using it just as I would if they admitted to using heroin or ecstasy. I could refer them for addiction treatment or maybe help them recognize how the drug might harm them, maybe even cause their psychiatric symptoms.
With the advent of physicians legally authorizing use of the drug as a treatment, however, I have struggled with how to approach new patients who believe that because a doctor recommended it they must need it. Were it any ordinary prescription drug I might consider whether to take over prescribing myself, or I might telephone the prescribing physician to coordinate treatment plans. But I suspect that physicians who authorize marijuana almost always do so indiscriminately with little regard for adverse effects, essentially circumventing the law in order to give these "patients" access to the drug for getting high, and I am not convinced the drug has any role in treating psychitric illness. In fact I suspect it would interfere with other treatments, or even worsen most psychiatric conditions. (Someday, just for kicks, I must try to call a marijuana doc and discuss the pros and cons of the drug for a particular patient.)
My choices of how to proceed:
- Pretend that the patient does not use the drug.
- Demand the patient stop using.
- Discharge the patient.
- Continue treating the patient, but regularly encourage them to give up the pot.
Recently another choice occurred to me: I can simply refuse to accept these patients into my practice even for an evaluation. This same approach has worked well for prospective patients who admit to wanting to continue benzodiazepines. Some time ago I made a decision to stop accepting these patients into my practice. Not only did I find the process of weaning them off to find out whether they still needed treatment of an anxiety disorder unsatisfying and troublesome, but it might discourage physicians from prescribing the drugs in the first place. I figure if physicians cannot assume that if something happens to them another physician will just pick up the ball, maybe they will try harder to find a different treatment.
Maybe if more of us refuse to accept "medical" marijuana patients we will discourage its use. Or patients will just lie about it.
I hope this just represents another stop on the road to legalizing marijuana so doctors can get out of that loop altogether.