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Should I tell my doctor about my marijuana use?
Posted 27 March 2009 - 09:21 PM
Posted 27 March 2009 - 10:10 PM
Posted 28 March 2009 - 02:43 AM
- graybeard likes this
Posted 09 April 2009 - 08:30 PM
Unfortunately, even though Cannabis use poses very little health risks and even benefits the health of many, conventional health care cannot be counted on to realize these facts. If you are in a medical position where it is prudent to your treatment that you receive controlled substances, I would not tell my doctor about marijuana use. Many doctors see marijuana use as an increased risk factor for addiction to controlled substances. This means if you have chronic pain or ADD, and would like access to opiates for pain or stimulants for ADD, telling your doctor about marijuana usage will significantly lower your chances of getting prescribed one of the aforementioned substances.
I have seen first hand the bias against marijuana smokers in our health care system. My friend has a chronic pain condition called visceral hypersensitivity, which is where the peripheral nerves of the internal organs (viscera), and the nerves they connect to in the CNS become over sensitive. What this means is that painful stimuli become even more painful and normally unpainful stimuli (the process of digestion) become painful.
Before he was diagnosed, he made sure to tell his doc about his MJ use just in case it could be somehow contributing to the problem in an unusual way. As the pain got worse and his larynx became particularly painful, he realized he wouldn't be able to rely on marijuana for pain relief as it causes his pain to increase in his throat (Marijuana causes increased acid reflux in some people due to the relaxation of the lower esophageal sphincter). His doc had been prescribing darvocet for when the pain got particularly bad. But now with the pain being worse, he needed around the clock opioid treatment. Unfortunately, his doctors would not prescribe anything over Darvocet or Tramadol (schedule II drugs) despite his tolerance to them and the fact that his pain dramatically reduced his functional ability.
IF YOU GO TO THE ER, BE AWARE THAT BIASES ARE LIKELY TO AFFECT HOW SERIOUSLY YOUR DOCTORS TAKE YOUR COMPLAINTS OR HOW THEY END UP TREATING YOUR SYMTPOM
If you go to the hospital for pain relief of an acute crisis, I would STRONGLY advise against mentioning MJ use. My friend (Brad) once had to go to the hospital because he suddenly developed an excruciating pain of his penis. I picked him up from his house and took him to the hospital because he couldn't drive. In the ER he was moaning and shaking/pulling at his hair, etc. He said he'd smoked before I picked him up but that it didn't help. In the hospital he told the nurse what was going on and that he'd just smoked to try to ease the pain but it didn't work. I instantly saw a change in the nurses disposition towards him. His mouth was also extremely dry due to the marijuana. He was told he wouldn't be able to receive any pain medication until the doctor saw him. He asked for some water for his dry throat, but was refused on the grounds that he couldn't have any water until the doctor saw him in case there were to be any blood tests (...odd rational). The nurse left and was gone for about a half an hour. When she finally came back my friend pleaded for some water but she wouldn't let him have any. (I started worrying they were wanting to drug test him for H or other Opies, because the way he was writhing in pain and complaining of nausea looked a lot like dope withdrawal). Just then my friend started to choke and gag and was spitting up on himself. He asked the nurse to look in his throat to see what was going on and she said that he was just having an acute instance of his hypersensitive condition that was being worsened by the Cannabis. She kept telling him to just calm down and I was getting infuriated in the way they were talking to him while he was in so much agony. He asked her to look in his throat just to make sure he wasn't going to die choking on something. Her response was angry and obstinate. I quote, "I don't do throats." I asked what my friend could do to help this supposed hypersensitivity. She kept talking to him like bad parent talks to a crying child. With a stern voice she said, "Just lay back and calm down, your are so excited right now its no wonder what's happening." She said he'd have to wait for the doctor to come in to have his throat looked at. I looked inside my friends throat and his Uvula (that hangy thing in the back of your throat that makes you gag if you touch it) was swollen and elongated with a bulbous grape looking thing on the end. It was hanging so low that it was resting on his tongue. The doctor finally came in asked about his pain which had subsided quite a bit at this point. He told the doctor that there was no more need for pain killers and she made a point of saying, "Well, we weren't going to give you any. We contacted your primary care physician and he said that we weren't to give you any pain medication." She looked at his uvula and confirmed that it was very swollen and elongated like I had seen. She ordered a strep test and went away. Sometime later a nurse took a swab from Brad's throat and disappeared. About 2 hours later the doctor came back and said there was no strep throat. Brad asked what had happened to his throat and what had caused the pain in his penis to onset in the first place. The doctor said that his body was in a state of hyperactivity/hypersensitivity due to the marijuana and that the pain would go away and the Uvula would shrink back to it's normal size once the marijuana wore off.
Brad was worried that this pain might generate itself again in the future and asked the doctor what to do in that situation and he told him he'd have to follow up with his PCP for that but in the meantime to stop smoking cannabis because it was "obviously" irritating the condition. This was "obviously" not the case since it wasn't until a good time after the pain was in full throttle that Brad had used cannabis that day.
There were so many things that were wrong with this hospital visit. First of all, you just can't fake the external signs of agony that accompany true unbearable pain. I would have thought they would have sent a doctor to him right away and they would given him morphine. It was two hours before he was even seen by a doctor. Second of all, I did a little research about Uvula elongation and swelling and found out that there are a number of protocol steps to take if a patient presents with this symptom. First of all, your supposed to check for epiglottitis, because it often accompanies uvilitis and can cause death by choking. They did not check for this (I would have known, because it is done by sticking a flexible tube through the nostrils and out of the nasal canal to look towards the larynx). Third, it is protocol to treat uvilitis with steroids or antihistamines depending on specific factors. Brad received no treatment for his swollen uvula. They claimed that his uvula had swollen because of a reaction to the Cannabis. Well, I did a little research and found out that while the irritants/heat of cannabis smoke can cause the uvula to swell, the most likely cause is prolonged dryness. Many people who snore, snore because of a swollen uvula which swelled as a result of sleeping with an open mouth, causing the throat to dry out. It's more likely that Brad's swollen uvula was a result of the dryness caused by cannabis use rather than from the smoke itself, considering he had went for about 3 hours immediately after smoking without a drink. This being the case, this whole problem could possibly have been avoided had he been given just a small drink of water OR if they had been more prompt about his evaluation he wouldn't have had to go so long with such a dry throat. The funny thing is, they never did run any blood tests.
The final thing about this visit that was questionable was the doctor's use of Brad's Physician's orders to justify not giving painkillers. First of all, ER doctors do not need PCP permission to administer narcotics. Second of all, Brad recently changed physicians and now sees a doctor who is comfortable with his cannabis use and believes that he would benefit from opiates for his chronic pain (he will not prescribe because he feels Brad would receive better long-term opiate treatment from a pain specialist). Apparently they have a very good relationship as well. Anyways, Brad asked his new doctor if the ER ever contacted him (it would have been at 8PM on a Saturday), and his doctor said no and was very confused and astounded that they had used his name to justify not giving pain meds.
Bottom line is this: Most health care professionals will be biased against you if they are aware of your cannabis use, unless you have one of those rare doctors who is actually educated about cannabis. Most health care professionals don't know enough about cannabis to know that it's use is not predictive of abuse of pain medication. The reason for this is that modern health care views any marijuana use as recreational and that any use is ABuse. They figure, "If he abuses one drug, he's likely to do the same with another." There is just no room in current conventional medicine (or in the law... obviously) for the distinction between marijuana use and abuse.
Still though, even if Brad were abusing cannabis (say, for example, he was smoking so compulsively that he dropped all other aspects of his life... social, academic, job, etc... and became completely dysfunctional), should that really mean that he is no longer entitled to the alleviation of excruciating pain?
I know this has been a long one and I've probably included a lot of irrelevant details to my point, but all I want to get across is that you are much less likely to receive proper palliative care if your doctor/nurse is aware of your cannabis use. I am not saying not to tell them about it in all circumstances. Ideally, a doctor would know everything about a person's lifestyle that could possibly affect the patient's health. Unfortunately, we are far from this ideal and we have to make judgement calls about when and when not to tell our doctors about our cannabis usage. If you are worried about a symptom that seems to be closely correlated or obviously caused by cannabis use, I would probably be honest with your doctor, as your doctor might misdiagnose or not find a diagnosis without that piece of information. On the other hand, if it is quite apparent that your condition is not caused by cannabis, it is probably best not to tell your doctor unless your are comfortable enough with them to be sure that they will not become biased. It is hard to decide what to do in many situations though, because you may not be sure that your symptom is unrelated to cannabis use. I can't think of any example situations right now, but I'm sure they exist. In addition to being unsure if cannabis is contributing to your symptom, if you are in pain that cannabis/OTC pain relievers cannot help, you have to recognize that your chances of getting opiates will likely be much lower if you tell your doctor about your cannabis use. I would imagine that the same would be true for ADD patients wanting schedule II stimulants like adderall, but this may be different. I don't have enough experience/information to say, but I do know that in many cases, admitting that you smoke cannabis to a doctor will create a bias in him/her and you will have a hard time receiving painkillers for legitimate purposes.
Unfortunately, there is still a large portion of the U.S. population (whether it be a majority or not, I am unsure) that views marijuana users as drug addicts and put them in the general group of "drug addicts" right along with those who heavily abuse other drugs like H or Cocaine. These people do not view marijuana as the relatively harmless drug with countless health benefits that we do. You've definitely got to keep that in mind when discussing these things with your doctor. Brad's doctor told him straight up that the likely reason he didn't get any pain alleviation at the ER was because he told them he used marijuana and that they were worried about giving controlled substances to a person with a history of "drug abuse."
Edited by dputty, 09 April 2009 - 08:38 PM.
Posted 30 July 2013 - 09:57 PM
I get that too it actually can be brought on by smoking cigs and weed or smoke of any kind
I've had an upper-respiratory infection for the past couple of weeks, and I just can't seem to kick it. I'm gonna go to the walk-in clinic in about an hour and get some antibiotics or something. I'm concerned that the doctor might ask me if I smoke. Is it medically relevant? Should I just say that I smoke cigs? I don't really know what to say.
And a good dr will be able to tell
But yes smoking can cause a respitory infection bronchitis and tonsil stones
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