Study Shows Marijuana Use May Be Linked to Opioid Noncompliance (2013)
Ft. Lauderdale, Fla.—As medical marijuana use continues to grow, pain practitioners are beginning to ask what effect, if any, its use has on the issue of potential nonadherence to existing pain treatment. Now, a study by a private corporation has revealed that marijuana use is, indeed, associated with potential nonadherence in chronic pain patients prescribed hydrocodone…
No, not indeed, not really at all.
“Physicians have different opinions on whether to test their patients for THC [a compound in marijuana],” said Michael K. DeGeorge, PharmD, associate director of medical affairs at Ameritox, a medication monitoring company based in Baltimore. “Either way, we thought it would be interesting to see if there was an association between marijuana use and nonadherence in patients, to give clinicians some information when implementing urine drug testing as part of their practice.”
You mean, you thought it would be interesting to pay for a study which the company could use to market its services to doctors who treat pain patients.
“I wasn’t really surprised that we found marijuana use to be associated with medication misuse,” Dr. Dawson said in an interview with Pain Medicine News. “But I was very surprised that it rivaled cocaine in terms of its association to other nonprescribed medications.”
Could it be because cocaine isn’t very good at relieving pain? Can even make pain worse? For a company that sells drug monitoring services, I’m surprised that ya’ll didn’t know that.
Lynn R. Webster, MD, cautioned against drawing broad-based conclusions from the retrospective study. “The analysis is based on information reported to the company at the time the tests were ordered,” said Dr. Webster, medical director at CRI Lifetree in Salt Lake City, and president of the American Academy of Pain Medicine. “It is therefore difficult to know how accurate the information is. More importantly, almost all hydrocodone is immediate release, and may not be detected if the urine sample is taken outside the detection window. For example, if a patient is prescribed hydrocodone 7.5 mg and the last dose ingested was 12 or more hours before the urine was collected, hydrocodone may not be present. Similarly, we don’t know the dose and we don’t know when the urine samples were collected for the cocaine and THC groups.”
Whether or not physicians should consider regular marijuana testing is a complicated issue given the rift between state and federal laws. “In states where marijuana is illegal, I would recommend testing,” Dr. Webster noted. “I’d also recommend that physicians counsel patients to discontinue use if they find it in their system, since physicians must advocate for legal use of all medications.
Obviously, Dr. Webster is advocating for physicians, not pain patients.
“In states that have legalized marijuana, it’s still probably wise to test for it,” Dr. Webster added. “Here, too, I would recommend physicians advise their patients to discontinue use if they are planning to prescribe a scheduled drug, particularly an opioid. Prescribing an opioid to someone using marijuana—even in states that have legalized it—may present additional legal issues due to federal laws.”
Well, Dr. Webster, if I didn’t know where you stand on treating pain patients as drug addicts, with all the monitoring that entails, I do now.