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Under the Influence: Should you treat the patient?

Recreational marijuana and alcohol use cross the lines of culture, age, gender and socioeconomic status. With more states legalizing marijuana, you should prepare for this situation by establishing office policy and procedure guidelines for patients who are suspected of being under the influence.

Your patient presents for his/her scheduled appointment and your staff suspects that he/she is under the influence of either recreational marijuana or alcohol. Your staffs’ and your first reaction might be shock; however, you need to examine the situation objectively.

Recreational marijuana and alcohol use crosses all cultures, ages, genders and socioeconomic statuses. With more states legalizing marijuana, you should prepare for this situation in your medical practice by establishing office policy and procedure guidelines for patients who are suspected of being under the influence.

There are significant standard of care issues involved in this type of situation. The physician should follow the standard of care with regard to health/medicine histories, indications and contraindications.

Generally speaking a patient whose condition is stable yet he/she is inebriated or otherwise impaired should be rescheduled.

Following are some policies and procedures to consider for your medical practice:

  • Discuss the situation with the patient as to the substance, amount and when ingested. 

    • Is there a history of dependency and does he/she want to discuss and remedy this situation?   

    • Give consideration as to how accurate the patient’s responses might be.

  • Does the patient understand the impact his/her actions and dependency might have on his/her health situation? 

  • Offer/provide support materials and referral information. 

  • Recommend rescheduling the appointment.

    • Advise the patient of the importance of not indulging prior to his/her visit, and the ramifications it might have on the success of treatment if he/she indulges after treatment is rendered.

  • Safe transportation protocols may need to be initiated, and your policy should define how this is determined. 

  • Establish in-office safety protocols for you and your staff (i.e., when to call police, code words to use to alert staff of a possible problem, etc.).

Document your discussion thoroughly. Include patient comments (quotes are recommended), advice/instructions given, patient education resources provided, as well as any non-compliance. Be objective and avoid labeling the patient or the scenario.

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