[MCOH-EH] Marijuana... again
nrodway at hotmail.com
Wed Feb 2 12:34:02 PST 2022
Thank you, Dr. Swift, as usual, for your insight.
Serial testing for THC is typically done with a THC/Cr ratio rather than absolute value of THC
Nancy Rodway MD MPH
From: MCOH-EH <mcoh-eh-bounces at mylist.net> on behalf of Swift, Melanie D., M.D., M.P.H. via MCOH-EH <mcoh-eh at mylist.net>
Sent: Wednesday, February 2, 2022 2:19 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>; Thorne, Craig <Craig.Thorne at YNHH.ORG>
Subject: Re: [MCOH-EH] Marijuana... again
Well, here we are in the Brave New World where pretty soon recreational marijuana will just be legal everywhere. I am not at all sure this is a good thing, but that’s my crotchety old fart side I suppose. We aren’t there yet, but it does seem the tide has turned and we’re headed there. So marijuana will be, like alcohol, a legal substance that is addictive and potentially impairing, and still has implications for safety-sensitive jobs. I think as we see more states legalize recreational marijuana, we’ll need to shift to treating it more like alcohol for work-relatd testing purposes. It’s not illegal to use alcohol when you are off duty, or before you start a job, but you cannot be impaired by it. The trouble with THC is (and that would be a great name for a musical – The Trouble with THC) that unlike alcohol we don’t have a laboratory test that correlates with impairment and clearance of metabolite is days to weeks (or even months sometimes) compared to hours.
Setting aside regulated testing for a moment, and just thinking about healthcare workers: I think we may see more employers remove it from their preemployment panel for HCP in states with legal recreational marijuana. But it really should remain on the panel for reasonable suspicion, return to duty, and follow up tests. If you have evidence of impairment, or you have a substance use disorder and are under a monitoring agreement that requires abstinence, it’s still important to test for THC metabolites. If positive, we have to assume impairment for reasonable suspicion tests. If positive on a RTD test one could do serial testing with quantitative values to confirm they are not continuing to use. Clearance can take a very long time, but if they are using their level should not be dropping consistently.
Just my opinion,
From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Thorne, Craig via MCOH-EH
Sent: Monday, January 31, 2022 12:29 PM
To: mcoh-eh at mylist.net
Cc: Thorne, Craig <Craig.Thorne at YNHH.ORG>
Subject: [EXTERNAL] [MCOH-EH] Marijuana... again
Good afternoon All,
So, with marijuana now legal in the state of CT, hospitals are looking to each other to determine if they should accept recreational marijuana use as a legitimate explanation for a positive THC test. The law gives some leeway to health care organizations to make their own decision about this – at least for now.
Another topic of discussion is whether we should find a reasonable HCW panel that does not include marijuana.
Any thoughts from you pioneers out there that you want to share would be greatly appreciated.
Craig D. Thorne, M.D., MPH, MBA
Chief Medical Director, Occupational Medicine and Business Health Services
(203) 687-5281 mobile
“Feeling gratitude and not expressing it is like wrapping a present and not giving it”.
-William Arthur Ward, American writer and thought leader
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