Exam Room 3: "I ate my dog's CBD treats..."

[drusso]

49 y.o. commercial fisherman with FBSS s/p L1-S1 fusion brings his "service Malamute" to office visit. Stable on methadone 10 mg BID for 9 years. "My pee test is going to be off because I ate King's medicine I get from his vet..."

What's your next move?

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[pastafan]

Obviously needs obedience training.

 

[Ligament]

Too stupid to be a patient. Discharge.

 

[TheLoneWolf]

Stupid but not criminal. Send to rehab and if gets certificate of completion then can continue the methadone. Common when someone stable, first time offence, low likelihood of diversion. If unwilling then send back to pcp. Common for our pts who test positive for marijuana or Etoh.

 

[hyperalgesia]

Convert office broom closet to supplement vending station.

 

[244913]

49 y.o. commercial fisherman with FBSS s/p L1-S1 fusion brings his "service Malamute" to office visit. Stable on methadone 10 mg BID for 9 years. "My pee test is going to be off because I ate King's medicine I get from his vet..."

What's your next move?

Take over King's meds from vet -have midlevel manage- attempt to get insurance to approve ketamine infusion for Malamute in out of network ASC as a justification for weaning CBD oil.

If insurance does not approve threaten to discharge pt and d/c methadone unless he pays cash for dog's ketamine infusion

 

[Orin]

I might piss test the malamute though just to be sure it isn't diverting, and make sure the human has got enough Naloxone to share. Good malamute's need to be protected.

That company touts 99% pure CBD without THC as measured by HPLC so I would call shenanigans on him if he pees positive.
Certificate of Analysis

 

[Ducttape]

The guy’s eating dog pills. Not that far from eating dog food.

He’s got sufficient psych problems right there.

Im willing to bet he doesn’t look like Martin Riggs.

 

[emd123]

49 y.o. commercial fisherman with FBSS s/p L1-S1 fusion brings his "service Malamute" to office visit. Stable on methadone 10 mg BID for 9 years. "My pee test is going to be off because I ate King's medicine I get from his vet..."

What's your next move?

Don't be duped by CBD. CBD is irrelevant. THC is relevant. If the UDS shows THC (which is illegal under federal law in all 50 states) then treat it as any other illicit drug in the urine, ie, no opiates ever again. If negative for THC then it's negative for THC. If you ignore a positive THC because of CBD, you're getting suckered. CBD is not THC and it's not supposed to have significant levels in it. If they test positive for an illicit, whether they took CBD or not is irrelevant. And if they took CBD with enough THC in it to show THC in their urine, then they're taking THC, and they're responsible. You either have an illicit in your urine, or not.

I can only imaging how much the DEA would love to present that in a court and make the doc look like a total idiot. "Haha. He believed the old 'I ate some dog biscuits' trick. Hahaha!" It reminds me of the doc that got duped into prescribing opiates to some guy who brought in some x-rays showing how much pain he was in. It turns out they were x-rays of his dog. And the 'pain patient' was a cop.

"Undercover cop goes to doctor with dog X-ray and is prescribed painkillers, doc arrested" Undercover cop goes to doctor with dog X-ray and is prescribed painkillers, doc arrested

 

[geauxg8rs]

The guy’s eating dog pills. Not that far from eating dog food.

He’s got sufficient psych problems right there.

Im willing to bet he doesn’t look like Martin Riggs.

You should turf him to the local vet for doggy Valium and tramadol