Lost Residency Spot

[Mad Jack]

I'm not saying this to judge, but it sounds like a you problem more than a MJ problem. There are many adults that use it recreationally on occasion without it interfering with their lives

Amotivational syndrome is quite a real issue, as is substance-induced psychosis and first break schizophrenia with marijuana being the second hit. These issues obviously don't affect everyone, but knowing who they will affect is impossible, and knowing when someone is and isn't under the influence is impossible due to the long half-life of metabolites. This makes marijuana a particularly high liability substance for an employee to be using, as a negative outcome can easily be attributed to an institution recklessly choosing to keep someone with an established history of substance use under their employ. So whether it interferes with your life or not, the risk of it interfering with your work as a physician makes it intolerable from the perspective of most employers

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[Mad Jack]

Is the marijuana laced with something? Or does the THC cause the symptoms?
In your expert opinion, do you think these people would have developed mania/psychosis without MJ use? As in some stressor comes up in life and these pre-exposed people get the mania/psychosis anyway?
Is there any research behind this? Speaking from first hand experience, the paranoia is real and horrible.
Didn't help that I was getting high with strangers or a person with anger management issues either. Not for me.

I see plenty of people coming in with dispensary grown cannabis that most certainly isn't laced with anything that develop psychosis. The *most common* second hit for my patients is marijuana, and I'd say >80% of my schizophrenic patients have their first break in the setting of heavy marijuana or THC vape use. The ones that actually listen when I tell them to never smoke again tend to never end up on my inpatient service again, while the ones that go back to smoking almost invariably develop schizophrenia that never resolves even with cessation of cannabis use. The same can be said for the patients of mine that have amphetamine-induced psychosis, but they are a bit more rare and tend to have better outcomes overall with regard to their psychosis for whatever reason. Marijuana seems to take two or three psychotic episodes to convert someone over to a lifelong psychotic disorder, while stimulant-induced psychotic episodes seem to take a dozen or more to permanently alter a person's brain structure enough to lead to their having continued psychosis despite abstinence from the substance in question.

Marijuana has a hazard ratio of approximately 2 when it comes to psychosis when all variables are taken into account. Your risk of psychosis over a lifetime goes from approximately 1% to 2%, which is something people should be more aware of.

 

[Dr Tapatio]

Amotivational syndrome is quite a real issue, as is substance-induced psychosis and first break schizophrenia with marijuana being the second hit. These issues obviously don't affect everyone, but knowing who they will affect is impossible, and knowing when someone is and isn't under the influence is impossible due to the long half-life of metabolites. This makes marijuana a particularly high liability substance for an employee to be using, as a negative outcome can easily be attributed to an institution recklessly choosing to keep someone with an established history of substance use under their employ. So whether it interferes with your life or not, the risk of it interfering with your work as a physician makes it intolerable from the perspective of most employers

I'm not in disagreement. Sorry for the double negative. I guess I had a poor word choice when I made my comment. I'm not saying Marijuana is benign, without side-effects, or that we can predict who it will hit or who will not. My only statement is that for most people recreational use does not affect them, and you can't use personal experience (whether it is yes side-effects or no side-effects) to conclude how it'll affect the next person. I hope this clarifies my previous statement

Also I do agree that substance use can interfere in your career in legal ways

 

[Dr Tapatio]

I did say that "to me" part in my post did i not? And whats not judgmental on saying i had more of a problem than weed? Are you high right now?

You made a statement that didn't come off that way (to me). It sounded like you were trying to counter the point the other poster was making about MJ

I don't see what's judgmental of saying that it was more of a you problem. If you had a penicillin allergy, it would be a you problem and not that penicillin is bad or many would physically react the same way

I wish I was high. This is not a fight, bro

 

[ganner2012]

Dont try to fight your way back in to that Residency. Your best bet would've been to get your personal doctor to PRESCRIBE the cannabis, so that it looks like you were taking it for medical purposes, because it is legal in some states.

Nonetheless, get your PCP to prescribe it for you, so that you can clearly indicate this in you r application, or even if they ask you why you wrre terminated, you can defend yourself that way.

But don't try to fight them, dont take them to court, just move on and re-apply

 

[Candidate2017]

OP, you can always try certain psychiatry programs. It seems half my faculty use weed and a minority use hallucinogens, which is why our UDS dates are given way in advance.

 

[RangerBob]

OP, you can always try certain psychiatry programs. It seems half my faculty use weed and a minority use hallucinogens, which is why our UDS dates are given way in advance.

That’s rather troubling. And I think the program could be on shaky legal ground if they know their staff are using illicit substances and are intentionally giving UDS dates in advance to accommodate them.

 

[Candidate2017]

That’s rather troubling. And I think the program could be on shaky legal ground if they know their staff are using illicit substances and are intentionally giving UDS dates in advance to accommodate them.

Why is it troubling? Psychiatry has a long, storied history of embracing psychogenic substances and experimentation. What faculty do on their own time is their business. No one seems impaired from substances. The biggest contributors to workplace impairment in academia are senility and narcissism, not substances.

Anyway, it's a joke. I doubt there's a conspiracy to beat drug testing. If it were possible to fire psychiatrists who smoke weed on their own time, surely Scientologists would've seized upon that.

 

[ThoracicGuy]

Why is it troubling? Psychiatry has a long, storied history of embracing psychogenic substances and experimentation. What faculty do on their own time is their business. No one seems impaired from substances. The biggest contributors to workplace impairment in academia are senility and narcissism, not substances.

Anyway, it's a joke. I doubt there's a conspiracy to beat drug testing. If it were possible to fire psychiatrists who smoke weed on their own time, surely Scientologists would've seized upon that.

These substances are still against federal law. It's not worth it.

 

[RangerBob]

Why is it troubling? Psychiatry has a long, storied history of embracing psychogenic substances and experimentation. What faculty do on their own time is their business. No one seems impaired from substances. The biggest contributors to workplace impairment in academia are senility and narcissism, not substances.

Anyway, it's a joke. I doubt there's a conspiracy to beat drug testing. If it were possible to fire psychiatrists who smoke weed on their own time, surely Scientologists would've seized upon that.

It wasn’t clear to me it was a joke.

I disagree about substances not being a big contributor to workspace impairment. It’s clearly a problem if you read your state board sanctioning notices. Just because there’s a history of in psychiatry (which I’m not sure there actually is) doesn’t mean it’s ok.

Psychiatry (much like my field of PM&R), has a problem with getting the respect it deserves as a medical specialty. Hearing someone say half of their academic psych attendings are using drugs isn’t helping.

 

[Candidate2017]

These substances are still against federal law. It's not worth it.

Fun fact: some of these substances are legally prescribed for use during psychotherapy.

 

[ThoracicGuy]

Fun fact: some of these substances are legally prescribed for use during psychotherapy.

And with your description, they are not being used during psychotherapy when you are talking about what faculty does on their own time...

 

[Mass Effect]

Why is it troubling? Psychiatry has a long, storied history of embracing psychogenic substances and experimentation. What faculty do on their own time is their business. No one seems impaired from substances. The biggest contributors to workplace impairment in academia are senility and narcissism, not substances.

Anyway, it's a joke. I doubt there's a conspiracy to beat drug testing. If it were possible to fire psychiatrists who smoke weed on their own time, surely Scientologists would've seized upon that.

This post is inaccurate (and somewhat bizarre) in my experience. Don't attribute it to all of psychiatry as I assure you, most of us disagree.

 

[clausewitz2]

This post is inaccurate (and somewhat bizarre) in my experience. Don't attribute it to all of psychiatry as I assure you, most of us disagree.

One of the more recent Medscape Lifestyle Report surveys actually found that psychiatrists were the specialty second-most likely to have ever smoked marijuana. Who was first? Emergency medicine, naturally. Sure, not all physicians in either specialty are potheads or anything but is literally anyone surprised by this?

@Raryn I really wish my medical school curriculum had focused more on cannabis hyperemesis syndrome. I see this on a relatively regular basis among heavy daily users. One poor unfortunate was smoking almost an ounce a week and did not really conceive of this as a problem until the vomiting got to the point that they carried a bucket with them from room to room in their home.

In general, I am very much for legalization. However, if you can anticipate the possibility of being tested in a short period of time (weeks to months) and will have major consequences if you test positive, but still find it difficult to abstain from use, you may wish to seriously consider the extent to which you are choosing to use v. are becoming dependent.

 

[Mass Effect]

One of the more recent Medscape Lifestyle Report surveys actually found that psychiatrists were the specialty second-most likely to have ever smoked marijuana. Who was first? Emergency medicine, naturally. Sure, not all physicians in either specialty are potheads or anything but is literally anyone surprised by this?

I agree with you, but I think "ever smoked marijuana" is somewhat different from a residency program where "half my faculty use weed and a minority use hallucinogens, which is why our UDS dates are given way in advance."

That program can find itself shut down.

 

[Candidate2017]

Cannabis is basically the new abortion or 2nd Amendment. Seems like most Americans are evenly split on the topic with opinions bordering on religious fervor, with each side grasping on to bits of scientific evidence to support their opinion.

It's funny people are having a conniption regarding my assumptions that (1) half the faculty use weed, (2) a minority use hallucinogens, and (3) our UDS dates are given in advance. Even if my assumptions about faculty are correct:

(1) As pointed out above, the proportion of cannabis use is about equal or less than that reported in Medscape. If it makes you feel better, half my faculty are militantly against cannabis, one puff means your stimulant or benzo is revoked. The other half, though, would rip me if I ever diagnosed a patient with "cannabis use disorder, mild."

(2) We have a sizaeble faculty. So hallucinogen use, probably equals that of the population, or less. I don't follow faculty around, I don't know when they last used hallucinogens, the 1960s or yesterday? Who's to say they don't have their own cash shrink prescribing for them?

(3) Of course UDS dates are given in advance, just like anyone else who isn't a professional athlete. USADA doesn't jump out of the bush with unannounced blood tests. And no where did I say/guess that faculty are using cannabis or hallucinogens daily or heavily. UDS are generally useless anyway, as most substances pass within 1-2 days. Hence, the OP's original point about being aggrieved by their program switching to hair samples unannounced.

 

[michaelrack]

Why is it troubling? Psychiatry has a long, storied history of embracing psychogenic substances and experimentation. What faculty do on their own time is their business. No one seems impaired from substances. The biggest contributors to workplace impairment in academia are senility and narcissism, not substances.

Get with the times. The era of psychiatrists using cocaine and having sex with their patients is long over. It's no longer the 20th century