question re patient

Buprenorphine Post
deegee
Posts: 137

Postby deegee » Mon Dec 15, 2014 10:22 am

I can't remember the source, but I recall that there is evidence that quitting everything at once is a better choice than doing it piecemeal. Of course it probably varies from pt to pt. I've found that if I allow something in the beginning, it's considered OK by the patient and becomes very difficult to stop later.
For cigarettes, it's sometimes helpful to calculate how much money is spent on them. Figure out what they could have used that money for. Put the cig money in a coffee can and it adds up.

Dave
Posts: 187

Postby Dave » Mon Dec 15, 2014 10:22 am

Well, the edible THC is healthier than inhaling its smoke, but it will still cause a job loss when the employer unexpectedly requires urine sampling. I rather doubt it is more dangerous than alcohol, which, according to some new research, is unhealthy at any dose. I am not aware of statistics showing that THC causes as many deaths and accidents as alcohol does. I've never had THC in my body in any form, but I am told by some people that smoking it had little or no effect on them. I have not heard anyone say that about alcohol.

drpasser
Posts: 1404

Postby drpasser » Mon Dec 15, 2014 10:22 am

Nice comment.

Sometimes I suggest to pts, biting the bullet and stopping everything at once.

So, as far as the smoke is concerned, what about folks who only use edible THC ( now widely available in two states)?

Best
Kevin

Dave
Posts: 187

Postby Dave » Mon Dec 15, 2014 10:22 am

I tell my patients that people who die in house fires usually are not dying by roasting but by smoke inhalation. Smoke, whether tobacco or MJ, is harmful to the respiratory system and the rest of the body. It seems that my patients have a more difficult time stopping tobacco smoking than MJ. In any case with people who have addictive personalities, it is very hard for them to stop these habits. So I work on one at a time, giving them suggestions on how to do it, like skip the morning coffee and/or substitute cocoa or tea so that they don't feel they have to light up with that cup. Or use an e-cigarette with the coffee. The nicotine is less harmful than inhaled smoke. Trying to stop more than one habit at a time is very difficult. Another motivation for stopping MJ is telling them the job they just got may require drug testing at times. MJ will get them fired. It is surprising the effect that can have on the newly motivated Suboxone patient. Once the bupe kicks in and they get a new life (truly a born again experience), they will do almost anything to keep that life.

kcairns
Posts: 571

Postby kcairns » Mon Dec 15, 2014 10:22 am

crmark,interesting to ponder about, mj becoming recognized as more injurious as country procedes towards making it more easily available...but is treatment for mj dependency w/o med****ist any better than that for opioid dependency w/o med****ist? otherwise the right approach would be just ask folks to just say no to both and we wouldnt have to bother w bup ---that vs the approach of not denying rx that works for a frequently fatal illness just because the pt also happens to have another illness (nonfatal) for which there is no rx that works very well .....for me tho, even more troubling is --(use this for an example) --the writer of very successful books on how to parent adolescents notes in passing that it is common for teens to go to drinking parties in parent's homes and she does not seem to regard this as an issue .. i read the evidence to say that w highly addictive substances which can be harmful...the only time one for sure has free will enough to just say no is before the very first use....and what we see is that teens are just going nuts to say yes to the first use of mj and etoh...the questions are , imo, DOES use of these make life better or not?..i am sure of my answer, but could i be wrong? ...seems to me that teen using is but the symptom of a disease ---and the disease is that of being clueless to that which would be our common human destination --nonsubstance highs -- like the significance/evocation of John Eberhart's "Lament for a Red Planet --"Ten thousand hundred thousand dusty years ago, did my river flow. It stroked the stones and spoke in tongues and splashed against my face" -- and Chris Hedges "Powerful Acts of Love" , "It is choosing to create good in the world...It is the small, inconspicuous things we do that reveal the pity and beauty and ultimate power and mystery of human existence" --- and -- like -- for teens -- that their clearminded peers do already know very well that the kids who really are coolest and those who get most out of any social setting and stand out as superior beings are doing so without the need of any substance....ie "Song of Myself".. "my soul stands cool and composed before a thousand universes"...o if only this could be so for so many more of this giving and needing earth's teeming coming of age citizens -- even if only for their own benefit in their own lives...

crmark
Posts: 38

Postby crmark » Mon Dec 15, 2014 10:22 am

Good pun Dave! I had a "fling "with MJ as a member of the "older" generation-today's MJ is at least 100 times more potent and more dangerous than we realize. I have a patient right now in residential treatment who is exhibiting "unmasked schizophrenia" that we're increasingly seeing in young MJ smokers. There is overlap of the endorphin and endocanabinoid systems-that's why MJ relieves opioid WD symptoms. The endocanabinoid system is also now being implicated and recognized as instrumental in the withdrawal syndromes and development of tolerance for other drugs of abuse. Just doesn't make intuitive sense to allow, condone, even promote continued MJ abuse in an opioid addict who is serious about recovery. Would be like telling my alcoholics it's ok to keep drinking "near beer"!

drpasser
Posts: 1404

Postby drpasser » Mon Dec 15, 2014 10:22 am

So, your pts get the first strike, without consequence? What about the second strike? Do your pts know, they are allowed three strikes?

entjwb
Posts: 180

Postby entjwb » Mon Dec 15, 2014 10:22 am

My criteria for continued treatment is to stay free of any opiate or illegal substance. I have a three strike program so I give them ample opportunity to change and continue therapy. If they can't do that them I will replace with a patient who will be serious about getting and staying clean.

drpasser
Posts: 1404

Postby drpasser » Mon Dec 15, 2014 10:22 am

MJ, IMO, is generally not as problematic as concomitant cocaine use in an opiate addict. Cocaine and Opiates are deadly by themselves and worse whem coadministered. I agree that MJ can and does negatively impact on recovery.

Dave
Posts: 187

Postby Dave » Mon Dec 15, 2014 10:22 am

crmark, you may be right. I wonder if the tendency to accept marijuana but not cocaine has anything to do with the younger generations of physicians who have had their fling with the weed and found it not too bad. Or is it the fact that so many opiate addicts also use the weed and that would reduce the treatable population if they were "weeded" out (pun intended) of the therapy group?


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