“I Had No Idea I Could Get in Trouble for That!”

Guidelines for Physicians and Recreational Alcohol/Drug Use

By Steve Adelman, M.D.

Attorneys who help physicians with employment and licensure issues are used to hearing doctors utter those words. The recreational use of psychoactive substances such as alcohol and marijuana can definitely be a source of trouble for practicing physicians.

Allow me to explain: Physicians are smart and capable problem-solvers with excellent interpersonal skills and the ability to adroitly navigate a complex, evolving health care system. However, for even the very best physicians, use of a psychoactive substance or the existence of a symptomatic health condition that interferes with a doctor’s proficiency has the potential to impair performance.

Simply, impaired physician performance can jeopardize patient safety. For this reason, on-duty physicians are expected to be free of the effects of mind-altering substances such as alcohol and marijuana. Furthermore, doctors who have been diagnosed with an addictive disorder are expected to remain clean and sober as long as they continue to practice medicine.

But what about recreational use of alcohol, a legal psychoactive substance, and marijuana, a psychoactive substance that has been decriminalized, medicalized, and legalized in Colorado and Washington? What should practicing physicians who do not suffer from an addictive disorder bear in mind as they consider personal use of alcohol and marijuana?

As for alcohol, I refer to this course of action as “clean-margin drinking.” Physicians without a history of an alcohol problem who choose to drink should consider the following guidelines:

  • Never on duty or on call (if you’re reachable, you’re on duty)
  • Aim to stay well below the legal limit (impaired cognitive performance commences at 0.05)
  • Women: one to two standard drinks per sitting; Men: one to three drinks per sitting (even less on nights before you are scheduled to work)
  • Avoid daily drinking
  • Avoid drinking before driving
  • Never combine alcohol with sedating medication

What about marijuana? Recreational marijuana use is currently illegal in the Commonwealth of Massachusetts. It continues to be classified in Schedule 1 by the DEA. Schedule l drugs are defined as having no currently accepted medical use and a high potential for abuse. It is never prudent for licensed physicians to violate the laws of the Commonwealth or the guidelines of the DEA.

What about physicians who suffer from debilitating medical conditions that qualify them to obtain and possess marijuana for medical use? This remains uncharted territory. It is possible that some may view physicians with debilitating medical conditions who use marijuana to control pain as unable to practice medicine with optimal skill and safety — either because of the debilitating condition itself, or because of the effects of the substance being used for medication.

However, even when someone may not be under the active effects of marijuana, the mere existence of it in one’s system could pose risks. Unlike alcohol, marijuana use has a biological footprint that lingers in the body for weeks. THC levels sometimes even rise after cessation of use before they decrease and disappear.

Because of the pharmacology of THC, and because various regulatory bodies have yet to weigh in on the potentially thorny matter of medical marijuana use in practicing physicians, this poses some particular risks for any use of marijuana by an actively practicing physician.

It may be difficult to demonstrate the difference between impairment as a result of the effects of marijuana in the system, and the mere presence of marijuana in the system absent any impairment.

As access and attitude toward alcohol and — in particular — marijuana change in our society, careful consideration must be given to the use of them by those in high-risk professions, including that of medicine.

This article first appeared in the August 2014 edition of the Massachusetts Medical Society publication Vital Signs. Steve Adelman, M.D., is director of Physician Health Services, a non-profit corporation founded by the Massachusetts Medical Society.

Physician Health Services, Inc., is a non-profit corporation founded by the Massachusetts Medical Society. PHS  provides confidential consultation and support to physicians, residents, and medical students facing concerns related to alcoholism, substance abuse, behavioral or mental health issues, or physical illness. PHS also provides a safe environment where physicians can talk to other physicians about the stress and demands of modern medical practices. For more information, visit the PHS website or call PHS at (781) 434-7404.

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