New state guidance for addiction services and treatment programs in New York advises against routine screening for marijuana use, an approach designed to parallel that used for alcohol. Some clinicians see the change, which is being implemented following the state\u2019s legalization of cannabis, as a step away from an abstinence-only view of recovery and toward a more flexible approach aimed at minimizing harm.<\/p>\n
\u201cWith the legalization of adult-use cannabis in NYS, testing for the metabolite of THC routinely is not recommended unless the patient has identified a reduction in, or cessation of cannabis as part of their treatment goals,\u201d says a guidance document from the New York State (NYS) Office of Addiction Services and Supports (OASAS) that was updated late last month.<\/p>\n
\u201cAlcohol and THC metabolites should not be included in routine toxicology panels,\u201d it adds, \u201cunless a clinician determines that alcohol or cannabis is a concern and toxicology testing would be appropriate clinically.\u201d<\/p>\n
The advisory from OASAS, which says it oversees approximately 1,700 prevention, treatment and recovery programs for substance use disorders (SUDs) across the state in addition to a dozen treatment centers it directly operates, applies to \u201cproviders working in OASAS-certified programs who use toxicology testing over the course of a patient\u2019s treatment.\u201d The office\u2019s website describes its approach as \u201cresponsive, data-driven, person-centered, and prioritizes equity.\u201d<\/p>\n
An OASAS representative told Marijuana Moment that the advisory \u201cis similar to guidance about alcohol use, and the same principles regarding alcohol were used to create this guidance document.\u201d<\/p>\n
Asked about the prudence of the shift, Bryon Adinoff, the president of the advocacy group Doctors for Drug Policy Reform (formerly known as Doctors for Cannabis Regulation<\/a>), said it made him reflect on why treatment programs typically screen patients for drug use in the first place.<\/p>\n \u201cAs an addiction psychiatrist who worked with individuals with SUDs for several decades and was director of two [Department of Veterans Affairs] SUD programs, I appreciated getting relatively complete urine drug panels on patients,\u201d he said in an email to Marijuana Moment. \u201cHowever, NY\u2019s guidance has got me thinking about it.\u201d<\/p>\n \u201cWhile I would still insist on a full screening upon admission, if there is no history of use or misuse of cannabis, then why continue to get it?\u201d he asked. \u201cIt\u2019s a fair question.\u201d<\/p>\n Adinoff said the change is \u201can understandable attempt to give patients agency over their treatment and allow them input into what labs are obtained.\u201d<\/p>\n He and other clinicians noted that while their goal is to help patients end problematic drug use, sometimes screening for drugs as a matter of course can actually put patients at risk. In some cases, for example, patients using medication for opioid use disorder, such as buprenorphine or methadone, might have access to those medications cut off if they test positive for THC.<\/p>\n \u201cI assume that at least part of this effort,\u201d Adinoff said, \u201cis to address this unfortunate legacy. In that sense, I appreciate the effort.\u201d<\/p>\n He noted that positive cannabis tests can also put patients at risk of employment, housing or legal consequences, even if cannabis isn\u2019t the substance causing problems in their lives.<\/p>\n In general, the OASAS guidance advises against reporting positive results of presumptive drug testing to third parties, saying such reporting \u201cshould not occur prior to receiving confirmation by patient self-report or definitive\/confirmatory toxicology testing.\u201d<\/p>\n Despite his overall support for the change, Adinoff doubted its practical effect. \u201cProbably the most important part of the guidelines is to get the clinician thinking about the purpose of the drug testing and how it will inform treatment,\u201d he said, though he acknowledged that determining an individually appropriate screening panel for each patient could be \u201ca time-consuming effort.\u201d<\/p>\n On top of that, Adinoff said clinicians are so used to defaulting to in-depth screenings, many won\u2019t heed the OASAS advice.<\/p>\n \u201cClinicians are used to ordering the full panel,\u201d he said. \u201cIt will take a lot more than \u2018guidance\u2019 to get them to change their ways.\u201d<\/p>\n Peter Grinspoon, a cannabis specialist at Massachusetts General Hospital and a Harvard Medical School instructor who\u2019s written about the messy interaction between politics and cannabis science in the book Seeing Through the Smoke, framed the OASAS guidance<\/a>\u00a0as a matter of reducing harm. \u201cThis is one of those questions where you can\u2019t really disentangle the social history and the politics from the science,\u201d he told Marijuana moment in an interview last week.<\/p>\n Historically, Grinspoon noted, \u201ca lot of this is predicated on the idea that cannabis was a gateway to addiction\u201d\u2014an idea he dismissed as a \u201cfoolish notion.\u201d<\/p>\n But often a doctor\u2019s views of the potential benefits or harms of marijuana, he added, \u201cdepends on his or her vantage point.\u201d<\/p>\n \u201cFor example, it\u2019s hard to find an oncologist who isn\u2019t pro-cannabis,\u201d given the potential benefits of cannabis use in treating the symptoms of cancer and cancer treatment, Grinspoon said. \u201cOn the other end of the spectrum is the pediatric psychiatrists, who see the very rare but tragic cases.\u201d<\/p>\n As for addiction treatment providers, he said they\u2019ve \u201cbeen a big part of the problem with cannabis, because they really just get in their own echo chamber about the harms, and they don\u2019t have the context of, like, yes, sure, this can happen, and it\u2019s tragic when it does happen, but it\u2019s not what usually happens.\u201d<\/p>\n Grinspoon said he\u2019s happy to acknowledge that some cannabis users do develop problem use, though he noted it\u2019s far less common\u2014and typically less extreme\u2014than other SUDs. Because of that, in cases where marijuana use is unrelated to or even beneficial for someone\u2019s recovery\u2014for example, in circumstances where cannabinoids might ease a patient\u2019s opioid withdrawal\u2014he said it makes sense not to screen for THC by default.<\/p>\n It\u2019s all about harm reduction, Grinspoon said, emphasizing that drug screening can be useful in some cases but also potentially carry severe negative consequences. He pointed to recent reports of South Carolina authorities taking children away from mothers who test positive for cannabis use. \u201cThat\u2019s way worse! We don\u2019t even know that cannabis is bad for people who are pregnant,\u201d he noted, \u201cWe just don\u2019t know it\u2019s safe.\u201d<\/p>\n He welcomed the OASAS guidance as a sign that officials are more aware of the nuances of drug testing.<\/p>\n \u201cAs a clinician, there\u2019s some circumstances where it\u2019s helpful,\u201d he said. \u201cWe just have to be very, very cognizant of the consequences of any screening, especially when it\u2019s something as politicized as cannabis, or we\u2019re going to end up harming more people than we help.\u201d<\/p>\n In an email response to questions from Marijuana Moment about the new guidance, OASAS said information from drug screenings \u201cis used in collaboration with the patient\u2019s history, medical exam, and other information to set an approach to care.\u201d<\/p>\n \u201cThese screens are done in a patient-centered way, tailored to each individual and their treatment goals,\u201d a spokesperson said. \u201cWhile urine drug screens provide information about substance use, they are not a diagnosis of a substance use disorder.\u201d<\/p>\n OASAS guidance isn\u2019t alone in focusing less on cannabis. Just last month, a major manufacturer of drug testing technology, Psychemedics, announced a new screening panel that no longer detects marijuana and instead prioritizes fentanyl<\/a> and other controlled substances like cocaine and amphetamines. The company described the change as \u201cshifting the spotlight from marijuana to the paramount threat of fentanyl.\u201d<\/p>\n Amid the shifting legal landscape, an increasing number of states have also enacted protections for workers who use state-legal marijuana off duty, preventing employers from taking adverse action over state-sanctioned activities.<\/p>\n For example, California\u2019s governor recently approved a bill to\u00a0prohibit employers from asking job applicants about prior marijuana use<\/a>.<\/p>\n In Michigan, a policy took effect this month that\u00a0ends\u00a0pre-employment drug testing\u00a0for marijuana for most government job applicants<\/a>, while also giving people who\u2019ve already been penalized over positive THC tests an opportunity to have the sanction retroactively rescinded.<\/p>\n In May, the governor of Washington State\u00a0signed a bill into law that will protect workers<\/a>\u00a0 from facing employment discrimination during the hiring process over their lawful use of marijuana.<\/p>\n That means Washington has joined Nevada in prohibiting discrimination against job applicants for testing positive for marijuana. New York also provides broader employment protections for adults who legally use cannabis during off-hours and away from work.<\/p>\n At the congressional level, the House Rules Committee has repeatedly blocked attempts by lawmakers to\u00a0end the practice of drug testing federal job applicants for marijuana<\/a>\u00a0as part of large-scale spending bills this session.<\/p>\n Over in the Senate, however, members passed defense legislation in July that contains provisions to bar intelligence agencies like the CIA and NSA from\u00a0denying security clearances to applicants solely due to their past marijuana<\/a>\u00a0use.<\/p>\n The House Oversight and Accountability Committee also passed a standalone bipartisan bill in September that would prevent the denial of federal employment or security clearances based on a candidate\u2019s past marijuana use<\/a>.<\/p>\n At the same time, there are growing concerns about fentanyl in the drug supply. While\u00a0experts have challenged claims about fentanyl-laced marijuana<\/a>, there\u2019s recognition that the potent opioid is being detected in drugs like heroin and cocaine.<\/p>\n Federal Health Agency Releases Revised Drug Survey With New Data On Marijuana Product Preferences And CBD<\/a><\/p>\n<\/blockquote>\n\n The post New York Officials Advise Drug Treatment Providers To Stop Testing Patients For Marijuana In Most Cases<\/a> appeared first on Marijuana Moment<\/a>.<\/p>\n
New state guidance for addiction services and treatment programs in New York advises against routine screening for marijuana use, an approach designed to parallel that used for alcohol. Some clinicians see the change, which is being implemented following the state\u2019s legalization of cannabis, as a step away from an abstinence-onlyContinue Reading<\/a><\/span><\/p>\n","protected":false},"author":24,"featured_media":0,"comment_status":"false","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[18,81],"tags":[],"_links":{"self":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts\/70183"}],"collection":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/users\/24"}],"replies":[{"embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/comments?post=70183"}],"version-history":[{"count":1,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts\/70183\/revisions"}],"predecessor-version":[{"id":70184,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts\/70183\/revisions\/70184"}],"wp:attachment":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/media?parent=70183"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/categories?post=70183"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/tags?post=70183"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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\nRead More: New York Officials Advise Drug Treatment Providers To Stop Testing Patients For Marijuana In Most Cases<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"