Drug testing

[Blade07]

Were you ever tested in your time at Saba? I'm not a regular user but let's just say I was in Amsterdam recently and I immersed myself in the local "culture." ;) It should be completely out of my system by the time I start next semester but I was just curious to know.

[tintin24]

yes, you are tested 'randomly' every semester.

[Reggie_Mantle]

What does 'randomly' mean? (they're biased against ....??)
And from what I hear it takes 30 days to clear out from the system??

[DRDRWMD]

Saba does drug testing? I never knew.

[tintin24]

What does 'randomly' mean? (they're biased against ....??)
And from what I hear it takes 30 days to clear out from the system??
no no, they are not biased or anything; i hope not.
but from observation, some people get tested more than others (its just my observation). i guess it depends on your history, and reputation as a student.
i heard that a 'group' of students in upper sem. were reported for recreational drugs, and the next day, the whole 'group' was asked to come to the office. it was very obvious...
from my obs. guys get tested more frequently than girls.

[golfman]

I have been tested 2 times this semester. I they say they just take a section of names on the roll and use those. But it seems to start wherever they want it to on the roll to include the people they want to test. The only thing in my urine is Rip-it. For those not here yet, you will get aquainted soon enough. It's all that keeps me awake in class.

[stephew]

you will be subject to testing the rest of your career. Local "culture" can get your license revoked. remember: you dont have a right to be a doc. you need to decide if you are willing to give up certain things.

[mafia29]

whaaaaaaa.... random drug tests? i didnt read or sign anything anywhere to that, did i?

[stephew]

if you havent you will at some point. no one wants a stoned physician.

[mafia29]

i wasn't insinuating that i take part in recreational drugs or activities of that nature, but rather a breach of civil liberties and rights....

[jameslynton]

... but rather a breach of civil liberties and rights....Actually - it is not a breach of your civil liberties. You are joining a heavily self regulated profession. I know of several Doc's who could not stay clean and sober. They have to take disability after being caught three times. No more license - until they are clean for a year if then.

[Blade07]

Personally, I think it's unfair. I can understand testing for dangerous narcotics like cocaine and heroin, which are highly addictive and can have very serious consequences on a user's mental and physical health. But there are no studies which indicate that cannabis is any worse than alcohol (and in many ways it is better). It is in fact much more difficult to become chemically addicted to cannabis than it is to alcohol. A doctor can enjoy a few drinks from time to time and still be a competent physician so long as he is completely sober on the job. Likewise, as long as a doctor isn't stoned on the job, there shouldn't be a problem if he uses marijuana in moderation. Just because a low concentratin of cannabis metabolites are found in a person's urine doesn't mean he/she is high. These metabolites stay in the urine for up to a month.

*end of rant*

But alas, there is nothing I can do about it and I value my medical career more than partaking in one of life's finer pleasures. But that doesn't mean I can't be angry about it!

[facetguy]

Blade,

Unfair?? Do you REALLY believe that it's ok for a physician to smoke pot even "in moderation"? If that is truly your belief system, please be sure to let us know where you'll be practicing so we can be forewarned.

[Blade07]

Blade,

Unfair?? Do you REALLY believe that it's ok for a physician to smoke pot even "in moderation"? If that is truly your belief system, please be sure to let us know where you'll be practicing so we can be forewarned.

Is it OK for a physician to drink alcohol in moderation? If your answer to this question is yes, then could provide some reasons as to why it's okay to use alcohol in moderation and not cannabis?

[ReckonerMD]

...provide some reasons as to why it's okay to use alcohol in moderation and not cannabis?

...because alcohol consumption is legal and cannabis is not?

[Blade07]

...because alcohol consumption is legal and cannabis is not?

Yes and not so long ago it was perfectly legal to deny housing, employment, education and service on the basis of race. But that's not the point.

What I'm getting at is: if it is possible for a physician to drink in moderation and still be competent, then what reason is their to assume that a physician cannot be competent if he uses marijuana in moderation? Let's just enter into a fantasy world for a second in which pot is legal/completely decriminalized.

[Reggie_Mantle]

blade07 ownd

[ducman]

You guys will get along just fine in Ethics class!

[Experienced]

if you havent you will at some point. no one wants a stoned physician.

LOL, or one that keeps leaving the exam room to go eat Twinkies. :shock:

[js_paramedic_1979]

The Grand Rounds topic last week at St. Mary's Health Center, St. Louis, MO was given by a guy who works as an interventionist for physicians in the state of MO. The top 4 things that he is called for include: 1) Drug/Alcohol addicition, 2) Attitude problems, 3) Sexual harrassment issues, and 4) Psychiatric illness. He came prepared with 14yrs of stories to support how common this stuff happens. Stories included tales of surgeons throwing scalpels, anesthesiologists who were addicted to narcotics, and physicians who were black-mailed by ex-girlfriends who had been their patients..

I'm not joining the above argument, I just thought it was interesting to see this topic after last week's lecture!!

[golfman]

Blade07

You are wasting your time trying to convince us why its ok to smoke pot. I'm afraid you can't change the rule of all the hospitals in the US on this forum. Ultimately, this is something you are going to have to deal with. If you want to be an MD, then you have to refrain from it. I understand your logic, but this is simply the decision you are going to have to make. Is it more important for you to recreationally smoke or to be an MD.

[JeebusLives]

I agree with Blade but also with golfman. Ive only been tested once so far in my time here but i still wouldnt risk getting disciplined. From what i know, if you test positive they send you back to the US (paid from your own pocket) for a psychiatric evalutaion to see if you should be allowed to continute. I suppose they want to find out if youre addicted or something. Also i was told by students currently in rotations that they havent been tested at all yet. Dont know anything beyond that.

[mower1000]

This is a pretty interesting discussion. Considering the DSM IV criteria for cannabis dependence (addiction), if a medical student insists on using pot knowing that they are risking their future MD chances (by getting caught, getting arrested, being reported by another student, being "given up" by their dealer, etc.), this would indicate to me that they have enough of "mental preoccupation with chemical use" that they may have a "problem" with pot and are not just recreationally using it anymore. IMHO.

While, I do agree that recreationally using pot is probably not much more dangerous than similarly using alcohol, the rest of the world certainly doesn't see it that way. I can rationalize all I want that "weed should be legal", etc., but it simply isn't in the US. I can see where my future patients would not want their doctor to use illegal drugs in any manner.

It is interesting to note that I am hearing more and more that hospital administrators and doctors are noting those residents/interns who may have problems with alcohol. Coming in for your shift red-eyed and hung-over isn't ignored anymore (so I hear). The truth is that 11-14 million alcoholics (and a smaller number of other drug addicts) are in the US population right now. That's a lot. Where do all of them work?

In my humble opinion, smoking pot while in med school or afterwards is a very bad idea. Similarly, abusing alcohol is also a very bad idea. We should all strive to do neither. If we find ourselves doing either, we owe it to the people we serve to get help and possible substance abuse treatment. Just my thoughts...

[Blade07]

You'll notice I ended my post with this:

"But alas, there is nothing I can do about it and I value my medical career more than partaking in one of life's finer pleasures. But that doesn't mean I can't be angry about it!"

Like I said, I'm not a regular user and I can do without it. Basically, for various cultural and political reasons, marijuana smoking is viewed as wrong whereas drinking isn't even though marijuana is no worse than alcohol. I was just ranting. It's the libertarian in me coming out.

[ReckonerMD]

..marijuana smoking is viewed as wrong whereas drinking isn't even though marijuana is no worse than alcohol..

Perhaps you can cite the scholarly sources you are basing your opinion on? All the research I've done (I must concede, limited at best) has pointed toward the results of retrospective studies following outcomes research (most notably the WHO study) where even the most optimistic interpretation of the results is tained by the fact that there are so many factors one cannot control for in retrospective analysis (the biggest being that most users of cannibis are also avid alcohol users, as cited in the WHO report.) that it's impossible to make an objective claim about the use of marijuana vs. alcohol such as you have.

Unless there is a double-blind placebo controlled, radomized trial comparing alcohol use and marijuana on some objective positive benefit to the general population (aside from medicinal use for certain patient populations) I've overlooked, I'm afraid I will never be sympathetic to this argument.

[mower1000]

You'll notice I ended my post with this:

"But alas, there is nothing I can do about it and I value my medical career more than partaking in one of life's finer pleasures. But that doesn't mean I can't be angry about it!"

Like I said, I'm not a regular user and I can do without it. Basically, for various cultural and political reasons, marijuana smoking is viewed as wrong whereas drinking isn't even though marijuana is no worse than alcohol. I was just ranting. It's the libertarian in me coming out.

Sorry Blade07--I did read your conclusion and I do agree with you. I am sorry if I appeared to be lecturing to you. I was speaking out loud as well. I think your conclusion is the correct one (IMHO).

[jameslynton]

....Like I said, I'm not a regular user and I can do without it. Basically, for various cultural and political reasons, marijuana smoking is viewed as wrong whereas drinking isn't even though marijuana is no worse than alcohol. I was just ranting. It's the libertarian in me coming out.If you look at the history of drug enforcement in the US - it is pretty much is fear based thing. There is not a not of logic in it. The US is now one of the most restricted governments as far as the use of drugs goes now.

Many local governments and school boards now have a zero tolerance policy to just about everything. There have been several cases where a student gave another student a loritab/vicodine or asprin/advil/tylonol and is punished like a drug dealer. One case a student had the small one blade swiss army knife left on the dash of his car in the school parking lot and was prosecuted as having a deadly weapon and they attempted to sentence convict him as a class A felon. To me this is government behaving badly. However, we have to life with these things. So it goes. That's my rant.

[mafia29]

there was a study done recently in the UK on marijuana use ... and how it affected every day activities such as driving etc. It was actually shown that it increased concentration and awareness of ones surroundings and even in some cases response time... just telling ya what i read...

so do you think doctors in the actual netherlands (amsterdam) smoke up?

[Blade07]

Perhaps you can cite the scholarly sources you are basing your opinion on? All the research I've done (I must concede, limited at best) has pointed toward the results of retrospective studies following outcomes research (most notably the WHO study) where even the most optimistic interpretation of the results is tained by the fact that there are so many factors one cannot control for in retrospective analysis (the biggest being that most users of cannibis are also avid alcohol users, as cited in the WHO report.) that it's impossible to make an objective claim about the use of marijuana vs. alcohol such as you have.

Unless there is a double-blind placebo controlled, radomized trial comparing alcohol use and marijuana on some objective positive benefit to the general population (aside from medicinal use for certain patient populations) I've overlooked, I'm afraid I will never be sympathetic to this argument.

I can't be bothered to dig up a bunch of links but this Wikipedia article is a good starting point:

Health issues and effects of cannabis - Wikipedia, the free encyclopedia

Yes, I know Wikipedia is not an authoritative source, but the article cites 92 references and many of them are studies published in peer reviewed scientific journals.

There are still a lot of unresolved issues regarding cannabis but there are a few things we can be reasonably certain about:

-Unless you're shooting it up (which is very rare), it's impossible to OD on marijuana unless you're trying REALLY hard to kill yourself. Even then there's some doubt as to whether it's physically possible.
-Marijuana is less chemically addictive than alcohol and narcotics such as cocaine, heroin etc.
-Although more research is required, the few studies that have been conducted so far have been unable to demonstrate that marijuana use (up to moderately high dosages) significantly impairs driving ability.

I've done some research on the topic and I haven't seen much evidence to indicate that marijuana is anymore dangerous than alcohol. Why are alcohol and tobacco legal and not marijuana? I think it's because alchol and tobacco have been well established as part of mainstream Western culture for a long time now whereas marijuana only started to become popular as a recreational drug relatively recently.

[Reggie_Mantle]

one obvious reason, taxing..
(Its easy to grow anywhere)

[ReckonerMD]

I can't be bothered to dig up a bunch of links..

Well, than if you are not prepared to defend your position on this issue with any rational, empirical evidence, than I don't understand why you think others should respect your opinion.

Yes, I know Wikipedia is not an authoritative sourceYou are correct.

Although more research is required, the few studies that have been conducted so far have been unable to demonstrate that marijuana use (up to moderately high dosages) significantly impairs driving ability.This is incorrect. I managed to find a research article on this topic and there are a few valid placebo controlled randomized trials (not retrospective analysis of accidents and blood alcohol/marijuana presence) done looking at this and all of them found marijuana to impair driving ability. It only took 3 seconds to find this on google Driving Impairment from Marijuana and Alcohol - October 1, 2000 - American Academy of Family Physicians (http://www.aafp.org/afp/20001001/tips/6.html) and I'm sure more detailed trials are available on PubMed.

I've done some research on the topic and I haven't seen much evidence to indicate that marijuana is anymore dangerous than alcohol.Absence of evidence is not evidence of absence.

Why are alcohol and tobacco legal and not marijuana? I think it's because alchol and tobacco have been well established as part of mainstream Western culture for a long time now whereas marijuana only started to become popular as a recreational drug relatively recently.Well, thats a testable thesis.

In any event, good luck.

[Gigi25]

Does anyone else think that this thread is pointless? There are ALWAYS going to be people defending both sides of the arguement. IF you want to smoke pot, go to Amsterdam (or back to college for some). If you want to be a doctor, it would be wise not to... And yes they do drug test and more than once a semester. If you are "blacklisted" or suspicious they will test you many times...So it's not really random

[ReckonerMD]

Does anyone else think that this thread is pointless?

Not in the slightest; perhaps the topic is taboo and dated, which was a sidepoint. Nonetheless the larger issue, which I was trying to highlight, was you cannot simply hold a certain opinion based on anecdote and not be able to provide evidence suffice to argue your side against anyone with a bit of reason and common sense.

Otherwise, things would be different. The main point (providing and analyzing data to support beliefs, and furthermore convince people to follow your lead) is invaluable as future physicians and scientists.

That is all..

[JeebusLives]

I think it'll be legalized soon enough. Almost all of the presidential candidates want to legalize it for medicinal uses so soon afterwards they can do legitimate studies on the effects it has on those people with prescriptions. It'll take a few years but i think it'll be done.

[Blade07]

Well, than if you are not prepared to defend your position on this issue with any rational, empirical evidence, than I don't understand why you think others should respect your opinion.
I could find links but that would take a great deal of time. I did provide you with 92 references including some articles published in peer reviewed journals. Of course, one major problem is that marijuana is not legal in most places and thus it is difficult to do testing on it.
This is incorrect. I managed to find a research article on this topic and there are a few valid placebo controlled randomized trials (not retrospective analysis of accidents and blood alcohol/marijuana presence) done looking at this and all of them found marijuana to impair driving ability. It only took 3 seconds to find this on google Driving Impairment from Marijuana and Alcohol - October 1, 2000 - American Academy of Family Physicians (http://www.aafp.org/afp/20001001/tips/6.html) and I'm sure more detailed trials are available on PubMed. The summary said severe impairment was reported when subjects took both marijuana and alcohol (big surprise!) but it said nothing about the extent of impairment when taking cannabis alone.
The Wiki article linked to this (http://www.dft.gov.uk/pgr/roadsafety/research/rsrr/theme3/cannabisanddrivingareviewoft4764). Here (http://www.dft.gov.uk/pgr/roadsafety/research/rsrr/theme3/cannabisanddrivingareviewoft4764?page=8#a1029) is a list of studies conducted on the effects of cannabis on driving ability. Not all of them found significant impairment.
Also that summary didn't quite elaborate on what specifically it meant by "impairment." Some studies found that users on average drove slower, took wider turns etc. but they still had a safe level control.
On a less serious note, check out this video:
http://www.youtube.com/watch?v=sLmHL7YznUI :p

At any rate, it’s prudent never to drive, work or handle machinery while in any pharmacologically altered state of consciousness.
Absence of evidence is not evidence of absence. That's true but that doesn't help the assertion that marijuana is more dangerous than tobacco or alcohol. That is (ostensibly) the reason why the latter two drugs are legal and cannabis isn’t.
Also, we can be reasonably certain that cannabis has a far lower toxicity than alcohol and that it’s virtually impossible to fatally overdose on marijuana through smoking. On the other hand thousands of people die of alcohol poisoning every year. We can also be reasonably certain that cannabis is less chemically addictive than alcohol and tobacco.

[JLea]

Dude, they even fire you at Wal-Mart for failing a test for Cannibis!

[darkmansaad]

if weed smoking makes students dumber i think the last thing saba needs is drugs...otherwise curves will change from the now standard 10 point curve to maybe 15 points thus lowering the effective pass rate to 60

yeah high standards

[JeebusLives]

or maybe were all already on weed and the curve without it would be only 5. making the pass a 70. :)

[mafia29]

do you have to sign a consent once youre ont he island?
do they test you as soon as you get on the island?

[wolfvgang22]

Marijuana can be detected for about a month. Hopefully you didn't take anything harder than that in Amsterdam.
I never got drug tested until the very end of my time on the island during basic sciences. I took this as a sign that school staff figured I never used drugs except an occasional social cigar or drink. On the other hand, those who were known to be much more "social" were tested each and every semester, sometimes twice. So no, it's not that random. It's a very small island.

My main complaint about drug testing in medicine, as a hard working student who has sacrificed a LOT to get this far has to do with the consequences of testing positive for drugs.
Why do physicians and students who abuse drugs and get caught often get only "slaps on the wrist"? From what I've personally seen at Saba, students who are caught abusing drugs are placed on probation and then given the choice to attend drug rehab and return to the island. If they don't do this they get expelled. Starting to use drugs is an immoral choice violating school policy that causes the illness of drug addiction. Well, cheating during tests is also an immoral choice that violates school policy. But if you get caught cheating - no, even just suspected of cheating, actually - you are immediately expelled at Saba. No rehab for cheaters. If you cheat on the USMLE you will likewise also never become a physician in the U.S. But drug abusers get chance after chance if you read state medical board proceedings. Being an impaired physician is just as bad as being an ignorant physician. Drug abuse by physicians is not better than something like cheating, it's just more sexy.

[darkmansaad]

so what your saying is.....wearing tight shirts after working out to look big will result in a steroid test? i guess i better upgrade those scrub sizes to L

[CMSS]

Yes, the drug test is random and it is done every semester.

[ancylostoma]

There is no steroid test..it is a simple drug test .and in first sem you will get tested at some point. If you smoke...stop now