# Medics with prescribed marijuana



## anonymou55 (Jun 29, 2014)

Here's a good one I've read from medics both American and Canadian. A current medic is prescribed medical marijuana by his MD for insomnia/sleep-aid due to stress. And it is used as prescribed (sleep aid ) i.e.: never before a shift. Appropriately. Would they suffer any consequences? Considering your MD suggested it for you, no different than being prescribed pills.

Opinions from medics working in Canada?


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## Anjel (Jun 29, 2014)

anonymou55 said:


> Here's a good one I've read from medics both American and Canadian. A current medic is prescribed medical marijuana by his MD for insomnia/sleep-aid due to stress. And it is used as prescribed (sleep aid ) i.e.: never before a shift. Appropriately. Would they suffer any consequences? Considering your MD suggested it for you, no different than being prescribed pills.
> 
> 
> 
> Opinions from medics working in Canada?




This should probably have it's own thread so it doesn't get lost.


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## Chimpie (Jun 29, 2014)

Anjel said:


> This should probably have it's own thread so it doesn't get lost.



Done.



anonymou55 said:


> Here's a good one I've read from medics both American and Canadian. A current medic is prescribed medical marijuana by his MD for insomnia/sleep-aid due to stress. And it is used as prescribed (sleep aid ) i.e.: never before a shift. Appropriately. *Would they suffer any consequences?* Considering your MD suggested it for you, no different than being prescribed pills.
> 
> Opinions from medics working in Canada?



This is borderline asking for legal advice which is against our rules...


> *No Legal Advice or Attorney-Client Relationship*
> 
> Information contained on or made available through EMTLife forums is not intended to and does not constitute legal advice, recommendations, mediation or counseling of any kind under any circumstance and no attorney-client relationship is formed. Do not act on or rely on any information from EMTLife Message Boards without consulting with a licensed attorney.



... but I'll allow it for the time being since this is a relevant time for the discussion. As marijuana becomes more legally available, all employers (inside and outside the EMS industry) will have to start discussing this and start writing policies.


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## TransportJockey (Jun 29, 2014)

As it stands if you test positive for it, with our without a script, you're probably going to be terminated.


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## Drax (Jun 29, 2014)

TransportJockey said:


> As it stands if you test positive for it, with our without a script, you're probably going to be terminated.



Citizens would question the provider's ability to make sound judgments and treat patients appropriately. Even more so if the paramedic was a firefighter as well. It is the media and also tradition, regardless of its use (and benefits-if there are any), that will prevent this from being acceptable.

Can one be tested for immediate marijuana use? Like a comparable BAC? If not, besides the provider, or who is to prove that it was used prior to a specified time constraint or after?

Personally, I think the purpose it was prescribed for can be and has been treated by other means.


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## TransportJockey (Jun 29, 2014)

Drax said:


> Citizens would question the provider's ability to make sound judgments and treat patients appropriately. Even more so if the paramedic was a firefighter as well. It is the media and also tradition, regardless of its use (and benefits-if there are any), that will prevent this from being acceptable.
> 
> Can one be tested for immediate marijuana use? Like a comparable BAC? If not, besides the provider, or who is to prove that it was used prior to a specified time constraint or after?
> 
> Personally, I think the purpose it was prescribed for can be and has been treated by other means.



It also is not under the FDA system as anything other than a schedule 1, so federally it's illegal. And we do fall under some federal regs, like DOT.


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## Anjel (Jun 29, 2014)

Let's say it was federally legal. 

What's the difference between people taking Vicodin and working or those smoking marijuana the day before a shift. 

I think it's gonna be a huge grey area. EMS providers should probably try and avoid marijuana use at all costs. There are other alternatives that just aren't as "cool".


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## Tigger (Jun 29, 2014)

Drax said:


> Citizens would question the provider's ability to make sound judgments and treat patients appropriately. Even more so if the paramedic was a firefighter as well. It is the media and also tradition, regardless of its use (and benefits-if there are any), that will prevent this from being acceptable.
> 
> Can one be tested for immediate marijuana use? Like a comparable BAC? If not, besides the provider, or who is to prove that it was used prior to a specified time constraint or after?
> 
> Personally, I think the purpose it was prescribed for can be and has been treated by other means.



I'm not sure how being a firefighter makes it any better or worse...

That said, there is a swab test in development to show current levels but there is no incentive for anyone to begin using it. It's still Schedule 1, so any trace of it in your system is considered illicit. 

Most companies drug test in the way their insurance wants it done, and I doubt a huge company like VFIS or something would develop separate plans for 2/48 states.


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## PotatoMedic (Jun 29, 2014)

Some employers test for nicotine because while employed for them they are not allowed to use it.   It is perfectly legal drug.  Over the counter even!  But the employer can say yes or no to it.  Also let's say you had teeth pulled.  Your Dr gives you a script for hydromorphone.  You take it and not before :censored::censored::censored::censored:.  If something happens and you test positive your still at fault.  Even though it was legal.  

I know a lot of PD that refuse to take narcotics for pain because they cannot work if there is even a trace of the medication in their system.  

TLR. Don't do drugs and work.  Even legal ones.


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## anonymou55 (Jun 29, 2014)

Exactly, medical marijuana is increasingly becoming more acceptable and available. I know in the US the federal laws trump a states legal standpoint. However in Canada medical marijuana is quickly gaining popularity as it is a natural plant opposed to taking pharmaceuticals. As a medic I believe in the wonders of modern day medicine, however when a natural substance works then, why choose man made. After all, as someone mentioned above taking a Vicodin the day before a shift should be no different then using a small amount of medical marijuana to alleviate stress. I'm sure a lot of medics enjoy a cold beer after a hard shift, alcohol has worse long term effects on the body. Again, presuming in the future when medical marijuana is available nation wide or even as far as regulated/taxed as alcohol. Some people had mentioned the medics reliability would be questioned. He/she would not be under the influence while on duty, presuming they use strictly as prescribed. I personally don't see anything wrong with this. Again presuming it is treated appropriately there for not effecting their duties.


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## Drax (Jun 29, 2014)

Anjel said:


> Let's say it was federally legal.
> 
> What's the difference between people taking Vicodin and working or those smoking marijuana the day before a shift.
> 
> I think it's gonna be a huge grey area. EMS providers should probably try and avoid marijuana use at all costs. There are other alternatives that just aren't as "cool".



To answer your question, you're not even really supposed to take Vicodin and work. 

"This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages." - WebMD


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## Drax (Jun 29, 2014)

anonymou55 said:


> Exactly, medical marijuana is increasingly becoming more acceptable and available. I know in the US the federal laws trump a states legal standpoint. However in Canada medical marijuana is quickly gaining popularity as it is a natural plant opposed to taking pharmaceuticals. As a medic I believe in the wonders of modern day medicine, however when a natural substance works then, why choose man made. After all, as someone mentioned above taking a Vicodin the day before a shift should be no different then using a small amount of medical marijuana to alleviate stress. I'm sure a lot of medics enjoy a cold beer after a hard shift, alcohol has worse long term effects on the body. Again, presuming in the future when medical marijuana is available nation wide or even as far as regulated/taxed as alcohol. Some people had mentioned the medics reliability would be questioned. He/she would not be under the influence while on duty, presuming they use strictly as prescribed. I personally don't see anything wrong with this. Again presuming it is treated appropriately there for not effecting their duties.



Why would natural be better for you than man made? I mean I can think of situations for preference of either forms of medicine. Smoke is still smoke. Honestly, I'll take the same stance on alcohol as anything else. A little bit, may not do a lot of damage, but a great deal of anything certainly can. Even cigarettes or caffeine. 

I'm not saying this should be a disqualifier or application for termination of employment, but if you are a chronic user of OTC medications, controlled substances/medications (including alcohol), or the addicted to legal substances and drugs, you really should take a step back and do a simple self eval for being fit for duty. After determining that under this circumstance that you're good to go, do you think 10 times out of 10 the next guy would be? Would you feel completely ok with admitting to doing these things at a physical health examination or is it something you would not bring up even if asked?

As previously stated, no one SHOULD be taking vicodin before a shift, it is as negligent as having a beer before taking a drive. Under the influence is under the influence and should not be based on levels in blood, urine, saliva, or otherwise. You know what you're doing is wrong-there isn't a grey area.

Professionalism isn't limited to EMS for me. Would taking vicodin or medicinal marijuana be acceptable for all professions? Say 8 hours before flying a passenger airplane? 12 hours before engaging in a fire fight against an enemy in combat?

My answer is, I would prefer someone to not be reliant on any particular substance/medication/drug at all.


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## Drax (Jun 29, 2014)

Tigger said:


> I'm not sure how being a firefighter makes it any better or worse...
> 
> That said, there is a swab test in development to show current levels but there is no incentive for anyone to begin using it. It's still Schedule 1, so any trace of it in your system is considered illicit.
> 
> Most companies drug test in the way their insurance wants it done, and I doubt a huge company like VFIS or something would develop separate plans for 2/48 states.



Doesn't make it any better or worse in terms of responsibility, just the concept that fire is paramilitary and it is more of a media thing. Private companies versus government. One doing drugs makes the company look bad as opposed to the entire public safety/government system looking bad. In the end, it is equally as bad, just difference in public view.


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## Anjel (Jun 29, 2014)

No but here if you test positive for narcotics and have a script it is ok. People work while taking pain medication all the time. 

Same with adderall. You will test positive for amphetamines. But it's ok if you have a script.


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## Drax (Jun 29, 2014)

Anjel said:


> No but here if you test positive for narcotics and have a script it is ok. People work while taking pain medication all the time.
> 
> Same with adderall. You will test positive for amphetamines. But it's ok if you have a script.



Right, well, I don't honestly don't know the situation with Adderall or amphetamine salts. My guess, since it is given to students and to professional football players, it is probably more welcome in the work place.

But yeah you're right, if you get tested and you have opiates in your system, in most cases, nothing comes of it if you have a prescription for it, at least, in the military. 

It should probably accompany a serious injury or recent dental work though. I would be shocked to find a work place that relied on individuals to be in their best physical condition as a condition of employment to accept chronic use of narcotics.


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## DrankTheKoolaid (Jun 29, 2014)

Your going to get termed with or without a recommendation from an MD. 

Due to a lack of a fail safe method of testing for acute intoxication vs chronic storage of the metabolite any positive will be construed as acutely under the influence


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## Tigger (Jun 29, 2014)

Drax said:


> Doesn't make it any better or worse in terms of responsibility, just the concept that fire is paramilitary and it is more of a media thing. Private companies versus government. One doing drugs makes the company look bad as opposed to the entire public safety/government system looking bad. In the end, it is equally as bad, just difference in public view.



I work for a government agency with a rank structure. We don't do anything fire related. I have many friends who work for similar systems. 

The public view is the same, there is no difference. 

Sorry, I'm just sick of people talking about how much more the public cares about the FD. Here they care about EMS first, fire second, and for good reason.


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## LACoGurneyjockey (Jun 29, 2014)

I know a medic who is constantly on a significant amount of opiate pain medication for a lingering back injury. This is when he's working, when he's at home, when he's driving, and the very rare occasion he operates heavy machinery...
Why is it that this is acceptable but someone smoking marijuana before, or in this case during, a shift is unacceptable. Personally, I don't think either have any place in this industry, and if that's what you need to function thru a shift you shouldn't be working. That's a career ending back injury, not a reason to be constantly in a diluted mental state.
And god forbid he doesn't have his norco for a few hours, as there's just no way he can function even as a marginally competent medic without it. Why is this even a discussion? Does anyone think it's ok to be drunk at work, even if I'm just a little buzzed? But because a doctor prescribed it (maybe the same doctor that was doing compressions on a conscious patient last week) there's nothing anyone can do about it.



Tigger said:


> Sorry, I'm just sick of people talking about how much more the public cares about the FD. Here they care about EMS first, fire second, and for good reason.



Drax, Tigger, can this be a separate thread where we just blatantly and unprofessionally bash firefighters? In good taste, of course... Strange how few of our calls actually involve a patient on fire.


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## Drax (Jun 30, 2014)

LACoGurneyjockey said:


> I know a medic who is constantly on a significant amount of opiate pain medication for a lingering back injury. This is when he's working, when he's at home, when he's driving, and the very rare occasion he operates heavy machinery...
> Why is it that this is acceptable but someone smoking marijuana before, or in this case during, a shift is unacceptable. Personally, I don't think either have any place in this industry, and if that's what you need to function thru a shift you shouldn't be working. That's a career ending back injury, not a reason to be constantly in a diluted mental state.
> And god forbid he doesn't have his norco for a few hours, as there's just no way he can function even as a marginally competent medic without it. Why is this even a discussion? Does anyone think it's ok to be drunk at work, even if I'm just a little buzzed? But because a doctor prescribed it (maybe the same doctor that was doing compressions on a conscious patient last week) there's nothing anyone can do about it.


There should be a company physician (for every type of agency) who screens any member taking medication that was not prescribed by that physician. That physician should make the fit for duty call. If you were placed on narcotics by an outside provider, you should then, be upfront about it.

Additionally as a means to deter this from being kept quiet by the individual. Randomized mandatory drug screening. A positive finding followed by a request for records from an outside provider by the company physician if not prescribed by him. This should be a condition of employment.


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## Drax (Jun 30, 2014)

Tigger said:


> I work for a government agency with a rank structure. We don't do anything fire related. I have many friends who work for similar systems.
> 
> The public view is the same, there is no difference.
> 
> Sorry, I'm just sick of people talking about how much more the public cares about the FD. Here they care about EMS first, fire second, and for good reason.



I am referring to any government owned agency, it is just the standard, at least where I am from and many places I'm familiar with do not have government owned EMS except through Fire. 

I even clarified here that I was referencing privately owned EMS:


Drax said:


> Doesn't make it any better or worse in terms of responsibility, just the concept that fire is paramilitary and it is more of a media thing. Private companies versus government. One doing drugs makes the company look bad as opposed to the entire public safety/government system looking bad. In the end, it is equally as bad, just difference in public view.



If you were government owned, it would look just as bad. 

If two articles were to be published in the paper, one being drug/substance abuse by an EMT working for a private agency and another by a member of a fire department who was an EMT, which do you think would gain the most attention by the public?


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## WildlandEMT89 (Jul 4, 2014)

Drax said:


> Why would natural be better for you than man made? I mean I can think of situations for preference of either forms of medicine. Smoke is still smoke. Honestly, I'll take the same stance on alcohol as anything else. A little bit, may not do a lot of damage, but a great deal of anything certainly can. Even cigarettes or caffeine.
> 
> I'm not saying this should be a disqualifier or application for termination of employment, but if you are a chronic user of OTC medications, controlled substances/medications (including alcohol), or the addicted to legal substances and drugs, you really should take a step back and do a simple self eval for being fit for duty. After determining that under this circumstance that you're good to go, do you think 10 times out of 10 the next guy would be? Would you feel completely ok with admitting to doing these things at a physical health examination or is it something you would not bring up even if asked?
> 
> ...


I agree with most everything you have said, but having done some research into the topic there are many smoke free avenues of ingestion as well as strains made specifically to not give a hallucinogenic effect.

That being said given the drugs federal status it really has no place in the public service and I can't see it being allowed by any agencies until that changes


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## Drax (Jul 4, 2014)

WildlandEMT89 said:


> I agree with most everything you have said, but having done some research into the topic there are many smoke free avenues of ingestion as well as strains made specifically to not give a hallucinogenic effect.
> 
> That being said given the drugs federal status it really has no place in the public service and I can't see it being allowed by any agencies until that changes



I didn't realize it was classified as a hallucinogenic drug at all. Wasn't during EMT school anyway. I mean, can we really determine it has no long term effect? Medication can take a toll on your liver after prolonged or excessive use.

I don't think I've seen any official studies on the substance, therefore I can not say whether or not it has beneficial properties and whether or not it's use outweigh's the cons of having it legalized either medicinally or recreationally.


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## LACoGurneyjockey (Jul 4, 2014)

WildlandEMT89 said:


> That being said given the drugs federal status it really has no place in the public service and I can't see it being allowed by any agencies until that changes



If it were legal under federal law would you then be ok with the paramedic treating your family having smoked weed earlier that day? Vicodin is legal, does that make it ok before or during a shift? Same goes for alcohol. The issue is how it impacts your judgement, cognition, and ability to make decisions on the fly, not its legal status.


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## Drax (Jul 4, 2014)

LACoGurneyjockey said:


> If it were legal under federal law would you then be ok with the paramedic treating your family having smoked weed earlier that day? Vicodin is legal, does that make it ok before or during a shift? Same goes for alcohol. The issue is how it impacts your judgement, cognition, and ability to make decisions on the fly, not its legal status.



Hit the nail on the head.


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## WildlandEMT89 (Jul 4, 2014)

LACoGurneyjockey said:


> If it were legal under federal law would you then be ok with the paramedic treating your family having smoked weed earlier that day? Vicodin is legal, does that make it ok before or during a shift? Same goes for alcohol. The issue is how it impacts your judgement, cognition, and ability to make decisions on the fly, not its legal status.


I personally do but believe that drug use has a place among fist responders of any role while active wether the substance has just been taken our is merely residual in the system. If something is debilitating enough to warrant such drastic medicating I feel that it off debilitating enough to warrant medical leave.
 And while marijuana is not a hallucinogenic, it's effects are often described as such, I was not intending to refer to that being the classification.

I was merely trying to state that if someday federal law changes stance on the subject that SOPs will have a lot more to take into account aside from a blanket yes or no.


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## DrParasite (Jul 5, 2014)

Anjel said:


> No but here if you test positive for narcotics and have a script it is ok. People work while taking pain medication all the time.
> 
> Same with adderall. You will test positive for amphetamines. But it's ok if you have a script.


not only that, but I don't know of any MD's who will prescribe nicotine or cigarettes.

The question isn't the substance itself, but rather having a physician directive to take it.  

If your physician is directing you to take any substance, that is legal with the doctors order, why should your employer be able to punish you?  And why should your employers subjective policy trump a medical professional who is treating you for a condition?


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## Rialaigh (Jul 5, 2014)

DrParasite said:


> not only that, but I don't know of any MD's who will prescribe nicotine or cigarettes.
> 
> The question isn't the substance itself, but rather having a physician directive to take it.
> 
> If your physician is directing you to take any substance, that is legal with the doctors order, why should your employer be able to punish you? * And why should your employers subjective policy trump a medical professional who is treating you for a condition?*




Not to drive off topic here with a sly remark but....because I can go to any number of doctors within 30 miles of here, complain about chronic back pain and anxiety, and get a script for 120 norcos and some xanax...bet I could pick them up with in 3 hours...


I completely understand employers skeptacism of employee conditions requiring controlled substances. 


There are many reasons an employers subjective policy should trump just about anything. The first of which is the employer should have the right to make just about any rules he/she wants and enforce them. If its a private company (I will completely agree that government agencies are held to a different standard, and rightfully so), the it is private money. They can decide who to hire, who to fire, what standards to use, etc. I have no issue at all with private companies having nearly free reign over all decision making. If a private company states you cannot drink or eat anything with caffeine while on duty but you can smoke anywhere you want...its up to them. If you don't like it don't work there. If the people utilizing the service don't like it they will lose their contract....just let the free market work..


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## MonkeyArrow (Jul 5, 2014)

Assuming it becomes legal under federal law, I can see a case like this going to court very quickly where an employee takes marijuana under the direction of a doctor to treat XYZ, tests positive for it, and gets fired. IMHO, it's a pretty strong and valid argument to sugget that an employer prventing you from getting the necssary medical treatment you require is borderline criminal negligent. Just like a policy not requiring seatbelt use is negligent as it will increase the chances of getting someone hurt in an accident, so it restricting access to a medical treatment. 

If you're worried about decision making abilities, you ask the employee to get a note from a doctor saying John's decision making process is not impaired by this medication in order to remove liability. Or even if you're still worried, you give him paid leave/short-term disability. It is not the employer's place to restrict your access to living a healthy lifestyle.


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## LACoGurneyjockey (Jul 5, 2014)

MonkeyArrow said:


> If you're worried about decision making abilities, you ask the employee to get a note from a doctor saying John's decision making process is not impaired by this medication in order to remove liability. Or even if you're still worried, you give him paid leave/short-term disability. It is not the employer's place to restrict your access to living a healthy lifestyle.



I'm not worried about the liability, and I fail to see how a doctors note makes a narcotic pain med any less of a mind altering substance. I live in the area where I work, and I'm simply not ok with the medic who treats me being under the influence of vicodin, marijuana, Ativan, whatever the duck a doctor decides to say "doesn't impact Johns decision making process". How is being reliant on opiates living a healthy lifestyle. There is no data that suggests narcotics have any benefit in long term pain management, and enormous potential for abuse and addiction. A healthy life style would be removing you and your chronic back injury from a career that will continue to physically tax you beyond your means, and requires more mental presence than you're willing to put in.


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## Carlos Danger (Jul 5, 2014)

LACoGurneyjockey said:


> There is no data that suggests narcotics have any benefit in pain management beyond 3-4 weeks, and enormous potential for abuse and addiction.



Uh.....what?


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## LACoGurneyjockey (Jul 5, 2014)

Remi said:


> Uh.....what?


In 2 words, were you trying to say you think opioids are a good solution in the long term for chronic pain, particularly in an EMS setting? You're gonna have to be more specific...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073133/
http://www.medpagetoday.com/PainManagement/PainManagement/33014

Don't get me wrong, I think 50mcg of fentanyl will do wonders for that hip fracture, but sending grandma home with 3 months of percocet is not an effective solution, and is only going to lead to dependance and ultimately withdrawals or addiction, your choice.


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## Carlos Danger (Jul 5, 2014)

LACoGurneyjockey said:


> Don't get me wrong, I think 50mcg of fentanyl will do wonders for that hip fracture, but sending grandma home with 3 months of percocet is not an effective solution, and is only going to lead to dependance and ultimately withdrawals or addiction, your choice.



The management of chronic pain is a broad and complex topic that is unfortunately made much more complicated by the ignorance and prejudices held by many, as well as both the direct and collateral effects of that ongoing farce that we still ridiculously refer to as the "war on drugs". 

I can't help but wonder about your (and most others) qualifications to judge the appropriateness of the analgesic prescriptions written by a physician for a specific patient. The fact that so many are so quick to judge that opioids aren't necessary for individuals is one of those prejudices that I mentioned above. These days, no one gives out a script for controlled substances lightly. There still aren't exactly a lot of options, though, for people who hurt. 

Also, you are vastly overestimating the effects of chronic controlled substances on an individual's ability to work. Not everyone who takes vicodin or asks for dilaudid in the ED is a drug seeker or ends up dying of an OD. There are lots of normal, functional, otherwise healthy people who take controlled substances every day. They work, drive, make decisions, and yes, even treat patients.


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## LACoGurneyjockey (Jul 5, 2014)

Remi said:


> The management of chronic pain is a broad and complex topic that is unfortunately made much more complicated by the ignorance and prejudices held by many, as well as both the direct and collateral effects of that ongoing farce that we still ridiculously refer to as the "war on drugs".





Remi said:


> These days, no one gives out a script for controlled substances lightly. There still aren't exactly a lot of options, though, for people who hurt.
> 
> Also, you are vastly overestimating the effects of chronic controlled substances on an individual's ability to work. Not everyone who takes vicodin or asks for dilaudid in the ED is a drug seeker or ends up dying of an OD. There are lots of normal, functional, otherwise healthy people who take controlled substances every day. They work, drive, make decisions, and yes, even treat patients.


 ...but they don't do so nearly as well as someone not impaired. And back to someone else's post earlier, I could walk into a pain management clinic 20 minutes from home complaining of chronic back pain, and have a script filled before bed that night. 
You are vastly overestimating the competency of some doctors who make their living on pain management. 
I may be prejudiced, and that may come from my own struggles with addiction, having an all too close up view of what it did to my ability to work and my general wellbeing. 

I never mentioned "the war on drugs", nor did I imply someone with chronic pain being treated with opioids is a drug seeker. The war on drugs is a joke, but that doesn't mean the healthcare professional responsible for my or my family's wellbeing has a pass to do whatever drugs they want. 
If you need narcotic pain meds to function as a medic, I don't think this is the place for you anymore. Just like if you needed alcohol, marijuana, or any other altering substance. You can't really believe that your decision making is unaffected by 10mg of hydrocodone, and once you get to that point of tolerance being without your drugs is just as debilitating. Yes, if you've been taking vicodin every 4 hours for the past 4 years, you won't have much of an altered mentation when you're on it (at least, not that you can notice anymore). But then try going without for a day, and see if you can function. Or you get a 5 hour hike out at hour 3.5 since your last pill. Are you going to be able to function as well as your partner, or are you going to be a liability to your patient and yourself? If you fell asleep at the wheel an hour after your last dose, can you say with 100% certainty that would have happened in the exact same way had you not been taking a medication known to cause drowsiness?

If you hurt, I don't think the solution is for you to suck it up and stop pretending, that's just absurd. But I also don't think you should continue to do a job that requires so much of you mentally and physically, with such a severe injury that requires long term narcotic pain management to have any quality of life. And the reality is, if you continue to take opioids for an extended period of time, you have such a high probability of developing an addiction on top of what was (and maybe still is) legitimate chronic pain.


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## Rialaigh (Jul 6, 2014)

Remi said:


> The management of chronic pain is a broad and complex topic that is unfortunately made much more complicated by the ignorance and prejudices held by many, as well as both the direct and collateral effects of that ongoing farce that we still ridiculously refer to as the "war on drugs".
> 
> I can't help but wonder about your (and most others) qualifications to judge the appropriateness of the analgesic prescriptions written by a physician for a specific patient. The fact that so many are so quick to judge that opioids aren't necessary for individuals is one of those prejudices that I mentioned above. These days, no one gives out a script for controlled substances lightly. There still aren't exactly a lot of options, though, for people who hurt.
> 
> Also, you are vastly overestimating the effects of chronic controlled substances on an individual's ability to work. Not everyone who takes vicodin or asks for dilaudid in the ED is a drug seeker or ends up dying of an OD. *There are lots of normal, functional, otherwise healthy people who take controlled substances every day. They work, drive, make decisions, and yes, even treat patient*s.



I'm not sure where your from but I am a 24 year old male here in the south. I could get off shift in 30 minutes and have a script written, filled, and picked up for 90 norcos by 10am. I have no medical history indicative of needing pain meds (really no medical history at all). If I stated I was anxious I could have myself 30 xanax with it. 




You may see them, the population I treat I don't. I would put money that 95%+ of the patients that I have picked up this year, that are on narcotics more then 6 months out of the year, are also on government disability. I don't see the people that work or make responsible decisions yet are on narcotics daily. I see lots of people who drive on them...and regularly pick them up out of the ditch.  Part of the problem here (like everywhere) is a very high percentage of the people that live in the county I work use narcotics. And there are 0 pain doctors or pain clinics in the county, It is simply from family practice doctors handing the stuff out to everyone because the residents are too poor or don't have the right insurance to travel out of the county to the pain clinic (or more simply put just dont have a ride.). 


In America we condition ourselves to have problems simply so we can fix them. We give everything a label in the name of finding a cure. I'm not saying pains not real, I am saying we do pain management incredibly poorly....


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## Carlos Danger (Jul 6, 2014)

The last two posts prove my point about prejudice.

In EMS, you see the negative results of people abusing narcotics very visibly. What's much less visible to you is the majority of people who use them responsibly. I've known flight nurses and even a surgeon who used narcotics long-term, and quite a few people who use clonazepam and other benzos for anxiety. All were working professionals who you would never know was "on something". 

As a clinician, it would serve you well to find a way to view these things more objectively.


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## Rialaigh (Jul 6, 2014)

Remi said:


> The last two posts prove my point about prejudice.
> 
> In EMS, you see the negative results of people abusing narcotics very visibly. What's much less visible to you is the majority of people who use them responsibly. I've known flight nurses and even a surgeon who used narcotics long-term, and quite a few people who use clonazepam and other benzos for anxiety. All were working professionals who you would never know was "on something".
> 
> As a clinician, it would serve you well to find a way to view these things more objectively.





I am fairly sure that the majority of people do not use them responsibly in my area. I can also assure you that regardless of the number of people that use them responsibly, the United States by far has the worst problem of narcotic abuse in the world. I see the negative results of people abusing them because they are visible, because they are a major problem with the healthcare system and how we handle these patients. 

Objectively the US has the largest problem of prescription drug abuse in the world. Objectively the US does an incredibly poor job of pain management despite having more tools than any other country in the world. Objectively the US spends more on recovering drug addicts than any other country with much worse results for the systems we use. 



This goes way off the marijuana topic and likely deserves a topic of its own. On the topic of legalized pot, I see a very complicated solution coming down the pipeline involving multiple supreme court rulings and lots of money spent on lawsuits. Any way it falls there will be lots of issues with enforcement. Along these lines this begs of the question of EMS personnel or other public service people using performance enhancing drugs to improve performance during work


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## Carlos Danger (Jul 6, 2014)

My comments were not intended to address the broad topic of chronic pain management and how good or bad we are at it, or rates of prescription drug abuse or federal drug policy.

I was simply responding to the assertions that 1) people on controlled substances are unable to perform, and 2) opioids don't work for longer than a few weeks. Both ideas are nonsense.


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## Ewok Jerky (Jul 6, 2014)

ON TOPIC
I agree that this is borderline legal advice.  I don't think the situation has been worked out legally yet, I am sure there will be a Supreme Court case (in the US, I have no idea how things work in CA) within the next 10 years.  But you bet your butt if you test +, especially after an incident, you will get canned.  It is a liability in the companies eyes, no matter what state you are in.  

At my old employer, I was never asked about anyb medical conditions or medications that would preclude me from doing my job.  I had to pass a physical every year that was it.  For the CA DMV though, I think there is a question on their about medicaitions...thank the universe I have been out of CA for a few years now though, so someone might be able to correct my memory.

There was an incident where one of our medics was accused, repeatedly of erratic behavior in and out of the station.  She was tested, it was + for I don't know exatly what, but she was put on some sort of leave.  This person was clinically a good medic, but a real a-hole to eeryone around her, a real short fuse.  Anyways, she was able to come back because it turned out she had some sort of perscription(s) and her behavior was explained as "medication interactions", and she was basically put on probation for a period of time and told to get her act together, and not let it get out control again.  If you are taking cannibis (for anxiety/sleep???) with a Rx, I don't really think it is your employers business...until it effects your ability to perform your job safely.  Plenty of peeps walk around on beta blockers and diuretics and are at risk for a syncopal episode now and then, but we don't make them quit their career because of it.

OFF TOPIC
Yes it is farely easy in this country to abuse the system.  That does not meen that plenty of people (probably the majority of them) are using long term opiates approiatly to manage their chronic pain.  I just finished a rotation in primary care, and half of our visits were monthly med refills for people with chronic pain taking 5, 10, 15, 20mg of oxycodone.  They have pain contracts, come in once a month in person for a refill, and take tests to show they aren't diverting.  In two months I could count the suspects on 1 hand who we suspected of diverting/seeking, and they all were made aware of the suspicions and given ultimatums for following the contract or being fired as patients.    

In EMS, we see a lot more the abuse, and not a lot of the success of chronic pain management regimes.  

Chronic pain is real, and opiods are the best treatment we have for long term pain management when conservative measures have failed.


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## Ewok Jerky (Jul 6, 2014)

Remi said:


> I was simply responding to the assertions that 1) people on controlled substances are unable to perform, and 2) opioids don't work for longer than a few weeks. Both ideas are nonsense.



1) I agree [see my post above]

2) While most patients on long term opiates do develope tolerance, and require ever increasing doses, current long-term opiate regimes see a dose-reduction benefit when switching to a different opiate once a max dose has been reached.  The new drug will eventually require a dose increase, as before, but again can be switched to another opiate, or back to the original.


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## Ewok Jerky (Jul 6, 2014)

LACoGurneyjockey said:


> In 2 words, were you trying to say you think opioids are a good solution in the long term for chronic pain, particularly in an EMS setting? You're gonna have to be more specific...



Yes, opiods are THE BEST solution for long term chronic pain.  Do you have a better alternative?  Now, if I require daily doses of ANY pain killer to get through my day, I will be thinking of a career change, but that is MY decision to make.  Unless it starts effecting my ability to perform my job.  We can't fire big fat medics for being obese can we? Unless it starts to interfere with their ability to perform their duties.



LACoGurneyjockey said:


> Don't get me wrong, I think 50mcg of fentanyl will do wonders for that hip fracture, but sending grandma home with 3 months of percocet is not an effective solution, and is only going to lead to dependance and ultimately withdrawals or addiction, your choice.



You are right , we should reduce that fracture.  Now grandma has arthritis and can't walk or perform ADLs because of chronic hip pain.  Now can we give her some effective pain management?


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## Rialaigh (Jul 6, 2014)

beano said:


> Yes, opiods are THE BEST solution for long term chronic pain.  Do you have a better alternative?  Now, if I require daily doses of ANY pain killer to get through my day, I will be thinking of a career change, but that is MY decision to make.  Unless it starts effecting my ability to perform my job.  *We can't fire big fat medics for being obese can we*? Unless it starts to interfere with their ability to perform their duties.
> 
> 
> 
> You are right , we should reduce that fracture.  Now grandma has arthritis and can't walk or perform ADLs because of chronic hip pain.  Now can we give her some effective pain management?



There are several government run public service agencies down here that require you to sign a no tobacco form when you get hired. It doesn't mean no tobacco on the job, it means you have not used in the previous 6 months period and will not as long as you are employed by them. This includes all Nicotine gums. Test + for Nicotine and you get put on leave or fired. They took a stance against Tobacco, they saw it is a negative projection of their image when they are trying to provide healthcare to patients, and they require their employees to abstain on and off the job. Don't like it, don't work there. 

Representing the company in a negative light whether it be through actions or in the media is something that you can be terminated for. This includes behavior that you engage in in your private life. This is where it will fall with Marijuana I believe, no matter legal or not if it is seen as a negative projection of the company to have employees that use even when they are off duty, then employees will be terminated.


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## Ewok Jerky (Jul 6, 2014)

Rialaigh said:


> There are several government run public service agencies down here that require you to sign a no tobacco form when you get hired. It doesn't mean no tobacco on the job, it means you have not used in the previous 6 months period and will not as long as you are employed by them. This includes all Nicotine gums. Test + for Nicotine and you get put on leave or fired. They took a stance against Tobacco, they saw it is a negative projection of their image when they are trying to provide healthcare to patients, and they require their employees to abstain on and off the job. Don't like it, don't work there.
> 
> Representing the company in a negative light whether it be through actions or in the media is something that you can be terminated for. This includes behavior that you engage in in your private life. This is where it will fall with Marijuana I believe, no matter legal or not if it is seen as a negative projection of the company to have employees that use even when they are off duty, then employees will be terminated.



Fascism!:rofl:

That is crazy.  Call me a libertarian I guess, but I believe that a job is a job and my life is my life.  As soon as I clock in, I am your's and will do whatever I need to keep my paycheck happening.  But when you aren't paying me I am not following your rules.  I guess I wouldn't work out down there.


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## Carlos Danger (Jul 6, 2014)

beano said:


> Fascism!:rofl:
> 
> That is crazy.  Call me a libertarian I guess, but I believe that a job is a job and my life is my life.  As soon as I clock in, I am your's and will do whatever I need to keep my paycheck happening.  But when you aren't paying me I am not following your rules.  I guess I wouldn't work out down there.



This.


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## LACoGurneyjockey (Jul 6, 2014)

beano said:


> Fascism!:rofl:
> 
> That is crazy.  Call me a libertarian I guess, but I believe that a job is a job and my life is my life.  As soon as I clock in, I am your's and will do whatever I need to keep my paycheck happening.  But when you aren't paying me I am not following your rules.  I guess I wouldn't work out down there.



So as long as I'm not on the clock, I can rack up endless speeding tickets, smoke weed, maybe a little heroin on the weekend, and top it off with getting black out drunk the night before work. But since I don't do it at work, it's ok? Maybe as an Assistant Sales Associate at Best Buy, but I like to think we can be held to a higher standard.


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## Ewok Jerky (Jul 6, 2014)

LACoGurneyjockey said:


> So as long as I'm not on the clock, I can rack up endless speeding tickets, smoke weed, maybe a little heroin on the weekend, and top it off with getting black out drunk the night before work. But since I don't do it at work, it's ok? Maybe as an Assistant Sales Associate at Best Buy, but I like to think we can be held to a higher standard.



If I am doing the things you suggest, then my ability to work has been compromised and I am not fit for duty. You are bringing the argument to the extreme.


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## Rialaigh (Jul 6, 2014)

beano said:


> If I am doing the things you suggest, then my ability to work has been compromised and I am not fit for duty. You are bringing the argument to the extreme.



That's the problem. Where's the line. Weed 24 hours before work okay but 12 hours before not? what about 16...

Until they have a way to test the levels of THC (or other worthwhile compound) in your system similar to a BAC there is simply no way to pick an enforceable arbitrary cutoff like with alcohol. At this point in the stage it has to be an all or nothing policy, which caution leaning on the side of nothing...


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## LACoGurneyjockey (Jul 7, 2014)

Rialaigh said:


> That's the problem. Where's the line. Weed 24 hours before work okay but 12 hours before not? what about 16...
> 
> Until they have a way to test the levels of THC (or other worthwhile compound) in your system similar to a BAC there is simply no way to pick an enforceable arbitrary cutoff like with alcohol. At this point in the stage it has to be an all or nothing policy, which caution leaning on the side of nothing...



What he said


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## Ewok Jerky (Jul 7, 2014)

Rialaigh said:


> That's the problem. Where's the line. Weed 24 hours before work okay but 12 hours before not? what about 16...
> 
> Until they have a way to test the levels of THC (or other worthwhile compound) in your system similar to a BAC there is simply no way to pick an enforceable arbitrary cutoff like with alcohol. At this point in the stage it has to be an all or nothing policy, which caution leaning on the side of nothing...



There is an element of personal responsability and adult judgement [both of which are lacking in our culture].  There is a big differenece between using a sedating medication as prescribed and booting heroin or showing up drunk to work.  If I use my medication appropriately no one at work should even know I'm taking it. Just like no one knows if I had my last drink at 8pm or 12pm, or if I use tobacco or not.  I leave "personal beano" at home and bring "work beano" with me. Adults, no matter what the profession, should be able to do this.

I agree with Rialaigh that there are no standards when it comes to weed.

If you are showing up all red eyed, expect to get fired. 
If you are involved in an I incident and test + for weed, expect to get fired.
Go blabbing around the station you have a pot Rx, expect to get fired.

Smoke your pot responsibly [joints, no bongs] at home, once in a while, go to bed, show up sober for work. If you can't do that you have a problem.


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## usalsfyre (Jul 7, 2014)

Rialaigh said:


> I am fairly sure that the majority of people do not use them responsibly in my area. I can also assure you that regardless of the number of people that use them responsibly, the United States by far has the worst problem of narcotic abuse in the world. I see the negative results of people abusing them because they are visible, because they are a major problem with the healthcare system and how we handle these patients.


This is known as confirmation bias and is based on anecdote and not data. The truth is the patient population you're referring to may well be FAR from a representative sample of the opiate users in your area, but you wouldn't ever know it because you fail to interact with the responsible ones.     



Rialaigh said:


> Objectively the US has the largest problem of prescription drug abuse in the world. Objectively the US does an incredibly poor job of pain management despite having more tools than any other country in the world. Objectively the US spends more on recovering drug addicts than any other country with much worse results for the systems we use.


1. Because what we consider "abuse" is often considered "therapeutic use" in the rest of the world.  

2. Because the US probably attaches more stigma than the rest of the world to prescription drug use and/or abuse 

3. See #2


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## Rialaigh (Jul 7, 2014)

usalsfyre said:


> This is known as confirmation bias and is based on anecdote and not data. The truth is the patient population you're referring to may well be FAR from a representative sample of the opiate users in your area, but you wouldn't ever know it because you fail to interact with the responsible ones.
> 
> 
> *1. Because what we consider "abuse" is often considered "therapeutic use" in the rest of the world.  *
> ...



The United States consumes 80 percent of the worlds prescription opioids and over 95% percent of the worlds Vicodin. 

Yet somehow we don't rank near the top in pain management. Are you telling me that people in the US just have that much more pain then people in other countries? 

I believe I read a statistic the other day that said accidental narcotic overdoses kill more people then car wrecks in something like 17 states.


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## jackbower (Jul 9, 2014)

its different because it is illegal federally even if you live in Washington or colorado federal law supersedes state law so still illegal


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## Mellowdnb (Oct 6, 2014)

In the next 10-15 years, if not sooner, marijuana will be legal to consume nation wide.
However, I can see companies saying an employee can't have any traces of THC in his/her system before work. Why? Like Rialaigh said, there is not an accurate test that can differentiate if one consumed less than 12 hours vs 4 days prior to work. Here's how it can backfire on an employer.

Let's say Paramedic Mary Jane and her co-work Bobby Bong had consumed marijuana 4 days before the next shift. Most of the THC would be out of the system but small traces might be found.
They get in a minor accident  when they come back to work. They piss test. Small traces of THC show up.

Let's say they go to court for the accident because the other driver is money hungry. A lawyer will pull some bull poop about how they had traces of THC in the system and that's what caused the accident. The lawyer can say "How do we know they didn't consume on shift?"
If one consumed they day of or during work, traces of THC would be very high. No pun intended. If one consumed 4 days prior, THC levels would be very low. However, lawyers are sneaky and manipulative. They know what to say and how to twist things around to make it look like they are right and the two Paramedics had consumed on shift.  

Employers don't want to deal with that. So I can see them still having a zero tolerance policy, even with a prescription.

If an accurate test comes along that can tell if one had consumed recently (less than 48 hours) I can see employers changing the policy.

On a similar note, I found this.


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## JWalters (Oct 6, 2014)

LACoGurneyjockey said:


> So as long as I'm not on the clock, I can rack up endless speeding tickets, smoke weed, maybe a little heroin on the weekend, and top it off with getting black out drunk the night before work. But since I don't do it at work, it's ok? Maybe as an Assistant Sales Associate at Best Buy, but I like to think we can be held to a higher standard.



This.


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## Tigger (Oct 6, 2014)

I am curious what departments that do polygraph examinations will do now. Some hiring processes include questions regarding past illicit drug use, yet if you live in Colorado it's no longer illicit. So what happens with a polygraph test taken by a former Colorado resident?


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## Chewy20 (Oct 6, 2014)

JWalters said:


> This.


 
All of our traffic tickets outside of work can get us canned. Among other things due to random drug tests.


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## chaz90 (Oct 6, 2014)

Tigger said:


> I am curious what departments that do polygraph examinations will do now. Some hiring processes include questions regarding past illicit drug use, yet if you live in Colorado it's no longer illicit. So what happens with a polygraph test taken by a former Colorado resident?


When I went back to Colorado on vacation shortly after legalization I was told by one of my supervisors about that loophole and that they were looking into changing the wording of the policy for that reason. It wasn't a problem for me since I've never used nor do I have plans to, but I did find it interesting.


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## PotatoMedic (Oct 7, 2014)

Tigger said:


> I am curious what departments that do polygraph examinations will do now. Some hiring processes include questions regarding past illicit drug use, yet if you live in Colorado it's no longer illicit. So what happens with a polygraph test taken by a former Colorado resident?


I think my policy says something along the lines of federally illegal drugs.  Since federally it is still illegal, there would be no issue on how to answer that question.


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## 9D4 (Oct 7, 2014)

http://www.marketwatch.com/story/po...-finally-see-cannabis-breathalyzer-2014-09-10


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## gotbeerz001 (Oct 9, 2014)

LACoGurneyjockey said:


> But I also don't think you should continue to do a job that requires so much of you mentally and physically, with such a severe injury that requires long term narcotic pain management to have any quality of life.



I get what you are saying, but I do not agree. One thing that often gets lost in translation here is Standard of Care and just what that means. One's personal idea re SOC (I need to be the best I can be for the good of...) is fine and well but is NOT the SOC required to function adequately and appropriately within a given system. 

This forum often bashes Fire for a myriad of reasons (lazy, sub-par etc), but what you will never hear us advocate is throwing away good people because they were broken doing the job, especially if there is a reasonable and legal solution available. If the guy/gal working next to me who has put in 10/15/20 years of service (and exhibits the battle wounds associated with it) takes pain meds every day but can do the job to the industry/employer standard, well then I support them. 

As a co-worker who cares about my team member, I will make efforts to be aware of signs of abuse; but even of these signs were Apparent, I would not change my tune. I would continue to support them in finding a plan to manage the situation (EAP etc). If it becomes unmanageable, then it is time to retire out of field work and be trained (on the employers dime) for a new function. 

We do not throw away people broken by the system.


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## LACoGurneyjockey (Oct 9, 2014)

gotshirtz001 said:


> I get what you are saying, but I do not agree. One thing that often gets lost in translation here is Standard of Care and just what that means. One's personal idea re SOC (I need to be the best I can be for the good of...) is fine and well but is NOT the SOC required to function adequately and appropriately within a given system.
> 
> This forum often bashes Fire for a myriad of reasons (lazy, sub-par etc), but what you will never hear us advocate is throwing away good people because they were broken doing the job, especially if there is a reasonable and legal solution available. If the guy/gal working next to me who has put in 10/15/20 years of service (and exhibits the battle wounds associated with it) takes pain meds every day but can do the job to the industry/employer standard, well then I support them.
> 
> ...



I can completely respect that, and its a really honorable way to approach the situation. But...in my experience those medics taking large amounts of pain killers every day to be able to work are not performing at the industry standard. That's not to say it's impossible to require narcotics to get out of bed in the morning and still be able to adequately perform your job duties. But I have yet to see it, and that's really all I can base my opinions on.


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## gotbeerz001 (Oct 9, 2014)

LACoGurneyjockey said:


> I can completely respect that, and its a really honorable way to approach the situation. But...in my experience those medics taking large amounts of pain killers every day to be able to work are not performing at the industry standard. That's not to say it's impossible to require narcotics to get out of bed in the morning and still be able to adequately perform your job duties. But I have yet to see it, and that's really all I can base my opinions on.





Going forward, I think we need to mandate a full-line space any time we are going to us the word "but" to introduce a counterpoint. 

Example: 
"its a really honorable way to approach the situation. 

But...in my experience those medics taking large amounts..."

This way we will know what is coming when we see the "but hole".


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## vcuemt (Oct 9, 2014)

LACoGurneyjockey said:


> I can completely respect that, and its a really honorable way to approach the situation. But...in my experience those medics taking large amounts of pain killers every day to be able to work are not performing at the industry standard. That's not to say it's impossible to require narcotics to get out of bed in the morning and still be able to adequately perform your job duties. But I have yet to see it, and that's really all I can base my opinions on.


If House can do it I can do it.


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## LACoGurneyjockey (Oct 9, 2014)

gotshirtz001 said:


> Going forward, I think we need to mandate a full-line space any time we are going to us the word "but" to introduce a counterpoint.
> 
> Example:
> "its a really honorable way to approach the situation.
> ...



Oh you so clever


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