Impact of Legalized Recreational Marijuana on EMS?
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No, it's not. And yes, it is.
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TheLocalMedic
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The general consensus is that the effects of marijuana depend on the dose and method of ingestion. However, in the case of a standard dose (i.e. a joint) that is smoked, multiple studies generally agree that the "acute intoxication" phase or "high" lasts 2-4 hours with some lingering effects (including motor impairment) may last up to eight hours. Heavier use or ingesting marijuana in food may make the intoxication stronger and longer lasting. Metabolites may be present for 2 weeks to 3 months, depending on body fat, kidney function and amount of use, but the metabolites do not get you "high" or in fact have any effect on cognitive function.
While the effects of marijuana vary from user to user (just like with alcohol, mind you) there are a collection of symptoms that are generally the same with most users. They include euphoria, loss of coordination or reaction time, memory impairment, dry mouth, bloodshot eyes, disorientation, impaired judgement, difficulty problem solving, increased appetite and somnolence. Uncommon side effects include paranoia, racing heart rate and acute psychosis (generally in those predisposed to mental illness).
>>>TL : DR VERSION: We know how pot affects people and roughly how long it lasts if you're smoking it.
There are tests being developed to more accurately determine whether a user is under the influence of marijuana, but one commonly being used is the oral swab. LAPD is now using one that can determine use within three hours.
http://www.scpr.org/news/2013/12/27/41219/la-dui-checkpoints-will-expand-testing-of-drug-imp/
I agree that nobody should drive under the influence, let alone practice medicine while high. However if it is used responsibly, I don't see this being an issue. Most, if not all, companies out there have policies stating no alcohol 8-12 hours before shift, and a similar policy should be in place for marijuana.
TheLocalMedic
Grumpy Badger
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On another note, where I live and work marijuana is very widely used. I mean, VERY widely used. While it's not legal, unless you're doing something really flagrant, like smoking pot in a really public place (like the mall) or around kids, law enforcement really doesn't give a hoot about it.
That being said, I have been on scores of DUI collisions, and only TWO where the driver was high on marijuana. One caused some pretty significant property damage, but neither resulted in any injuries or involved other vehicles. I have had more collisions with people blitzed on prescription meds than stoned.
That being said, I have been on scores of DUI collisions, and only TWO where the driver was high on marijuana. One caused some pretty significant property damage, but neither resulted in any injuries or involved other vehicles. I have had more collisions with people blitzed on prescription meds than stoned.
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Why?
And who gets to decide what this "higher standard" is?
Are physicians responsible to this standard, as well? What about teachers? Electricians? Taxi drivers? Why or why not? How do you come to that conclusion?
And why would/should recreational, off-duty (of course) use of THC violate this "higher standard", anyway? Does off duty use of alcohol violate it? Am I not allowed to have a glass of wine with my dinner, or a beer while watching a football game?
What else would this "higher standard" require? Do I need to attend church? Work out every day? Maintain a certain bodyfat or be able to bench press a certain % of my body weight? Read a certain number of books per year? Volunteer in soup kitchens for a certain number of hours per year?
I think the best approach by far is to simply leave adults alone to make their own decisions about what to put in their body and what to do with their own time. Unless you have COMPELLING evidence that some off-duty activity negatively impacts on-duty performance and the safety of others, it simply isn't your business to say what decisions other people should or shouldn't make.
ExpatMedic0
MS, NRP
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If it can be proven that the effects of it are not in your system while on duty, its no ones business and I think its fine ifs legal in your area.
However, if its effects are in anyway still impairing the provider, its the same as coming to work under the influence of any other mind altering substance(eg ETOH)
The question is, is there a test which we can give to a suspected provider to prove if they are high or not? The main problem is THC stays in your body for longer than the therapeutic effect of the marijuana and you will still test positive on a UA, even days after the effects of the drug are gone. At least that is my understanding?
However, if its effects are in anyway still impairing the provider, its the same as coming to work under the influence of any other mind altering substance(eg ETOH)
The question is, is there a test which we can give to a suspected provider to prove if they are high or not? The main problem is THC stays in your body for longer than the therapeutic effect of the marijuana and you will still test positive on a UA, even days after the effects of the drug are gone. At least that is my understanding?
Because those of us that work 911 are public servants just like police and fire and we serve at the pleasure and need of our respective communities. Would your EMS organization have an issue employing someone part time who also works part time as a very high publicity porn star? How about your local law enforcement, do you think the community would tolerate a sheriff that smoked weed every time he got off work?
Like it or not as public servants we are and should be held to a higher standard. If you don't want to be held to a higher standard and looked at differently then EMS is just a taxi driver job...its the public service that sets us apart, and it's sad to see many agencies doing their best to get away from that.
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Why? Why should we be held to a higher standard? Are you serious? It's a job. That's all it is. A means to earn money to support your family and do things that you like to do and live your life. Work is a means to live, not life. By that argument mailmen should be held to a higher standard because they're public servants so are trash men and referees. Hell the we're all covered by the same statute when it comes to assault and battery.
And with that I'm done with this thread.
And with that I'm done with this thread.
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So you think all jobs are only a means to earn money and serve no other purpose...If the only reason you are in EMS is for the money then I would urge you to find another field. there are a lot more lucrative jobs out there that require less time and effort to do right that don't involve killing someone when you aren't on top of your game.
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I love my job, I chose it because I love medicine and enjoy interacting with and caring for people. I'm a damn good medic and go above and beyond for my patients. I've been out for 8 weeks secondary to a shoulder injury and can't wait to go back.
That still doesn't change the fact that my job is just that, a job. My life is my life. I didn't say I work just for money. I said I work so I can do the things that I want to do in my time off. If that means that I'm a :censored::censored::censored::censored:ty medic and don't know what I'm doing then fine, you're entitled to your opinion.
It's pretty insulting to me that you'd tell me there are more "lucrative" jobs out there. You think I don't know that?
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Here is the NHTSA' s research on THC and human performance while driving. Note that some symptoms of high level impairment could persist up till 24 hours.
We know that alcohol can impair individuals at least 12 hours after consumption, yet policies were enacted at EMS agencies allowing employees to consume so long as it wasn't 12 hours prior to work. I'm not sure why that couldn't also occur with marijuana. It's well documented that even with most aggressive methods of ingestion possible that the effects will still be gone 24 hours after last use. I've had hangovers that lasted as long, but by company policy I could have certainly still been at work, as I am sure many others have done as well.
I'm not trying to be insulting at all. Your last post said this
I'm sorry if I misread the post but it appeared to me you basically said work is a means to earn money. That EMS is a job, to earn money, and that is all.
I never said anything about you being a :censored::censored::censored::censored:ty medic, please don't put words in my mouth like that. On the contrary from your posts on this forum I hold you in very high regard.
My post was just to iterate that this is more than just "a job", for many people it is a career, and there is a difference. People who are good at this don't do it for the money, they do it for the love of the job. When your talking about a public service career, and not just a means for 15 dollars an hour, there is a higher standard.
TransportJockey
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I'm a 911 medic. But I am by no means a public servant. Their tax dollars don't go to my paycheck at all. We are healthcare not public safety. Even on the 911 side. And with ems abuse rampant and ERs being used as safety nets, a lot of time we are just very expensive taxi cabs.
So by your definition of being held to a higher standard what do you think should be allowed or disallowed?
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Since driving is a big part of this job, then using the data from the NHTSA works for me, as does a 24 hour since last use policy if the data is accurate.
I know a lot of us in this thread keep comparing THC use to alcohol use, because there are some similarities pertaining to this discussion. I would just like to point out that while the BAC limit for most people is .08 to drive, commercial drivers operating under a CDL have a much lower limit. Given our group history (EMS as a whole) driving record, does anyone really advocate people driving ambulances under the influence of any substance that can affect judgement and reaction times?
To be clear, I don't care what people do in their own homes, and think the government has intruded too far into personal lives and actions. I do have an issue with what people do at home that affects their performance on the job.
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Sorry, but I am no one's servant. I provide my services for a wage or a fee and I have no obligation to anyone beyond fulfillment of the contracts that I agree to. Beyond that I am not bound by anyone else's idea of what constitutes a moral choice.
If my employer doesn't want me using weed or alcohol then they can make that a stipulation of the employment contract, and I'll have to decide to either accept that term or go somewhere else. But there is no inherent, lofty "higher standard" to which all EMS workers are obligated to adhere just by virtue of the fact that they are EMS workers instead of mechanics.
Anyway, those who are widely considered "public servants" are actually typically held to a much lower standard than the general public. No one has more privileges and gets away with more things (that would get a normal citizen thrown in jail) than police, judges, and politicians.
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I think that is reasonable.
The problem is (and this might be different for commercial drivers, I don't know - but I doubt it) that the .08 threshold was chosen not because it is the magic BAC at which people become prone to causing accidents; it was lowered from 0.1 for purely political reasons. Very few accidents are caused by people with a BAC of 0.1, usually it is quite a bit higher in accidents, and 95% of those charged with DUI are caught at a checkpoint or are pulled over for a taillight out or a minor moving violation, not for driving recklessly and endangering others.
The point is that there is a problem with these limits, and it is that they aren't evidence based and really aren't even intended to make us safer, just to expand police power. I just hate to see the same thing happen with marijuana, although it is bound to.
ExpatMedic0
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Yep, and if there was, off duty legal marijuana use is pretty much at the bottom of my list of concerns when weighed against the other issues in EMS. I mean, considering you can staff an ambulance after 2 weeks of training for EMT, what kind of standard is that? The mailman, (who is a federal employee not private) that was mentioned earlier, likely makes more than twice what an EMT does and probably had more training.
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Wouldn't it make sense then to first determine what the limit should be BEFORE we allow it?