Even in states where cannabis is legal. Yolanda Ng was on the cusp of a full time job as a pediatric nephrologist at Providence Sacred Heart Children’s Hospital in Spokane, Washington, in the summer of 2014. She was going through the motions of onboarding at the hospital—filling out paperwork and finalizing her new position. Then she took a drug test, and it came back positive for cannabis use. A few months prior, Ng had started to take a few drops from a cannabis-infused tincture that her friend recommended to help with menstrual cramps for a few days every month when she had her period. She tells me that it was such a small amount that she’d had no concerns about giving the requisite urine sample. Weed was already decriminalized in Washington at the time, and Ng says she had never used cannabis at work or before seeing patients. But when the positive result came back, her supervisor said it was protocol to report her to the state’s physician health program, an organization tasked with protecting the public from unsafe medical practice. What followed was a costly and messy process of legal proceedings, suspended licenses, mandatory rehab, and regulatory middlemen—a process that pushed Ng to decide to leave the field altogether. Now Ng’s story is another cautionary tale, adding to a growing number from medical professionals facing repercussions for using medical and recreational cannabis in the 23 states where it has been decriminalized. As the country continues to push for legalization, the lack of clarity and regulation within the medical establishment is leaving physicians in the crosshairs with little guidance and often fewer rights than other working citizens. “The law doesn’t provide paths forward for [physicians like Ng],” says Nicole Li, an attorney who represents Ng and several other physicians who have faced similar issues as a result of both authorized medical and adult cannabis use. “Resolving the situation is going to require a political solution prompted by political pressure.” Cases like Ng’s have cropped up across the country. There’s the neurosurgery resident in California who said she smoked weed on her days off. Or one of Li’s current clients in Washington who was only reported and tested when a patient complained about him after he refused to prescribe unnecessary opioids. Physician Paul Bregman in Colorado lost his medical license after he used marijuana as a treatment for bipolar disorder. There are no specific laws that govern what a physician can and cannot do when it comes to cannabis. It’s widely accepted that a doctor cannot legally practice if his or her work is compromised by any drug—be it opioids, alcohol, or weed. But marijuana poses a specific challenge since the substance can stay in your system, and show up on drug tests, for up to a month after use. There is no way to distinguish between someone who smoked a joint in the morning before work and one who did so three weeks ago on a weekend. Sometimes the rules around whether or not a doctor can use cannabis depends on the workplace, not the state. Micah Matthews, deputy executive and legislative director for the Washington Medical Commission, the state licensing agency, says that hospitals or clinics that accept federal dollars often have to comply with federal, not state, regulations. And under the US law, marijuana is still a Schedule I—i.e., illegal—drug. “An employer may not have a problem with recreational use,” he says, “but if they accept federal money, as all hospitals tend to do, that creates some requirements for continued funding should cannabis use be discovered.” The grey area, however, is not just about what is permitted. It’s also about who determines what happens to physicians who are found using cannabis. This task often falls to physician health programs, semi-voluntary organizations that are meant to direct physicians to rehab or report dangerous behavior. State licensing boards, like the one in Washington, often defer to these organizations to evaluate the physicians and recommend a course of action. Physician health programs are controversial in the medical community, and have been criticized for forcing doctors into unnecessary treatment. There’s also the chance that these programs have a financial interest in sending physicians to costly treatment centers. “They’re pursuing our clients when there are dangerous doctors out there,” Li says, referring to physicians who put their patients’ safety at risk. When psychiatrist Michael Alpert in Cambridge, Massachusetts, created a Change.org petition to protect doctors who use marijuana safely, the petition was directed at the Federation of State Physician Health Programs, which oversees the state programs. (Full disclosure: I know Alpert socially). When I reached out to Chris Bundy, the director of Washington’s physician health program, he told me that his organization tries to address and rehabilitate doctors so that they don’t have their licenses revoked. He also emphasizes that the organization believes that regular cannabis use (which he defined as at least weekly) leads to cognitive impairment, and shouldn’t be used by doctors, especially since it is federally illegal. “How would we know or define safe limits for physicians?” he says. “The danger is the assumption that most people have that getting drunk or high on Sunday won’t impact practice performance on Monday." There is a dearth of research on the long-term use of cannabis, and we still don’t know if using the drug has permanent impact on cognitive functioning in adults. But Bundy says the program would never make a decision about referral for evaluation, treatment or monitoring based only on the frequency of cannabis use. Instead, he says it has to be evaluated in the context of the other clinical information available. (Bundy didn’t comment on any specific cases.) Doctors have spoken out against the state programs and their treatment of doctors in the past, saying the programs are not looking out for physicians like Ng. “Mandating people go for evaluations at physician health programs solely on the basis of a marijuana test is ridiculous,” says J. Wesley Boyd, a physician and associate professor of psychiatry at Harvard Medical School. “The fact that the state board of medicine in Washington state went along with that is appalling.” In Ng’s case, the physician health program she was referred to conducted an interview, determined they couldn’t make a conclusion, and referred her to Hazelden Betty Ford Foundation Center, an addiction program, for a $5000, three-day evaluation. And while the psychologist and psychiatrist determined she wasn’t at risk, Ng tells me that one of the program’s counselors decided she had “severe substance abuse” and that her marijuana use had permanently impacted her brain. They then recommended that she enter a three-month inpatient rehabilitation program at the same center, which would have required her to pay $50,000. When she didn’t comply, she was reported to the Washington Medical Quality Assurance Commission. “There were some people who legitimately needed to be there,” she says. “I don’t understand why I qualified.” The misunderstanding and lack of research around cannabis use can have severe repercussions on a physician’s career, not to mention their well-being. Li says that none of the clients she’s currently representing had been reported for threatening a patient’s safety. But even then, some of their names appeared in local media, stating that they were reported for using illegal drugs. “Physicians call me from across the country—they don’t know what kind of lawyer they need. There’s shame and stigma around it,” Li says. “The amount of suicide talk is alarming.” Meanwhile, Ng, now living in California, says she wants to leave her past, and the stress of her three-year ordeal, behind. After hearing the requirements for probation—working every day, and remaining 100 miles away from the original hospital—she hung up her white coat entirely and is now working as an interior designer. Source
