Answer of the Day (Archives)

NSAIDs reduce the production of prostaglandin E2 (PGE2) and prostacyclin (PGI2), which mediate pain and inflammation.

Most likely, it will be positive. Immunoassay urine drug tests can detect THC for up to 2-4 days after marijuana use.

Sometimes. The test results can suggest pharmacokinetic factors. Some patients could metabolize the drug at an accelerated rate and thus may be experiencing suboptimal analgesia. Also, patients with Celiac disease, Crohn’s disease or some other mal-absorptive disorder might not absorb the opioid as well as other patients.

The CDC recommends avoiding the use of long-acting/extended release opioids to treat acute pain. (Of note, methadone and the fentanyl patch have very high abuse potential.)

Yes, it can! Poppy seeds contain traces of codeine and morphine. In fact, three hours after consuming just one poppy seed bagel, a person will have urine opiate levels of approximately 250 ng/ml. In the early 1990s, the National Institute of Drug Abuse (NIDA) had guidelines with the cut-off for urine opiate levels at only 300ng/ml. As a result, many people, who had consumed large quantities of food with poppy seeds, had tested positive for opiates and were falsely accused of taking opioids. In recent years, the NIDA guidelines were changed and the cut-off for urine opiate levels was increased more than six-fold up to 2,000 ng/ml.

There are significant and substantive differences between the recreational use and the medicinal use of marijuana. Individually and in combination, these differences could dramatically affect the outcome of a clinical study. Some of the many differences include: the purity and quality of the marijuana product, the mode of administration of the product, the concentrations/ratios of the various cannabinoids in the product, the duration of marijuana use, and healthcare provider oversight.

THC is an effective antiemetic agent in patients undergoing chemotherapy, but patients often state that marijuana is more effective in suppressing nausea. Other, unidentified compounds in marijuana may enhance the effects of THC.

The effects of marijuana consumption are dependent on many factors, including the dose of marijuana consumed, the ratio of the various cannabinoids in the marijuana product, the route of administration, the timing (the effects of marijuana are different right after consumption as compared to hours after consumption), the health status of the patient, the age of the patient, the co-administration of other drugs/medicines, and whether or not the patient has been using marijuana long-term or if the patient recently started using marijuana.

Even a physician who does not certify patients for medical marijuana may be at risk for malpractice liability. If, for instance, such a physician is aware that a particular patient is taking medical marijuana and prescribes a drug or treatment that is contraindicated, the physician could be sued for failing to recognize such risks and causing an adverse event. This result may seem particularly unjust given that the physician had no role in recommending marijuana to the patient at issue. However, like any other drug, a physician must be able to recognize the risks that marijuana can pose for a particular patient.

There are a few reasons why opioids are not considered first line medications for the treatment of the pain due to CRPS. Generally speaking, higher doses of opioids are required to effectively decrease neuropathic pain as compared to the doses needed to treat nocioceptive pain. High doses of opioids increase the risk of side effects, tolerance and long-term toxicity. Also, some research has raised a concern that long-term opioid use may actually elicit allodynia, hyperpathia and/or hyperalgesia.|Opioids may be useful in crisis situations.