Tell your doctor about your marijuana usage?
October 7, 2010 6:34 PM   Subscribe

Do you disclose to your doctor that you smoke pot?

I smoke a little marijuana pretty much every night before going to bed. I visited a doctor last week, my first doctor visit since I developed this habit; it's been about 10 years. When she asked if I use any recreational drugs, I was unprepared and instinctively lied. Now, I'd like to tell my doctor everything relevant to my health, but I worry about the implications of revealing illegal drug usage. I'm in the US, male, married, and have 4 kids (4, 8, 11, 15), and worry that a doctor with strong opinions might, I dunno, call child protection services or something. I go back for a follow up next week, and if it is the wise thing to do, I'd like to come clean with her, just so she has all the facts. So I'm looking for advice from either health professionals or other pot smokers. From the former... do you often get honest answers about pot smoking from patients? Do you or do you know of any doctors that take action outside of the bounds of the doctor-patient relationship based on knowledge of a patient's drug use? From fellow pot smokers, and this is what I most want to know... do you tell your doctor about your pot usage? If so, have you ever regretted it? If you don't, why not? (The reason I'm going to the doctor now is that I'm nearly 40, need to quit smoking cigarettes, get a vasectomy, lose weight, start exercising, generally taking better care of myself, etc. And also, I've been experiencing some strange tingling sensations in my face, arms and feet, with general muscle soreness, and I'd like to find out the cause of that. But I'd rather this thread not be all "You need to tell your doctor so she can diagnose you," because, duh, yeah, that'd be ideal. I'm more looking for advice and anecdata on what risks I would be taking in being honest.) Throw away email address for anyone that doesn't even disclose to metafilter that they smoke pot:
posted by anonymous to Health & Fitness (33 answers total) 4 users marked this as a favorite
If you live in California, remember that now in California it's about the same as a traffic violation. Keep that in mind if you decide to disclose and are concerned about the possible ramifications.
posted by doh ray mii at 6:40 PM on October 7, 2010

I think it's kind of ridiculous that you're withholding information that could have potential medical consequences, and also something that she asked you directly about. If you're quitting smoking cigarettes, it might increase other smoke inhalation habits, which I imagine might be of some interest to your medical provider. I suspect you're being overly paranoid about light recreational use of marijuana if you think your doctor would call child services. Either that, or you don't trust her, maybe you should look around for another doctor.
posted by QuarterlyProphet at 6:46 PM on October 7, 2010

I didn't tell a surgeon years and years ago, when I was a minor, because I was really freaked out about my parents finding out. I had a horrible experience with the anesthesia, woke up in the middle of surgery, lots of trauma ensued. Being young I didn't really get any answers at the time, but now decades later I still wonder if my not disclosing it made a difference.

I know you're not asking w/r/t any life-threatening procedures or anything, but my experience has made me more likely to tell the truth now. Although I do not have children so perhaps others may have more experience on that front.
posted by stellaluna at 6:46 PM on October 7, 2010

No, honestly, it's probably a bad idea to tell your doctor, especially if you have kids. Unless you are getting high with your doc, I'd keep this under your hat.
posted by Leta at 6:46 PM on October 7, 2010

I have a medical marijuana card, it's legal in my state with a doctor's note (hence the card) and I lie about it to everyone, including to my new doctor 2 days ago.

(I make pot brownies, no smoke.)

I lie for data and insurance reasons. I feel some things are private, and my once or twice a month pot brownie usage for back pain is 100% private. (Incidentally, I was surprised to find that my little brownies also helped cure me of occasionally very debilitating insomnia symptoms, but there ya go.) I'm freaked out about how information gets shared these days and do not relish this information being shared in ways I do not directly authorize, or counting against me twenty years from now when I stub my toe and my future insurance company refuses to pay for a doctor's visit because I ingested marijuana a few times back in 2010.... but maybe I'm paranoid:))

I can't tell you what to do, and I would never suggest that anyone do anything they do not feel is ethical or moral. But this is how I handle this dilemma and why, FWIW.

(Upon preview, I would disclose recent usage in an emergency situation if I were able and for my own well-being. But my usage is much less frequent than yours, so I don't normally worry about drug interactions and such... maybe you should look into that and evaluate the risks as you make this decision?)
posted by jbenben at 6:52 PM on October 7, 2010 [3 favorites]

I wouldn't tell a doctor anything you wouldn't want an insurance company to know. Medical records last a long time.
posted by something something at 6:53 PM on October 7, 2010 [9 favorites]

I have a card and I do NOT tell my doctor. The ramifications that could occur are not worth it.While I am legal in my state, it can still cause issues with insurance in relation to Dr. file notes or worse being labeled a drug seeker. Marijuana is incredibly benign and helps me in the evening dealing with pain instead of taking scripted narcotics. I don't see it as relevent information as it would only cause more problems than it would solve.
posted by handbanana at 7:00 PM on October 7, 2010

I'm in Canada, I've told many dr's, as have my friends. The dr's have universally shrugged mj as not a real "drug". I've never had reprecussions in any way or any known confidentiality breach in the past twenty years and I still have all my kids. YMMV
posted by saucysault at 7:01 PM on October 7, 2010 [1 favorite]

The fact you made this post anonymous should have provided the answer you seek. If you can't tell essentially a board of strangers, you probably shoudnt tell a doctor with the possibility of permanent documentation.
posted by handbanana at 7:09 PM on October 7, 2010

I always surprise doctors when I answer "no" to everything (Molly Mormon here,) and the nurses like to tell me the wild admissions they get.

I think that if you had less to lose, they would be less interested. I also think the insurance/government reporting concern is valid. But I am remarkably risk-averse and my mom's a prosecutor who pretty much specializes in taking kids from their druggie parents (mostly meth/heroin, but hey.)
posted by SMPA at 7:10 PM on October 7, 2010

posted by phunniemee at 7:30 PM on October 7, 2010 [1 favorite]

If there are medical symptoms secondary to your use, your doctor will figure it out anyway, empirically. Admitting your use won't accomplish anything good. Besides, doctors are already well aware that patients lie about their vices. When you say "no drug use", if the doctor suspects actual drug use which is leading to problems, s/he will follow up on it with whatever tests are needed. From a medical perspective, whether you admit to drug use or not hardly matters. From a legal perspective, it is a completely different story. Your concerns along those lines are completely justified.

I wouldn't tell a doctor anything you wouldn't want an insurance company to know. Medical records last a long time.

I second this wholeheartedly.
posted by Maximian at 7:30 PM on October 7, 2010 [3 favorites]

Is there actually any medical risk caused by marijuana use?

Anyway, I would say no. You don't even know this person. I know there have been cases where people have their driver's licenses suspended because they admitted alchohol consumption (which does seem like something that might have medical repercussions)
posted by delmoi at 7:30 PM on October 7, 2010

Thirding something something's comment.

In addition, the use of recreational marijuana use will often lead a physician to decline to provide narcotics for pain relief to patients who truly need them.
posted by yclipse at 7:44 PM on October 7, 2010 [1 favorite]

handbanana writes "The fact you made this post anonymous should have provided the answer you seek. If you can't tell essentially a board of strangers, you probably shoudnt tell a doctor with the possibility of permanent documentation."

You don't know how well known their handle is; could be that's jessamyn or asavage making use of the anonymous feature.
posted by Mitheral at 8:03 PM on October 7, 2010

Wife's in health insurance underwriting. Don't tell the doctor. Insurance companies make money by denying claims.
posted by PSB at 8:16 PM on October 7, 2010 [1 favorite]

could be that's jessamyn or asavage making use of the anonymous feature.

It's not me, my doctor knows I [very occasionally] smoke the stuff. I figured it made more sense to tell them the truth than have to deal with it alter down the line. When I was having a big anxiety problem years ago, telling the doc "I'd like to stop self-medicating and actually work with a medical professional on this" I think they liked it. That said, I'm comfortable never having the sort of job that requires a drug test or that sort of thing, so my experience is likely not typical.
posted by jessamyn at 8:17 PM on October 7, 2010 [1 favorite]

@ Mitheral - This is true, I didn't contemplate that. I feel admitting one likes to toke is a no biggie as long as you a.) Are not running for office, B.)Have a public job that could be in jeopardy due to admittance or C.) My doctor/Insurer
posted by handbanana at 8:18 PM on October 7, 2010

If I were doing something illegal, I would never confess it to anyone that had the power to turn it into a permanent sort of record.
posted by sickinthehead at 8:30 PM on October 7, 2010 [5 favorites]

could be that's jessamyn or asavage making use of the anonymous feature.

Well, we now know it's not Jessamyn, and asavage has been open on AskMeFi about his past psychedelic usage, so I would wager it's not him either.

Anon, only you know your doctor and what kind of relationship you two have. You could always outright ask him not to write about your usage in your files; he might be sympathetic.

My own doctor (in California, which is relevant) always asks his patients if they routinely or in the past used drugs. The first time he did this, he must have seen my slight hesitation, because he quickly followed that up with "I mean, anything serious", which was pretty much an admission that it was "don't ask, don't tell" with him with regards to marijuana.
posted by Asparagirl at 8:33 PM on October 7, 2010

I don't tell my doctor anything I'm not prepared to have my insurance company (and every insurance company down the line till I croak) know. I ink that's an unfortunate thing but if you have read the information sharing disclosures your doc makes you sign you'll realize there's nothing that gets written down that they can't see.

So if you really want to tell your doc because this is relevant I think the thing to do is ask "is that the kind of thing your going to write down in my records?" Your doc isn't stupid and perhaps will indicate willingness to talk "off the record." If you trust that then share.
posted by phearlez at 8:53 PM on October 7, 2010

Please Lie, at least until society will comfortably allow the truth about something so trivial.
posted by ovvl at 9:04 PM on October 7, 2010

I've never known or heard of a doctor turning someone in for recreational drug use. It's not the business they're in. Tell your doctor if you think it's relevant, and it might be.
posted by chairface at 10:19 PM on October 7, 2010

Read this previous AskMe.
posted by bonobothegreat at 10:23 PM on October 7, 2010

the issue is not your doctor turning you in, but someone else (insurance, current or future employer, some jerk) getting your medical records and using them against you.

what does it cost you to protect yourself? cannabis use is extraordinarily irrelevant in most medical circumstances, and if you have any issues you can still make anonymous inquiries via other channels.
posted by paradroid at 10:52 PM on October 7, 2010 [1 favorite]

I have never used marijuana (or any other drugs), but if I was in your situation,
I would lie to the GP rather than risk it ending up on my permanent health insurance records with possible repercussions (denied coverage, etc.)

You can always see another doctor anonymously or under a false name and pay for it as cash out of pocket if you want to check if your marijuana use could be causing your symptoms.
posted by Hot buttered sockpuppets at 11:01 PM on October 7, 2010 [1 favorite]

Why would you tell your doctor? Do you really want a written confession of your illegal drug use enshrined in a medical record accessible by any insurer, potentially by employers and who knows who else (HIPPA be damned)? Unless you need to communicate this information for a specific medical problem, and I can not think of one which applies here, then keep it to yourself. This information could be used against you in ways that you can not even contemplate right now. It seems that attitudes towards dope are loosening, but I believe Federal law still encourages drug testing under the Drug Free Workplace act and political pendulums can swing backwards. Very little good and potentially great bad can come from releasing this information. I recommend that you keep it to yourself.
posted by caddis at 4:10 AM on October 8, 2010 [1 favorite]

As a doctor, I'd prefer that patients tell the truth. We're trained (and are supposed to be) objective and non-judgmental. Many doctors (and certainly most of my colleagues) do not see recreational drug use as a moral failing. By not telling her, you are making it that much harder for her to have all of the information that she needs to be fully effective in her role as diagnostician and physician. Is there a genuine reason that you don't trust her with this information? If so, maybe you should find a new physician that you trust, because an effective doctor-patient relationship is based on mutual trust.

With regard to your concerns about physicians calling child protective services, they're unfounded. Unless your 4 year old is smoking marijuana, you've got nothing to worry about. Physicians only have a duty to report abuse. If you were getting high, beating your kids, and then brought them in with suspicious bruises or injuries, the doctor would have a duty to report if they suspected child abuse. But your habit is your habit, and doctor-patient-confidentiality would trump any unfounded speculation about secondary pot smoke affecting children.

In terms of insurance, yes, it may go in your doctor's clinical notes, but the odds of your insurance company actually ever seeing your doctor's clinic notes are very, very low - almost zero. If your doctor coded your visit on the billing sheet as having to do with substance abuse, then that's another story, but if you only mention it as part of your medical history, it should never show up for your insurance company. You can also be frank and mention your concerns about insurance to your doctor. She'll probably reassure you in a similar way. Doctors do not mail their clinic notes to the insurance company with claims, and insurance companies don't come to doctors offices to check every chart. Occasionally there will be audits if insurance companies think that doctors are overbilling, where they'll ask for representative charts to compare the clinic notes to what was billed. But this is rare. Inpatient care is a little different, where patients who are hospitalized for major illnesses may have insurance company people come in and do "utilization review" and look at charts, but you're talking major illnesses resulting in expensive care.

Now, all of this goes out the window if you know a prioiri that your doctor is an intolerant zealout or anti-drug crusader of some sort. But you should probably have a feel. I bet, though, that the benefits of fully disclosure far outweigh any real risks to you, your family, or your insurance status. If you truly have concerning medical symptoms and want them diagnosed to the best of your doctor's ability, you'll provide the fullest and most complete medical history and work with her to get to an accurate diagnosis. Since you can't fully real out that your pot use isn't involved, and since you're not a doctor (and even if you were, you shouldn't be diagnosing yourself), you should enable your doctor to properly do her job.

(As an aside, because the expectation was that patients always lied about their alcohol consumption, I was trained to take the number of drinks per week that patients self-reported in the ER and multiply it by 3 to estimate the truth)
posted by scblackman at 4:16 AM on October 8, 2010 [13 favorites]

Deny till you die.

Or at least until America stops making such criminals out of a lot of people.
posted by WeekendJen at 5:43 AM on October 8, 2010

the odds of your insurance company actually ever seeing your doctor's clinic notes are very, very low - almost zero

How many people potentially have access - legal or otherwise - to those notes? How certain can you be of their motivations? Could exposure cost you your health insurance or the job that provides it? Or some costly public embarrassment?

And you must consider these questions not just under your present circumstances, but for as long as the information in those notes remains in existence - which you must assume will be for the rest of your life. How eager will your insurance company be to dump you in 10 years? What will the legal penalties be then?

You wouldn't take even a 1% risk of, say, losing your home without an extremely compelling reason. And it doesn't sound like you have an extremely compelling reason here. If you think pot may be causing you bad symptoms, stop smoking it for a month. If the symptoms remain, you'll know it's not the pot and you can resume enjoying it with the added benefit of lowered tolerance. If you can't bear the thought of going without it for a month, that's a sign you should probably stop anyway.
posted by Joe Beese at 5:57 AM on October 8, 2010 [1 favorite]

Doctors will not turn you in to the police if that is what you are worried about. There is that issue with patient confidentiality.

It really depends if smoking pot is an issue or not. If you are a heavy or daily user then yeah, mention it to them. A couple times a month, then it doesn't bear mentioning unless you are showing symptoms of lung problems. I am not a regular smoker by any stretch of the imagination but I do smoke a cigar from time to time. This does not bear a mention to my doctor unless I am having related problems which is highly unlikely.
posted by JJ86 at 6:19 AM on October 8, 2010

I agree wholeheartedly with scblackman. It does depend on the physician you are seeing as to how they react, but for the most part it is no big deal. I live in a very conservative part of the country: we elected Paul Broun to congress. He is a physician that I would think twice about disclosing pot use to (although even he is ambivalent on the issue, having admitted marijuana use in the past and voted in favor of preventing the feds from going after medical marijuana users; he has also said "...marijuana is a gateway drug that leads to the nightmare of drug abuse." Personally I have been told a number of times by patients that they smoke pot or worse and have never considered labeling them as drug abusers or involving any sort of government interference in their lives unless I had reason to believe something more was going on ("sure I smoke pot; sometimes it's funny to give our toddler shotguns" would probably get you in trouble). Most of my colleagues feel the same way and a number of us (myself included) have smoked pot at some point in our lives (and I am sure there are some that still do). I wish pot were legal in fact, because it would probably make an excellent preop sedative and be safer than the more powerful drugs that we now use. If a patient admitted they smoked pot but asked me to keep it out of the record, I would give serious consideration to their request but try to reassure them that their records are private. In the linked question above what seemed to attract the insurers attention is the diagnosis "cannabis abuse", not an entry in the record. I wouldn't even begin to know when cannabis use becomes abuse and so wouldn't give that diagnosis in the first place.

It eventually boils down to trust. If you trust your physician with your life, you should trust them enough to share your pot smoking history with her. If you do not trust her with that information perhaps you need to find someone you do trust. It is not unreasonable to get to know her a little before coming clean, though.

Also, as scblackman said, we assume that people are less than honest when it comes to answers about substance abuse. When I see a teenager with a big pot leaf tattooed on his arm who denies any type of drug or alcohol use I am skeptical. But perhaps he is just Canadian.
posted by TedW at 6:30 AM on October 8, 2010 [1 favorite]

If you have some trust in your doctor, you could say when they ask about drug use, "If I were smoking something, I wouldn't be comfortable telling you about it because I don't want it in my chart." This gives them an opening to say, "I'm concerned about XYZ symptom that you've reported, which could be related to smoking marijuana, so this is important." Or for them to say, "OK, you don't seem to be having any problems either way" and leave it out of your chart. The worst they could do is directly quote you and make a note that they think you might be smoking.
posted by vytae at 8:15 AM on October 8, 2010

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