● What are emerging issues in states that have legalized marijuana related to widespread use? It is important to consider some of the identified health considerations and concerns related to the growth of the marijuana industry in American communities. In general, healthcare professionals’ approach to shared decision making and person-centered care suggests that they will take a patient’s personal experience into account. People have various reasons for choosing their self-care practices. Research has shown that they are often quite rational in their thought processes concerning their health choices, even when they seem to be making choices “alternative” to mainstream biomedical culture’s view of safe and effective care (O’Connor, 1995). Even when patients request further information, such requests should not be interpreted necessarily as a sign of ignorance. The medicinal marijuana culture is a dominant subculture of the larger self-care culture, identified by social scientists as the “hidden health care system” (Levin & Idler, 2010). Medicinal plants have been part of the foundation of healthcare systems for centuries (Libster, 2004), yet many people may feel disconnected from their environment and the plants that are responsible for their food, shelter, and medicine. They may have no knowledge of what it takes to grow the tomato and prepare the tomato sauce that is on their pizza, or what plant has been the prototype for the newest cancer drug. Then, lacking this knowledge, they are faced with the decision points that have always come with use of medicinal plants. Marijuana is a plant no different from any other. It has many uses and forms, as well as hundreds of constituents, all seemingly at odds when the plant is examined in its reduced parts – but Marijuana drug screening issues Finally, although marijuana is legal for medical and recreational use in more and more U.S. states, under federal law, cannabis use is illegal, and employers in industries that are heavily regulated by the federal government screen their employees randomly and include drug testing as part of their hiring process. For non-federally regulated employers, federal law does not require drug testing. However, some state and local governments enforce laws regulating drug testing. Employers have the legal right to maintain a drug- and alcohol-free work environment and are allowed to test applicants and employees as long as the employer clearly informs those applicants and employees of the company’s drug testing policies, including pre-employment screening and random drug testing. In some cases, an offer of employment may be conditional pending the results of a drug test. These policies may be outlined in the job description, but most often will be stated in a clearly written agreement within the application or employee handbook, which applicants and employees are required to agree to and sign in order to be hired or maintain employment. Some employers have a company policy that directly addresses marijuana use, while others do not. Conclusion Oral healthcare practitioners face significant challenges today, as patients are living longer, developing chronic diseases that require a myriad of medications, while at the same time retaining their dentition and requiring the services of dental professionals. In the management of oral health, dentists will often employ surgical and pharmacological interventions that have been time tested yet continue to evolve based on current medical evidence. Keeping current with the latest therapies to treat patients, while trying to stay aware of the many more medications patients may be taking outside of the office (nutraceuticals, herbals, botanicals, and prescription and non- prescription medications, as well as social and illicit drugs) adds to the overall challenge of treating patients safely and effectively.
with scientific evidence of an intricate and powerful synergy of substances, an “entourage of effects,” when examined as a whole (Russo, 2011). Herbalists, who are often community experts on the subject of the application of medicinal plants, are an excellent referral resource for healthcare professionals who are learning to counsel people considering or already taking plant medicines such as marijuana (Libster, 1999). Nurses, pharmacists, and behavioral health practitioners can forge partnerships with knowledgeable herbalists to begin to address existing and emerging public health considerations and concerns. Brief and easy-to-use screening instruments commonly employed in assessing marijuana-related problems are the Severity of Dependence Scale (SDS – symptoms of dependence), Cannabis Use Disorders Identification Test (CUDIT – motivational aspects of use), Cannabis Abuse Screening Test (CAST – social and health problems), and Problematic Use of Marijuana (PUM). All scales have shown moderate to high internal consistency (Cronbach’s alpha ranging from 0.72 to 0.92), which means that the scales are good at measuring what they are supposed to measure. The SDS is a five-item scale that measures the degree of psychological dependence, that is, the individual’s feeling of impaired control and anxiety toward drug taking. The CUDIT screens for current marijuana use disorders (abuse or dependence), whereas the PUM measures harmful use, problems in interpersonal relationships, and psychophysical functioning. Basically, designed for adolescents or young adults, the CAST identifies patterns of marijuana use leading to social or health problems for the user or others in society (Piontek, Kraus, & Klempova, 2008). Drug screening for marijuana has become a debated topic in states where medical or recreational use is legal. The biggest difference between alcohol and cannabis is how they are detected through testing. Alcohol does not linger in the bloodstream in the way that marijuana does. Someone can fail a marijuana drug test weeks after using marijuana because THC takes a long time to leave the bloodstream. A positive test does not mean the person is impaired at that moment. It merely shows that the person used marijuana within the last few weeks or could have been exposed to second-hand smoke during that timeframe. In the case of alcohol, on-the-spot assessments such as the breathalyzer test can determine the alcohol level and resulting impairment of an individual at that moment. These tests enable lawmakers to create laws regarding the consequences of a person having more than the legal limit of alcohol in his or her system. The technology to test marijuana levels with such accuracy has yet to be developed. Without the ability to do accurate on-the-spot testing, it is challenging to determine what a legal level (the highest level that does not cause impairment) of THC would be. Therefore, any trace can be considered exceeding the legal limit. Medicinal marijuana is a highly controversial topic in the United States today. Although it is unlikely to play a role at this time in patient management from a dental perspective, the number of patients using marijuana is steadily increasing. Therefore, dental professionals need to understand and be able to manage patients who are using marijuana for both recreational and medicinal purposes. There is much to learn about medicinal marijuana from evidence other than clinical trials since many more patients are exposed to this medicine. This course has included historical data and evidence from in vitro studies, literature reviews, meta-analyses, surveys, and community health studies that have contributed in a meaningful way to current scientific understanding of the health outcomes witnessed in the public sphere, where marijuana use is proliferating. It is the duty of oral healthcare practitioners to be knowledgeable
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