Category Archives: Responsibility

Doctors Want out of Medical Cannabis when it is legalized

Doctors want medical pot phased out after legalization: Canadian Medical Association

‘There’s definitely some physicians who feel comfortable in that area, but most don’t’

CBC News Calgary
Dr. Jeff Blackmer on medical cannabis after legalization

00:00 05:21

Dr. Jeff Blackmer with the Canadian Medical Association says doctors want medical marijuana phased out after legalization. 5:21

Doctors in Canada want to see the medical cannabis system phased out once legalization happens later this year, says a Canadian Medical Association vice-president.

“The medical profession, as a whole, has really struggled with the whole concept of medical cannabis. There’s definitely some physicians who feel comfortable in that area but most don’t,” Dr. Jeff Blackmer, vice-president of medical professionalism for the Canadian Medical Association, told CBC Calgary News at 6.

“And [that is] primarily because of the lack of evidence, the lack of scientific studies showing it actually works, the lack of knowledge around dosing and interactions with other medications — all these types of things. Our recommendation was that once it is legalized, that there really is no reason for a separate medical system.”

The federal government has tabled legislation that will make marijuana legal in Canada on Oct. 17.

A lack of clinical studies is the reason most healthcare plans in Canada don’t cover the cost of medical marijuana, said Blackmer.

“Right now, the type of evidence, the quality of evidence that we typically look for before approving drugs or before funding drugs, isn’t there for cannabis,” he said. “That’s not necessarily to say that it won’t be there in the future, and certainly that’s something that a lot of physicians are watching carefully.”

Education, said Blackmer, will be important in the lead-up to legalization.

“The reason for that is there’s a lot of misperceptions around cannabis and we know that, from surveys and studies that have been done,” he said. “We really want people, when they’re deciding whether or not to use cannabis once is becomes legalized, to make an informed decision. To understand there are risks associated with that, that there are potential health consequences.”

Dr. Jeff Blackmer says many doctors don’t feel comfortable prescribing marijuana due to a lack of study around the effects of consuming cannabis. (Robyn Miller)

One concern Blackmer has centres around teenagers using cannabis. Some provinces — including Alberta — have set the minimum age for use at 18, while others set the minimum age at 19.

“We know that more young people use this substance than older people. We know it is something teenagers often try in high school and we know that it has a detrimental impact,” he said.

“There’s a difference between a 15-year-old smoking cannabis versus someone who’s in their 40s, where the brain is already fully developed. It does have a detrimental impact [in young people] and we’ve seen that in studies and surveys and other research.”

Cannabis is set to be legalized in Canada on Oct. 17. (THE CANADIAN PRESS/Graeme Roy)

Once legalization happens, Blackmer said, there will be no reason for people to access it through their doctor.

“If anyone can go down to the local dispensary and get cannabis, there’s really no need for a separate medical authorization system. You really don’t need to have people going to their doctors because anyone who has a medical condition and thinks they might benefit from it can go ahead and try it,” he said.

“And there’s nothing to stop them from asking their doctor, ‘might it work for this condition,’ or ‘do you have any idea about what doses I should use,’ or these types of things.”

Doctors want education to be a big component of marijuana legalization. (Ron Ward/Canadian Press )

Blackmer says the number of medical authorizations has gone down in jurisdictions where cannabis has been legalized, something he expects to see here as well.

“The hypothesis is that there’s a lot of people who may have initially turned to the medical system to get access who now don’t need to do that anymore. So the number of prescriptions, or authorizations, seems to go down,” he said. “And that’s sort of what we’re anticipating in Canada, that the system sort of phases itself out over time, as we get more experience with [legalization].

“There will be some physicians who feel that this has a real place in terms of treatment options and will continue to have those conversations with patients. But we’re hoping for the vast majority of physicians who are uncomfortable, it will mean their patients can just seek it out on their own, they won’t have to find another doctor or to go to a cannabis clinic. They can go down to the dispensary and see if it works for themselves.”

Not a typical prescription

And it’s “more accurate to say authorized,” rather than prescribed, says Blackmer.

“It’s not a typical prescription because it’s not something where you’d give it to a patient on a piece of paper and they’d take it to a pharmacy of their choice — that’s really a prescription,” he said.

“An authorization is something the doctor authorizes and faxes it or emails it to a specific distributor of cannabis and then the patient goes through that distributor, so it’s definitely a different process.”


With files from CBC Calgary News at 6

 

https://www.cbc.ca/news/canada/calgary/canadian-medical-association-cannabis-legalization-1.4772000

Please follow and like us:

Problems, Ignore, Repeat, Problems again

When managers ask me how to help one of their employees, I usually ask them some questions to find out what the problem is. I have seen the same patterns repeated over and over again in many workplaces trying to deal with an addicted employee. The employee gets in trouble, he or she gets a talking to or maybe even a letter, the addict promises to be good, everyone forgets the issue and then the addict gets in trouble again. The problem here is that with no serious action, there is no accountability and therefore there are no results. Without boundaries, the problem will reoccur.

The workplace needs a procedure that can be used to find solutions that are legal, ethical and helpful but primarily geared to safety. If substance abuse and addiction are looked at from the standpoint of safety, then a whole new pathway opens up. We then see that untreated addiction can be a serious risk that must be mitigated in some way. Our future action will stem from this viewpoint, with safety as the focus.

Keeping the workplace safe has positive implications for the whole of society. If a suffering person is helped before resources in the community are involved, then that is a big savings. For instance, health care, social services and the justice system can be tied up with problems that are really addiction in disguise. If the workplace has a practical procedure for dealing with substance abuse, then they are in a position to help. I have seen many people recover because their workplace was using a procedure to deal with substance abuse issues.

Please follow and like us:

Why Can’t I Stay Sober (part 2)

Maybe you are hanging with the wrong people. 

It could be your environment is bad for your sobriety. Are you hanging around bars for example? There is an old saying…”with whom you assemble you will resemble.” I believe that this is true.

If you want sobriety you have to find people that have it and learn how they got it. Same as making a million dollars, you want to find people that have done this if that is what you want. Sobriety is the same.  Prioritize that you have a problem and find people that have solved the problem.  There you go.

 

Please follow and like us:

Ralph Waldo Emerson

“Men imagine that they communicate their virtue or vice only by overt actions, and do not see that virtue or vice emit a breath at every moment.”

41HgrBGzwTL._SX331_BO1,204,203,200_

I got a call from a union representative to call a guy. He never got back to me with the name but the next day a man called me 5 times and left two messages within 45 minutes and the messages said he failed a drug test and to call him right away. It sounded urgent and five calls in a short period seemed excessive. I called within 60 minutes of the last message he left but he there was no answer so I left a message. I imagine that it was the guy referred to by the union man. I found that strange to call so many times in a short period of time, leave two messages and not be there when I call.  Maybe there was an emergency……….?

When the union man called me he asked me if I could help the union member. I said that I could but I would need cooperation.  It is not a one sided thing. I can’t make someone change unless they want to change.

What I mean by this small story that seems to happen allot in one way or another is that every action shows something as Emerson expounds upon in his essay.  Tell me one thing and do another. Don’t show up or be late. It all says something.  I would suggest everone Read Emerson.

 

 

Please follow and like us:

Addiction Assessment for the Workplace and Return to Work Process

1493081765697

When an employee first learns that the assessment has determined they have a substance problem and they need help, the question I love to hear is, “What do I have to do to get better?” But the question I get often is, “When I am going back to work?” The answer to the second question is in the first question. Appropriate action from the employee will make a good case for returning to work. Remember that these employees are off work for a reason – safety!

During a follow-up interview after treatment, I ask, “What are you doing today that makes it reasonable for me to assume that you are not going back to your drug of choice?” I look for two key indicators that an employee is working on themselves: action and attitude. First, they need to be doing something to help themselves. When they are, they also feel better. When employees are grateful for the chance to change, I believe they are on the right track. Gratitude and action together shows me that they are moving ahead. This does not happen overnight, so the employer has to have strong boundaries, only returning employees to safety-sensitive work once certain actions are fulfilled.

People are people, and what they say they are going to do, they don’t always do. Some people are moved to change when the pressure is on, but after that their effort dwindles. The return-to-work process cannot be dogmatic or inflexible; it must be reasonable. Sometimes we just have to give some solid direction and wait to see what happens.

While looking for characteristics in the employee and their behaviour that indicate a good change is taking place. I ask myself, “Does this person have a reasonable chance of not allowing alcohol or drugs to affect their job when they return to work?” The key word is reasonable. The process must be fluid while taking into account what the employee does. Are they moving away from drug usage or back to it?

If a person attends counselling rehab or self-help, the ultimate goal is the same, to get sober, stay sober and become a useful, safe employee that is not a risk due to substances. Just as addiction has recurring patterns or themes, recovery has patterns and themes that indicate whether the person is going in the right direction or not.

Please follow and like us:

Returning a worker to Work after Alcohol or Drug Infraction

20170710_114319One day in a shopping mall I overheard a conversation between two young ladies. One was telling the other that she had just failed her driving test because she did not completely stop at a stop sign. Apparently, the examiner immediately cancelled the rest of the test and told her she had failed because of that one action. She told her friend how shocked and hurt she was as she felt she performed pretty well during the other parts of the driving test. She was furious at the examiner for not passing her. She claimed it was all his fault that she didn’t pass.

I thought about how this story relates to my role in the whole return-to-duty process. The driving examiner was preventing unsafe drivers from getting their license. The young woman thought that since she only went through one stop sign and didn’t hurt anyone, she should be forgiven. She reasoned that lots of people go through stop signs without harm. The difference was she was with an examiner trained to spot mistakes. If she was unable to refrain from going through a stop sign with an examiner in the car, what kind of driver would she be when she was by herself? That is basically how I look at return-to-duty as well. If an employee is not going to make the effort to help themselves while they are out of work and being monitored, why would they make any effort to stay well when they are returned to their job functions?

The answer is that they won’t.

Please follow and like us:

There is No Magic to Sober Someone Up but ….

There is No Magic to Sober Someone Up

but

The Magic is in the Process

I don’t have any power over anyone and I can’t sober people up and keep them that way. That is way beyond my capabilities. There can be some magic created when an employee has to face a well- run process that causes them to have to look at themselves. There is the magic. That is my experience and that is what I have seen. We don’t wait for people to “come around” and take on that risk and liability. We act with a process that has boundaries and that makes people accountable for their own actions.

Steve Chandler, a business author, has a book where he discusses the choice between people pleasing others or serving them. Serving them gives them reality and employees acting out sometimes are very unhappy to get a dose of that. People pleasing is what the suffering employee wants because they don’t really want to change. They tell you they want to change and promise this is the last time but they don’t. Baby them, tell them it is all right this time, bend the rules and risk an unsafe workplace and they will be happy with you but that is people pleasing and it could bite you in a bad place down the road. Serving can be unpopular but it is the right and safe thing to do. The employee won’t like it but they may thank you for saving their life when they do straighten up.  Do you serve or people please?

 

Please follow and like us:

Nova Scotia Doctor Charged With Trafficking Oxys, this is very bad

http://thechronicleherald.ca/novascotia/1344413-n.s.-doctor-charged-with-trafficking-oxy-pills

Prescription pill bottle containing oxycodone and acetaminophen are shown in this June 20, 2012 photo. (CP)

Prescription pill bottle containing oxycodone and acetaminophen are shown in this June 20, 2012 photo. (CP)

A Nova Scotia doctor has been charged with drug trafficking after police accused her of prescribing 50,000 potent opioid pills to a hospital patient who never received them.

Bridgewater police said Wednesday that 35-year-old Sarah Dawn Jones wrote prescriptions for oxycodone and oxyneo pills of a variety of dosages over a one-year period.

Police Chief John Collyer said it’s alleged the physician prescribed the powerful painkillers for a patient at the local hospital, but picked up the prescriptions herself at a Bridgewater pharmacy.

He said he’s concerned that a doctor is at the centre of the case, in a province that’s seen a series of deaths of young people tied to illegally circulating prescription drugs. According to the Canadian Journal of Addiction Medicine, there were 295 deaths tied to prescription drugs in Nova Scotia between 2007 and 2010.

“The trafficking of prescription narcotics is a problem throughout Nova Scotia. We’ve had a number of high profile deaths over the years, so we take it very seriously,” Collyer said in a telephone interview.

Jones is also accused of possession of narcotics for the purpose of trafficking, theft, breach of trust, drawing a document without authority and fraud.

This isn’t the first time a health care professional in Nova Scotia has been accused of malpractice in relation to prescription drugs. Dr. Trevor Locke, a family doctor based in Truro, was reprimanded in November for loosely prescribing opiates and failing to meet standards.

In September, Amanda Reid pleaded guilty to selling hydromorphone and fentanyl after stealing the drugs from the hospital where she worked.

Dr. Gus Grant, registrar and CEO of the College of Physicians & Surgeons of Nova Scotia, said medicine as an industry needs to accept a degree of responsibility for the “extraordinarily damaging social reality” of prescription drug abuse in Nova Scotia, and continue working to find solutions.

“Medicine has an important ownership to claim part of this problem,” he said in an interview. “I think finding a solution begins with a broader and clearer awareness of the extent of this problem within the medical profession and society as a whole.”

Grant said the college works closely with physicians to ensure opioid painkillers are always prescribed appropriately. The college also conducts peer reviews, as well as investigating and initiating complaints.

“We point physicians in the direction of resources and learning tools that will allow them to continue prescribing appropriately,” he said.

“We are primarily a watchdog, but I like to think we’re a guide dog as well.”

Grant also said the Nova Scotia prescription monitoring program, which he runs, is a great resource for physicians, regulators and lawmakers.

The provincially-funded program tracks specific prescription data for monitored drugs all over the province.

“Everything in medicine begins with data,” he said.

“The prescription monitoring program is an important tool for physicians to provide good care, and get feedback about the use of medications by their patients. It also allows regulators to track prescription data. We can track how much prescribing is being done, by whom, and where.”

Jones worked at the Crossroads Family Practice in the Halifax suburb of Tantallon, but Grant said she’s under an interim suspension and has stopped practising.

He also said Jones’ alleged crimes were reported to the college by a clinical pharmacist.

“The proactive steps taken by the individual who contacted the college should be applauded. That’s what health professionals should do,” he said. “The college and law enforcement have also worked very well together in this regard.”

Jones has been released from custody and is scheduled to appear in provincial court in Bridgewater on May 11.

Please follow and like us:

Last Chance Agreements

Last Chance Agreements

There is another tool for accountability that can be used in certain situations with an employee if you have decided that their next disciplinary action is termination. This tool makes it very clear that certain behaviour will not be tolerated.

Basically, it is a document that is drawn up by the employer where it has been agreed that no more chances will be given to this employee unless certain continued conditions are met. Legal counsel is desirable in this type of agreement to make sure that the document is solid in the eyes of the law. It is then thoroughly explained to the employee what the conditions are for continued employment like passing drug tests or showing up for work on time for example. The effect of the agreement is that it promotes the idea that there is a limit to what the employer will tolerate. The employee hopefully gets the picture that firm boundaries are in place and the next and final action will be termination.

The employee agrees to behave in an acceptable manner going forward and could be terminated without a grievance or a legal dispute if problems arise. That agreement is then signed as a condition for their return to work. This may be a very useful tool as it promotes responsible action by helping the person realize that there are serious consequences to continued poor choices that affect workplace performance.

Unfortunately, with some individuals, even that consequence does not promote enough motivation for a change in behaviour. They slip and get back on some substance and are caught and that is that. Strangely enough, this is when many addicts actually look at themselves after they have lost their job so this scenario can have a positive outcome. I have seen recovering addicts re-apply for their job after a year of clean time and get it because they have straightened out their life so all is not lost.

What do you do if you think there may be hope when the employee slips? You can keep an employee working after they violated a last chance agreement if you feel they deserve another chance. Maybe a re-assessment is in order to see what their motivation for change really is and if there is a solid action plan. You can then let them go or keep them on the payroll as you will have more information to make your choice after the assessment. There may have been a good long period of acceptable behaviour and you may believe that the slip was more of a bump in the road than a permanent decent. Again, last chance agreements are not for all situations but simply another tool worth knowing about in dealing with substance abuse issues. From what I have seen, accountability promotes behaviour change with substance abuse and addiction and this is one way to help and keep the workplace safe.last chance

Please follow and like us:

Enjoy this blog? Please spread the word :)