It’s been six months since I took a diagnostic test to see if my long-held suspicions about the vagaries of my brain were true.
Since adolescence, I wondered if ADHD, or attention-deficit hyperactivity disorder, could be a root cause of some of the problems I was having. Last summer, about two years after I sought therapy, I started to accept that medication might be the best next step to help round out my treatment plan.
What I didn’t realize is that seeking medication would come with one major caveat: A drug test, screening for all kinds of illicit substances including marijuana. And during a lengthy psychiatric consult to seek a prescription, it became clear that my consistent cannabis use was a red flag, even if I had the therapy files to justify why and how the drug fit into my life.
“Chronic marijuana use is… going to be a problem,” the consulting physician told me after a pregnant pause. “So we’re going to need you off of that for the urine test.”
This was a jarring crossroads to hit after an hour of explaining my struggles to a literal stranger. At no point during my mental-health treatment had I been warned that I would need abstinence from a legal, safe form of self-medication in order to just qualify for a prescription. Marijuana was everywhere in California, where I live, and I assumed that meant it wouldn’t be much of a barrier to health care. But no matter how I tried to articulate my drug-use history, it was clear that the answer was to quit or go home.
I finally snapped: “You can’t test for alcohol or nicotine, which people use to self-medicate all the time. So you’re telling me a daily joint is worse than ripping cheap wine and Parliaments all day?”
The silence on the other end of the phone call was deafening.
The prospect of spending several weeks abstinent to clear my body of THC, plus the hassle of arranging my urine lab appointment, all for the potential outcome of being rejected for the prescription anyway, made me wilt. I didn’t want to spend more time answering questions with care and transparency, only to be treated like a walking criteria form after saying “the wrong thing.” Exhausted and disillusioned, I peeked at the message in my inbox with the instructions for next steps, and then set it aside.
Marijuana is fully legal for recreational use by adults in 18 states, and 37 states have given the green light for medical use with a doctor’s approval. Nonetheless, across the country, people who smoke, vape and eat pot products are running into walls while trying to seek medication for their mental-health diagnoses. You can find countless testimonies online of people in this awkward position, most often involving those who are seeking ADHD stimulant drugs like Adderall or benzodiazepines like Xanax. And many experiences highlight confusion in the system — like the arrival of new policies that force people to arbitrarily test, or inconsistencies in drug testing from one psychiatrist to the next.
Of course, chronic pot use can be indicative of harmful addiction, and there’s certainly evidence that marijuana can worsen mental-health issues like anxiety, depression and fatigue in some people. Even after my own consultation, I wondered whether I had it all wrong. People who are neurodivergent, especially those with attention disorders, are disproportionately likely to seek drug use as a way to cope with imbalances in the brain. And there’s a reason why doctors discourage using pot with stimulants (or benzos, or SSRI antidepressants) during a treatment regimen.
Despite that, I still didn’t understand how a major health-care network could literally just disqualify anyone who didn’t piss clean of pot. First of all, it’s infamous for lingering in the body much longer than other drugs. But secondly, people with conditions like ADHD and PTSD have long discussed their positive personal experiences with marijuana as a balm for their symptoms… yet there’s a serious dearth of research to guide professionals on best practices. We just have glimmers of the possibilities, and far more blunt warnings about why pot is to be avoided in mental-health care. It’s a complex situation, which is why Alex Dimitriu of Menlo Park Psychiatry & Sleep Medicine in California says that “transparency and trust” between a patient and doctor is key to effective treatment.
“Marijuana is a particularly touchy subject because unlike alcohol, or even cocaine, it can linger in the body for weeks. My patients are often forthcoming about marijuana use, and I rarely will request drug testing. With a good therapeutic relationship and trust, many people are often willing to reduce use on their own, recognizing that this is a form of self-medication,” Dimitriu says. “I very rarely will cease working with a patient over a ‘failed drug test,’ and rather, do my best to help from a harm-reduction approach.”
One of the bigger concerns is sussing out whether a patient really does suffer from a substance-use disorder, adds Priscilla Hidalgo of Lux Psychiatry in Raleigh, North Carolina. Both she and Dimitriu note that “non-transparency” (aka lying) from a patient may justify the use of a drug test in order to keep them accountable, and protect them from unintended side effects. Conversely, regular drug tests can be used to prove a patient is actually taking their prescription and doing so safely, rather than abusing dosages or ignoring it altogether.
“We’re required by law to monitor the use of controlled substances we prescribe, and one way to do it is by using drug tests. If we don’t follow regulations, we could lose our licenses to practice medicine and/or prescribe certain meds,” she adds.
Dimitriu also notes that some people with established histories of drug abuse may require treatment that avoids habit-forming substances (such as benzos or sleep aids). But more than anything, both psychiatrists stress that drug testing shouldn’t be a barrier to care, but rather a tool used to help a patient in good faith.
“I find that once I explain to the patient the neurochemistry of how a substance acts and why giving up a substance might be helpful, patients understand and start working on reducing the use,” she says. “The other thing we doctors should do is be less judgmental and meet the person where they are. If I believe someone should stop using marijuana or alcohol, if they go from using it every day to three times a week, that’s a success that needs to be celebrated. I don’t see much of that going around, and patients need a partner in health care.”
In similar fashion, Dimitriu emphasizes that the whole point of mental health is addressing root causes of suffering, not merely the symptoms — and it’s a reason why he views marijuana use as a subjective, not objective, factor to be weighed. “In my work, I consider these three items to often be tips of the iceberg: Sleep, sex and drugs. When there is something wrong in any of these domains, there is often a lot more going on beneath. Our role as physicians and healers is to help and understand root causes. Very, very rarely does substance abuse exist in a vacuum,” he says.
That may be so, but for now, there remains a sea of people confounded by mandatory drug testing in psychiatry, wondering whether their habit of puffing a post-dinner blunt really justifies all kinds of headaches in seeking, and keeping, mental-health care. At this point, I’m ready to just forge ahead with my drug test, even if I end up failing it, in the hopes that I can spark a conversation and explain why I think my THC levels aren’t a hindrance to medication — and why I think that THC count will fall over time if I’m being treated.
And if I just get rejected again? Like many people who are venting online, I might just have to seek a different caregiver, with fingers crossed that a positive drug test won’t mean I get a door shut in my face.