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How to Talk to Your Doctor About Your Recreational Drug Use

‘Hey, doc. I’m high as shit right now.’

If I had a nickel for every time I lied to a doctor about smoking like Snoop Dogg, I’d be a less maniacal but equally wealthy Jeff Bezos. There’s no excuse, either, since being open with your doctor about drugs can only really help you (at least, for the most part).

Whenever your doctor doesn’t have a good understanding of your habits, things will get missed,” says Eric Curcio, an internist and pediatrician at UCLA Health. “It might be that a symptom you’re describing to me is a side effect that some people get from using a certain recreational drug. One example that I see come up from time to time is, certain people who smoke marijuana regularly become very nauseous and can’t stop throwing up. If I know you’re a regular smoker, we might be able to get to the bottom of that very quickly. But if I don’t, we’ll probably be ordering blood work, imaging and sometimes even invasive tests. This leads to a lot longer time for diagnosis and treatment, and of course, a lot of extra medical expenses.”

Plus, having a candid conversation with your doctor about your regular benders can help you circumvent potentially dangerous drug interactions. “It’s also important to remember that recreational drugs can interact with many medications we prescribe,” Curcio says. “If your doctor doesn’t have a good picture of what else you’re putting in your body — whether it be other medications, supplements or recreational drugs — it really can put you in danger.”

And obviously, if you’re seriously struggling with an addiction, talking to your doctor is one of the simplest ways to get help. “Mental health symptoms and substance use should not be minimized, because these issues can worsen and create problems in other areas of our lives,” says Neeraj Gandotra, SAMHSA’s chief medical officer. “Furthermore, these issues, once present, rarely resolve without assistance.”

But while important, opening up to some rando in a lab coat about your potentially illegal substance use is easier said than done. “There’s no doubt that many things that we should discuss with our doctors are intimidating,” Curcio acknowledges. “These are often things we’d never speak about with close friends, let alone someone who might practically be a stranger. But guaranteed, your doctor just wants to know the truth and provide you the best care they can. We’re not here to judge anyone.”

Unfortunately, that’s not always the case: Studies show that doctors sometimes discriminate against patients who use substances, either by refusing prescriptions, specifically pain medications, or treatment until the patient gets “clean and sober.”

And sadly, while doctor-patient confidentiality would prevent your doctors from contacting the police if you admit to using illegal drugs, they’re required to document your substance abuse history in your medical records, which, if submitted to your insurance agency, may result in increased premiums, denied coverage and extra authorizations down the line. For now, the Affordable Care Act passed in 2010 technically eliminates addiction as a disease insurers can discriminate against, but again, that’s not always the reality, and the ever-shifting landscape of health insurance policies may present more problems for drug users in the future. Even under the ACA, for example, health insurance companies are able to charge smokers up to 50 percent more for premiums in most states. This shouldn’t stop you from talking to your doctor about drugs, but it’s something to think about.

Then, how do you actually talk to your doctor about something so personal? 

It’s really about however you feel most comfortable, and the best advice I can give you is to find a doctor who you really, really like. “It’s so important for everyone to have a primary care physician that they build a relationship with and grow to trust over time,” says Curcio.

If you need to, wait a few visits to feel them out before opening up about drugs. But once you do, you’ll be better for it, because, as primary care physician Marc Leavey  says, “What you tell your physician may, in fact, be the most important part of the visit.” 

Even if it’s about the wicked bong rips you took before coming in.