Treating Patients Who Are Under the Influence: Clinical and Compliance Considerations
With the legalization of recreational marijuana in Illinois, chiropractic physicians are increasingly encountering patients who arrive for care while under the influence. While not an entirely new issue, it presents growing challenges that require careful clinical judgment and compliance awareness.
Not Illegal, But Not Simple
Similar to a patient arriving after consuming alcohol, the use of cannabis may be legal, but it introduces risk factors that must be evaluated before treatment. There are no absolute legal prohibitions against treating a patient under the influence of any substance, but the circumstances demand thoughtful consideration.
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Key Questions to Evaluate Before Treatment
Before proceeding with care, chiropractic physicians should assess the following factors:
- Informed Consent – Is the patient cognitively impaired to the extent that they cannot fully understand or consent to treatment? This is critical, as valid informed consent is a cornerstone of patient care and legal protection.
- Interaction with Treatment Modalities – Could the effects of cannabis or other substances interfere with the effectiveness or safety of the planned modality? Certain physiologic effects of marijuana -such as altered perception, delayed reflexes, or dizziness – may complicate the use of therapies like spinal adjustments, electrical stimulation, or balance-dependent treatments.
- Risk of Injury – Does the patient’s impairment elevate the likelihood of falls, instability, or accidents during treatment? For example, an impaired patient may be more prone to rolling off a treatment table or experiencing coordination issues while moving in the clinic.
Risk Management Insights
NCMIC offers guidance on this topic. Their articles outline real-world examples and provide best practices for navigating care when a patient is under the influence:
These resources underscore the importance of clinical discretion and thorough documentation when making a treatment decision.
Final Thoughts
Ultimately, there is no one-size-fits-all answer. The decision to treat a patient who is under the influence of cannabis or other substances should be based on a careful, case-by-case assessment that accounts for the patient’s ability to consent, treatment safety, and potential risks. When in doubt, document your rationale and consider postponing care until the patient is unimpaired.
