Home Audiology SLPs in the Home: What’s Pot Got to Do With It?

SLPs in the Home: What’s Pot Got to Do With It?

by Melanie Potock MA
written by

I never thought I’d be writing an article for ASHA about marijuana, but because I live in Colorado, I’ve got the latest news on weed to pass along to my fellow SLPs. In fact, if you were sitting here with me in the privacy of my own home (and you were over 21), we could chat about it while lawfully smoking a joint, munching on an edible cannabis-laced cookie, sucking on a marijuana lollipop or even, inhaling the vapors from an e-cigarette packed with marijuana oil. That’s just a sampling of the options we have to get high in the “mile high city.” Before you shout “I’m coming over!” I should probably disclose that I’m not a marijuana user, medical or recreational. If your next thought is “But I DON’T live in Colorado (or Washington) so this doesn’t apply to me – at least professionally” please read this entire article. Colorado law is considered a “springboard for other states” to legalize marijuana soon. Plus, illegal shipping to other states, often discovered during a routine traffic violation committed by the average Joe next door, has increased significantly. According to the El Paso Intelligence Center & National Seizure System, the mini-vans and SUVs bringing home “souvenirs” from Colorado aren’t just from the states bordering the Rocky Mountains. New York, Florida, Illinois and Wisconsin were some of the most popular destinations and consequently, you may experience some unexpected safety issues if you are providing home-based care for children and adults.

In an effort to educate therapists on the new laws and our responsibility to inform our families of issues that may arise with recreational marijuana use, Jane Woodard, the executive director of Colorado Drug Endangered Children, is traveling the state providing health care professionals the necessary information to keep ourselves and the families we serve safe. SLPs are required by law to report suspected conditions that would result in neglect/safety issues or abuse of children and adults. However, many of our families are simply not aware of the safety concerns and home based therapists are often the first resource for educating those families who choose to partake in using, growing or processing recreational marijuana.

Given the various populations that we serve, here is an overview of some of the safety issues:

Infants: As a pediatric feeding therapist, just one of the populations in my care are babies who require support for breast and bottle feeding. In this Colorado culture of embracing our new freedom, mothers are commenting to me without restraint that they’re using marijuana to combat nausea during pregnancy or enjoy “a little pot now and then” while breastfeeding.Studies indicate that by age four alarming changes occur in children that have had prenatal exposure. It’s noteworthy that the studies focused on a much lower amounts of delta-9-tetrhydrocannibinol (THC: the chemical that produces the psychoactive effect) than what is present in today’s super-charged marijuana products. The children demonstrated “increased behavioral problems and decreased performance on visual perceptual tasks, language comprehension, sustained attention and memory.” Marijuana use while breastfeeding is contraindicated because the THC is excreted into breast milk and stored in fat and is suspected to impact a baby’s motor development. There are no established “pump and dump” guidelines for THC and it stays in the bloodstream for much longer than other drugs. Consider the increased risks from both second-hand smoke and third-hand smoke or the “contamination that lingers” after smoking, including an increased risk for SIDS and more. For the home-based SLP, exposure to second and third-hand smoke or residue means that I will likely carry that aroma with me to the next home. I am responsible for the safety of all of the children I treat, and many are medically fragile and/or have sensory challenges and would be impacted by these odors. Today, I am faced with difficult conversations with parents that I never imagined I would have.

Children: In four short months, from January to April 2014, Colorado’s Poison Control Center has reported 11 children who ingested edibles, one as young as five months old. Over half of those children had to be hospitalized and two were admitted to the ICU. Consider that those are the reported cases – and what goes unreported is difficult to ascertain. While the law requires that the packaging cannot be designed to appeal to kids, current practices are questionable. Some argue that edibles are packaged too much like junk food, with boxes of “Pot-tarts” similar to the popular toaster pastry, bottles of fizzy “soda-pot” and candy bars with labels that rival Mars® and Hershey’s®.  In April 2014, Karma-Candy was the marijuana candy that a father in Denver consumed just before hallucinating and killing his wife, who was on the phone with 911 dispatchers at the time. She could be heard yelling to her kids to go downstairs as she desperately tried to get help for her family.

Packaging of certain products must also be in an opaque and re-sealable container, but that law only applies to the time of purchase. Plus, most edibles contain multiple servings and it’s not unusual for one cookie to serve six people. Even adults are mistakenly eating whole cookies and in April 2014, one visiting college student consequently jumped to his death from a hotel balcony after eating too much of an edible. A New York Times columnist visiting Colorado ate a whole candy bar labeled as 16 servings, and “laid in a hallucinatory state for 8 hours.” Home baked marijuana options are equally confusing. As a feeding therapist, I used to be comfortable offering foods to a child from a family’s pantry. But now, a tempting plate of brownies may be more than just a plate of brownies. By law, edibles, like any marijuana product (even plants), must be in an “enclosed, locked space.” However, it is not unusual for Colorado therapists to arrive for their home visit and find a bong, topical lotions or a half-eaten edible on the living room coffee table. Early intervention and home health care agencies are considering how to educate families on the first day of contact, during the intake process. Susan Elling, MA, CCC-SLP, who treats both children and adults in the home, notes that “It will be very important to have an open and honest conversation with a patient (and their family) regarding marijuana use as part of taking the medical history – just as we do for alcohol and smoking.”

Adults: Ms. Elling reported that “the population in need of homecare services may be more likely to use marijuana to control pain and nausea” because family members are more likely to suggest it and there will no longer be a need to obtain a medical marijuana card. Ms. Elling also notes that marijuana “affects sleep, balance, coordination, and cognition.  This may be amplifying the conditions a patient is already dealing with related to medical issues.  It can also significantly raise anxiety.  These are all factors that increase fall risk, confusion, lead to poor judgment, and can setback a patient’s recovery. It may be very difficult to determine what issues are related to the patient’s medical condition and which are related to the marijuana use.  Interventions, progress and prognosis may be affected.” Edibles in particular are a safety hazard for this population, because of the inability to self-regulate. There is no predicting how an edible will effect one person or another.

“It’s not your grandmother’s marijuana,” reported Dr. Richard Zane, who is the head of the Department of Emergency Medicine at the University of Colorado Hospital. Well-meaning family members, hoping to control their loved one’s discomfort, may not realize that the strength of today’s marijuana is significantly higher than the pot your cool grandma smoked in the 60’s. In fact, THC levels represent a 121% increase just from 1999 to 2010. Family members may not understand that the strength and effect of the drug varies from product to product. For example, compare two hits on today’s joint and an individual will ingest approximately five mg of the chemicals that produce the psychoactive and/or sedative effects compared to up to 100 mg in one packaged edible. Plus, even using the exact same method of ingestion does not guarantee the exact same dosage every time. Zane reported in this interview with Colorado Public Radio that the “drug isn’t always spread evenly through food or candy, so several people eating the same amounts can be ingesting different quantities of marijuana.”

The uncertainty of dosage and effects has Elling on guard: “I am concerned that the high potency, unpredictable effect, easy availability, and unclear dosage information of edibles may have serious consequences for homecare patients with already fragile health. It is also misleadingly considered quite “benign” and safe compared to alcohol consumption and smoking.  I feel the need to know the signs and symptoms of a marijuana overdose and know the contraindications with any other prescription or OTC drugs they may be taking and be able to educate my patients and their caregivers regarding this issue.”

Additional Safety Concerns: In the course of this short article, it’s impossible to cover all of the safety issues, including those related to growing and processing marijuana in the home. These concerns include electrical hazards from impromptu wiring (not to code); cultivation hazards such a mold and poor air quality for medically fragile patients;  increased carbon dioxide and carbon monoxide necessary for growing; chemical exposures and improper storage of pesticides and poisonous fertilizers; THC on household surfaces and airborne exposure; and exploding hash oil labs. From January to April 2014, hash oil explosions occurred on a weekly basis in Colorado, some triggered just by turning on a nearby light switch.

Consider Family Functioning: The impact on safety is the tip of the iceberg. Woodard explained that home health professionals must consider a parent’s behavior when using marijuana, the impact on a child’s behavior and family functioning overall. Difficult but often necessary questions to ask include: What steps have you taken to protect your children and family members? How do you store your marijuana and paraphernalia? What are you like when you use? Most importantly, she recommended asking yourself “Do I believe that the conditions in this home could reasonably result in harm” to anyone in this household? If so, educate the family and be mindful of mandatory reporting laws.

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of “Happy Mealtimes with Happy Kids” and the producer of the award-winning kids’ CD “Dancing in the Kitchen: Songs that Celebrate the Joy of Food!”  Her two-day course on pediatric feeding is offered for ASHA CEUs and includes both her book and CD for each attendee.  Melanie@mymunchbug.com.

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Home Health SLPs & …. Marijuana? | SLPTTT July 24, 2014 - 1:16 pm

[…] just finished reading this interesting article from the ASHAsphere blog about the new laws in Colorado that legally allow the usage of marijuana. It points out, not only […]

Melanie Potock July 24, 2014 - 6:35 pm

Thanks for your feedback. It’s a new issue here in CO and certainly one that I never expected to have to learn to manage.

Jennifer Pauler Garrison Ofs July 24, 2014 - 1:51 pm

I’m sorry, but this particular piece seems completely one-sided and completely negative. It paints the average user of marijuana (I myself DO NOT use) as a irresponsible, ignorant druggie, perpetuating a stereotype that helps no one.
Marijuana has helped many, and many (INCLUDING some children that we serve) have a LEGITIMATE health condition that is helped by its use. Nowhere in this piece is this EVER stated. Instead of proclaiming its use as seemingly the product of a “system and people gone awry”, we should be respectful of its user’s legal and legitimate choices.

Melanie Potock July 24, 2014 - 6:28 pm

Jennifer, Thank you for your thoughts on my piece. I’m sorry that you found it to be one-sided and completely negative. One thing that we are learning in Colorado in the workshops on this topic, is to let go of any stereotypical views of marijuana use. I’m not sure where you feel that I painted the average marijuana user as a “druggie”. This wasn’t an article about who it has helped (although I agree, it can be very helpful medicinally) or passing any judgment on growing, using or purchasing. It was an article about home health care workers being educated on our own safety as well as our clients and their families. With the extraordinary number of children admitted to the ER, the recent deaths, the once-a-week hash oil explosions and more, safety is indeed the issue. What has been stressed to us is that we are often the first point of communication around these safety issues.

pamslp July 24, 2014 - 3:03 pm

I found this article very informative – the one thing I didn’t know that was today’s pot is so much stronger than decades ago and the possible effects of over-ingestion. So much for “benign” effects so many people tout. I’m sure marijuana has some benefit when used properly, but how can a person judge the appropriateness once they’re under the influence? No different than an alcoholic’s judgment. It will be interesting to see how this all pans out over the years but I hope not at the expense of the innocents.

Melanie Potock July 24, 2014 - 6:33 pm

Thank you Pam, I agree. The issue you bring up – that a person may not be able to judge his or her own parenting skills and child’s safety when impaired, just like with some alcohol use, was a hot topic in the workshops I attended. We all care very much about the safety of our clients and of course, our own safety. Just as I would need to respond to a situation that may be harmful (by law I am required to do so) I need to be aware of potential hazards in the home. Like liquor, marijuana can be used safely and responsibly. But with our new freedom that came quite suddenly in CO, many parents simply aren’t aware of some of the dangers, like the possible effects of over-ingestion.

Rachel Wynn, MS CCC-SLP July 24, 2014 - 3:41 pm

Interesting perspective. As a fellow Coloradan I have had patients that have benefited from cannabis use. One adult with poor appetite, food acceptance, and nausea began eating again. A key thing to understand are the cannibanoids. You may recognize THC for it’s recreational properties, but other cannibanoids such as CBD are becoming more well known for their medicinal properties. I’m not a user myself, but since I moved to Colorado I have learned so much. It’s very intriguing and what happens when a good friend is an organic chemistry professor preparing to teach a course on drugs of use and abuse. We totally geek out and chat about neuroscience (and how drugs affect the brain). Check out Josh Stanley’s talk about CBD and seizures. http://tedxtalks.ted.com/video/The-surprising-story-of-medical

Also check out the different cannibanoids. http://marijuana.com/community/threads/know-your-medical-marijuana-what-cannabinoids-help-with-different-ailments.303094/ Once I started learning about it, I found it to be a topic with many gray areas. I simply want to learn more. And did you catch where Josh Stanley said they were going to do a trial with cannabis and Alzheimer’s. I’ll stay tuned for that! I am open to answers being found in unexpected places.

Melanie Potock July 25, 2014 - 10:04 pm

Thanks Rachel. All very good points for a follow-up article. This one was focused on safety now that recreational use/growing/processing/etc. is legal in CO. Appreciate all that you had to say, very helpful and informative, thanks!

Rebecca Ryan July 24, 2014 - 10:25 pm

I am uncomfortable with this blog as it is one sided and judgemental. There are medications, cigarettes, drugs,alcohol etc that continue to be available and used in homes of our clients. I do not see why marijuana is singled out in this way. As professionals, we need to be aware and able to have open and honest discussions about the effects of any substance that may change the behavior or future of our clients and patients. I do not believe this article is helpful in our work as speech-language pathologist due to the tone of the article.

Melanie Potock July 25, 2014 - 1:27 pm

Hello Rebecca, Thank you for your comments. I didn’t mean to appear one-sided or judgmental. Marijuana was singled out because it is the new issue in CO and the state is taking proactive steps to educate health care workers on the safety precautions, so that we are not only aware for our own safety, but for our clients and their families safety. I truly intended the tone to be educational in nature. Thank you for pointing out your feelings about it, I’ll be sure to take that into consideration.

sal July 25, 2014 - 10:16 am

Did you actually read any scientific peer reviews on the study that you cite? If you had, you would realize that when controlling for variables, like tobacco smoke, most of the issues you claim to cannabis go away. This isn’t unfounded, this is the scientific consensus and easily discovered by use of the “google” button. Are you purposely trying to mislead people by not acknowledging that this study had no controls for alcohol, tobacco, or other drugs? I recommend looking at other studies that controlled for these variables such as the one done by Melanie Dreher and published by the American Academy of Pediatrics.

Melanie Potock July 25, 2014 - 9:48 pm

Hi Sal, thank you for that information. I am familiar with Dreher and will definitely explore your recommendations. No, I would never purposely mislead people by not acknowledging anything. I was just trying to report on safety concerns raised at a recent workshop that was attended specifically by home health care workers in CO to educate them on the precautions.

Shannon Planck July 25, 2014 - 10:28 am

I found this article extremely interesting. I live in Vermont and we may become a state that legalizes Marijuana. Personally, I didn’t know any of the dangers mentioned and think that this should be shared with all Home Health workers. Does anyone know if kids can be taken away from parents in CO if the parents use marijuana regularly and the children are experiencing neglect? Is Marijuana use on the rise?

Melanie Potock July 25, 2014 - 9:52 pm

Hi Shannon, I don’t know the extent of what happens when a health care worker is mandated by law to report neglect, but typically the first step is that social services steps in to help educate the family on the situation and help to make changes to ensure the entire family’s safety. My understanding from attending the workshop is that it’s too early to draw conclusions on marijuana use due to the recent legalization for recreational purposes. It’s all very new here, with a lot to sort out!

Amy July 25, 2014 - 11:54 am

I felt that it was one sided as well, it also expells judgement and lack of understanding related to the multitude of diseases we work with. This post fails to mention anything positive about MJ or CBD Oils. The emergence for medicinal MJ use is proved by research to kill cancer, cure childhood seizure disorder (CBD Oils), kill brain tumors in babies, increase appetite in people who have progressive weight loss, and is widely used by those with CNS, neuromuscular (MS, ALS) and Gastrointestinal diseases. I agree that more women need to understand the developmental effects it can cause while pregnant or breast feeding but we also need not to close our eyes to those people who require it to improve the quality of their lives. I have a neuromuscular and gastro disease, and I am an SLP.

Melanie Potock July 25, 2014 - 9:58 pm

Hi Amy,I think where the confusion lies in my article is that it was reporting on recreational marijuana, not medicinal. The confusion may be partly due to the photo, my apologies. It the surge in legal recreational use/processing/growing/etc and the unfortunate limited knowledge on those choosing to do so, that creates the dangers. This post is about educating home health workers on those issues to protect themselves and the families they serve.

Melanie Potock July 25, 2014 - 10:07 pm

Hi Amy, the post did include information about oils. Please refer to the safety discussion on explosions. This was an article about home safety, not about medicinal marijuana.

Seana Morgan July 25, 2014 - 12:50 pm

As someone who is pro legalizing marijuana, i actually think this article really represents the facts about Marijuana in our day and age. Absolutely marijuana has a legitimate place in our medicine and for some can be a positive recreation. However it is not without drawbacks. Just like I don’t think a drunk parent can be a good parent, I don’t think that a stoned parent can be good. And as someone who has used in the past (hey I went to college) I can attest to personal cognitive deficits even after 24 hours. It’s not something I would use while I was working with my patients or even before working with them because of the cognitive deficits.

In addition, we really have very little research done on the long term physical consequences of the chronic (no pun intended) long term use of marijuana. And it may be years before we have the data.

So even though I am pro legalizing for even recreational use. I also believe that we as clinicians should be aware of the impact that marijuana can have on our clients. One of the benifits of it being legalized, is now patients and their family can be more honest with us (Because believe me, they were consuming before it was legalized). This means we can educate families about the effects, so that they can make good decisions.

Melanie Potock July 25, 2014 - 10:01 pm

Thank you Seana, yes, I agree. It’s about safety, not about pros or cons or personal beliefs. This article was intended to communicate to home health professionals that times are changing and part of mandatory reporting is understanding the precautions, educating ourselves on strategies to communicate those to families, and keeping everyone as safe as possible as part of our daily work.

DiAnne Grieser July 26, 2014 - 2:38 pm

Good for ASHA readers. I live in WA where it’s legal and have been around it for 50 years.

Melanie Potock July 26, 2014 - 6:55 pm

Thank you Diane. (-:

Maureen McCarron July 26, 2014 - 5:53 pm

Having had many years experience with home care, and even acknowledging the possible benefits of legalization, I agree with the writer about the unknowns. Home care therapists deal with the entire range of parenting/caregiver skills: including good, bad and, unfortunately, the indifferent. As a SLP in New York State, I do not look forward to the additional challenges marijuana legalization may lead to here. Thanks for your perspective.

Pam Rowe July 26, 2014 - 7:16 pm

Informative article, but am I the only Fuddy Duddy that is a little uncomfortable with marijuana jokes? Perhaps I am a little old school.

Melanie Potock July 27, 2014 - 8:12 am

Hi Pam, I tried to keep the first paragraph light, because it’s such a new and frankly, a bit uncomfortable subject for some. Thanks for understanding, and I apologize if my humor didn’t quite hit the mark.

Melanie Potock July 27, 2014 - 10:36 am

I think for many readers, the confusion may lie in the terms medical and recreational. The article came about after a recent workshop I attended in CO for home health care workers to learn more about the safety precautions for the families we serve who may be processing/using/purchasing/growing recreational marijuana, which was recently legalized in CO. While the article was not intended to be about the pros and cons of medical marijuana and focuses on the new freedom and learning curve around recreational cannabis, I believe many of the same safety issues can be considered for any marijuana product in the home. I’m grateful for our state helping to education home health care professionals. As a pediatric therapist, it is very concerning to me to know that children are ending up in the ICU because of accidental exposure. That was my intent, to share the safety precautions and hopefully, spread awareness.

Erica July 29, 2014 - 9:40 pm

Thank you for this article, Melanie! This issue is very interesting to me because as an SLP, I am inclined to wonder whether smoking marijuana frequently may exacerbate voice disorders and swallowing issues, and whether clients who receive speech therapy for those issues and smoke marijuana may be hindering their progress. The National Institute on Drug Abuse states the following…

“Marijuana smoke is an irritant to the lungs, and frequent marijuana smokers can have many of the same respiratory problems experienced by tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections. One study found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than those who don’t smoke marijuana, mainly because of respiratory illnesses. It is not yet known whether marijuana smoking contributes to risk for lung cancer.”

I too have seen research about how marijuana use can affect thinking and memory, and how these effects can even be permanent with continued and frequent use. Home-based SLPs may need to be concerned (or at least aware) when parents use marijuana while caring for children, as their judgement may be impaired and they may be unwittingly risking their children’s safety (much like ingesting alcohol while caring for children).

All that being said, I agree that there may be potential health benefits, and THC-based drugs to treat pain and nausea are already FDA approved.

Thank you for summarizing the safety issues related to marijuana use that home-based SLPs may encounter!

Melanie Potock July 30, 2014 - 3:34 pm

Hi Erica,
So many things to consider in this new age of ours! I know Colorado is just the tip of the iceberg – it will be interesting and important for us to consider all the pros and cons and how the families we serve (and our fellow professionals) may be impacted. Thank you for your input!

Shannon Planck July 30, 2014 - 5:22 pm

Come to think of it, has anyone seen research on if marijuana can be detrimental for patients suffering from TBIs or Post concussive syndrome?

Melanie Potock August 1, 2014 - 11:24 pm

Update: http://www.childrenscolorado.org/about/news/2014/marijuana-safe-packaging-bill Safer, child proof packaging for edibles in CO. Adults are urged to keep edibles in child-proof, locked containers out of reach.

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