A Patient Under The Influence: To Treat or Not?

What would you do if you suspect a patient is under the influence? Here are some things to consider.

Let's say a patient presents for their scheduled appointment and your staff suspects the person is under the influence of recreational marijuana or alcohol.  Your staff’s and your first reaction might be shock; however, you need to step back to examine the situation objectively. 

Recreational marijuana and alcohol use crosses all cultures, ages, genders and socioeconomic status. You should prepare for this situation by establishing office policies and procedures to deal with patients who are suspected of being under the influence.  

There are significant standard of care issues involved in this type of situation. As a Naturopathic Physician, you should make sure to follow the standards of care with regard to health/medical histories, indications and contraindications.

Generally speaking, a patient whose condition is stable yet is inebriated or otherwise impaired should be rescheduled. 

Practice Policies and Procedures to Consider

Following are some policies and procedures to consider for your practice:

  • Discuss the situation with the patient as to the substance, amount and when ingested. 
    • Is there a history of dependency, and does the patient want to discuss and remedy the situation?
    • Consider how accurate the patient’s responses might be.
  • Does the patient understand the impact of his/her actions and how dependency might affect their health? 
  • Offer/provide support materials and referral information. 
  • Recommend rescheduling the appointment.
    • Advise the patient that the intoxication may limit your ability to accurately assess and treat.
    • Advise the patient not to indulge prior to the visit. Explain the impact of indulging.
  • Safe transportation protocols may need to be initiated, and your procedures should define how this is determined. 
  • Establish in-office safety protocols for your staff (i.e., when to call the police, code words to be used to alert staff of a possible problem).


Document your discussion thoroughly.  Include patient comments (quotes are recommended), advice/instructions provided, patient educational resources provided and any noncompliance. Be objective and avoid labeling the patient or the scenario.

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