Do You *Really* Need To Talk to Your Doctor About Supplements and Recreational Drugs You Take?

Photo: Stocksy/ Martí Sans
There are specific questions you've likely come to expect from a new doctor: "Do you smoke?" and "How many alcoholic drinks do you have per week?" Whether you answer these honestly or gloss over the details, they're everyday conversations for your provider. It's clear why a doctor would ask these questions—smoking and drinking, especially if done frequently, have an impact on your health. But what about other substances? It's less likely you're explicitly asked about using drugs like marijuana, LSD, or psilocybin (magic mushrooms), or even about your nutritional supplements of choice. Doctors may gloss over recreational drug use questions, and you might worry that sharing will result in a lecture.

Experts In This Article
  • Michael Fingerhood, MD, Dr. Michael Fingerhood is an associate professor of medicine and public health at the Johns Hopkins University. His areas of clinical expertise include addiction medicine and internal medicine.
  • Tori Rodriguez, MA, LPC, Psychotherapist based in Georgia.

Unfortunately, there's no guarantee that your healthcare provider won't judge you for drug or supplement use. Doctors are people, too, and they have biases. Even worse—depending on identities like race, socioeconomic status, and age—your doctor might make assumptions about whether or not you use drugs. "A 25-year-old physician might have trouble realizing that their 70-year-old patient is using crack cocaine on Friday nights because they're passing a judgment on someone who looks like their grandparents," says Michael Fingerhood, MD, director of the Division of Addiction Medicine at Johns Hopkins.

"Our job isn't to police clients, but to help them." - Tori Rodriguez, LPC

In an ideal situation, open-ended questions would allow patients to feel more comfortable sharing information. The question "what do you do to unwind?" led one of Dr. Fingerhood's older patients to explain that he gets together with friends once a week to play card games and use cocaine. Other questions like "how do you deal with stress?" or "tell me about a typical day for you" help patients feel more comfortable, Dr. Fingerhood says. "To me, the whole essence of provider-patient care is the trusting relationship, and that trust should go both ways," he says.

Unfortunately, it can be challenging to build trust with your primary care physician, who is often busy and may only meet with you for a few minutes each visit. Although it feels unfair for the burden of starting a good doctor-patient relationship to fall on the patient, beginning to build trust can work to your benefit.

1. Listen for opportunities to open up to your doctor (and go beyond "yes" and "no" answers)

One way to bring up drug and supplement use is to listen for opportunities to volunteer information. For example, if your doctor asks what a typical week looks like, include the fact that you eat an edible once or twice a week to destress. Or, if they ask whether or not you smoke, you can go beyond a one-word answer. Sharing that you don't smoke but enjoy an edible gives your doctor a more complete picture. More information is always better. And, if no opportunities present themselves, simply say that you'd like to share something that could be relevant given your overall health. Sharing that you don't smoke but enjoy an edible gives your doctor a clearer picture.

2. Trust that disclosing can only help your overall health

The obvious reason to talk to your doctor about using drugs or supplements is that they can affect your health or interact with medications. In the case of the 70-year-old cocaine user, Dr. Fingerhood explained that because the man had diabetes and hypertension, he worried using cocaine could impact the patient's heart. Another patient of his complained of feeling off every morning, and through asking about recent changes in diet, drug, or supplement use, Dr. Fingerhood learned that the young man had been drinking herbal tea made of Kratom, a legal substance that can have effects similar to opioids. "He was actually having withdrawal," he says.

Talking about recreational and psychoactive drug use may be even more critical if you're on mental health medications. Many people use drugs like marijuana and magic mushrooms to feel good, but there's very little research about how safe it is to mix these kinds of drugs with antidepressants like SSRIs. In fact, many recent clinical trials exploring if psychedelics can treat mental illness ask participants to stop taking antidepressants before joining the study, according to the Mind FoundationOne big worry is inducing serotonin syndrome, a sometimes lethal drug reaction that happens when two drugs meant to raise serotonin are taken together. Many antidepressants and psychoactive drugs work by increasing serotonin levels, so they can have dangerous complications when combined.

You might also be pleasantly surprised to find your therapist or other provider is open to discussing treatment options like medical marijuana. "Few therapists deny that risks may be associated with marijuana use—depending on many factors, such as age and amount of use—but most agree that some adults can use it in moderation without consequence," Tori Rodriguez, LPC, a psychotherapist in Georgia, wrote for Psychotherapy Networker. "Our job isn't to police clients, but to help them."

3. Know that you won't get "in trouble" for sharing

It can be stressful to bring up recreational drug use, especially if the drug you're using is illegal in your state or federally. Remember that you have doctor-patient confidentiality on your side. Even if you're using illegal drugs, your doctor can't report that drug use unless you seem to be a danger to yourself or someone else. The American Psychological Association lists privacy and confidentiality in its code of ethics, as does HIPAA.

"There should be a comfort zone," Dr. Fingerhood says. "Clinicians should not be judgemental and should be welcoming for patients and not view them in a legal or moral basis as a result of any recreational drug use, whether it be caffeine, cocaine, cannabis, or opioids."

At the moment, these conversations aren't happening enough. Much of our healthcare in the U.S. is driven by quick conversations and quick answers, Dr. Fingerhood says. It's worth taking the time to really talk to your doctor. About everything that goes into your body.

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