Should you treat a stoned patient? It's complicated

Adult dental patients who reek of marijuana and seem stoned but who can still move and communicate should probably be treated for planned procedures, according to a commentary published in the June issue of the American Journal of Orthodontics and Dentofacial Orthopedics.

Clinicians should proceed with care, such as simple adjustments, in these patients because they have given their informed consent to treatment plans and should have already been afforded sufficiently detailed information about the treatment mechanics that will be used. If the plan or the mechanics change, the visit should be rescheduled, wrote the author, Dr. Laurance Jerrold, JD, a private practice orthodontist in Woodbury, NY, and the associate editor of litigation and legislation for the American Journal of Orthodontics and Dentofacial Orthopedics.

"The patient knows what you are doing, has consented to it, and if they want to be slightly buzzed and relaxed, as long as they are not catatonic, it's probably okay," Jerrold wrote (Am J Orthod Dentofacial Orthop, June 2022, Vol. 161:6, pp. 886-887).

What about minors?

Additionally, clinicians should likely proceed in treating minor patients who appear impaired and arrive at an appointment for similar active treatments. However, clinicians are obligated to report a minor who is under the influence because they are engaging in illegal activity, Jerrold wrote.

Though a parent or legal guardian previously consented for treatment, there is the issue of a clinician being a mandatory reporter. Clinicians who believe a child's welfare is endangered because of parental or another person's abuse or neglect must report it to an appropriate state agency.

But if it's unclear that the parent or guardian of the minor patient is aware of the child's state, a clinician could contact the patient's parent or guardian and discuss the situation. The clinician could tell the parent or guardian that if a minor comes to another appointment while under the influence, it will be reported to the proper state entity, Jerrold wrote.

In most cases, alerting a minor's parents will be met with appreciation. If it isn't, clinicians should report it to the state immediately, he wrote.

Stoned adults presenting for pretreatment visits

Adult patients who come to a pretreatment appointment and are under the influence are another story, according to Jerrold. For adults, clinicians need to be concerned with a patient's ability to give informed consent regarding a proposed treatment, according to the commentary. For minors, there's nothing to really consider, since their parents or guardians are the only ones who can grant consent.

With adult patients who are under the influence, first, dentists need to make a clinical determination of whether patients can understand their dental problem, the proposed solution to correct the issue, and the expected outcome and long-term prognosis. Second, patients should understand the consequences of accepting or rejecting treatment options and other factors, he wrote.

"If they can exhibit all of this while stoned, cool; it's safe to proceed," Jerrold wrote. "If not, you probably should reschedule the appointment until they can get their act together to allow you to feel comfortable believing that you are treating someone who is relatively grounded in reality."

As recreational marijuana use becomes legal in more states each year, dental professionals should prepare for these situations before they occur. Clinicians should discuss these issues with their dental teams, their malpractice carriers, and their legal counsel.

"To be forewarned is to be prepared," Jerrold wrote. "You don't want to be the one who gets biblically stoned because of what you didn't do."

Disclosure: This commentary is Dr. Jerrold's opinion and does not represent the views of the American Journal of Orthodontics and Dentofacial Orthopedics or the American Association of Orthodontists.