Impaired medical professionals caring for the public is a main concern of marijuana legalization, medical or otherwise, to which the states’ legislatures’ attention has been drawn. What was typically not-to-fertile an enforcement area has become overridden with "weeds" of impaired physicians, nurses, physician assistants, and all other licensed professionals getting caught high on or off the job. These cases involve professionals legally or illegally utilizing marijuana in any number of jurisdictions and then either treating patients in their legalized jurisdiction or returning to Pennsylvania -a non-legalized jurisdiction - and practicing impaired.I am finding that Pennsylvania’s enforcement protocols are the same as those in marijuana legalized jurisdictions; focus is on the impairment, not necessarily the illegal use. Currently, Pennsylvania's policy decision is per se impairment (simply having traces of pot in your system based upon a positive drug test) rather than having to establish proof of impairment level. Standardized dosing calculations for many prescriptions and alcohol allow for easy calculation of intoxication levels and corollary degrees of impairment. Licensing Board experts acknowledge there does not exist a similar calculus of impairment for marijuana use.Pennsylvania’s licensing boards are trying to avoid dosing and impairment calculation issues. Prosecutors are simply filing a petition for a mental and physical examination and letting a drug addiction expert professionally evaluate the professional. I attend and prepare my clients for these evaluations as they are an easy disciplinary trap for the unprepared.My previous blogs address the many ways impaired professionals’ cases are brought to be attention of the licensing boards. The concern in the prescribed marijuana-positive-drug testing case is if the medical licensee has a medical condition warranting a prescription for the medical marijuana. (Not yet in Pa.) Here, the medical practitioner is too scared for that medical condition to be present in their medical records indicating a level of health impairment requiring medical marijuana. The professional either self-prescribes or pays privately for the medical marijuana prescription. Under either scenario, the underlying medical condition provides an independent basis for license restrictions.Medical practitioners acknowledge many doctors or nurses are under the influence of impairment causing medications but are being medically supervised by someone else. This is to be compared with personal or medical marijuana use that is illegally purchased, self-prescribed, self-administered, with no medical oversight. In these cases, licensing boards are treating these cases like all other impaired professionals who take prescribed medications that render them incapable of practicing their profession safely. The disciplinary implications are greater because of impairment issues, record keeping violations for the self-prescriber, and in Pennsylvania the illegal nature by which the marijuana is secured.Pennsylvania’s licensing boards’ strict approach to physicians focuses of other states’ experiences that pot “impaired” or “high” physicians commit more medical errors that non-impaired practitioners. Studies exists suggesting that that among airline pilots, impairment on flight simulators persisted up to 24 hours after smoking a marijuana cigarette, even though subjects were unaware of it (Am J Psych. 1985;142:1325-1329). Another study showed decision-making errors 50% to 70% of the time in long-time marijuana users compared with 8% of the time in nonusers (Neurology. 2006;66:737-739).Public safety and conservative approaches will permeate this issue in Pennsylvania. Call me to discuss any Pennsylvania professional board impairment allegations.