guide for the responsible use of medical marijuana guide

16/10/20

Guide for the Responsible Use of Medical Marijuana

Guide for the Responsible Useof Medical Marijuana

8/11/20

Medical DirectorDr. Suzanne Arlene Sisley, MD

AZ Medical License #[email protected]

480-326-6023

26/11/20

Self - Assessment Checklist

DATE:

Please indicate below your typical level of severity of the following symptoms: Symptom Severity (low to high) Comments Pain 1 2 3 4 5 Cachexia or Wasting Syndrome 1 2 3 4 5 Nausea 1 2 3 4 5 Seizures 1 2 3 4 5 Muscle Spasms 1 2 3 4 5 Agitation 1 2 3 4 5 Other 1 2 3 4 5

Notes:

Copy this page to keep an on-going log of your symptoms

Enigami Systems at enigamisystems.com has symptom tracking software at a nominal cost.

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MEDICATION TRACKING CALENDAR DATE:

PatientName: WeekStarting:________________________

Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Strain/Product

Amount

MethodofAdministration

BeneficialEffects

NegativeEffect

Bring this sheet & your symptom tracking sheets to your appointment with your recommending doctor. These will help determine the effectiveness of your medication.

Copy this page to keep an on-going log of your medicine usage.

Dose Tracker

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INTRODUCTION

TheobjectiveofthismanualistogivePatientServiceProvidersallthetoolsnecessarytounderstandmedicalcannabis,beabletoidentifystrains,andusethisknowledgetobettertheirdailyhealthandwellness.

CANNABIS OVERVIEW: Cannabisisnaturalherbthatmaynowbethemoststudiedplanteverworldwide.IntheUnitedStates,the FDA has been approving numerous studies and the Federal Government has recently authorizedNIDA to double its cultivation facilities in order to grow more cannabis to supply the many FDAapproved studies currently underway. The effects of cannabis are wide-ranging and substantial intherapeutic value, while physical side effects are very minimal. Cannabis is used to treat symptomsrather than curing diseases. Understanding how cannabis works is the key to utilizing marijuana asmedicine.Asmanypatientsarenewtothisexperience,wefeelaneedtoexplainthereasonswhywesuggest a certain strain for specific medical benefit.We hope this information helps us build lastingrelationshipswithourwell-informedpatients.THE BASICS: Marijuanaconsistsof86knowncannabinoids,butstudieshavebeendoneononlyafew:THC (delta-tetrahydrocannabinol) THC is themost famouscannabinoid, isknownfor itspsychoactivetraits.Thepotencyofmarijuana ismeasuredbytheTHClevels.Thereareglandular,resinoushairsontheinflorescencesandfloralbractsoffemaleplants(trichomes)thatcontainthisphenolcomponent.Thesearenotgenerallyfoundonthemalecannabisplant.THCisthemostpotentcannabinoidandistechnicallyanalcoholbecauseitisnotan alkaloid and lacks nitrogen. As a result, it is not recommended that ALCHOL beverages not beconsumed with cannabis as this combination can create a disorienting effect. The interaction of anaturalcompoundinthebraincalledanandamide,attachestospecificreceptors inthebrainthatTHCalsobindstocausingtheintoxicatingeffectfeltbytheuser.

THChasshowntohaveawiderangeofmedicalbenefitsassociatedto it.THCismostassociatedwiththehighandEuphoria feelingwhenusing cannabis. THCpotency is farhigher today thanback in theseventies or eighties. Today’s medical grade cannabis typically features THC ranging from 5 to 25percent.OvermedicatingwithTHCcancauseadversesideeffects, includingdisorientationandevenhallucinations.Althoughlesscommon,studieshaveshownadditionalsideeffectstoincludedepression,anger,anxiety,andevenshorttermmemoryloss.WecautionallmedicaluserstoGOSLOWondosingthemselves iftheyhavenotusedmarijuanainrecentyears. Thinkaboutdosethesamewayadoctorandpharmacistdosespillmedication.Takeoneortwoperiodicallyandwaittoseeifithelps.Typically15to20milligramsofTHC(oneoftwohitsoffofapipeorblunt)isallthatisrequiredforeffectivepainrelief.Too strong a dose can actually reduce pain relief effectiveness.

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StudieshaveshownTHC’sparticularmedicinalvalues:

Helpswithcontrollingpain

Helpswithrelaxation

Suppressespainfromnervedamage

Helpsreduceriskofnervedamage

Helpscontrolanxiety

Suppressesmusclespasmsandconvulsions

Helpscontrolcertaincancers

Helpswithnausea

Slowsinflammation

Helpsfightfreeradicalsinthebloodstream

Encourageseatingandappetitestimulation

Stimulatesnewgrowthinnervetissue

Relieveschroniceyepressureandpaincausedfromglaucomaandothereyedisorders

CBD’s (Cannabidiol) Spurredby growing reports of themedical efficacy of Cannabidiol (CBD), the second leading active ingredient inmarijuana,patientsareincreasinglyseekingouthigh-CBDvarietiesfortreatmentofconditionsrangingfromsevereepilepsyandmultiplesclerosistoanxietyandcancerpain.

CBDhaslongbeenovershadowedbydelta-9-THC(tetrahydrocannabinol),theprimaryactiveingredientinmarijuana,becauseunlikeTHC, itdoesnotproduceapsychoactive“high.”CBDhasnonetheless longbeenknowntohaveusefulanti-spasmodic,anti-epileptic,anti-anxiety,andanti-psychoticproperties.

AlthoughCBD lacksnoticeableeffectswhen takenalone, ithasa calming, sedativeeffectwhencombinedwithTHC, cuttingdown on the anxiety, paranoia, and memory impairment that many users find unpleasant or debilitating with regularmarijuana.CBDhasbeenfoundtogivethemostmedicalbenefitsofallthecomponentsfoundinmedicalcannabis.

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CBD can also decrease the social isolation characteristics introduced by THC. CBD have low psychoactive characteristicsassociatedtoitrangingfrom0.1–12percent.CBD-richstrainsaccordinglyhaveparticularappealtoolderusersandmedicalpatientswhoareuncomfortablewiththeTHChigh.

Contrary to popular misconception, so-called indica varieties are nomore likely to have CBD than Sativas. Lab studies co-sponsored by California NORML, found no relation between chemical profiles, as measured by cannabinoid and terpenecontent,andvarietaltypes,whether indicaorsativa.Breedershavedevelopedspecialhigh-CBDhybridsfromvariousgeneticstocks.SomehavevirtuallypureCBD,whileotherstypicallyhaveTHC;CBDratiosrangingfrom2:1to1:2.

TheoptimaldosagelevelsofCBDareuncertainduetoalackofhumanstudies.Chronichighdosesofupto1500mgperdayarewelltoleratedandproducenonoticeablephysiologicaleffects.However,thereisevidencetosuggestthatthemedicalbenefitsofCBDdisappearwhendosagesbecomeexcessive.For inhaledmedicaluse,mostusersprefervarietieswithTHC:CBDratiosbetween2:1and1:2.Extremelylow-THCvarietiesareusefulformakingCBDextractsandtinctures.UnlikeTHC,CBDdoesnotshowuppositiveonstandarddrugtestsformarijuana.

StudieshaveshownCBD’sparticularmedicinalvalues:



Stimulatesbonegrowth

Stopsgrowthofbacteria


SlowsInflammation

Helpswithnausea

Reducestheriskofarteryobstructions

Decreasespressureinthebloodvesselwalls

Reducesbloodsugarlevels

Assistsincontrollingepilepticseizures


DecreasesthesocialisolationcausedbyTHC

CBN’s (Cannabinol)

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CBD can also decrease the social isolation characteristics introduced by THC. CBD have low psychoactive characteristicsassociatedtoitrangingfrom0.1–12percent.CBD-richstrainsaccordinglyhaveparticularappealtoolderusersandmedicalpatientswhoareuncomfortablewiththeTHChigh.

Contrary to popular misconception, so-called indica varieties are nomore likely to have CBD than Sativas. Lab studies co-sponsored by California NORML, found no relation between chemical profiles, as measured by cannabinoid and terpenecontent,andvarietaltypes,whether indicaorsativa.Breedershavedevelopedspecialhigh-CBDhybridsfromvariousgeneticstocks.SomehavevirtuallypureCBD,whileotherstypicallyhaveTHC;CBDratiosrangingfrom2:1to1:2.

TheoptimaldosagelevelsofCBDareuncertainduetoalackofhumanstudies.Chronichighdosesofupto1500mgperdayarewelltoleratedandproducenonoticeablephysiologicaleffects.However,thereisevidencetosuggestthatthemedicalbenefitsofCBDdisappearwhendosagesbecomeexcessive.For inhaledmedicaluse,mostusersprefervarietieswithTHC:CBDratiosbetween2:1and1:2.Extremelylow-THCvarietiesareusefulformakingCBDextractsandtinctures.UnlikeTHC,CBDdoesnotshowuppositiveonstandarddrugtestsformarijuana.

StudieshaveshownCBD’sparticularmedicinalvalues:






SlowsInflammation

Helpswithnausea

Reducestheriskofarteryobstructions

Decreasespressureinthebloodvesselwalls

Reducesbloodsugarlevels

Assistsincontrollingepilepticseizures


DecreasesthesocialisolationcausedbyTHC

CBN’s (Cannabinol)

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ThereisverylittleCBNpresentinfreshmarijuanaplants.ThemoreCBNthelessTHC,medicalcannabiscontaininghighlevelscanalsoindicateitsageandimproperhandlingofmedicine.HighCBNlevelsalsohaveshownundesirablesymptomslikeconfusion,lightheadedness,andactsasaweakagonistofthecannabinoidreceptors.CBNhaveamildlypsychoactivecharacteristicsassociatedtoit.

Studies have shown CBN’s particular medicinal values:

Actsasasleepaid

Slowsinflammation



helpsfightfreeradicalsinthebloodstream CBC’s (Cannabichromene) VerylittleisknownaboutCBChoweverresearchhasshowntohavevaluablemedicinalproperties.CBChasnopsychoactivecharacteristicsassociatedtoit.

Studies have shown CBC’s particular medicinal values:


StopsgrowthofFungi

Slowsinflammation


Encouragescellgrowth


Assistsincontractionofbloodcells

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ThereisverylittleCBNpresentinfreshmarijuanaplants.ThemoreCBNthelessTHC,medicalcannabiscontaininghighlevelscanalsoindicateitsageandimproperhandlingofmedicine.HighCBNlevelsalsohaveshownundesirablesymptomslikeconfusion,lightheadedness,andactsasaweakagonistofthecannabinoidreceptors.CBNhaveamildlypsychoactivecharacteristicsassociatedtoit.

Studies have shown CBN’s particular medicinal values:

Actsasasleepaid

Slowsinflammation



helpsfightfreeradicalsinthebloodstream CBC’s (Cannabichromene) VerylittleisknownaboutCBChoweverresearchhasshowntohavevaluablemedicinalproperties.CBChasnopsychoactivecharacteristicsassociatedtoit.

Studies have shown CBC’s particular medicinal values:


StopsgrowthofFungi

Slowsinflammation


Encouragescellgrowth


Assistsincontractionofbloodcells

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THCA (Tetrahydrocannabinolic acid) THCAisaprecursorofTHC.THCAistypicallythemainconstituentfoundinfreshcannabisandwilldecarboxylatetoitsactiveformwhiledryingorwhenheated.THCAdoesnothavepsychoactiveeffectsbutcanbeusedasananti-inflammatoryorneuroprotectivemedication.

Studies have shown THCA’s particular medicinal values:

Slowsinflammation

Helpcontrolcancercellgrowth

Suppressesmusclespasmsandconvulsions THCV (Tetrahydrocannabivarin)

THCVisananaloguetoTHCandsharescharacteristicsthathelptoincreaseadditionalbenefitsofTHCinsmaller

doses.RecentlystudieshaveshownTHCVinlargerdosesreducethemedicinaleffectsofTHC.THCVhave

mediumpsychoactivecharacteristicsassociatedtoit.

Studies have shown THCV’s particular medicinal values:

Effectiveinappetitesuppressant

Helpscontrolobesity

TypeIIdiabeteshumantestingcurrentlyunderway

CBG’s (Cannabigerol)

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CBGarenotfoundtooofteninmedicinalcannabisbutmorecommonlyfoundinhigherconcentrationsofhemp.CBGhavenopsychoactivecharacteristicsassociatedtoit.

Studies have shown CBG’s particular medicinal values:



EncouragescellgrowthUnderstanding the differences between Indica and Sativa Cannabis

SATIVA (DAY CHOICE) The name Sativa comes from a Swedish scientist Carolus Linnaeus, who was the first to classify theplant.Hecalled itCannabisSativaL (forLinnaeus).Originatedmainly inAsia, theAmericas,andAfricaCannabissativaisatall,slowergrowingandmaturingplantthattypicallyhaslongthinleaveswhichmayvary in color from light green to darker greens. Sativa buds are long and thin and turn red as theymatureinwarmerenvironments.Incoolerenvironmentsthebudsmaybeslightlypurple.Sativaplantsusuallysmellsweet,fruity,andfloralwherethesmokeisgenerallymild. SativaplantsusuallyhaveahighTHCtoCBDratiothatproducesasoaringandenergeticfeeling.Itissaidtobe focusing,energizing, inspirational,andmostlyacerebralhigh.Sativasgivea feelingofoptimismandwell-being,aswellasprovidingagoodmeasureofpainreliefforcertainsymptoms.Thesestrainshavebeen found toworkwellwith creativemindsandgood choice fordaytimemedication. Sativa isknown for treatingmultiple sclerosis, Tourette syndrome, and glaucoma. Common Sativa strains aresourdiesel,bluedream,silverhaze,andlambs’bread.INDICA (NIGHT CHOICE) The name Indica comes from a French biologist named Jean-Baptiste de Lamarck who discovered asecondspeciesofcannabisandnameditCannabisIndicaLam.ItissaidthathenameditIndicabecausetheplantspecimenheclassifiedwasfromIndia.OriginatedmainlyinPakistanandIndia,CannabisIndicaisashorttomoderateheight,bushyplant,generallybetweenthreeandsixfeet.Theleaveshaveshortbroadfingersandaregenerallydarkgreenandaresometimestingedwithpurple.Thisisaverystrongpungentplantwithdry,acrid,even“stinky”or“skunky”smell.

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CBGarenotfoundtooofteninmedicinalcannabisbutmorecommonlyfoundinhigherconcentrationsofhemp.CBGhavenopsychoactivecharacteristicsassociatedtoit.

Studies have shown CBG’s particular medicinal values:



EncouragescellgrowthUnderstanding the differences between Indica and Sativa Cannabis

SATIVA (DAY CHOICE) The name Sativa comes from a Swedish scientist Carolus Linnaeus, who was the first to classify theplant.Hecalled itCannabisSativaL (forLinnaeus).Originatedmainly inAsia, theAmericas,andAfricaCannabissativaisatall,slowergrowingandmaturingplantthattypicallyhaslongthinleaveswhichmayvary in color from light green to darker greens. Sativa buds are long and thin and turn red as theymatureinwarmerenvironments.Incoolerenvironmentsthebudsmaybeslightlypurple.Sativaplantsusuallysmellsweet,fruity,andfloralwherethesmokeisgenerallymild. SativaplantsusuallyhaveahighTHCtoCBDratiothatproducesasoaringandenergeticfeeling.Itissaidtobe focusing,energizing, inspirational,andmostlyacerebralhigh.Sativasgivea feelingofoptimismandwell-being,aswellasprovidingagoodmeasureofpainreliefforcertainsymptoms.Thesestrainshavebeen found toworkwellwith creativemindsandgood choice fordaytimemedication. Sativa isknown for treatingmultiple sclerosis, Tourette syndrome, and glaucoma. Common Sativa strains aresourdiesel,bluedream,silverhaze,andlambs’bread.INDICA (NIGHT CHOICE) The name Indica comes from a French biologist named Jean-Baptiste de Lamarck who discovered asecondspeciesofcannabisandnameditCannabisIndicaLam.ItissaidthathenameditIndicabecausetheplantspecimenheclassifiedwasfromIndia.OriginatedmainlyinPakistanandIndia,CannabisIndicaisashorttomoderateheight,bushyplant,generallybetweenthreeandsixfeet.Theleaveshaveshortbroadfingersandaregenerallydarkgreenandaresometimestingedwithpurple.Thisisaverystrongpungentplantwithdry,acrid,even“stinky”or“skunky”smell.

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Indicasaremorerelaxing,sleep-inducing,anti-nauseate,andrelievingofstressandpain.Indicasarethetraditionalsourceofhashishandthemostpopularforindoorcultivationastheyareseenashardyandyieldalargerharvest. HavingahighCBDtoTHCratio,Indicasgivecalmandrelaxingfeelingoftendescribedasabody“buzz”.Theyarealsoeffectiveforoverallbodypainreliefandoftenusedinthetreatmentofinsomnia.ItissaidthatIndicasarefortreatinganxiety,inflammation,schizophrenia,nausea,andconvulsions.Therearesomany hybrids now that testing is the only realway to know the ratios, but knowing the base strainshelpsinthedevelopmentofopinionsonthedifferentstrains.TIME EXPECTATIONS Theeffectsofcannabisareexperiencedalmostimmediately(10-15minutes)afterinhalingorsmoking.Whensmoked,theeffectsaremostpronouncedforthefirsthourortwo,declininggraduallyoverthenext three or four hours. They normally disappear after a good night’s sleep and do not produce anunpleasant“hangover”effect,thehighjustfadesaway.Whendigestedtheeffectsaredelayedanhourormore. POSSIBLE SIDE EFFECTS Anxiety–MostassociatedwithSativastrainsPanicAttacks–MostassociatedwithSativaCannabisIncreasedchanceoflunginfection–SmokingrelatedDepersonalization–Mostassociatedwithover-medicatingwithCannabisDrynessofthethroat–Rednessoftheeye’soutercoating,orconjunctiva,duetodilationofthesmallbloodvesselsthere.Despitemarijuana’sabilitytoinducethesesideeffects,manysufferingfromhundredsofdiseaseshaveclaimed to find therapeutic benefit to its use. In the past few decades, the medical and scientificcommunitieshavediscoverednumerousmechanismsbywhichthecomponentsofmarijuanacanbothalleviateandcurecertaindiseases.

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WHY USE MARIJUANA Marijuana’stherapeuticiswelldocumentedaseffectivetreatmentforthoseexperiencingpain,nausea,and many other conditions that caused discomfort. Now legal for medical use in 33 states, manypatientsusemedicalcannabisasanalternativeforFDAapprovedpharmaceuticalstowhichtheydidnotfindsatisfactoryresultsorcouldnotbearthesideeffects.

MARIJUANA AS A MEDICINE Marijuanahasbeenusedforthousandsofyearsasbothamedicineandintoxicant.Cannabishasbeenknowntoberelativelyharmless;however,therehavebeensomedocumentedcasesofuserswithpre-existing health conditions experiencing harmful side effects. Patients with cardiovascular diseasesshouldtakespecialconsiderationwhentryingnewmedicine,particularlySativastrainsofCannabis.CAUTION: different strains of marijuana may contain various levels (6- 28%) of THC, the psychoactive ingredient in medical marijuana. Please use caution while taking medicine. CAUTION: Do not operate Heavy Machinery or a Motor Vehicle while using medications. The care of children and work performance may be compromised while using medications.

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*Doesnotinclude1. NursingcareinstitutionsasdefinedinA.R.S.36-4012. HospicesasdefinesinA.R.S.36-4013. AssistedlivingcentersasdefinedinA.R.S.36-4014. AssistedlivinghomesasdefinedinA.R.S.36-4015. AdultdaycarefacilitiesasdefinedinA.R.S.36-4016. AdultfostercarehomesasdefinedinA.R.S.36-4017. Privateresidences

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THE ARIZONA DEPARTMENT OF PUBLIC HEALTH AND SAFETY HAS DETERMINED THAT CONSUMING MARIJUANA IN IN A PUBLIC PLACE IN PROHIBITED. PUBLIC PLACES INCLUDE THE FOLLOWING:1. Airports2. Banks3. Bars4. Childcarefacilities5. Childcaregrouphomesduringhoursofoperation6. Commonareasofapartmentbuildings.Condominiumsforothermultifamilyhousing

facilities7. Educationalfacilities8. Entertainmentfacilitiesorvenues9. Healthcareinstitution*10. Hotelandmotelcomingareas11. Laundromats12. Libraries13. Officebuildings14. Parkinglots.15. Parkspublictransportationfacilities16. Receptionareas17. Restaurantsretailfoodproductionandmarketingestablishments18. Retellserviceestablishments19. Retailstores20. Shoppingmalls21. Sidewalks22. Sportsfacilities23. Theaters24. Waitingroom

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WHAT ARE MY OPTIONS TO ADMINSTER MY MEDICINE? Thereareseveralmethodsforadministeringmedicalmarijuanaincluding: VaporizationSmokingdriedbudsorextractsTransdermalortopicalapplication(i.e.lotion,oil)DrinkingteasorconcentratedextractsEatingmedicine-infusedfoodproducts(i.e.candy,brownies,cookies,butter)Takingcapsules

Thereareavarietyofapparatusesavailabletodelivermarijuanaintothebody:RollingPaperstorollcigarettesPipeWaterPipeVaporizerVaporizerPen

METHODS OF CONSUMPTION There are several types of ways to consume cannabis; most are some form of smoking or oralconsumption:SMOKING- This is themost common formof cannabis consumptionand it is the inhalationof vaporsreleasedbyheating the flowers, leaves,orextractsof thecannabisplant.Smoking releaseschemicals(THC,CBD’setc.…)whichareabsorbedinyourbloodstreamviathelungs.Whenmarijuanaissmokedtheeffectsarealmostinstantaneously.Thereareseveralwaysinwhichcannabiscanbesmokedwhicharejoints,blunts,pipes,bongs,andvaporizers.

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JOINTS-“Joint”isaslangtermusedtoforacigaretterolledusingmarijuana.Thepapersinwhichareusedforcigaretterollingareusuallymadefromhemporricepaper.Thisisdefinitelyahealthierchoiceincomparisontoablunt. BLUNT- A blunt is cannabis rolled in a tobacco leaf (cigar wrapper). Essentially, as the bluntburns,amixtureoftobaccosmokeandmarijuanasmokeisinhaledbytheuser.

PIPES-Pipesmadeforsmokingcannabis,sometimescalledpiecesorbowls,aremade of a variety of materials, including blown glass, metal fittings (except aluminum), ceramic,borosilicate,stone,wood,bambooandothermaterials.Subtypesofpipesincludeone-hitters,bubblers,chillums,glassblunts,corncobpipes.BONG-Abong issimilartoapipe,only ithasawaterchamberthroughwhichcannabissmokepassespriortoinhalation.Usersfillthebongwithwater,sometimesaddingiceinthewaterinordertocoolthesmoke.Somebongshavea"choke"or"carb",asmallholeusuallylocatedonthesideofthebowlabovewaterlevel,usedtoclearthepipeofsmokeortoconservematerialbystoppingburningwhenenoughsmokehasbeencreated.

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VAPORIZER-Avaporizerisadeviceusedtoextractforinhalationtheactiveingredientsofplantmaterial.Vaporizing isanalternative toburning (smoking) thatavoids the inhalationofmanyirritatingtoxicandcarcinogenicby-products.Theextractedvapormaybecollectedinajarorinflatablebag or inhaled directly through a hose or pipe. With little to no smoke produced and coolertemperatures, lessmaterial is required toachieveagiven levelofeffect. Therefore, the irritatingandharmfuleffectsofsmokingarereduced.EDIBLES-Ediblesarefoodproductsmadewithcannabis inherbalorresin formasan ingredient.Theyareconsumedasanalternatedeliverymeanstoexperiencetheeffectsofcannabinoidswithoutsmokingmarijuana. Instead, the cannabinoids are put into cake, cookie, brownie, or other foods, and areconsumed. Oral consumption of cannabinoids can result in a similar psychoactive effect or "high" assmokingmarijuana,althoughitmaybedelayedduetoslowerabsorptionoftheTHCfromthedigestivetract. The EVOLUTION OF THE MMJ COMMUNITY InNovember2010,voterspassedtheArizonaMedicalMarijuanaAct.Thecitizeninitiative(Proposition203)calledontheArizonaDepartmentofHealthServicestocreateamedicalmarijuanaprogramtohelppatientsthatdesiredalternatives fromtraditionalpharmaceuticalmedicationsandtheirpotentialsideeffects.ThirtyThree(33)statesnowofficiallyrecognizethespecificmedicalbenefitsofcannabis.AsofMarch, 2014, over 50,000 citizens in Arizona have utilized the program they have voted-in to get adoctor’srecommendationtobecertifiedasanMMJPatientbyArizona’sDepartmentofHealthServices,andtocarrya“PatientCardthatallowsfortheconsumptionofmedicalmarijuanapurchasedthroughanADHS licenseddispensary.Althoughsomepatientsarestillnervousaboutgoing intodispensaries, it isour job, through the use of professionalism, friendliness, education, and compassion, tomake everypatientfeelathomeandcomfortablewiththedecisiontheyhavemadetousemedicalmarijuana.Thisisourexpressedgoalwitheverypatientvisit.

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HEALTH CONDITIONS AND THE BENEFITS FROM CANNABIS (MMJ) Medicaluseofcannabisgoesbackover3,500yearswithinseveralcivilizationsrangingfromChina,India,EuropeandAfrica.Thesewereamongthefirsttowidelyuseseveralstrainsofthemedicinalplants,butmedicalmarijuana use has now spreadworldwide. Treatment for bothmental and physical illnesseshavebeenproveneffectiveinrelievingmanysymptomsassociatedwithavarietyofhealthchallenges.Cannabisisanut-likefruitthatcontainsproteinsthatprovideexcellentnutritionalbalanceandbolsterthe immunesystem.MarijuanaSativastrainshavebeenshowntohaveastimulanteffect followedbyrelaxation and overall stress reduction. It can also enhance one’s sense of well-being. Certaincannabinoidsfoundinmedicinalmarijuanahaveananalgesiceffectthatreducesinflammation,painandsoothjoints.Manypatientswithneurologicalormovementdisorderscanbenefitfromthecannabistohelp them relax their muscles and reducemuscle cramps or spasms. Smoked or vaporized cannabisworks as a bronchodilator by dilating the bronchia, alveoli and blood vessels with improved oxygenintake.Wheningestedsafely,cannabisisoneofthemostusefulmedicinesforarangeofqualifyingconditionsapprovedbyTheArizonaDepartmentofHealthServicesincluding:

AIDS/HIV:Helpsreducefatigue,appetiteloss,anddepression.

Alzheimer’s:MMJactsasaneuroprotector,thusslowingtheprogressionofAlzheimer’s

Anorexia/Cachexia/Wasting Syndrome: Cannabis helps increase appetite as well sooth thestomach.

Nausea:Symptomreliefforlackofappetite.

Arthritis,MS,Osteoarthritis:Anexcellent2in1treatment.Medicalmarijuanaprovidesreliefforpainandjointstiffnessaswellasactasananti-inflammatory.MUSECTrialshowedrelieffrommusclestiffnessoverplacebowas fourtimes (4X)greater.Satieumhasnowbeenapproved inCanadaandthroughoutmostofEurope.FDAtestingcurrentlyunderwayintheU.S.

Cancer, Chemotherapy: Cannabinoids help boost the immune system; in leukemia and breastcanceritinhibitstumorgrowth.Excellenttohelpsoothethesideeffectsofchemotherapy.Helpseasenauseaandvomiting.

Crohn’s Disease/Gastrointestinal Disorders: Cannabis soothes and settles the gastrointestinaltractandrelaxesthecolon.Cramping,inflammationanddiarrheaarereportedtoberelievedbyuseofMMJ.

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ChronicPain:Therearemanycausesofchronicpain;severalmedicalconditionsassociatedwithchronicpainarewellmanagedwiththeuseofcannabisanditsanalgesiceffect.Excellentasananti-inflammatoryandpainreliever,MMJcantrulyhelpimproveapainsufferer’squalityoflife.StudieshaveprovenMMJadd+27%greaterpain reliefeffectivenesswithopioidpain relieverOxycodone.

Glaucoma:Helpsreducepressureandpaincausedbyfluidbuildupintheeye.

Hepatitis C: The effectiveness of hepatitis C therapy is improved by reliving nausea, loss ofappetite,fatigueanddepression.

Fibromyalgia: Many symptoms of this condition such as chronic pain, fatigue, depression,anxiety,andinsomniaarealleviatedbycannabisuse.

MultipleSclerosis:MMJhasbeenknowntoofferpainreliefandhelpsleeping.

MuscleSpasms:MMJhasbeenknowntogiveimmediatepain/spasmrelief.

PTSD/Mental Health: PTSD will be added to the qualifying conditions list January 1st, 2015.ResearchhasindicatedthatCannabishelpsstabilizemoodswings.IndicaCannabisstrainshelpreducenightmaresandanxietycausedfromPTSD.IndicashavealsobeenreportedtobeagreattreatmentfortheinsomniaoftencitedbyPTSDsufferers.

Seizures:CDBrichCannabiscanlowerseizureratesdramatically.

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Here are the results of a recent patient survey regarding the medical benefits of Cannabis:

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KNOW YOUR RISKS

There are legitimate concerns about long-termmarijuana use thatmust be taken into considerationwhen deciding to use the plant medicinally. The following is a list of research-derived possible sideeffectsforSativaformsofmarijuana:

Anxiety/Panic attacks Exacerbation of schizophrenia in predisposed individualsHigher heart rates

Patients with cardiovascular diseases should avoid all sativa forms of cannabis. Arrhythmia,CongestiveHeartFailure,neurocirculatorysyncope,orthostatichypotension,Betablockers(highbloodpressuremedications) - stay away fromSativasCannabis. MMJ in any form shouldnotbeusedwithsystemic Anticoagulants (risk of. Falling), Erectile Dysfunction Agents (risk of rebound hypotension).MMJisanaturalerectiledysfunctionmedicationonitsown,soyoumaygetanexaggeratedresult.Allformsofsmokedcannabismaycause:

· Increased chances of lung infections AllformsofhighpotencyTHCcannabis,iftakeninhighdoses,couldcause:

· Depersonalization, Amotivational Syndrome

Contact your certifying doctor if contra-indications or side effects occur.

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POTENTIAL DRUG INTERACTIONS WITH MEDICAL MARIJUANA Sedative Medications (Barbiturates, CNS Depressants, and Alcohol): Taking marijuana along withsedativemedicationmaycausetoomuchsleepiness.Theophylline (a Bronchodilator used for asthma & other lung problems): Smoking marijuana mightdecreasetheeffectsoftheophylline.Butthereisn’tenoughinformationtoknowifthisisabigconcern.Disulfiram (Antabuse, an alcohol antagonist drug): Takingmarijuana alongwith Disulfiram can causeagitation,troublesleepingandirritability.Fluoxetine (Prozac, an antidepressant): Taking marijuana with fluoxetine (Prozac) might cause you tofeelirritated,nervous,jittery,andexcited.Doctorscallthishypomania.Warfarin (Coumadin, a blood thinner (anticoagulant)): Smoking marijuana while taking warfarin(Coumadin)mightincreasethechanceofbruisingandbleeding.Reference:rxlist.com

DO NOT use marijuana if:

Youarepregnantorbreast-feeding.

Youareschizophrenic.

Youhaveheartproblemsorhypertension(highbloodpressure).

Youhavelungproblemsandaresmokingyourmedicine.

Youhaveimmunesystemproblems.

You are scheduled for surgery in the next two weeks. Marijuana might cause excessive sedation ifcombinedwithmedicationsusedduringandaftersurgery.

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ALTERNATIVE OPTIONS TO TREAT SYMPTOMS

Thereareanumberofadditionaloptionsyoumayconsiderpursuingeitherasanadjuncttoorentirelyinplaceofmedicalmarijuanatherapy.Belowisjustabrieflist: HypnosisAcupunctureMassageChiropracticNon-marijuana-basedherbalmedicines(Teas,tinctures,andsalves)Over-the-counterpharmaceuticalmedicationsHomeopathyBio-feedbackPsychologicalCounselingLifeCoachingSupportgroups

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KNOW THE SIGNS OF SUBSTANCE ABUSE Please note that we reserve the right to refuse sale of medical marijuana to anyone who we deem to be impaired or who display signs of substance abuse of any kind. Note additionally that this is a reportable offense that may result in the revocation of your marijuana ID card. It is important you review this list of common signs and symptoms of substance abuse. Mostdrugaddictionsstartwithcasual,socialormedicaluseofadrug.Forsomepeople,usingthedrugbecomesahabit,anditsusebecomesmoreandmorefrequent.Astimepasses,theymayneedlargerdosesofthedrugtogetthedesiredeffect.Eventuallytheymayneedthedrugjusttofeelgood.Astheirdruguseincreases,theymayfindthatitbecomesincreasinglydifficulttogowithoutthedrug.Stoppingmaycauseintensecravingsandmakethemfeelphysicallyill(withdrawalsymptoms).Drug addiction symptoms or behaviors include: • Feelingthatyouhavetousethedrugregularly—thiscanbedailyorevenseveraltimesaday• Failinginyourattemptstostopusingthedrug• Makingcertainthatyoumaintainasupplyofthedrug• Spendingmoneyonthedrug,eventhoughyoucan'taffordit• Doingthingstoobtainthedrugthatyounormallywouldn'tdo,suchasstealing• Feelingthatyouneedthedrugtodealwithyourproblems• Drivingordoingotherriskyactivitieswhenyou'reundertheinfluenceofthedrug• Focusingmoreandmoretimeandenergyongettingandusingthedrug Recognizing signs of drug use and dependence Theparticularsignsandsymptomsofdruguseanddependencevarydependingonthetypeofdrug.Youmightbeabletotellthatafamilymemberorafriendisusingorabusingadrugbasedonthephysicalandbehavioralsignsandsymptomsassociatedwiththedrug.

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Addendum8/11/2020

Inpatient/OutpatientDrugRehabCentersInArizonaHereisalistofdrugrehabcentersinArizona.Theyareprimarilyhospital-basedprograms.Most hospital-based programs accept Medicare, Medicaid, state-funded and privateinsurance. Ingeneral theydomedicaldetox.Mostoffer someother levelofcare, suchasIntensiveOutpatient(IOP)and/orPartialHospitalizationPrograms(PHP).

Listedinalphabeticalorderbycity

CrisisHotlines24-HourCrisisHotlines–National

• 1-800-273-TALK(8255)NationalSuicidePreventionLifeline• 1-800-662-HELP(4357)NationalSubstanceUseandDisorderIssuesReferraland

TreatmentHotline

Suicide/CrisisHotlinesbyCounty

• NavajoCountyservedbyWhiteMountainApacheBehavioralHealthServices:o 1-928-338-4811

• MaricopaCountyservedbyMercyMaricopaIntegratedCare:o 1-800-631-1314or602-222-9444

• Cochise,Graham,Greenlee,LaPaz,Pima,Pinal,SantaCruzandYumaCountiesservedbyCenpaticoIntegratedCare:

o 1-866-495-6735• Apache,Coconino,Gila,Mohave,NavajoandYavapaiCountiesservedbyHealth

ChoiceIntegratedCare:o 1-877-756-4090

• GilaRiverandAk-ChinIndianCommunitiesservedbyEMPACT:o 1-800-259-3449

City Facility Phone

Chandler ValleyHope (480)899-3335Flagstaff FlagstaffMedical (928)213-6400

ShowLow CommunityMedicalServices (928)251-2030SunCityWest BannerDelWebbMedical (623)214-4056

Tucson Cottonwood (520)743-0411Tucson SierraTucson (800)624-9001Tucson SaintJoseph's (520)873-6840Tucson SonoraHealth (520)469-8700Tucson Compass (520)628-3400

Wickenburg Meadows (928)684-3926

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(928) 537-4888 • www.greenhillspatientcenter.com1

6/10/20

Guide for the Responsible Use of Medical Marijuana

guide for the responsible use of medical marijuana guide

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