Those currently suffering from debilitating conditions unrelieved by legally available drugs, and who might find relief with marijuana, will find little comfort in a promise of a better drug 10 years from now. In terms of good medicine, marijuana should rarely be recommended unless all reasonable options have been eliminated. But then what?
It is conceivable that the medical and scientific opinion might find itself in conflict with drug regulations. This presents a policy issue that must weigh, at least temporarily, the needs of individual patients against broader social issues. Our assessment of the scientific data on the medical value of marijuana and its constituent cannabinoids is but one component of attaining that balance.
It should be noted that THC, the primary active ingredient in marijuana, is an FDA-approved drug referred to as dronabinol and marketed as Marinol. Marijuana is advocated primarily for relief from the symptoms of disease rather than as a cure.
The accumulated scientific data indicate a potential therapeutic value for cannabinoid drugs, primarily THC, particularly for mitigating symptoms such as:
o Pain Relief
• A medical condition for which it is more effective than any currently available medication.
• It has a broad clinical spectrum of efficacy and a unique side effect profile.
• It has synergistic interactions with other analgesics.
• It exhibits "side effects" that are considered useful in some clinical situations.
• Its efficacy is enhanced in patients who have developed tolerance and resistance to the treatment of opioids.
o Control of Nausea and Vomiting o Appetite Stimulation o Wasting Syndrome For those patients with AIDS or who are undergoing chemotherapy, and who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication.
The data is weaker but moderately promising for:
o Neurological Symptoms (including muscle spasticity) o Glaucoma Legal Uses: NRS 453A.050 “Chronic or debilitating medical condition” means:
1. Acquired immune deficiency syndrome; 2. Cancer; 3. Glaucoma; 4. A medical condition or treatment for a medical condition that produces, for a specific patient, one or more of the
a. Cachexia; b. Persistent muscle spasms, including, without limitation, spasms caused by multiple sclerosis; c. Seizures, including, without limitation, seizures caused by epilepsy; d. Severe nausea; or e. Severe pain; or
5. Any other medical condition or treatment for a medical condition that is classified as a chronic or debilitating
medical condition by regulation of the Division or approved as a chronic or debilitating medical condition pursuant to a petition submitted in accordance with NRS 453A.710 Psychological Effects: These effects can influence potential therapeutic value and can prove beneficial to some but may also be potentially undesirable for certain patients.
o Anxiety Reduction Sedation
M M P a g e |1 of 5 MEDICAL MARIJUANA
People vary in their responses to medications, and there will likely always be a subpopulation of patients who do not respond well to some medications where others might find it to be beneficial.
o Smoked marijuana is a crude THC delivery system that also delivers harmful substances.
• Chronic cannabis smoking is harmful to the lungs.
• The inhalation of cannabis poses a risk of abuse and dependency.
• Cannabis smoke contains many of the components of tobacco smoke.
Can deposit as much as four times the amount of tar in the lungs than smoking tobacco. This effect results from the fact that cannabis cigarettes lack filters and cannabis smokers inhale more deeply and hold their breath longer than tobacco smokers hold theirs.
o Crude herbal cannabis is not a homogeneous material; the term “medical marijuana” therefore does not refer to a single, consistent substance or entity. o The composition of herbal material, including its THC content, varies widely depending on the
o The methods of herbal cannabis administration (smoked/vaporized, baked goods, teas, infused honeys, elixirs, candies, etc.) do not ensure an identifiable, standardized, and hence reproducible, dose.
• Patients therefore cannot be certain they will experience the same degree of benefit or extent of side effects.
• Patients, particularly those unfamiliar with cannabis, may be unwittingly dosed excessively, and incur frightening or severely unpleasant effects.
o Quality control mechanisms are generally absent. As a result:
• The manufacturers have essentially no accountability and the FDA does not inspect their facilities.
Cannabis products may be contaminated with microbes. Patients injured by harmful products have no legal recourse.
o Distribution does not take place within the monitored and regulated channels of supply for pharmaceuticals.
The acute effects of pure THC and high-THC cannabis that are relevant to medical use include intoxication (including dysphoria), anxiety (including panic attacks), hallucinations and other psychotic-like symptoms, somnolence, confusion, psychomotor impairment, cognitive impairment, dizziness, orthostatic hypotension, dry mouth and tachycardia. In clinical trials of cannabinoid products, patients with pre-existing serious mental disorders, significant hepatic or renal impairment, epilepsy, cardiac conditions, or prior substance abuse/dependence are typically excluded. I understand the potential risks and benefits of medical marijuana. Signature: ___________________________ Date: _______________________ Printed Name: ________________________________
M M P a g e |2 of 5 MEDICAL MARIJUANA CONSENT FOR EVALUATION PATIENT’S SUITABILITY FOR USE OF MEDICAL MARIJUANA
I, ___________________________________________________, declare that all the information provided to the physician is true and correct under penalty of perjury. I believe that I have a debilitating medical condition as defined by the Nevada Medical Marijuana Program. I have presented copies of my pertinent medical records regarding previously diagnosed debilitating medical condition(s) for this evaluation.
I understand that I am consulting with a physician of Innovative Care Physicians herein known as ICP for the purpose of evaluation of my medical condition to obtain an opinion as to whether or not I might benefit from the medical use of marijuana in connection with a debilitating medical condition as defined by the Nevada Medical Marijuana Program.
The physician(s) at ICP who evaluates me will base their opinion on the contemporaneous assessment of my medical history and current medical condition.
In performing an evaluation of my medical condition as it relates to determining if I might benefit from medical use of marijuana, a bona fide physician-patient relationship is established for the purpose of fulfilling the physician’s role in regulating the Nevada Medical Marijuana Program. This bona fide physician-patient relationship is limited to the physician’s role as defined in the Nevada Medical Marijuana Program and in no way can be construed to have formed a physician-patient relationship for any or all other purposes. The physicians at ICP advise you to consult both with ICP and with your primary care provider at least once a year to re-evaluate your debilitating medical condition.
If the physician's opinion is that I might benefit from the medical use of marijuana, that opinion does not, in any way imply that the physician who evaluates me or ICP is prescribing or advising me to use medical marijuana. The decision to use medical marijuana is at my sole discretion as a patient. Medical Marijuana is a drug and will impair your mental faculties and physical abilities. If I choose to use medical marijuana, I understand that marijuana may cause side effects that include but are not limited to: drowsiness, dizziness, decreased reaction time, and decreased coordination; and I must avoid hazardous activities, such as driving a vehicle, and operating heavy machinery when using medical marijuana. There is a potential for differing strengths of medical marijuana strains and products. There may be interactions with alcohol, prescription drugs, non-prescription drugs, and supplements; all uses should be reported to avoid contraindications.
Once/if I have chosen to use medical marijuana, ICP's physicians advise me to assess the benefit I receive from using medical marijuana on an ongoing basis, and continue its use only if it is benefiting symptoms of the debilitating medical condition. Signs and symptoms of substance abuse, including tolerance, dependency, and withdrawal should be reported immediately as well as instances when other side effects or contraindications occur.
ICP and their physicians in no way imply or recommend that you purchase medicinal marijuana from any specific dispensary or caregiver.
I understand the potential risks and benefits of medical marijuana. By signing this form the patient states he/she has read, understands, and agrees to the above statement(s). Signature: ___________________________ Date: _______________________ Printed Name: ________________________________
M M P a g e |3 of 5 MEDICAL MARIJUANA I M P O R T A N T N O T I C E ISSUANCE OF A STATE OF NEVADA MEDICAL MARIJUANA REGISTRY CARD DOES NOT EXEMPT THE HOLDER FROM PROSECUTION UNDER FEDERAL LAW. THE MEDICAL MARIJUANA REGISTRY CARD IS ONLY GOOD IN THE STATE OF NEVADA, IT IS NOT RECOGNIZED BY ANY OTHER STATE AND IS NOT RECOGNIZED BY THE UNITED STATES GOVERNMENT NRS 453A.810 STATES: “THE STATE MUST NOT BE HELD RESPONSIBLE FOR ANY DELETERIOUS OUTCOMES FROM THE MEDICAL USE OF MARIJUANA BY ANY PERSON” A person who has a registry identification card issued by the Division of Health is NOT exempt from prosecution if: 1. They drive, operate, or control a vehicle or vessel under power or sail while under the influence of medical marijuana. Unlawful amounts of marijuana in the blood or urine, per N.R.S. 484.379, are 10 nanograms per milliliter of urine and 2 nanograms per milliliter of blood. 2. They water ski, surfboard or use any similar device while under the influence of medical marijuana. 3. They operate an aircraft while under the influence of medical marijuana. 4. They have physical possession of a firearm while under the influence of medical marijuana. 5. They embark on an amusement ride while under the influence. 6. The possession of the marijuana or drug paraphernalia is discovered because the person engaged or assisted in the medical use of marijuana: 1. In a public place. 2. In a detention facility, county jail, state prison. 3. While delivering marijuana to another person, even if they hold a registry card. SPECIAL NOTE: Holding a marijuana registry card does NOT exempt a person from the laws that apply to marijuana. It ONLY allows the holder of the card to possess: 1. One ounce of usable marijuana (defined in NRS 453A.160) 2. Three mature marijuana plants (defined in NAC 453A.080, sec. 2) 3. Four immature marijuana plants (defined in NAC 453A.080, sec.1) All other laws apply. I understand the potential legal risks of the Nevada Medical Marijuana Program. Signature: ___________________________ Date: _______________________ Printed Name: ________________________________ n t I -P eft L
M M P a g e |4 of 5 MEDICAL MARIJUANA PAINMEDICATIONS REVIEW Please the medication(s) that you have sampled in the past. Acetaminophen Gabapentin Hydrocodone Ibuprofen Indomethacin MS-Contin Tylenol #3 Naproxen Neurontin Nortriptyline Wellbutrin Oxycontin Fluoxetine DATE: _____________________ Marijuana as Medicine Prior to the usage of cannabis, sampling other analgesics may be beneficial in managing pain. Although U.S. law classifies marijuana as a Schedule I controlled substance (which means it has no acceptable medical use), a number of patients claim that marijuana has helped them deal with pain or relieved the symptoms of glaucoma, the loss of appetite that accompanies AIDS, or nausea caused by cancer chemotherapy. There is, however, no solid evidence that using marijuana creates any greater benefits than approved medications (including oral THC) now used to treat these patients, relieve their suffering, or mitigate the side effects of their treatment. Anecdotal assertions of beneficial effects have yet to be confirmed by controlled scientific research.
Some of the marijuana dangers include impaired perception; diminished short-term memory; loss of concentration and coordination impaired judgment; increase risk of accidents; loss of motivation; diminished inhibitions; increased heart rate,
anxiety, panic attacks, and paranoia; hallucinations; damage to the respiratory, reproductive, and immune systems; increase risk of cancer; and psychological dependency.
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