The Medicinal Cannabis Treatment Agreement slated for distribution by the Medical Board of California. Interspersed comments are from members of the Society of Cannabis Clinicians. (I don’t know why WordPress won’t italicize them. —FG)
I understand that _______________________(clinician name) is helping me with the treatment of my chronic pain.
In considering the possibility of using medicinal cannabis, it is important to recognize that the risks of medicinal cannabis may be impacted by specific medical conditions and patterns of use. I understand what has been explained to me and agree to the following conditions of treatment:
1. I must prevent children and adolescents from gaining access to medicinal cannabis because of potential harm to their well-being. I will store cannabis in locked cabinets to prevent anyone else from using it.
The locked cabinet pledge is unnecessary and impractical for most grown-ups who don’t live around children. Why make people make promises that they won’t keep?
2. I know that some people cannot control their use of cannabis. One example is using cannabis for reasons other than for the indication for which it was prescribed; like getting stoned. This may lead to not going to work, or not doing my household chores. I agree to discuss this with my doctor if this happens.
In the accompanying article by Wilsey et al, a graphic explains that patients using cannabis for unapproved indications should be steered to “expert psychiatric care.” Since chronic pain patients often have other medical problems —and pain itself promotes Depression, for which the pain specialist is explicitly not providing treatment— many, perhaps most patients will find themselves using cannabis “for purposes other than response to pain levels.”‘ Where I come from (Brooklyn Before Gentrification) this what they call a “set-up.”
3. I realize that unless specifically recommended by my doctor, I should abstain from medicinal cannabis if:
I am pregnant or am of child-bearing age
I am middle-aged or older and have a heart disease or heart rhythm problem
I have a history of serious mental illness (e.g., schizophrenia, mania, or a history of hallucinations or delusions)
This would literally enjoin all young women from using medical cannabis.
4. In order to reduce the risk of lung disease, I will avoid smoking cannabis with tobacco; avoid deep inhalation or breath-holding; and use a vaporizer rather than smoke joints or use a water pipe.
5. I will not drive a car or operate heavy machinery for 3-4 hours after use of medicinal cannabis, or longer if larger doses are used or the effects of impairment persist. I will use a designated driver for automobile transportation if I have to go out sooner than 3-4 hours after taking this medicine.
Two minutes after inhalation is plenty, and 10 minutes after ingestion is not enough.
6. As the potency of cannabis varies widely I will use the minimum amount of medicinal cannabis needed to obtain relief from pain or other symptoms. When trying a new strain of cannabis, I will start with a very small amount and wait at least 10 minutes to see how it affects me.
This should apply only to edibles and the wait period should be an hour. (The effect of smoked cannabis is felt almost immediately.)
7. If thought advisable by my health care provider, I might want to substitute one of the Food and Drug Administration (FDA) approved medicines containing THC rather than take natural cannabis.
Who but the pharmaceutical manufacturers want to encourage this substitution?
8. I might notice a withdrawal syndrome for two weeks if I stop cannabis abruptly. Trouble getting to sleep and angry outbursts might require that I withdraw from the cannabis slowly.
Going without coffee is much more impactful for a regular user than going without cannabis. Psychiatry requires a robust cannabis “withdrawal syndrome” because withdrawal is a defining feature of “dependency.”
9. I understand that the course of treatment will have to be re-evaluated regularly after I start the medicinal cannabis.
Why must the 71-year-old with severe arthritis —or anyone with an uncurable condition for which cannabis provides relief— have to get a doctor’s consent annually?
10. I will not use medicinal cannabis in public places unless the law specifically permits this.
Homeless patients have no private place to use cannabis. This is a matter for law enforcement, not clinicians.
11. I know there is no legal precedent to help me if I am terminated from employment if a urine toxicology screen is positive for cannabis.
Several states do have legal precedents protecting employees who are medical users. California law might change.
12. I know that I may be asked to reduce or stop my intake of opioids (narcotics), sedative-hypnotics (benzodiazepines), and/or alcohol. This will be done to reduce the risk of side-effects from a combination of medications that affect the central nervous system.
This is positively harmful. It encourages discrimination against marijuana use by opiate users and there is no good scientific evidence supporting it.