PATIENT EDUCATION GUIDE MEDICAL 4

CANNABINOIDS 6

RISKS & RISK REDUCTION 7

SIDE EFFECTS 8

DRUG INTERACTIONS 9

DELIVERY METHODS 10

ALTERNATIVES 12

SUBSTANCE ABUSE PROGRAMS 13

INDEX PATIENT TRACKING SYSTEM 14 3

Medical Cannabis comes in two basic types: specific conditions and symptoms. We suggest Sativa and Indica. Each type has its own distinct that patients keep records of their own experienc- set of characteristics. The efficacy of cannabis is es at the time of medicating, strain used, dosage, directly related to strain selection, therefore, we and method of delivery to determine what works recommend care be taken in selecting appropriate best for them. strains to meet your needs. Science is beginning to identify particular varieties that are effective A patient tracking systems and log is provided in for sleep, pain, appetite, and energy, as well as for this document.

4 INDICAS

As opposed to , indica plants are normally shorter and stockier, reaching between SATIVAS three and six feet tall. Their leaves are short, broad and deeply serrated and sometimes tinged with The sativa plant is a tall, slower growing and a hint of purple and the flowers form in compact, maturing plant characterized by long, thin leaves. dense clusters. The indica plant has a strong Sativa buds, the part of the plant that contains the stinky or skunky smell and the smoke in generally most medicine, grow in long, thin, spear like clus- heavy and can produce a coughing response. ters and can be red or purple in color depending The medicating effect of indica is predominantly on the environment they grow in. The plants smell physical, although the relief of certain physical sweet and fruity and the smoke is generally mild. symptoms can have positive emotional results as The effect of sativa is often characterized as cere- well. Indicas are characterized as relaxing, sedat- bral, uplifting, and energetic. It provides excellent ing, and pain reducing and are excellent at reliev- pain relief for certain symptoms, listed below, and ing stress. They produce an overall sense of calm fives a feeling of optimism and well-being. These and serenity and are very effective for overall body benefits can be particularly helpful for the psycho- pain relief, allowing a patient to simply sit still. logical component of many illnesses. Sativas are Indicas are generally best for later in the day and generally better for daytime medication. before bed.

Patients have reported that sativa pro- Patients have reported that indica pro- vides the following medicating effects: vides the following medicating effects:

Reduces nausea • Reduces depression Reduces pain • Reduces inflammation • Relieves headaches and migraines • • Relaxes muscle spasms • Stimulates Reduces pain awareness appetite • Aids sleep

Stimulates appetite • energizes and Reduces headaches and migraines • stimulates • Increases focus and cre- Reduces intra-ocular pressure • Anti- ativity • Supports immune system convulsant

HYBRIDS

Strain crosses, or hybrids, are the result of cross-pollination of various strains. The characteristics, and hence, the effects of one strain will usually be dominant. For example, indica-dominant crosses are good for pain relief, with the sativa component helping with energy and activity levels. Sativa-dominant crosses are good for stimulating appetite, with the indica component helping to reduce body pain and increase relaxation.

5 CANNABINOIDS

Above all, medical cannabis is known for its ability to help people cope with nausea and reduced appetite, pain and discomfort, muscle tension and Safety is the primary benefit spasms as well as provide a feeling and sense of of cannabis use, as there is overall well-being and comfort. The new cannabis no overdose level. No one has studies that are starting to emerge along with changing laws and public opinion are very exciting ever died from ingesting too for potential treatment advancements. much cannabis; nor has canna- bis ever caused liver or kidney Another benefit of medical cannabis is the rapid onset of relief that patients can achieve through damage or organ failure. inhalation dosing methods.

6 constantly seeking a state of balance. The ingestion of any of any ingestion The of balance. astate seeking constantly and complex is very of aperson state mental-emotional The of well-being. sense apowerful producing at is effective cannabis that reasons of the is one This state. mental-emotional to aperson’s changes profound producing of is capable as it substance, is apsychoactive Cannabis effective. also are etc. soaps, poultices, infusions, balms, salves, oils, and creams as in such skin the through delivery Transdermal teas. or foods capsules, in delivery dose as edible as well vaporization, include to smoking ternatives Al sanitized. and clean kept be should and tuberculosis even and as viruses such illnesses, to spread vehicles potential are pipes water that shown has been However, it of smoke. temperature the decreases pipe awater Employing dosing. of methods alternative using or smoke of inhaled perature tem the decreasing by reduced may be Risk performance. long-term overall, and elasticity lung may affect lungs and passages air to the delivery heat repetitive believe community medical the in Some heat. and products combustion smoke, from risk potential to reduce order in to smoking alternative as an sued be can A vaporizer smoke products. and combustion of inhalation to the avoid healthier is always it general, in Although humans. in occurrence cancer in increase an and smoke cannabis between link causal aclear clude con not does literature medical of the However, areview cannabis smoke cellular and changes. precancerous between arelationship may suggest studies Some inhales. if body and lungs to the harmful are that products other or carcinogens contains potentially of combustion product or smoke any that is true It ADDITIONAL INFORMATION • • • • • is strictlyprohibited under anycircumstances Driving avehicle and/or operating whileunderthe influenceofMedical Marijuana heavy machinery utilizing and/orbeingunder theinfluenceofMedicalMarijuanawhileworking It isadvisedthatyou regarding consultyour employer their policies for andtheHRdepartment childrenwhile caringfororsupervising At alltimes,MedicalMarijuana isto bekept outofthereach ofchildren andshouldnotbeused It ishighlyrecommended thatALLmedicationbekept inalocked andsecure location It isunlawfulto smoke oringestMedicalMarijuanainpublicplaces - - -

result there is the potential for prosecution and punishment. and prosecution for potential is the there result as a and Government, Federal States United the by illegal considered is still Cannabis usage. cannabis by proposed risk greatest the may be of cannabis status social and legal The impaired. not when even cannabis for positive may test they that aware be should patients therefore, days, to 30 up for one’s in system remain can metabolites Cannabis stance. sub other any or cannabis of influence to the due impaired while vehicles motor or equipment heavy operate should one no Therefore, coordination. physical and making decision aperson’s may affect cannabis substance, a psychoactive As exist. does dependence psychological for risk potential the substance, However, as apsychoactive patients. most in symptoms withdrawal physical to serious lead use tinuing discon does nor dependence, physical in result not does use Cannabis dosage. changing or of cannabis ingestion the ning begin before environment asafe in are you sure make Always RISKSolizes. metab medication as the hours within resolve will it occurs, anxiety or discomfort mental-emotional any if and cannabis, from overdosed physically has ever one no that noted again & be should it all, Above doses. of larger ingestion of the result as a especially intended, had way they the feel may not they RISK is arisk there substance, apsychoactive ingests person a time any that understand must one importantly, Most REDUCTION imbalances. mental-emotional induced to cannabis risk of higher may be as , such illness mental-emotional from suffering or illness tional to mental-emo predisposed Individuals of motivation. lack sadness, anxiety, , and depression, panic attacks, as anger, such symptoms inducing and balance the upsetting of temporarily potential has the substance psychoactive

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! 7 POSSIBLE SIDE EFFECTS AND CONTRAINDICATIONS TO CANNABIS (MARIJUANA) USE

SIDE EFFECTS LISTED BY THE ARIZONA DEPARTMENT OF HEALTH SERVICES

SHORT TERM • Problems with memory and learning, distorted perception, and difficulty in EFFECTS thinking and problem-solving • Loss of coordination • Impairs driving abilities • High doses: Mental confusion, panic reactions and

SHORT TERM • Sedation PHYSICAL EFFECTS • Blood shot eyes • Increased heart rate • Coughing • Increased appetite • Decreased blood pressure • Bronchitis • Bronchial asthma

CONTRAINDICATIONS • Patients with respiratory disorders exacerbated by smoking should use alternative forms of ingestion • Cannabis use may have effects on heart rate and blood pressure. There- fore, patients with severe heart conditions should discuss this with their physician • Cannabis may elicit schizophrenic episodes in patients who are predis- posed to schizophrenia. Individuals with a past medical history of schizo- phrenia or family history of schizophrenia may be contraindicated for cannabis use. Discuss with your physician • Patients with a past history of adverse reactions to cannabis • Patients using other prescription mood altering medications or narcotic pain medications should inform their physician of medical cannabis use • Pregnancy: Cannabis constituents can pass through breast mild and to the fetus during pregnancy, therefore, patient should inform the physician if currently pregnant or considering pregnancy • Patients should not drive or operate heavy equipment while impaired or participate in responsibilities and activities that require focus and atten- tion such as childcare

8 CANNABIS (MARIJUANA) DRUG INTERACTIONS

Cannabis (marijuana) has no known lethal dose or LOSO. This makes cannabis one of the least toxic substances known. Therefore, it has very few drug interactions and low potential to cause combined PLEASE adverse effects. Although, a few have been report- ed that should be discussed. NOTE

Alcohol effects may be increased when combined with cannabis, increasing risk of dizziness, loss of coordination, nausea and vomiting. Theoretically, Non-prescription drugs and over cannabis is an and may suppress the counter supplements, such as vomiting and lead to poisoning. However, Tylenol and herbs, may cause an this is not significantly reported interaction with medical marijua- na. Please contact your physician Opiate medications are highly toxic, having a high for advice on using these prod- potential for overdose, causing death. Combined ucts with medical marijuana. cannabis use does not increase the risk of over- dose by opiate medications. In fact, studies are suggesting that cannabis may make opiate med- ication more effective at managing pain at lower doses Cannabis use, along with other changes in lifestyle and health, can make patients very drowsy. Combin- may initiate fluctuations in vitals, ing these medications with cannabis may cause blood pressure, blood sugar and excessive sleepiness. Examples: other parameters that may re- (Klonopin), (Ativan), quire alterations to prescription (Donnatal), (Ambien) medication recommendations and dosages Disulfiram (Antabuse) manufacturer reports that combined with marijuana may cause irritability and disturbances of sleep

SSRI’s and other mood altering drugs have had a Always communicate any health few reports of interactions such as irritability and and/or medication changes with nervousness. Patients taking these medications your primary care physician! should discuss their medical cannabis use with the prescribing physician. Examples: fluoxetine (Prozac) and sertraline (Zoloft)

9 CANNABIS (MARIJUANA) DELIVERY METHODS The following are general guidelines. Each indi- such as tinctures or edibles, the effects can take vidual patient will respond differently to dosing up to 90 minutes. When choosing a method with a methods. A general rule is to start with a smaller longer onset, it is important yet sometimes diffi- dose until you are comfortable with the level cult to know exactly how much you are consum- necessary to achieve the desired effect. You must ing. Lab tested medication is highly recommended take into consideration the length of time to feel for this very reason. We recommend that you keep full effects. With smoking or vaporizing, the onset a journal to help you find your ideal dosing method is almost immediate and, therefore, dosage is easy and start low, especially when trying something to self-regulate. For other methods of delivery, new.

SMOKING A fast and effective method, smoking ANYTHING raises health concerns. Recent research indicates that smoking cannabis is far less dangerous than cigarette smoking. The medical effects will be fully felt in a very short time, usually less than five minutes, but some can take longer. It is also inex- pensive. This delivery method is good for those needing fast relief or those who medicate less frequently

VAPORIZING Vaporizing is a technique for avoiding irritating respiratory toxins in marijuana smoke by heating cannabis to a temperature where the psychoactive ingredients evaporate without causing combus- tion. Cannabis vaporizers are designed to let users inhale active cannabinoids while avoiding harmful smoke toxins. They do so by heating cannabis to a temperature of 180°C - 200°C (356°F - 392°F), just below the point of combustion where smoke is produced. At this point, THC and other medi- cally active cannabinoids are emitted with little or none of the carcinogenic tars and noxious gases found in smoke. Many medical marijuana patients who find smoked marijuana highly irritating report effective relief inhaling through vaporizers.

10 START LOW, ESPECIALLY WHEN TRYING SOMETHING NEW

EDIBLES Edibles are an extraction of cannabis to butter, oil or syrup. Edibles are ingested and are found to be most effective on an empty stomach. Edibles are typically baked goods or candy such as brownies, cookies, chocolate, hard candies, etc. For those with strict diets, healthier options can be prepared and are only limited by the cook’s creativity.

TINCTURES Tinctures are an extraction of cannabis, commonly vegetable glycerin or alcohol. A tincture provides a non-smoking alternative to medicating. Glycerin tinctures are sweet and may be cooked or cold pressed. Alcohol tinctures may burn under the tongue but can also be cooked or diluted for easier consumption. Typically, tinctures allow the patient to remain high-functioning with pain relieving ben-

Dosing is sub-lingual and can be adjusted easily. Tincture can also be added to liquids for ingestion, i.e. hot tea or coffee.

TOPICALS Topical preparations are made through extract- ing cannabis into handmade creations (lotions, salves, lip balm, soap, etc.). Topical delivery can be effective for arthritis, muscle spasms, rashes, etc. Recent studies have shown topical applications to be as or more effective than oral delivery methods for some conditions. The majority of patients who use topical preparations do not feel the internal medicating effects that come with smoking or other oral preparations. Often, topical preparations are only felt in healing the skin and muscles.

11 ALTERNATIVES TO MEDICAL CANNABIS • Medical cannabis has the potential of palliating symptoms that may be ALWAYS TREAT indicators of an underlying disease process • Always consult and inform your physician about any symptoms that may THE CAUSE arise, whether or not they are relieved by medical cannabis OF DISEASE • Never stop looking for an underlying cause or cure for your symptoms • Obtaining a second or alternative medical opinion is always good practice RATHER THAN • Naturopathic doctors are licensed primary care physicians in Arizona that JUST TREATING focus on treating the root cause of disease. They use natural therapies such as botanicals, acupuncture and Chinese medicine, nutrition, homeop- SYMPTOMS athy and physical medicine to name a few • Modern medicine is rapidly evolving. Consult your medical physician(s) regularly concerning new/alternative treatments for your condition • Prescription Marinol is a pharmaceutical, synthetic form of THC that is FDA approved and available in the United States • Sativex is a trademarked tincture consisting of THC and cannabidiol avail- able in some countries outside the United States, such as Canada

SIGNS & SYMPTOMS OF AND ABUSE

The dialog of is ongoing and has Other substances may not have a strong chemical many different perspectives. The simple medical view dependence. This is associated with an intense un- can be broken down to chemical and psychological controllable sensation or desire to use the substance, dependence and substance abuse. Dependence is discontinued use may result in mood imbalances and the continued need to use a substance. This may be symptoms such as irritability. Cannabis (marijuana) is caused by a chemical dependence, meaning one will not associated with a chemical dependence. However, potentially become ill or have medically significant it does pose potential for . withdrawal symptoms if they quit or decrease the dose of the substance. Opiate based drugs and medications Substance abuse is simply defined as the continued such as and are known to cause use of a substance even though it is causing problems strong chemical dependence. in an individual’s life.

• Increase in substance seeking behavior THINGS TO • Increases in the amount of substance being used • Cannot stop using substance despite desire or attempts to quit LOOK FOR TO • Continued unaffordable spending of money on substance HELP IDENTIFY • Spending excessive amounts of time thinking about how to get and/or getting the substance SUBSTANCE • Engaging in dangerous or illegal activities under the influence of the drug DEPENDENCE or to obtain the drug • Neglected appearance and changes in behavior and/or socially inappropri- AND ABUSE ate behavior

12 SUBSTANCE ABUSE PROGRAMS AND REFERRAL INFORMATION Contact the Regional Behavioral Health Authority in your region of the State:

WESTERN JUDICIAL SERVICES COMMUNITY BRIDGES, INC. 9550 W. Van Buren St. #11, Tolleson AZ 85353 824 N. 99th Ave, Avondale AZ 85323 623-936-8828, westernjudicial.com 877-931-9142, communitybridgesaz.org

INTENSIVE TREATMENT SYSTEMS, LLC CHICANOS POR LA CAUSA, INC. 4136 N. 75th Ave. #116, Phoenix AZ 85033 3639 W. Lincoln St., Phoenix AZ 85009 623-247-1234, itsofaz.com 602-233-9747, CPLC.org

CHICANOS POR LA CAUSA, INC. RESOURCES INC. 6850 W. Indian School Rd., Phoenix AZ 85031 4337 W. Indian School Rd. #105, Phoenix AZ 85031 623-247-0646, CPLC.org 602-233-9401, addictionresourcesinc.com

TREATMENT ASSESSMENT SCREENING CENTER, INC. JEWISH FAMILY AND CHILDREN SERVICES 6409 W. Glendale Ave. #K-L, Glendale AZ 85301 3001 N. 33rd Ave, Phoenix AZ 85017 623-842-4535, tascsolutions.org 602-353-0703, jfcsaz.org

VALLE DEL SOL ARIZONA BEHAVIORAL COUNSELING 502 N. 27th Ave., Phoenix AZ 85009 6710 N. 47th Ave. #1, Glendale AZ 85301 602-258-6797, valledelsol.com 602-788-1116, azbehavioralcounseling.com

CORRECTIONAL HEALTHCARE COMPANIES TERROS HEALTH 4425 W. Glendale Ave. #5, Glendale AZ 85301 3864 N. 27th Ave., Phoenix AZ 85017 480-487-7486, chccommunityhealthservices.com 602-797-7000, terros.org

EMMARIE BEHAVIORAL HOME CARE WEST VALLEY ASAP IOP PROGRAM 2926 W. Wayland Dr., Phoenix AZ 85041 8607 N. 59th Ave. #C-6, Glendale AZ 85302 602-276-2204, Emmarie-bhc.com 602-434-0249, asapaz.com

MARICOPA INTEGRATED HEALTH SYSTEMS 10550 W. Mariposa St. #3, Phoenix AZ 85037 623-344-3700, mihs.org/behavioral-health/first-episode-center

Call: 1-800-662-HELP

A free referral helpline from the Substance Abuse and Services Administration

This information is intended only to complement, not to replace or contradict, any health or medical advice or information provided by healthcare professionals. Patients who have questions should contact their doctor or other healthcare professional.

13 PATIENT TRACKING SYSTEM LOG FOR CANNABIS USAGE, SYMPTOMS, AND SIDE EFFECTS

GUIDELINES FOR A daily log or journal is the best way to evaluate one’s benefit and/or negative NOTIFYING YOUR effects from medical cannabis use.

PHYSICIAN Patients should use these logs to self-evaluate symptoms, effects and benefits as well as to provide this information to the physician that is recommending their medical cannabis use.

Symptoms are very important to the treating physician. Please be as specif- ic as possible, including details of onset, quality, duration, associations and severity. • Severity of symptoms can be quantified with a number scale of 1 to 10 with 10 being the most severe and 1 being the lease severe • Be sure to immediately notify recommending physician of any side effects that occur as a result of cannabis use

ITEMS TO BE 1. Symptoms or reason for using medical cannabis RECORDED 2. Amount and type of cannabis utilized REGARDING MEDICAL CANNABIS 3. Method of use USE INCLUDE: 4. Positive effects and/or relief from symptoms 5. Unwanted side effects

A patient symptom tracking log is provided on the following page to assist in documenting information. This daily log can be photocopied and used to record the above information

14

Date: Time: Date: Time:

Reason for Use/Symptoms: Reason for Use/Symptoms:

Strain: Method of use: Strain: Method of use:

Amount used: Amount used:

PAIN N/A 1 2 3 4 5 6 7 8 9 10 PAIN N/A 1 2 3 4 5 6 7 8 9 10 CACHEXIA CACHEXIA NAUSEA NAUSEA SEIZURES MUSCLE SPASMS MUSCLE SPASMS AGITATION AGITATION

Post Use Report: Post Use Report:

Date: Time: Date: Time:

Reason for Use/Symptoms: Reason for Use/Symptoms:

Strain: Method of use: Strain: Method of use:

Amount used: Amount used:

PAIN N/A 1 2 3 4 5 6 7 8 9 10 PAIN N/A 1 2 3 4 5 6 7 8 9 10 CACHEXIA CACHEXIA NAUSEA NAUSEA SEIZURES SEIZURES MUSCLE SPASMS MUSCLE SPASMS AGITATION AGITATION

Post Use Report: Post Use Report:

Hours of operation and delivery Monday to Saturday: 9 AM to 9 PM Sunday: 10 AM to 6PM

The Phoenix | 600 South 80th Avenue | Tolleson AZ 85353 [email protected]