Download Medical Cannabis Toolkit

American Association of Colleges of Pharmacy
Medical Cannabis Toolkit
July 2016
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The Medical Cannabis Toolkit is intended for educational purposes only. It is not intended as a
substitute for professional medical advice; individuals should be encouraged to seek advice
from their health care providers regarding the use of medical marijuana.
The Toolkit is not an all-inclusive list of resources or references. It provides a basic framework
and suggestions of resources to support efforts to educate faculty, staff and students about the
laws, potential benefits and health and safety risks of medical cannabis. It is not intended as a
primary reference. Because the Toolkit is not a dynamic reference, resources may not
necessarily be most recent. Users of the Toolkit are encouraged to review additional
information sources as needed.
ACKNOWLEDGEMENTS
This publication was initiated for the American Association of Colleges of Pharmacy (AACP) in 2015.The
Task Force on Non-Medical Marijuana was formed in 2014 to discuss whether AACP should create an
educational policy on the non-medical (recreational) use of marijuana. After discussion, the task force decided
to focus on educating faculty, staff, and students about the use of medical cannabis as many but not all states
have legalized or are pending legislation about its use. The terms marijuana and cannabis are used
interchangeably throughout document.
For purposes of the Toolkit, “Medical Cannabis/Marijuana” refers to the use of marijuana that is specifically
defined as “Medical in the laws of the state of jurisdiction”.
It is important to realize that although states may legalize marijuana use, whether for medical or recreational
use, the Supremacy Clause (Article VI, Clause 2) of the United States Constitution declares that federal laws
are the "supreme Law of the Land." Hence, state court laws are inferior so long as the federal law is valid
(constitutional). Task Force members discussed issues regarding state/land grant and private university
policies about drug screens for illicit drug use. Example: Use of marijuana on the University of Washington
(UW) campus, including UW-managed residence halls, is strictly prohibited. Legalization of marijuana in WA
does not change the fact that marijuana is illegal under Federal Law. UW is a recipient of Federal funding
and continues to prohibit the use of marijuana. Those with a license or prescription for marijuana still must
abide by the Federal law. Also, keep in mind, many WA employers may still prefer employees to be drug free,
regardless of the legal status.
AACP USE OF MEDICAL CANNABIS TASKFORCE (2015-2016)
Laura Borgelt: University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Frank Caligiuri: Drake University College of Pharmacy and Health Sciences
Allison (Ally) Dering-Anderson: University of Nebraska College of Pharmacy
Michaelene (Micki) Kedzierski: University of Washington School of Pharmacy (Co-Chair)
Cynthia (Cindi) Koh-Knox: Purdue University College of Pharmacy (Co-Chair)
Sarah Melton: Gatton College of Pharmacy at East Tennessee State University
Don Stanford: University of Mississippi School of Pharmacy
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TABLE of CONTENTS
Page
MEDICAL CANNABIS/MARIJUANA ..................................................................................................... 4
Medical Cannabis/Marijuana Timeline ............................................................................................... 4
Pharmacology of Cannabis/Introduction to Pharmacological Discoveries .......................................... 4
Endocannabinoid system (ECS) .......................................................................................................... 4
Cannabinoid receptors ......................................................................................................................... 4
Endocannabinoids................................................................................................................................ 5
Cannabis nomenclature and constituents ............................................................................................. 5
Cannabinoids ....................................................................................................................................... 5
Tetrahydrocannabinol (THC) .............................................................................................................. 5
Non-Psychoactive Cannabinoids ......................................................................................................... 6
Cannabidiol (CBD) .............................................................................................................................. 6
Future Drug Development ................................................................................................................... 6
OBJECTIVE OVERVIEW OF RISKS OF MEDICAL CANNABIS .............................................................. 7
Risks Associated with Medical Cannabis ............................................................................................ 7
Adverse Effects of Cannabinoid use.................................................................................................... 7
Effects of Repeated Use of Medical Cannabis .................................................................................... 8
Effects from Smoked Marijuana .......................................................................................................... 8
Respiratory Problems Associated with Heavy Marijuana Smokers .................................................... 8
Cardiovascular Effects of Marijuana ................................................................................................... 8
Psychoactive Effects from Marijuana Use........................................................................................... 8
PTSD and Marijuana ........................................................................................................................... 8
Brain Development and Marijuana Use in Adolescents ...................................................................... 8
OBJECTIVE OVERVIEW OF POTENTIAL BENEFITS OF MEDICAL CANNABIS ................................... 9
Medical Marijuana for Different Disease States.................................................................................. 9
Epilepsy and marijuana ....................................................................................................................... 9
Pain and Marijuana .............................................................................................................................. 9
Use of Opioid and Marijuana .............................................................................................................. 9
FEDERAL AND STATE LEGISLATION ................................................................................................ 10
“DRIVING UNDER THE INFLUENCE” ................................................................................................ 11
IS CANNABIS ADDICTIVE? (HOW DO YOU KNOW IF SOMEONE IS DEPENDENT?) ............................. 11
TREATMENT AND RECOVERY SUPPORT RESOURCES FOR SUBSTANCE USE DISORDERS............... 12
RESOURCES ....................................................................................................................................... 12
Health Care Provider Resources ........................................................................................................ 12
For Patients and General Public ........................................................................................................ 14
Books ................................................................................................................................................. 16
Social Media ...................................................................................................................................... 16
Educational Opportunities ................................................................................................................. 16
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MEDICAL CANNABIS/MARIJUANA
MEDICAL CANNABIS/MARIJUANA TIMELINE
http://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026
http://norml.org/about/item/marijuana-law-reform-timeline
www.scientificamerican.com/article/the-science-behind-the-dea-s-long-war-on-marijuana/
Policy and Ethics: The Science Behind the DEA’s Long War on Marijuana. David Downs on April 19, 2016
PHARMACOLOGY OF CANNABIS
Medical marijuana is the generally accepted term for the use of the constituents of the cannabis genus for
therapeutic effects. These references review the pharmacology of the cannabis plant and the endocannabinoid
system that the majority of the plants effects are mediated through.
INTRODUCTION TO PHARMACOLOGICAL DISCOVERIES
[A Note to Readers: This research initiative was very similar to that employed in the discovery of the opioidbased pain relievers, the mu receptors system, and the endogenous compounds known as endorphins.]
Ben AM. Cannabinoids in medicine: A review of their therapeutic potential. J Ethnopharmacol.
2006;105:1-25.
Hi HL. An archaeological and historical account of cannabis in China. Econ Bot. 1973;28(4):437-48.
Pacher P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy.
Pharmacol Rev. 2006;58(3):389-462.
Pearce DD, Mitsouras K, Irizarry KJ. Discriminating the effects of Cannabis sativa and Cannabis indica:
A web survey of medical cannabis users. J Altern Complement Med. 2014;20(10):787-91.
Pertwee RG. Cannabinoid pharmacology: the first 66 years. Br J Pharmacol. 2006;147:S163-71.
Pertwee RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: D9tetrahydrocannabinol, cannabidiol and D9-tetrahydrocannabivarin. Br J Pharmacol. 2008;153:199-215.
ENDOCANNABINOID SYSTEM (ECS)
De Petrocellis L, Cascio MG, Di Marzo V. The endocannabinoid system: a general view and latest
additions. Br J Pharmacol. 2004;141:765-74.
DiMarzo V. The endocannabinoid system: Its general strategy of action, tools for its pharmacological
manipulation and potential therapeutic exploitation. Pharmacol Res. 2009;60:77-84.
Pacher P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy.
Pharmacol Rev. 2006;58(3):389-462.
Pertwee RG. Targeting the endocannabinoid system with cannabinoid receptor agonists: pharmacological
strategies and therapeutic possibilities. Philos Trans R. Soc Lond B Biol Sci. 2012; 367(1607):3353-63.
CANNABINOID RECEPTORS
Di Marzo, V. ‘Endocannabinoids’ and other fatty acid derivatives with cannabimimetic properties:
biochemistry and possible physiopathological relevance. Biochim Biophys Acta. 1998;1392 (2-3):153-75.
Pertwee RG. The pharmacology of cannabinoid receptors and their ligands: an overview. Int J Obes.
2006;30:S13-8.
Pertwee RG. Targeting the endocannabinoid system with cannabinoid receptor agonists: pharmacological
strategies and therapeutic possibilities. Phil. Trans. R. Soc. B. 2012;367:3353-63.
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ENDOCANNABINOIDS
[Note to readers: Anandamide was the first endocannabinoid discovered and was named after the Sanskrit
word ‘ananda’ which means “bliss” due to its actions on mood.]
Di Marzo, V. ‘Endocannabinoids' and other fatty acid derivatives with cannabimimetic properties:
biochemistry and possible physiopathological relevance. Biochim Biophys Acta. 1998;1392(2-3):153-75.
Galal AM, Slade D, Gul W, El-Alfy AT, Ferreira D, Elsohly MA. Naturally occurring and related
synthetic cannabinoids and their potential therapeutic applications. Recent Pat CNS Drug Discov.
2009;4:112-36.
Grotenhermen F, Müller-Vahl K. The therapeutic potential of cannabis and cannabinoids. Dtsch Arztebl
Int. 2012;109(29–30):495-501.
Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review.
CMAJ. 2008;178:1669-78.
CANNABIS NOMENCLATURE AND CONSTITUENTS
 Cannabinoids or phytocannabinoids - cannabinoids found within the cannabis plant
 Endocannabinoids – cannabinoid compounds produced endogenously by humans and animals
 Synthetic cannabinoids – cannabinoids compounds created by researchers. These agents have varying
effects on the ECS (e.g. full agonists, partial agonists, antagonists, CB receptor specific)
Pearce DD, Mitsouras K, Irizarry KJ. Discriminating the effects of Cannabis sativa and Cannabis indica:
A web survey of medical cannabis users. J Altern Complement Med. 2014;20(10):787-91.
Pertwee RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: D9tetrahydrocannabinol, cannabidiol and D9-tetrahydrocannabivarin. Br J Pharmacol. 2008;153:199-215.
CANNABINOIDS
Cannabinoids are lipophilic, odorless compounds that produce a multitude of effects depending on which
receptors they work on within the body. The major cannabinoid found in cannabis is delta-9tetrahydrocannabinol, commonly referred to as THC. THC has been researched extensively both in terms of
its abuse potential and adverse effects, as well as its therapeutic benefits.
Mehmedic Z, Chandra S, Slade D et al. Potency trends of delta(9)-THC and other cannabinoids in
confiscated cannabis preparations from 1993 to 2008. J Forensic Sci. 2010;55:1209-17.
TETRAHYDROCANNABINOL (THC)
Marinol ® dronabinol – FDA Approved synthetic THC
Cesamet ® nabilone – FDA Approved synthetic THC analog
THC is produced in the glands on the leaves and flowers of cannabis plants. Strains of cannabis have been
bred to increase their content of THC over the years for both medical and recreational purposes. THC is
highly psychoactive and these effects are mediated through its partial agonism of the CB1 receptor. THC also
is a partial agonist for the CB2 receptor, but to a lesser degree than CB1.
Borgelt LM, Franson KL, Nussbaum AM, Wang GS. The pharmacologic and clinical effects of medical
cannabis. Pharmacother. 2013;33(2):195-209
Russo E. Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br
J Pharmacol. 2011;163:1344-64.
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NON-PSYCHOACTIVE CANNABINOIDS
The non-psychoactive cannabinoids are a promising area for researchers as they are able to work on the ECS
and other receptors without producing any psychotropic adverse reactions. These cannabinoids include
cannabigerol (CBG), cannabichromene (CBC), tetrahydrocannabivarin (THCV), cannabidivarin (CBDV),
cannabinol (CBN), and cannabidiol (CBD) among others.
CANNABIDIOL (CBD)
CBD is the second most abundant cannabinoid in the drug-type plant following THC, and is the most well
studied among the non-psychoactive cannabinoids. In certain plant strains intended for medical use CBD is
the predominant cannabinoid while THC is only present in very low concentrations.
Campos AC, Moreira FA, Gomes FV, Del Bel EA, Guimara FS. Multiple mechanisms involved in the
large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. Philos Trans R Soc Lond B
Biol Sci. 2012;367:3364-78.
Izzo AA, Borrelli F, Capasso R, Di Marzo V, Mechoulam R. Non-psychotropic plant cannabinoids: new
therapeutic opportunities from an ancient herb. Trends Pharmacol Sci. 2009;30(10):515-27.
Mechoulam R, Parker LA, Gallily R. Cannabidiol: an overview of some pharmacological aspects. J Clin
Pharmacol. 2002;42:11.
FUTURE DRUG DEVELOPMENT
Epidiolex® cannabidiol – Pharmaceutical grade CBD preparation currently in clinical studies
Sativex ® nabiximols (THC:CBD in a 1:1 ratio) – approved in several; countries for the treatment of pain and
spasticity associated with multiple sclerosis. In Phase III FDA trials and is expected to be approved in the
near future.
The Endocannabinoid System (ECS) is widespread in human tissues and appears to have a role in maintaining
homeostasis and locally regulating levels or actions of other chemical signals or neurotransmitters. Cannabisbased as well as synthetic compounds that manipulate the actions and levels of endocannabinoids at their
receptors have been and are being developed currently.
Aggarwal SK, Carter GT, Sullivan MD, ZumBrunnen C, Morrill R, Mayer JD. Medicinal use of cannabis
in the United States: historical perspectives, current trends, and future directions. J Opioid Manag.
2009;5(3):153-68.
Galal AM, Slade D, Gul W, El-Alfy AT, Ferreira D, Elsohly MA. Naturally occurring and related
synthetic cannabinoids and their potential therapeutic applications. Recent Pat CNS Drug Discov.
2009;4:112-36.
Izzo AA, Borrelli F, Capasso R, Di Marzo V, Mechoulam R. Non-psychotropic plant cannabinoids: new
therapeutic opportunities from an ancient herb. Trends Pharmacol Sci. 2009;30(10):515-27.
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OBJECTIVE OVERVIEW OF RISKS OF MEDICAL CANNABIS
Cannabis is a generic term used for drugs produced from plants belonging to the genus Cannabis. Medical
cannabis refers to the use of cannabis or cannabinoids as medical therapy to treat disease or alleviate
symptoms. Cannabinoids can be administered orally, sublingually, topically or in rectal or vaginal suppository
form and they can be smoked, inhaled, mixed with food, or made into tea. Prescribed cannabinoids that are
approved by the Food and Drug Administration include dronabinol and nabilone capsules. A systematic
review was recently published in the Journal of the American Medical Association that extensively evaluated
the evidence for the benefits and adverse events of medical cannabinoids across a broad range of indications.
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and metaanalysis. JAMA. 2015;313(24):2456-73.
RISKS ASSOCIATED WITH MEDICAL CANNABIS
D'Souza DC, Ranganathan M. Medical marijuana: Is the cart before the horse? JAMA.
2015;313(24):2431-2.
Gage SH, Hickman M2, Zammit S. Association between cannabis and psychosis: epidemiologic
evidence. Biol Psychiatry. 2016;79(7):549-56.
Macleod J, Robertson R, Copeland L, McKenzie J, Elton R, Reid P. Cannabis, tobacco smoking, and lung
function: a cross-sectional observational study in a general practice population. Br J Gen Pract.
2015;65(631):e89-95.
Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by
marijuana. Circulation. 2001;103(23):2805-9.
Moore BA, Augustson EM, Moser RP, Budney AJ. Respiratory effects of marijuana and tobacco use in a
U.S. sample. J Gen Intern Med. 2005;20(1):33-7.
National Cancer Institute. Discovering the causes of cancer and the means of prevention Available at
http://dceg.cancer.gov/news-events/linkage-newsletter/2011-03/research-publications/03113 . Accessed
October 18, 2015.
National Institute of Drug Abuse. Marijuana: facts for teens. Available at
https://www.drugabuse.gov/publications/marijuana-facts-teens/want-to-know-more-some-faqs-aboutmarijuana. Accessed October 18, 2015.
Sidney S, Quesenberry CP Jr, Friedman GD, Tekawa IS. Marijuana use and cancer incidence (California,
United States). Cancer Causes Control.1997;8(5):722-8.
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and metaanalysis. JAMA. 2015;313(24):2456-73.
Wilkinson ST, Stefanovics E, Rosenheck RA. Marijuana use is associated with worse outcomes in
symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry.
2015;76(9):1174-80.
ADVERSE EFFECTS OF CANNABINOID USE
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and metaanalysis. JAMA. 2015 Jun 23-30;313(24):2456-73.
7
EFFECTS OF REPEATED USE OF MEDICAL CANNABIS
Very little data exists that have identified the interactions of marijuana with other drugs that may be
concurrently prescribed. Proponents of medical marijuana claim that use may allow patients to lower their
opioid analgesic doses. However, the existing evidence does not support this contention.
D'Souza DC, Ranganathan M. Medical marijuana: Is the cart before the horse? JAMA.
2015;313(24):2431-2.
EFFECTS FROM SMOKED MARIJUANA
National Cancer Institute. Discovering the causes of cancer and the means of prevention Available at
http://dceg.cancer.gov/news-events/linkage-newsletter/2011-03/research-publications/03113. Accessed
October 18, 2015.
National Institute of Drug Abuse. Marijuana: facts for teens. Available at
https://www.drugabuse.gov/publications/marijuana-facts-teens/want-to-know-more-some-faqs-aboutmarijuana. Accessed October 18, 2015.
Sidney S, Quesenberry CP Jr, Friedman GD, Tekawa IS. Marijuana use and cancer incidence (California,
United States). Cancer Causes Control.1997;8(5):722-8.
Tashkin DP. Effects of Marijuana Smoking on the Lung. Ann Am Thorac Soc. 2013 Jun;10(3):239-47.
Tashkin DP. Does Marijuana Pose Risks for Chronic Airflow Obstruction? Ann Am Thorac Soc. 2015
Feb; 12(2):235-6
Tashkin DP. The Respiratory Health Benefits of Quitting Cannabinoid Use. Eur Respir J. 2015Jul;
46(1)1-4
RESPIRATORY PROBLEMS ASSOCIATED WITH HEAVY MARIJUANA SMOKERS
Macleod J, Robertson R, Copeland L, McKenzie J, Elton R, Reid P. Cannabis, tobacco smoking, and lung
function: a cross-sectional observational study in a general practice population. Br J Gen Pract.
2015;65(631):e89-95.
Moore BA, Augustson EM, Moser RP, Budney AJ. Respiratory effects of marijuana and tobacco use in a
U.S. sample. J Gen Intern Med. 2005;20(1):33-7.
CARDIOVASCULAR EFFECTS OF MARIJUANA
Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by
marijuana. Circulation.2001;103(23):2805-9.
PSYCHOACTIVE EFFECTS FROM MARIJUANA USE
Gage SH, Hickman M, Zammit S. Association between cannabis and psychosis: epidemiologic evidence.
Biol Psychiatry. 2016;79(7):549-56.
POST-TRAUMATIC STRESS DISORDER (PTSD) AND MARIJUANA
Wilkinson ST, Stefanovics E, Rosenheck RA. Marijuana use is associated with worse outcomes in
symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry.
2015;76(9):1174-80.
BRAIN DEVELOPMENT AND MARIJUANA USE IN ADOLESCENTS
D'Souza DC, Ranganathan M. Medical marijuana: Is the cart before the horse? JAMA.
2015;313(24):2431-2.
8
OBJECTIVE OVERVIEW OF POTENTIAL BENEFITS OF MEDICAL CANNABIS
Medical marijuana laws across the United States vary from state to state as to which disease states can
legally be treated and the dispensable legal limit. Indications often include epilepsy, pain syndromes, nausea
and vomiting from chemotherapy, spasticity from multiple sclerosis, hepatitis C, Parkinson’s disease,
Tourette’s syndrome, psoriasis, sickle cell disease and posttraumatic stress.
For most conditions, approval for use has relied on limited scientific evidence, anecdotal reports,
individual testimonials, legislative initiatives, and public opinion. Therefore, the evidence often fails to meet
FDA standards. Additionally, the composition of cannabis preparations can vary substantially in its content of
cannabidiol (CBD) and tetrahydrocannabinol (THC) so dosing is difficult. Given the variable composition,
patients have to experiment with different strains and doses to achieve the desired effects, without much input
or oversight by trained prescribers. Because the federal Drug Enforcement Administration has classified
marijuana as a schedule 1 drug, it is exceptionally difficult to do high-quality studies on its medicinal effects
in the United States.
MEDICAL MARIJUANA FOR DIFFERENT DISEASE STATES
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and metaanalysis. JAMA. 2015;313(24):2456-73.
EPILEPSY AND MARIJUANA
Friedman D, Devinsky O. Cannabinoids in the treatment of epilepsy. NEJM. 2015;373(11):1048-58.
Gloss D, Vickrey B. Cannabinoids for epilepsy. Cochrane Database Syst Rev. 2014;3:CD009270.
Koppel BS, Brust JC, Fife T, et al. Systematic review: efficacy and safety of medical marijuana in
selected neurologic disorders: report of the Guideline Development Subcommittee of the American
Academy of Neurology. Neurology. 2014;82(17):1556-63.
PAIN AND MARIJUANA
Abrams, D. Integrating Cannabis into Clinical Cancer Care. JPain.2015;16:1221-32
Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH. Efficacy of Inhaled Cannabis on Painful
Diabetic Neuropathy. J Pain. 2015 Jul;16(7):616-27.doi:10.1016/j.pain.2015.03.008.Epub 2015 Apr 3.
Wilsey B, Marcotte TD, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low Dose Vaporized Cannabis
Significantly Improves Neuropathic Pain. J Pain. 2013;14:136-48.doi:
10.1016/j.pain.2016/j.pain.2012.10.009.Epub 2012 Dec 11.
Ware M, Wang T, Shapiro S, et al. Smoked Cannabis for Chronic Neuropathic Pain: A Randomized
Controlled Trial. CMAJ 2010;182:E694-701
Lynch ME, Campbell F. Cannabinoids for Treatment of Chronic Non-cancer Pain: A Systematic Review
of Randomized Trials. Br J Clin Pharmacol 2011;72(5):735-44
Rhyne DN, Anderson SL, Gedde M, Borgelt LM. Effects of Medical Marijuana on Migraine Headache
Frequency in an Adult Population. Pharmacotherapy. 2016;36(5):505-10
USE OF OPIOIDS AND MARIJUANA
Batchhuber M, Saloner B, Cunningham CO, Barry CL. Medical Cannabis Laws and Opioid Analgesic
Overdose Mortality in the United States, 1999-2010. JAMAInternMed. 2014;174(10):16681673.doi:10.1001/jamainternmed.2014.4005
Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use is Associated with Decreased Opioid
medication Use in a Retrospective Cross-sectional Survey of Patients with Chronic Pain. J Pain.2016
Jun;17(6):749-44.doi:10.1016/j.pain.2016.03.002.Epub2016 Mar 19.
9
FEDERAL AND STATE LEGISLATION
[NOTE: Because the status of marijuana in the US is dynamic review, the Task Force suggests inquiries
related to federal and state regulations are directed to their respective state Departments of Health, Pharmacy
Commissions, etc. with regard to legislative issues. In addition, College and University policy with regard to
use of cannabis on campus should be reviewed.]
The Marihuana Tax Act of 1937 did not outright ban the use and possession of cannabis, rather it provides for
a tax on all buyers, seller, prescribers, and possessors. Interestingly, marihuana is frequently categorized as a
“narcotic” during this era and the Federal Bureau of Narcotics enforces many sections of the Marihuana Tax
Act of 1937.
http://www.druglibrary.org/schaffer/hemp/taxact/mjtaxact.htm
ProCon, a nonprofit public charity found online at http://www.procon.org/ or
http://medicalmarijuana.procon.org/view.resource.php?resourceID=002481ProCon provides unbiased
resources for critical thinking and education about a number of issues including extensive information on
medical marijuana and related up-to-date information on state-by-state legislative issues.
National Institute on Drug Abuse
http://www.drugabuse.gov/publications/research-reports/marijuana/letter-director
Research Report is intended as a useful summary of what the most up-to-date science has to say about
marijuana and its effects on those who use it
White House Office of National Drug Control Policy
https://www.whitehouse.gov/ondcp/marijuanainfo
https://www.whitehouse.gov/ondcp/state-laws-related-to-marijuana
Web-based resource center provides the general public, community leaders, and other interested people with
the facts, knowledge, and tools to better understand and address marijuana in their communities.
New Frontier
https://frontierfinancials.com/
The website states the following: “New Frontier is the premiere data collection and industry-reporting firm in
the cannabis industry and provides data, analytics, and customized actionable intelligence to investors,
operators, and legislators in this new blooming sector. New Frontier collects millions of data points gathered
across the nation from the government, trading associations, strategic partners and operators to correlate them
with other big data relevant to energy, real estate, demographics, and crime rates focused answers allowing
them to grow their investments, find new opportunities, and make educated decisions. New Frontier’s data
collection, aggregation and reporting efforts are ultimately intended to improve industry standards, increase
transparency, and create one centralized and reliable data repository for this still nascent market space.”
Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana
Memorandum for selected United States attorneys. David W. Ogden, Deputy Attorney General, October 19,
2009
https://www.justice.gov/opa/blog/memorandum-selected-united-state-attorneys-investigations-andprosecutions-states
Guidance Regarding Marijuana Enforcement Memorandum for All United States Attorneys
James M. Cole, Deputy Attorney General, August 29, 2013
http://www.oregon.gov/olcc/docs/commission_minutes/2015/Cole_Memorandum.pdf
10
DRIVING “UNDER THE INFLUENCE”
Each state has a definition of substances that result in driving under the influence offenses. A summary of
scientific review of marijuana and effects on driving (1988 – 2002) can be found on NORML website:
http://norml.org/library/item/marijuana-and-driving-a-review-of-the-scientific-evidence. Links can also be
found for information about individual states’ drugged driving laws. Example: In Washington, under RCW
46.61.502, 5 nanograms of active THC per mL of blood (5ng/mL) or higher is considered driving under the
influence. By driving on WA state roads, individuals give consent for an arresting officer to test blood and
breath if there is reason to believe he/she is under the influence. In 2012, Washington state voters passed a
law making it legal for adults 21 years and over to possess and use small amounts of marijuana. Similarly, to
alcohol, it is unlawful to consume marijuana or infused marijuana products in public and drive under the
influence.
IS CANNABIS ADDICTIVE? HOW DO YOU KNOW IF SOMEONE IS DEPENDENT?
Is marijuana addictive? Like many other mood-altering substances, marijuana affects the reward center in
the brain, which is why it has the capability to be addictive. Addiction potential is most likely in people who
start using marijuana in their teens and those who use daily.
What does it mean to be “dependent” on marijuana? “Dependency” related to any type of substance or
activity can be both physiological and psychological. To be dependent means you need to use that substance
or do that activity to feel “normal.”
How do you know if someone is dependent? A person is considered dependent if he or she experiences
three or more of the following each year:
• tolerance, meaning more marijuana is needed to get the same effect
• withdrawal effects upon stopping marijuana use
• using more than intended
• numerous failed attempts to quit or cut back
• spending a lot of time obtaining, using, or recovering from the use of marijuana
• giving up other activities in order to use marijuana
• using marijuana despite knowing it causes problems
What are the withdrawal symptoms associated with marijuana? Common withdrawal symptoms include:
loss of appetite, weight loss, grouchiness, anxiety, restlessness and difficulty sleeping. Less common effects
are chills, sweats, depressed mood, anger, stomach pain, and shakiness.
“How long after using marijuana do I need to wait before I can drive?” The blood concentration after
using marijuana varies depending on the amount, potency, route, frequency of use, concurrent drug and/or
alcohol use, etc. It is not uncommon to have a blood concentration over 100ng/mL after smoking. It will
generally take 3 hours to decrease to less than 5ng/mL Concentrations after oral administration take longer to
reach peak concentrations. “Impairment” is an entirely individual and controversial determination. Marijuana
is shown to impair performance in driver simulator tests for up to three hours, however, many “experts” (i.e.
those who have been defending DUI MJ users), have recommended waiting up to 10 hours after use before
driving or until the user has a “clear head”. The individual who is “under the influence” may not be able to
accurately assess their personal level of impairment.
How long will marijuana test positive on a urinalysis? A urinalysis (UA) tests for the major breakdown
product of marijuana, THC-COOH. Generally, it takes about four hours for THC-COOH to show up in the
urine. It can be detectable for an average 2-4 days, depending on amount, route, and frequency of use. In
chronic users, it may be detectable in the urine for up to 30 days because marijuana is stored in fatty body
tissue and released slowly back into the blood.
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TREATMENT AND RECOVERY SUPPORT RESOURCES FOR SUBSTANCE USE
DISORDERS INCLUDING MARIJUANA
Substance Abuse and Mental Health Services Administration (SAMHSA)
http://www.samhsa.gov/
Find treatment facilities and programs in the United States or U.S. Territories for mental and substance use
disorders. Also provides information on a wide variety of topics related to substance use and mental health.
Addictions and Recovery.org
http://www.addictionsandrecovery.org/marijuana.htm
Public service website meant to help you or a loved one overcome addiction. It is based on independent and
verified medical research
Marijuana Anonymous
https://www.marijuana-anonymous.org
Fellowship program that uses the basic 12 Steps of Recovery founded by Alcoholics Anonymous
National Institute on Drug Abuse
http://www.drugabuse.gov/publications/research-reports/marijuana/letter-director
Research Report is intended as a useful summary of what the most up-to-date science has to say about
marijuana and its effects on those who use it
National Suicide Prevention Lifeline
http://www.suicidepreventionlifeline.org/
Provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a
day, 7 days a week
Recovery.org
http://www.recovery.org/topics/find-a-reputable-marijuana-addiction-recovery-hotline/
Privately funded resource to connect people and their families with the information and resources to help
them recover from substance abuse and behavioral disorders
Smart Recovery
http://www.smartrecovery.org/addiction/marijuana.htm
Self-empowering addiction recovery support group
RESOURCES
HEALTH CARE PROVIDER RESOURCES
The American Alliance for Medical Cannabis (AAMC)
http://www.letfreedomgrow.com/
Bring patients, caregivers and volunteers the facts they need to make informed decisions about whether
Cannabis is the right medicine for them, the laws surrounding Medicinal Marijuana in your area, political
activism and even handy recipes and guides to growing your own nontoxic medicine.
The National Association of Cannabis Pharmacy (NACP)
For information contact: [email protected] purpose of the association, established in 2014, is to
support pharmacists who dispense, administer and compound cannabis-based products to treat specialty
diseases including multiple sclerosis, HIV, oncology and rheumatoid arthritis. NACP focuses on the patient
and how they are receiving guidance and education to manage conditions in which medical marijuana is
incorporated as part of the treatment plan.
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HEALTH CARE PROVIDER RESOURCES (CONTINUED)
American Pharmacists Association (APhA)
Medicinal Use of Marijuana (1980)
https://www.pharmacist.com/policy/medicinal-use-marijuana-32
 APhA supports research by properly qualified investigators operating under the investigational new
drug (IND) process to explore fully the potential medicinal uses of marijuana and its constituents or
derivatives.
 APhA opposes state by state, marijuana specific, or other drug specific legislation intended to
circumvent the federal laws and regulations pertaining to:
 marketing approval of new drugs based on demonstrated safety and efficacy; or
 control restrictions relating to those substances having recognized hazard of abuse.
How pharmacists can counsel patients on medical marijuana (2014)
https://www.pharmacist.com/how-pharmacists-can-counsel-patients-medical-marijuana
Role of the Pharmacist in the Care of Patients Using Cannabis (2014-2015 APhA Policy Committee)
https://www.pharmacist.com/policy/role-pharmacist-care-patients-using-cannabis
American Cannabis Nurses Association
http://www.americancannabisnursesassociation.org/
Mission is to advance excellence in cannabis nursing practice through advocacy, collaboration, education,
research and policy development
IACM (International Association for Cannabinoid Medicine)
http://cannabis-med.org/
Publishes news bulletins that capture updates in the international cannabis movement and new cannabis
studies. Large database of clinical studies and case reports (last update October 2011). Also provides
international legal resources. Has a FAQ section, but includes a disclaimer that the answers may not always
be the most up-to-date.
Marijuana Science Forum
http://marijuanascienceforum.org/
Group of concerned academics, public health experts, research scientists and medical professionals committed
to ensuring that factually accurate scientific information is disseminated in the ongoing public policy
discussion about marijuana usage.
Medical Cannabis Caregivers Institute
http://www.mccdirectory.org/
Non-profit Association founded in 2006 with the support of California branch of the National Organization
for the Reform of Marijuana Law (CANORML.org) for the purpose of providing Information, Classes and
Resources that support the compliant implementation of California Medical Marijuana Program
National Institute on Drug Abuse
http://www.drugabuse.gov/publications/research-reports/marijuana/letter-director
Research Report is intended as a useful summary of what the most up-to-date science has to say about
marijuana and its effects on those who use it
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HEALTH CARE PROVIDER RESOURCES (CONTINUED)
Office of National Drug Control Policy
https://www.whitehouse.gov/ondcp/marijuanainfo
Web-based resource center provides the general public, community leaders, and other interested people with
the facts, knowledge, and tools to better understand and address marijuana in their communities
https://www.whitehouse.gov/ondcp/state-laws-related-to-marijuana State laws/bills related to marijuana
Patients Out of Time
http://www.medicalcannabis.com/
Provides information to health care professionals, patients, and caregivers about cannabis. Clinical
conferences, information about the therapeutic basis of cannabis, and indications for use are also provided.
The Pot Book: A Complete Guide to Cannabis by Julie Holland, MD
Comprehensive book that covers role of cannabis in medicine, politics, history, and society. Includes
comprehensive information on scientific research involving marijuana. It discusses myths about marijuana, its
physiological and psychological effects, and its potential uses and risks.
RESOURCES FOR PATIENTS AND THE GENERAL PUBLIC
The American Alliance for Medical Cannabis (AAMC)
http://www.letfreedomgrow.com/
Bring patients, caregivers and volunteers the facts they need to make informed decisions about whether
Cannabis is the right medicine for them, the laws surrounding Medicinal Marijuana in your area, political
activism and even handy recipes and guides to growing your own nontoxic medicine.
Americans for Safe Access
http://safeaccessnow.org/
ASA provides training and resources for activists. Including legal resources, resources by state, information
on talking to the media, testifying, lobbying, movement building, etc. Condition-based booklets and legal
information by state manuals can also be purchased from this site.
Cannabis Plus
http://cannabisplus.net/
Dr. Deborah Malka’s website with a large research article database and information for patients on specific
conditions. The site also includes articles personally written by Dr. Malka on medical marijuana and related
topics.
High Times
http://www.hightimes.com/
Newspaper with sections including news, legalization efforts, cultivation, entertainment, videos, and events
related to marijuana.
IACM (International Association for Cannabinoid Medicine)
http://cannabis-med.org/
Publishes news bulletins that capture updates in the international cannabis movement and new cannabis
studies. Large database of clinical studies and case reports (last update October 2011). Also provides
international legal resources. Has a FAQ section, but includes a disclaimer that the answers may not always
be the most up-to-date.
Leafly
http://www.leafly.com/
Describes many marijuana strains and their anticipated effects. Also has information about dispensary
locations, varieties offered at that location, and daily specials.
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RESOURCES FOR PATIENTS AND THE GENERAL PUBLIC (CONTINUED)
Marijuana Policy Project
http://www.mpp.org/
The mission of this group is to increase support for non-punitive, non-coercive marijuana policies, identify
and activate supporters of those policies, change state laws to reduce or eliminate penalties for medical and
non-medical use of marijuana, and gain influence in Congress. Information about significant issues and
policies as well as news is available.
NORML
http://norml.org/
Provides information about marijuana, including a primer; personal, medical, and industrial use; testing;
health endorsements; legal issues, and a “research library” of information. State NORML chapters provide
varying levels of education, primarily regarding legal issues. Their physician finder links to Weedmaps.
O'Shaughnessy’s
http://www.beyondthc.com/
Several different sections including a reader (ongoing history of marijuana), dispatches (original articles),
second column (information worth sharing), and a CBDiary (blog).
Cannabis Patient Network
www.medicalcannabis.comA blog dedicated to patients that are chronically and/or terminally ill. This website
provides patient testimonials on the efficacy of medical cannabis.
Patients Out of Time
http://www.medicalcannabis.com/
Provides information to health care professionals, patients, and caregivers about cannabis. Clinical
conferences, information about the therapeutic basis of cannabis, and indications for use are also provided.
Procon.org
http://www.procon.org/
This is a nonprofit public charity that provides resources for critical thinking and to educate without bias.
Marijuana is one of many issues discussed on this website.
Sensible Colorado
http://sensiblecolorado.org/
An organization which has fought for medical marijuana patient rights and worked to reform laws in
Colorado to make marijuana regulated like alcohol. Patient resource center is available for patients,
caregivers, and business members.
Toke of the Town
http://www.tokeofthetown.com/
As their tagline indicates, “cannabis news, views, rumor, and humor”. Sections include news, medical,
culture, dispensaries, products, growing, legislation, and global.
United Patients Group
http://www.unitedpatientsgroup.com/
Website states it is dedicated to being the most professional and safe resource for medical cannabis
information
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BOOKS (A small sampling of books on cannabis provided without specific endorsement by the Task Force.)
Werner C. Marijuana gateway to health: how cannabis protects us from cancer and Alzheimer’s disease. San
Francisco (CA): Dachstar Press; 2011. 232p.
Martin M, Rosenthal E, Carter GT. Medical marijuana 101. Oakland (CA): Quick American Archives; 2011.
128p. Introductory resource about medical marijuana for those with little experience treating illness.
Bello J. The benefits of marijuana: physical, psychological, and spiritual. Susquehanna (PA): LifeServices
Press; 2007. 194p.
Rosenthal E, Gieringer D, Mikuriya T. Medical marijuana handbook: a practical guide to the therapeutic uses
of marijuana. Oakland (CA): Quick American Archives; 2008. 266p.
According to the Amazon book review, “candid, objective advice on using marijuana for healing,
understanding its effects on the body, safe administration, targeting illnesses, side effects, and the various
delivery methods from edibles and tinctures to smokeless vaporizer pipes. The book also details supply
issues, cultivation solutions (in a chapter by renowned expert Ed Rosenthal), and legal consequences.”
Holland J, editor. The pot book: a complete guide to cannabis. South Paris (ME): Park Street Press; 2010.
579p.
Comprehensive book that covers role of cannabis in medicine, politics, history, and society. Includes
comprehensive information on scientific research involving marijuana. It discusses myths about marijuana, its
physiological and psychological effects, and its potential uses and risks.
Richmond L, director. What if cannabis cured cancer. [DVD]. Santa Monica (CA): Len Richmond Films;
2011. DVD, sound, color, 4 3/4 in.
Marijuana Gateway to Health: How Cannabis Protects Us from Cancer and Alzheimer's Disease by Clint
Werner
SOCIAL MEDIA SITES
Patients and the general public often look to social media sites such as Facebook, Twitter, YouTube and
Pinterest for information on a variety of topics, including marijuana. The Task Force urges caution as
information provided on these sites is anecdotal and may be misinformed and/or misleading.
EDUCATIONAL OPPORTUNITIES
Medical Cannabis Institute
http://themedicalcannabisinstitute.org/
Online medical cannabis courses for healthcare professionals seeking continuing medical education
Cannabis Training Institute
http://www.cannabistraininginstitute.com/
Online training & certification resource for cannabis businesses, entrepreneurs, clinicians, & policymakers
Clinical Cannabinoid Curriculum (The Medical Cannabis Institute in collaboration from the Society of
Cannabis Clinicians.)
https://themedicalcannabisinstitute.org/users/sign_in and http://cannabisclinicians.org/medical-cannabiscontinuing-education-cme-course/
On-line course focused on pharmacy professional audience.
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