Understanding the

Endo-Cannabinoid

System

And Usage of

Medicinal Cannabis in

Massachusetts

We are not making recommendations for

or against legal recreational use of

Cannabis

Any name brand cannabis products or

services are for example only, we are not

endorsing any specific products, brand

or businesses

This Presentation Focuses

on the use of Cannabis for

Medicinal Purposes Only

OB

JE

CT

IVE

S

1. History of cannabis

2. How the Endo Cannabinoid

System works

3. The healing properties and

side effects of cannabis

4. Process of obtaining

medical cannabis in MA

5. Legalized cannabis laws in

Massachusetts

“Stoner”

Stereotype

What’s in a name ?

"There are 100,000 total marijuana smokers in the US, and

most are Negroes, Hispanics, Filipinos, and entertainers.

Their satanic music, jazz, and swing, result from marijuana

use. This marijuana causes white women to seek sexual

relations with Negroes, entertainers, and any others.“

Harry Anslinger, head of Federal Bureau of Narcotics

Therapeutic

Ratio

Effective dose/

Lethal Dose

No cases of death

by cannabis ever

recorded

DrugDependence

Withdrawal

ToleranceIntoxication

Nicotine 6 4 3 2

Heroin 5 5 6 5

Cocaine 4 3 3 4

Alcohol 3 6 4 6

Caffeine 2 2 2 1

Cannabis 1 1 1 3

Illustration by Adam Simpson

Cannabinoid

Receptors

found on

the surface of

cells

Metabolic

enzymes

break down

endocannabinoids

after they are used

Endocannabinoids

small molecules

that activate

cannabinoid

receptors

Key Pieces of the Endo

Cannabinoid System

Cannabinoid Receptors

Cannabinoids and

Neural Function

There

are

over 85

Cannabinoids

Cannabis Strains

Sativa Indica Hybrid

Whole plant

works together

for a more

therapeutic

effect

Terpenes

Possible medication

interactions

Birth Control Pills may be less effective

Bleeding risk may increase with anti-

coagulants

May cause mania with some SSRIs

May cause over sedation with sedatives,

anti-psychotics, opiates and

benzodiazepines

Top 3

side effects

of cannabis

Other Possible Negative effects of

cannabis

Feelings of panic, anxiety and fear (paranoia)HallucinationsIncreased heart rateTrouble concentratingDecreased ability to perform tasks that require coordinationSlowed reaction timeDecreased interest in completing tasksDizzinessShallow breathing

Marinol & Cesamet”MARINOL is part of a

class of medications called

cannabinoids.

The active ingredient of

MARINOL Capsules is

man-made dronabinol also

chemically known as

tetrahydrocannabinol, or

THC”

http://www.marinol.com

Synthetic Medications-THC

only

Chapter 369 of acts of 2012

AN ACT FOR THE HUMANITARIAN

MEDICAL USE OF MARIJUANA.

The citizens of Massachusetts intend that there should be no punishment

under state law for qualifying patients, physicians and health care

professionals, personal caregivers for patients, or medical marijuana treatment

center agents for the medical use of marijuana, as defined herein.

105 CMR 725.00 May 24, 0213-DPH implements the Act

Scientific review of marijuana’s status as a federal Schedule I

controlled substance and relisting marijuana as a federal Schedule II

controlled substance for purposes of facilitating research.

Development of prescribing standards that includes indications for

use, specific dose, route, expected effect and possible side effects, as

well as indications for stopping a medication.

Establishing evidence-based standards for the use of marijuana and

related cannabinoids.

Protection from criminal or civil penalties for patients using

therapeutic marijuana and related cannabinoids as permitted under

state laws.

Exemption from criminal prosecution, civil liability, or professional

sanctioning, such as loss of licensure or credentialing, for health care

practitioners who discuss treatment alternatives concerning marijuana

or who prescribe, dispense or administer marijuana in accordance with

professional standards and state laws.

Confirmation of the therapeutic efficacy of medical marijuana

Prescription Drug Use Falls in

Medical Cannabis States

Researchers at the

University of Georgia

found that the use of

prescription drugs is

significantly less in

states with legal medical

marijuana.

The drop was especially

pronounced for patients

with chronic pain, a

condition often treated

with opioids.

Massachusetts Qualifying

Conditions of “Debilitating

Medical Condition”

Cancer or malignant tumors

Glaucoma

AIDS

Hepatitis C

ALS

Crohn's disease

Parkinson's disease

Multiple Sclerosis

“Other conditions as determined in writing by a qualifying patient's physicianSuch as (but not limited to):”

Chronic back painRheumatoid ArthritisInsomniaAnorexiaAnxietyDepression

Massachusetts Qualifying Conditions of

“Debilitating medical condition”

Weakness

Cachexia

Wasting Syndrome

Intractable Pain

Nausea,

Impairing Strength or

Ability

The symptom(s) need

to be progressing to

such an extent that

one or more of a

patient’s major life

activities is

substantially limited.

“Debilitating Medical Condition that has

caused one or more of the following

symptoms”:

So.. You want to try medical Cannabis…

Guidance for Physicians

Regarding the Medical use of Cannabis

Must hold an active full license

No prescribing restrictions

MA controlled Substances registration

At least 1 established practice in MA

Completing minimum 2.0 category 1 CME’s that must

explain the proper use of cannabis, including side

effects, dosage, and contraindications, including with

psychotropic drugs, as well as on substance abuse

recognition, diagnosis, and treatment related to

cannabis.

DPH will conduct random audits for compliance.

4. Make an appointment

5. Bring:a. Medical documentation such

as doctor’s office notes, a referral from the physician/clinician stating your condition(s), MRI or Radiography reports, Laboratory reports (for certain conditions),and in some cases prescription records from the pharmacy.

b. Proof of MA residency**c. Fee for the visit ($150-$225) Is

usually not covered by any insurance although there is usually a small discount for veterans-must provide proof of military experience such as a DD-214 or military/veterans ID.

6. If the MD finds you qualified, s/he will register you with the Department of Health-Medical Use of Marijuana Program at the end of the visit and give you a registration number

7. The medical marijuana law requires that there is a bona-fide relationship with the qualifying physician so they will schedule a follow up appointment per their office policy. (Cost usually $125-200)

MMJ

Registration In

Mass:

Be Prepared

Items needed for online

registration in mass1. Internet access and the PIN emailed after

the MD visit

2. Access to a scanner, mobile scanning

software, cell phone that can upload pictures

or pre-scanned digital copies of the

documents

3. A printer

4.Registration number as given by health care

provider after they have issued a certification;

5. A valid form of identification

6. Form of $50 payment or proof of financial

hardship

Should qualify for $50 waiver or reduction if meet

one of these conditions:

Masshealth recipient

SSI recipient

Household income does not exceed 300% of the

federal poverty level

Must provide at least 1 of the following:

MassHealth card

(SSI) benefit verification letter;

State or federal tax return from this year or last year

SNAP Electronic Benefit Transfer (EBT) statement

from the current year

#notlikethisguy

How to take the

perfect id photo

(according to

Massachusetts)

Only head

and

shoulders

No Eyewear

& eyes open

No Smiling

Must have plain or Off-White Background

No

headwear

Face

camera at

eye level

“Everyday”

Clothing

A utility bill that is less than 60 days old

Your current Massachusetts Driver’s license

Tuition bill with a due date of less than 6 months ago

Car insurance policy or bill within last 60 days

Home mortgage, lease or loan contracts dated within 6

months

Original or certified copy of a U.S. Marriage Certificate

dated within the past 6 months;

A property tax or excise tax bill for the current year

First-class mail dated less than 60 days old from any

federal or state agency

Current Massachusetts -issued Professional License

with your address.

Several emails will be sent with instructions

Some links will expire in 7 days and some links are valid only

the first time that you click on the link

1. Visit https://gateway.hhs.state.ma.us/authn/selfReg.do

2. Select “Medical Use of Marijuana Program” from dropdown

menu* and Follow the

3. Once the registration is reviewed by the Department, they

will be notified by email regarding the status of the

registration.

4. If approved, print a paper Program ID card which is good for

4 weeks until the plastic Program ID card comes in the mail.

On-Line Registration

More time consuming

(may take 3-4 weeks)

Ability to pay by check

or money order

Will still need all documentation

Call 617-660-5370

Mon-Fri 9am -4:30 pm

unable to go

to the Dispensary ?

May designate/register up to

2 caregivers

Cannot be currently designated

by another patient, unless that

caregiver is an immediate family

member.

Pt and caregivers MUST carry

registration card at all times when

have medical cannabis on person

Delivery services

https://www.allbud.com/

http://cannabusdelivery.net/

How Much Medical Cannabis in

MA?

what does that look like?

10 Ozs

Bring the paper ID until the plastic card arrives

Find a Massachusetts Dispensary here

There is a ¼ Ounce total flower limit per patient per

day

“A RMD shall not advertise the price of marijuana, except that

it shall provide a catalogue or a printed list of the prices and

strains of marijuana available at the RMD to registered

qualifying patients and personal caregivers upon request. “

105 CMR: Department of Public Health

Go Shopping…

Average prices at

MA Dispensaries

subject to change daily

¼ oz flower $100

Pre-rolled $15 each

Tincture $50-70

Edibles $5-30

Topicals $20-55

Onset 5-15 minutes

Duration 1-4 hours

Rolled

AKA ”joints”

Rolling Papers $3-

5

Rolling Machine

$7-15

Pipes

$5-200+

Water Pipes

AKA “Bongs”

$25-200+

use of precise heat to vaporize the active

ingredients

ConcentratesKief the tiny, sticky crystals that

cover the cannabis flower

contains terpenes and cannabinoids

Concentrates

Shatter

Wax

80 percent cannabinoid content

Highly hallucinogenic

Highly Flammable

Cannabis

Infused

Alcohol

Onset 5-15 mins

Duration 1-3 hours

Severe paranoia

Fear and anxiety

Lack of energy

and enthusiasm

Heavy limbs

Lack of mobility

Extreme dry

mouth

Burning eyes

Shortness of

breath

Tachycardia

Shaking

trembling

Chills / sweats

Disorientation

Upset stomach

Grow Your Own

Allowed up to a dozen plants

$100 annual cultivation fee

$8-25 per seed

May not cultivate cannabis plants in places where

plants are "visible from a public place without the

use of binoculars, aircraft or other optical aids."

1. Date/Time: 2. Amount: 3.

7. Therapeutic Effects: 8. Negative Side Effects:9. Response

So now what?

Massachusetts and Cannabis

1911• MA Becomes First State to Outlaw Cannabis

2008

• Possession of small amounts of cannabis decriminalized

2012

• Became the eighteenth state to legalize medical cannabis

2013• Eliminated criminal and civil penalties for the possessions

and use of up to a 60-day supply of marijuana for patients possessing a state issued registration card

2016• Recreational use legalized with parameters

Legal Grey Area

Cannabis remains illegal under federal law

It’s legal to purchase butRetail stores selling cannabis won’t open

before Summer of 2018

Selling will remain a crime punishable by up to two years of incarceration and up to a

$5,000 fine.

You can “gift” but may not sell

Internet shipping not allowed

Medical cannabis patients transferring products to other people

remains illegal

Questions?

Sourceshttp://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026https://www.leafly.com/news/cannabis-101/where-did-the-word-marijuana-come-from-anyway-01fbhttps://en.wikipedia.org/wiki/Cannabis_in_Massachusettshttps://www.bostonglobe.com/metro/2016/12/13/with-legal-marijuana-massachusetts-state-enters-hazy-legal-gray-zone/jLjYVpIvgevl28jidQQWtO/story.htmlhttp://www.rxlist.com/marijuana-page3/supplements.htmhttp://herb.co/2016/07/28/endocannabinoid-system-dummies/http://greenito.com/news/how-much-is-a-gram-ounce-of-weed/https://www.coloradopotguide.com/images/blog/Health-Effects-of-Marijuana-Reduced.pnghttp://www.narconon.org/drug-information/marijuana-faq.htmlhttp://www.lung.org/stop-smoking/smoking-facts/marijuana-and-lung-health.html?referrer=https://www.google.com/http://netacare.org/wp-content/uploads/2016/06/Patient-Handbook.pdfhttp://www.huffingtonpost.com/inverse/what-is-shatter-weed-and_b_8924396.htmlhttps://s-media-cache-ak0.pinimg.com/736x/13/35/46/13354616df24336310fd93d57a4bbfbb.jpg

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