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Mass Dept of Public Health- Medical Use of Marijuana

Instructions for Patient Registration after MD certification

Terms to know:

1. Cannabinoids are derived from cannabis (marijuana)
2. Medical marijuana is usually supplied as the dry flower of the Cannabis sativa plant
3. The primary active ingredient of cannabis is delta-9-tetrahydrocannabinoid (THC), though the plant contains more than 100 unique compounds known as (phyto)cannabinoids
4. There are available pharmaceutic cannabinoids commonly prescribed in oral and sublingual forms. 

Introduction:
Medications using the primary active ingredient of cannabis (THC) have been available and prescribed in the United States for many years. The most commonly known prescribed cannabinoids are dronabinol and nabiximol. These medications have been a widely accepted adjunctive therapy for symptom management in some patient populations such as cancer patients with severe nausea, cancer-related wasting syndrome, and patients with spinal cord injury.
Recent Advances
The last few years has seen a change in philosophies on the type of cannabinoids used in general medical treatment. Though cannabis use remains a Federal crime, the use is now legal in many states including Massachusetts. This shift in general thinking is partly attributable to patient advocacy and a culmination in scientific research.
Some notable research Findings
Some studies suggest that smoked cannabis may be more effective than other manufactured THC in the management of some diseases such as HIV neuropathy. Other studies have revealed that THC provides similar pain relief when compared to opiate medications in the management of chronic pain (without some of the inherent risks of chronic opiate therapy). Other studies specifically suggest that smoked cannabis may provide greater benefits when compared to commercially available cannabinoids. Overall, there is increasing evidence that cannabis use beyond commonly prescribed pharmaceutic cannabinoids may be beneficial in symptom management for various disease entities. Such as

• non-cancer related chronic pain 
• Neuropathic pain
• Multiple sclerosis
• Epilepsy
• Severe nausea associated with Cancer
• Alzheimer's disease
• Arthritis
• Glaucoma
• Crohns disease
• Parkinson's disease
• Other debilitating conditions as certified by the patients certifying physician (after a thorough medical evaluation)

Side Effects of marijuana use
Risks of cannabis use ranges from infection, exposure to unintended toxic agents, cancer(some evidence suggest smoked cannabis may be carcinogenic), respiratory irritation from smoking, habituation, cyclic vomiting, delayed reaction time, underachievement in children and young adult users are some of the cited effects of cannabis use. Further, chronic use with abrupt cessation may result in acute withdrawal symptoms such as anxiety, headache, increased sleep. 
Where does the Medical Profession stand on cannabis therapy?
The controversy surrounding the use of smoked, vaporized or ingested cannabis in the medical profession are centered mostly around the inability to accurately know the concentration, titrate or tell the dose that may be beneficial to a specific patient. Though there are notable side effects to cannabis use, there seems to be reasonable medical consensus that should patients experience symptoms that are not responding to conventional therapy and/or report personal use and benefit from cannabis, then it is reasonable to accept the patient's decision to try medical cannabis.
SSPUC Philosophy on medical use of marijuana
As a board certified Internist with years in practice both academically and in the community, it is clear to me from experience that many of our chronically ill patients who need our help for symptoms management, may stand to benefit from alternative forms of cannabis therapy beyond prescribed cannabinoids to optimize their care. The use of dronabinol as adjunctive therapy in the appropriate patient population has been commonplace in my practice and teaching for years. As your doctor, I am first obligated to the relief of your pain and suffering while mitigating risks of therapy. Because we can never fully mitigate the risks of therapy, one must always fully weigh the risks and benefits for each treatment and therapy decision for each individual patient.

In taking the time to care for the whole you at SSPUC, we are better able to determine how best to optimize your medical therapy and improve your quality of life
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If you are a current patient or are interested in evaluation for the medical use of marijuana, you may contact us by clicking here or calling us at 781-561-0460

Consult for Medical use of marijuana evaluation