Part A — required for all patients
a. Federal classification. The federal government has classified marijuana as a Schedule I controlled substance — defined as having a high potential for abuse, no currently accepted medical use in U.S. treatment, and a lack of accepted safety for medical use. Federal law prohibits manufacture, distribution, and possession of marijuana even in states such as Florida that have modified state laws to treat marijuana as a medicine.
When in possession of medical marijuana, the patient or caregiver must have his or her medical marijuana use registry identification card in his or her possession at all times.
b. FDA status. Marijuana has not been approved by the Food and Drug Administration for marketing as a drug. The "manufacture" of marijuana for medical use is not subject to federal standards, quality control, or oversight. Marijuana may contain unknown quantities of active ingredients varying in potency, impurities, contaminants, and substances in addition to THC.
c. Addiction potential. Some studies suggest marijuana use may lead to tolerance, dependence, or addiction. If I require increasingly higher doses to achieve the same benefit, or if I think I may be developing a dependency, I will contact the physician.
d. Coordination, motor skills & cognition. Marijuana use can affect coordination, motor skills, and cognition. Driving under the influence of cannabis can double the risk of vehicular accident, and increases further with alcohol. While using medical marijuana I should not drive, operate heavy machinery, or engage in activities that require alertness or quick response. Driving under the influence of marijuana can result in a DUI arrest.
e. Side effects. Potential side effects include dizziness, anxiety, confusion, sedation, low blood pressure, short-term memory impairment, euphoria, difficulty completing complex tasks, immune suppression, effects on sex hormones, inability to concentrate, impaired motor skills, paranoia, psychotic symptoms, apathy, depression, restlessness, and exacerbation of schizophrenia in predisposed persons. Use under age 25 may result in long-term problems with attention, memory, learning, drug abuse, and schizophrenia. Long-term cannabis smoking is associated with worsening respiratory symptoms, chronic bronchitis, airway inflammation, and concerns about cancer and lung disease similar to tobacco.
I understand that using marijuana while consuming alcohol is not recommended, and additional side effects may occur with combined use.
I agree to contact the physician if I experience any side effects listed above, become depressed or psychotic, have suicidal thoughts or crying spells, experience respiratory problems, changes in sleep, extreme fatigue, increased irritability, or begin to withdraw from family or friends.
f. Withdrawal. Signs of withdrawal can include depression, sadness, irritability, insomnia, restlessness, agitation, loss of appetite, trouble concentrating, sleep disturbances, and unusual tiredness.
Overdose. Symptoms of marijuana overdose can include nausea, vomiting, hacking cough, heart rhythm disturbances, numbness in the hands/feet/arms/legs, anxiety attacks, and incapacitation. If I experience these symptoms I agree to contact the physician immediately or go to the nearest emergency room.
Drug interactions. Numerous drugs are known to interact with marijuana and not all drug interactions are known. Some mixtures can lead to serious and even fatal consequences. I agree to follow the physician's directions regarding prescription and non-prescription medication and will inform my other treating physicians of my use of medical marijuana.
Marijuana may increase the risk of bleeding, low blood pressure, elevated blood sugar, liver enzyme changes, and effects on other body systems when taken with herbs and supplements. I agree to contact the physician immediately or go to the nearest emergency room if these symptoms occur.
Pregnancy / breastfeeding. Medical marijuana may have serious risks and may cause low birthweight or other abnormalities in babies. I will advise the physician if I become pregnant, try to get pregnant, or will be breastfeeding.
g. Efficacy research. The physician has provided (or will provide) a summary of the current state of research on the efficacy of marijuana to treat my qualifying medical condition, including any limits or uncertainty of that evidence.
h. De-identified data & research. I understand my de-identified health information in the physician certification and medical marijuana use registry — including qualifying condition, daily dose, and forms of marijuana certified — may be submitted by the Department of Health to the Consortium for Medical Marijuana Clinical Outcomes Research.
