Medical Cannabis Program. Dr. Maureen Small Co Medical Director Andrea Sundberg Program Coordinator

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1 Medical Cannabis Program Dr. Maureen Small Co Medical Director Andrea Sundberg Program Coordinator

2 Disclaimer The following information is based upon research of current studies. The Department of Health is providing the research for information purposes only. The following are not recommendations by the department of health, rather information as to how cannabis MAY affect a person.

3 Presentation layout Introductions Andrea Purpose of the program/brief history Dr. Small- Medical Cannabis Science Andrea-NM Program and enrollment Questions and Answers Closing

4 Purpose of the Program The Lynn and Erin Compassionate Use Act (CUA): The purpose of the act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments

5 History of Cannabis Cannabis plant and its uses date to as early as 4000 BC Long recorded history in medical writing Rendered illegal in 1937 Dropped from the US Pharmacopeia in U. S. Controlled Substances Act Classifies Marijuana as a Drug with "No Accepted Medical Use Nov. 24, Federal Court Rules Robert Randall's Use of Marijuana a "Medical Necessity 1978-New Mexico Passes First State Law Recognizing Medical Value of Marijuana Mar. 13, New Mexico Becomes 12th State to Legalize Medical Marijuana

6 Endocannabinoids Natural substances produced by the body Bind to receptors throughout the body Exogenous cannabis plant has > 60 cannabinoids CB1 Receptors CB2 Receptors

7 Brain (CB1) GI Tract (CB2 and CB1) Adipocyctes (CB1) Endocannabinoid System Peripheral Nerves (CB1) Liver (CB1 and CB2) Skeletal Muscle Immune System (CB2)

8 Endocannabinoids Anandamide and 2AG 1. Synaptic moderators move both ways at synapse unlike Dopamine 2. May be involved in Runners High

9 Risks and Benefits Researched Risks of Cannabis Use: Risks of smoking product Cardiovascular issues General effects to the body Neuropsychiatric Researched Benefits of Cannabis Use: Appetite stimulation Antiemetic Antispasmodics Analgesic

10 CBD vs. THC CBD and THC are two of the main chemicals in cannabis effecting symptoms. CBD (Cannabidiol) Sedative and analgesic, pain-reducer, antiemetic, anti-anxiety *CBD lessens the side effect of THC THC (delta-9-tetra hydrocannabinol) Euphoric, stimulant, muscle-relaxing, analgesic, anti-emetic, appetite stimulating, antidepressant qualities. The chemical that makes you high A high CBD is 5-15% A High THC is 15-25%

11 Ingestion options Please see handout for more detailed information regarding ingestion options Smoke Vaporize Edible Tincture Topical Tea/soda Hash/wax

12 NM Medical Cannabis Program Types of cards Patient Card Primary Caregiver Card Producer ID Card Licensed Non-Profit Producer Card

13 Qualifying Conditions Cancer Glaucoma HIV/AIDS Multiple Sclerosis Epilepsy Spinal Cord Damage with Intractable Spasticity Painful peripheral neuropathy * Intractable nausea/vomiting Severe anorexia/cachexia Huntington's Parkinson s Hepatitis C infection currently receiving antiviral treatment Chrohn s disease Post-traumatic Stress Disorder * Amyotrophic Lateral Sclerosis Inflammatory autoimmune mediated arthritis Spasmodic Torticollis (Cervical dystonia) Severe Chronic pain * Any patient in hospice care

14 Patient Application Requirements Consent to Release Medical Information Valid NM Drivers license or ID confirming New Mexico residency Medical Provider Certification Diagnosis of the Medical Condition Provider Information Certification Condition is debilitating Standard treatments have failed to bring adequate relief Potential risks & benefits have been discussed with patient.

15 Protection to Medical Providers A practitioner shall not be subject to arrest or prosecution, penalized in any manner or denied any right or privilege for recommending the medical use of cannabis or providing written certification for the medical use of cannabis pursuant to the Lynn and Erin Compassionate Use Act. The Department must keep the names of practitioners who sign the certification confidential.

16 Application Requirements Some qualifying conditions have additional requirements Severe Chronic Pain Requires a second certification from a medical specialist with expert knowledge of either pain management or of the condition that is causing the Severe Chronic Pain PTSD Must have annual medical records or documentation from a Psychiatrist or Psychiatric Nurse Practitioner confirming the diagnosis and that diagnosis meets the requirements under DSM for PTSD. Painful Peripheral Neuropathy Medical records must be sent to document of objective evidence of neuropathy Inflammatory autoimmune mediated arthritis Rheumatologist certification required

17 Additional Application Requirements Depending on the case, applicants are sometimes asked to submit additional medical records. Records may be requested in order to verify prior treatments, confirm debilitating condition, etc.

18 Review Process Within 30 days: Program staff will verify that all required documents are present. If documents are missing, staff will either send a letter or contact the applicant. Medical Director reviews/approves application Verifies provider s authority to certify If needed, calls certifying provider for verification of the patient s medical condition, history, time in care, etc. Confirms that the certifying medical provider believes that the benefits of medical cannabis usage outweigh the risks for the applicant. If denied, a formal notice is mailed to the patient. If approved, the patient will receive; Patients registry I.D. Card Contact information for licensed non-profit producers. Basic Do s and Do Not's of the Program

19 Yearly Renewal Pursuant to statute Patient enrollments expire 1 year from the date of enrollment printed on their registry ID card Patient personal production licenses expire at the same time the patient s annual enrollment expires, whichever is sooner.

20 What Enrollment Provides Under Compassionate Use Act Patients receive: Legal protection to possess an adequate supply which is defined in regulation as a supply of up to 6 ounces over a three month period. The right to purchase from Licensed Non-Profit Producers. The right to be is possession of any paraphernalia used in connection with their use of medical cannabis. A patient or primary caregiver shall be granted full legal protection if they are in possession of their medical cannabis card. If they are not in possession of their card they shall be given time to produce the card before any arrest or criminal charges (Lynn and Erin Compassionate Use Act Section 4 (D))

21 Patient Limitation The statute states: Participation in a medical use of cannabis program by a qualified patient or primary caregiver does not relieve the qualified patient or primary caregiver from: (1) criminal prosecution or civil penalties for activities not authorized in the Lynn and Erin Compassionate Use Act; (2) liability for damages or criminal prosecution arising out of the operation of a vehicle while under the influence of cannabis; or (3) criminal prosecution or civil penalty for possession or use of cannabis: (a) in a school bus or public vehicle; (b) on school grounds or property; (c) in the workplace of the qualified patient's or primary caregiver's employment; or (d) at a public park, recreation center, youth center or other public place.

22 No Legal Protection In a school bus or public vehicle; On school grounds or property; In the workplace of the qualified patient's or primary caregiver's employment At a public park, recreation center, youth center or other public place; To a person not approved by the department pursuant to this rule; Outside New Mexico or attempts to obtain or transport cannabis from outside New Mexico; or That exceeds the allotted amount of useable medical cannabis.

23 What Enrollment Does Not Provide Protection regarding patient sales Employment and Housing Protection Patients must follow all other laws (DUI, Use in front of children, etc.)

24 Will the federal government come after me? U.S. Dept of Justice Memorandum Oct. 19, 2009 Subject: Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana As a general matter, pursuit of there priorities should not focus federal resources in your States on individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana. For example, prosecution of individual with cancer or other serious illnesses who use marijuana as part of a recommended treatment regimen consistent with applicable state law, or those caregivers in clear and unambiguous compliance with existing state law who provide such individuals with marijuana, is unlikely to be an efficient use of limited federal resources.

25 Supply Options Purchase through a Licensed Non-Profit Producer Upon acceptance into the Program, patients are provided with contact information for licensed nonprofit producers. Non-profit producers are businesses that have been granted a production license from the Department of Health. Purchase of product is an individual transaction between the qualified patient and producer Producers information is confidential.

26 Supply Options Personal Production License Patients enrolled in the medical cannabis program may apply for a personal production license Grants permission to grow 4 mature ( i.e. flowering) cannabis plants and 12 seedlings (i.e. non-flowering) at any given time Non-refundable $30 fee waived with proof of income < 200% of Federal Poverty Guidelines

27 What the program can provide Information on locations and people if conducting an investigation Confirmation of status in the program 24 Hour Law Enforcement Number

28 Questions and Answers

29 For More Information Website: nmhealth.org divisions-mcp Phone: (505) Hour Law Enforcement Number