Cannabis and HIV/AIDS:

Cannabis and HIV/AIDS: 1. The Medicinal Use of Cannabis Included in this series of fact sheets on Cannabis and HIV/AIDS: 1. The Medicinal Use of Cannabis 2. How to Apply to Use Medicinal Cannabis Legally 3. How to Speak to your Doctor about Medicinal Cannabis 4. Information Sheet for Physicians 5. Where to Find Cannabis for Medicinal Purposes 6. A Few Tips for Safer Use and Better Health 7. Cooking with Cannabis 8. Tips for Growing Cannabis Safely 9. How to Deal with the Stigma and Discrimination of Cannabis Use What is cannabis? Cannabis, or marijuana, is a plant that contains over 60 active ingredients called cannabinoids. The major active and commonly known cannabinoid is THC, which stands for delta-9- tetrahydrocannabinol. There are hundreds of varieties or strains of cannabis. Two main types of cannabis are of interest for people who seek its medicinal properties: cannabis sativa and cannabis indica. The different strains of cannabis contain different blends of cannabinoids. Many people report experiencing different medicinal effects from different strains. There is not much research into the medicinal effects of different strains. Most people rely on word of mouth and trial and error to choose a strain that works for them. Your best bet is to try one to see how it works for your symptoms. Contact Information: These fact sheets have been prepared by the Canadian AIDS Society, in consultation with a National Steering Committee and a Legal Consultant. They are easily photocopied. We encourage you to distribute them widely. For updates on these fact sheets, or for more information, please visit our web site at <www.cdnaids.ca/cannabis> or contact us at: Canadian AIDS Society 190 O Connor Street, Suite 800 Ottawa ON, Canada, K2P 2R3 Tel: 1-613-230-3580 Toll free: 1-800-499-1986 How is cannabis used medicinally? Currently, an estimated 14% to 37% of people living with HIV/AIDS use cannabis to help with some of their symptoms. You may be one of them. People living with HIV/AIDS report many reasons for using cannabis: to stimulate their appetite, to help with nausea and vomiting, to manage pain, to relax, to help with anxiety, to improve their mood, to help with depression, to help manage their weight, to help stick to their medication regimen, to help with sleep, and others. Cannabis is not for everyone. You need to determine whether or not it is right for you. Scientific research has been limited and slow to study the effects of cannabis on these symptoms. At this time, we know that cannabis is helpful with the stimulation of appetite, and relieves nausea and vomiting. Relief of nausea may help you stick to your medication regimen. Some types of pain that don t respond well to other medications are sometimes relieved with cannabis. Many people report using cannabis to cope with depression, anxiety, stress and other psychological effects; however, there is not much research in this area. Please refer to the fact sheet on A Few Tips for Safer Use and Better Health. 1 i

How can you use cannabis legally to manage your symptoms? Cannabis is a controlled substance in Canada which means that it is illegal to possess it, cultivate it, traffic it, possess it for the purpose of trafficking, import it, and export it. Health Canada has developed the Marihuana Medical Access Regulations to enable compassionate access to cannabis for medicinal purposes. You can obtain an Authorization to Possess cannabis legally for medicinal purposes. You can also obtain a License to Produce cannabis for yourself, or you can designate someone to grow cannabis for you and only you. Please refer to the fact sheet on How to Apply to Use Medicinal Cannabis Legally and Tips for Growing Cannabis. Are there any risks in using cannabis? Cannabis is a relatively safe plant. The toxicity of cannabis is so low that you would need to consume 682 kg (1500 pounds) of cannabis in 15 minutes to die of an overdose, and even that has never been proven. (Do not try this at home!) To put it in perspective, the lethal dose for salt is about 0.2 kg. There has never been a single death attributed to cannabis in the thousands of years it has been used by humans. This said, it is still possible to consume too much cannabis, in the sense that the experience can be unpleasant for some people. Too much cannabis It is possible to consume too much when smoking or eating cannabis, NOT in the sense that it may kill you, but consuming too much cannabis can be unpleasant. Caution must be taken especially when eating food that contains cannabis. Please refer to the fact sheet on Cooking with Cannabis for more information. A person who has consumed too much cannabis may become dizzy, agitated, nervous, or paranoid. When this happens, the person should be kept calm and reassured that this too shall pass. The most intense feelings will last about an hour and the effects of the cannabis should wear off in about 4 or 5 hours. While they are not in physical danger, they may feel chilly. If so, keep them warm. Most people fall asleep quickly after consuming too much cannabis. Things you should be aware of: HIV Meds: For those of you on protease inhibitors, you will be happy to know that studies completed to date have not found any harmful effects or interactions between protease inhibitors and the use of cannabis. Keep in mind that these studies were short-term. One study even showed an improvement of the immune function. If your meds make you nauseous, one study showed that cannabis can help you better stick to your medication schedule. It is a good idea to inform your doctor of your use of cannabis for medicinal purposes so that they have the full information about your therapy. Doctors and pharmacists may also be able to provide you with the latest information about possible negative interactions with your medication. Smoking: Most people smoke cannabis to get the desired effects. Of course, smoking cannabis has long-term effects on the lungs, similar to those of smoking tobacco: lung irritation, coughing and the production of phlegm. However, a link between smoking cannabis and chronic lung diseases or cancer has not been established. Cannabis smoke does not have the same 1 ii

effects as tobacco smoke and scientists are still trying to understand the different effects on the body. If you are concerned about the effects of smoking on your health, please refer to the fact sheet on A Few Tips for Safer Use and Better Health. Contamination of Cannabis: Some moulds, bacteria or other contaminants may grow on your cannabis, whether the plant is still growing, or has been harvested and stored. While some of these organisms are harmless, others may be very toxic and dangerous to your health. They can cause serious lung infections, cancers and other health issues. People get infected by breathing them in when smoking or by contact with the mouth. Even the burning of the cannabis when smoking does not kill the dangerous toxins. It is best not to take a chance. If your cannabis has darkened in colour, or if you see some white, grey, black, or even blue-green, sometimes fuzzy mould growing on your weed, throw it out, just like you would mouldy food! You may also notice a stale or musty smell, and the cannabis may feel warm to the touch. Note: Trichomes are little white glands that grow all over the cannabis plant and contain the cannabinoids. These glands are NOT dangerous. They give the plant a frosty look. If you are not sure whether you are looking at trichomes or mould, please consult the internet, books, or speak with someone who could help you. Dependence: While there is no physical dependence from cannabis use, some people do develop a psychological dependence to cannabis. Please consult the fact sheet on A Few Tips for Safer Use and Better Health for more information. Withdrawal Symptoms: There are no significant withdrawal effects when cannabis use is stopped or decreased. Some people may experience sleeplessness, irritability, and loss of appetite. These symptoms usually disappear after a few days. Is cannabis right for you? If you have a history of psychiatric illness, especially schizophrenia, or if mental illness runs in your family, cannabis may trigger some of these tendencies. If you have high blood pressure or heart disease, cannabis may increase your risks as it does tend to speed up the heart rate. If you are using medications of any kind, cannabis may interact with your medication. It is best to discuss your cannabis use with your health care practitioners or pharmacist, just to be sure. If you have a history of struggling with substance use, you may wish to seek counselling to help you integrate cannabis in your life in a healthy way. Please refer to the fact sheet on A Few Tips for Safer Use and Better Health. 1 iii

Useful Resources: Canadian AIDS Society: <www.cdnaids.ca/cannabis> for an electronic copy of these fact sheets and other relevant materials Health Canada Medical Use of Marihuana: <www.healthcanada.gc.ca/mma> Medical Marijuana Information Resource Centre: <www.medicalmarijuanainformation.com> VICS Medical Cannabis Guide: <www.thevics.com/publications/vics/vicsmedsguide2005.pdf> Canadians for Safe Access: <www.safeaccess.ca> Cannabis Health Magazine: <www.cannabishealth.com> Medical Cannabis Resource: <www.medicalmarihuana.ca> or <www.medicalcannabis.ca> Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada, nor those of Health Canada. The Canadian AIDS Society thanks Solvay Pharma for their contribution to this project. 1 iv

Included in this series of fact sheets on Cannabis and HIV/AIDS: Cannabis and HIV/AIDS: 2. How to Apply to Use Medicinal Cannabis Legally 1. The Medicinal Use of Cannabis 2. How to Apply to Use Medicinal Cannabis Legally 3. How to Speak to your Doctor about Medicinal Cannabis 4. Information Sheet for Physicians 5. Where to Find Cannabis for Medicinal Purposes 6. A Few Tips for Safer Use and Better Health 7. Cooking with Cannabis 8. Tips for Growing Cannabis Safely 9. How to Deal with the Stigma and Discrimination of Cannabis Use Who Can Apply? Through Health Canada, and according to the Marihuana Medical Access Regulations (MMAR), people with the following medical reasons can apply to obtain an Authorization to Possess under Category 1: MEDICAL CONDITIONS Cancer; AIDS, HIV Infection SYMPTOM Severe pain, cachexia (wasting), anorexia (appetite loss) weight loss, severe nausea Contact Information: These fact sheets have been prepared by the Canadian AIDS Society, in consultation with a National Steering Committee and a Legal Consultant. They are easily photocopied. We encourage you to distribute them widely. For updates on these fact sheets, or for more information, please visit our web site at <www.cdnaids.ca/cannabis> or contact us at: Canadian AIDS Society 190 O Connor Street, Suite 800 Ottawa ON, Canada, K2P 2R3 Tel: 1-613-230-3580 Toll free: 1-800-499-1986 Multiple Sclerosis; Spinal Cord Injury; or Spinal Cord Disease Severe Arthritis Epilepsy Compassionate End of Life Care People who suffer from symptoms of a medical condition other than those stated above fall under Category 2 Severe pain, persistent muscle spasms Severe pain Seizures and will need to get Form B2 filled out by their doctor, who will then need to consult with a specialist. 2 i

What Steps Do You Need to Take to Apply? 1. Get the forms. From Health Canada s web site at <www.healthcanada.gc.ca/mma>, go to How to Apply, where you will find all the forms and instructions you need. You can also phone 1-866-337-7705 to request that the forms be sent to you by mail. We suggest that you also print out or obtain the Applicant s Guide which clearly explains the process. It is available on the same web page. 2. Fill out Form A to apply for an Authorization to Possess, then get 2 passport photos made. 3. Make an appointment with your doctor. To prepare for your appointment with your doctor, please refer to the fact sheet on How to Talk to Your Doctor about Medicinal Cannabis. When you visit your doctor: Bring in Form B1 for your doctor to sign. You will also need to bring in 2 passport photos, which must be signed by your doctor. These photos will be valid for 5 years. Bring in the Canadian Medical Association s Release Form for Medical Practitioners, available at <www.cmpa.org>. (Note: This form is not applicable in Quebec). Simply search for Release Form for Medical Practitioners. This form may help reduce your doctor s concerns about liability issues and get your doctor s support for your application. 4. You will need to decide on how to obtain your cannabis. You have 3 legal options: You can order the government s cannabis. For this, you need to complete Form E1 to access the Health Canada supply of dried cannabis. You can produce your own cannabis. For this, you need to complete Form C for Personal Cultivation. If you want to order seeds from Health Canada, complete Form E2 to access the Health Canada supply of cannabis seeds. You can designate someone to grow for you, and only you. For this, your grower must complete Form D for Cultivation by a Designated Person. They must also supply 2 passport photos, which YOU have to sign, and have a Criminal Record Check done at their local police station. Note: You MUST select one of these options for your application to be processed and accepted. DO NOT identify a compassion club or cannabis club as your source, or any other source, other than the 3 legal options. If you do, your application will be returned to you and this will delay the process. 5. If you decide to grow your own cannabis or get a designated grower. If you will be growing cannabis where you live, you DO NOT NEED your landlord s permission. If you are growing in a place OTHER than where you live, or if your grower is growing in a place other than where he or she lives, permission MUST be obtained by the person who owns the property where the cannabis is grown. For this, Form F must be completed. 6. Once you have gathered all of the applicable forms and information, make copies for your own files and make note of when you send the forms in. Mail your application to: Marihuana Medical Access Division Drug Strategy and Controlled Substances Programme Address Locator # 3503B Ottawa ON K1A 1B9 Processing times will vary. Be patient, and follow up if you have not heard back after a month. Call the toll free number at 1 (866) 337-7705 to get information about the status of your application. This is a call centre that will most likely take your name and number and get back to you with the requested information. 2 ii

What does an Authorization to Possess allow me to do or not do? It allows you to possess, store and carry dried cannabis for a medical purpose. It does not allow you to grow cannabis UNLESS you have a Personal Use Production Licence ; others to use any of your cannabis; you to take your cannabis outside Canada or to otherwise export it from Canada; you to carry cannabis with you when entering or leaving Canada; you to bring cannabis into Canada or otherwise import it into Canada; nor you to sell or give any of your cannabis to others. It does not apply to any derivatives of cannabis such as hashish or hash oil. Regarding smoking in public and private places Authorized persons are required to abide by all by-laws restricting smoking in public places and policy restrictions regarding the use of controlled substances in institutions, or other private or public facilities. What does a License to Produce allow you or your grower to do or not do? It allows you to cultivate and store cannabis for your own medical purpose (Personal-Use Production Licence), or to cultivate and store cannabis for an authorized person (Designated-Person Production Licence); A designated grower can only grow for the authorized person whose name is indicated on their licence, at the location indicated on the licence; A designated grower can transport cannabis directly from the production site to the place of residence of the authorized person, and transfer, give or deliver cannabis directly to the person for whom they produce; and A Personal-Use Production Licence does not allow others to cultivate cannabis on your behalf. Please note, however, that some people are licensed as designated growers for an authorized person, in which case they would hold a Designated-Person Production Licence to produce cannabis for that person. These licenses do not allow others to have any of your cannabis (including seeds) in their possession; you to take cannabis (or seeds) outside Canada or to export it from Canada; you to bring cannabis (or seeds) into Canada or to import it into Canada; you to carry cannabis (or seeds) with you when you enter or leave Canada; nor you to sell or give any of your cannabis (or seeds) to others. Please note that a designated grower may receive some money from the person they are growing for to cover the costs of growing cannabis. These licenses do not apply to any derivatives of cannabis such as hashish and hash oil. 2 iii

What are some things I should be aware of? Building Codes When you set up a home garden, you will need lighting and ventilation (see the fact sheet on Tips for Growing Cannabis Safely for more information). There are safety considerations to keep in mind and you will need to comply with municipal building codes. The electrical supply will need to be adequate for your lighting and ventilation. Moisture barriers may be required to protect the building from structural damage. You can get municipal inspectors to verify your installation to ensure that you are meeting these requirements. These inspections can serve you well in the event that you need to make an insurance claim in the future. Be advised that bringing inspectors in may put you under the police s attention. House Insurance If you are growing cannabis in a place that you own, you should verify the wording on your home insurance policy. Your policy should have an exclusion clause with regard to the production of drugs. It should say something like this: This policy does not insure against loss or damages directly or indirectly caused, in whole or in part, by an illegal drug operation. The key word to look for is illegal. If you have a License to Produce, then you are growing legally and your insurance should cover you. If the clause does NOT contain the word illegal, you could face some problems if you need to submit an insurance claim for any reason. Check your policy. If you are in the process of getting insurance for a home, then the best advice is NOT to volunteer information about the fact that you are growing cannabis for medicinal purposes. The questions on the application form will not ask you about the production of cannabis. Answer only the questions on the application and volunteer only the information required on the application. Check the wording of the exclusion clause BEFORE you sign up with an insurance company and make sure that it refers to illegal drug operations. This will be important if you need to submit an insurance claim in the future. Information Sharing with Police When you apply for an Authorization to Possess, it is implied that you are agreeing that your information will be shared with the police as needed. What does this mean? The police forces DO NOT have access to Health Canada s database, nor will Health Canada release any of your medical and health information. They will only confirm to the police, if the police ask, whether or not you have an Authorization to Possess, a License to Produce, your address and the amounts of cannabis that you are allowed to possess and grow. This avoids unnecessary police intervention should you or your grower be under investigation for whatever reason. Plans to Phase Out Licenses to Produce Health Canada s vision is to phase out issuing Licenses to Produce by 2007, by which time they plan on distributing medicinal cannabis in pharmacies. It is unclear when this process will begin, or how it will happen. The Canadian AIDS Society believes that people should have a choice to produce their own cannabis, and the Society will do what it can to advocate for that. Renewals You must renew your Authorization to Possess and License to Produce every year. However, if your situation does not change, you will be able to complete a quick one-page form, signed by both you and your doctor, in order to renew. The photos you submit with your application are valid for 5 years. Be sure to start your renewal process early!! Get the forms online or order them from Health Canada. Make an appointment with your doctor months before your Authorization and License expire. Make sure you submit your paperwork at least 6 weeks before your expiry date. This will help to ensure that you will receive your new card before your old one expires. 2 iv

What are your rights if you are approached by police? Each situation is different and you must use your common sense to handle the situation. Stay calm, quiet and try to remember everything that happens. If you are stopped by police and you are authorized to possess cannabis, you must show the police officer your card as proof. If you are not authorized to possess cannabis legally, give the police officer your name, address, birth date and driver s license if it applies. Then, do not say anything until you talk to a lawyer. If they tell you to do something, politely ask why, and then do it silently. Here are your rights: You can refuse to talk to the police or answer their questions. List of legal aid services by province: Commission des services juridiques du Québec Telephone: (514) 873-3562 Law Society of Nunavut Telephone: (867) 979-2330 Legal Aid Commission of Newfoundland and Labrador Telephone: (709) 753-7860 Toll Free: 1-800-563-9911 Legal Aid Manitoba Telephone: (204) 985-8500 Toll Free: 1-800-261-2960 TTY: (204) 943-1131 Legal Aid New Brunswick Telephone: (506) 458-8540 Legal Aid Ontario Telephone: (416) 979-1446 Toll Free: 1-800-668-8258 TTY: (416) 598-8867 TTY: Toll Free: 1-866-641-8867 Legal Aid Prince Edward Island Telephone: (902) 368-6016 You can insist on your right to speak with a lawyer as quickly as possible. You can get help from a lawyer even if you cannot afford to pay for one. You can ask the police officer to tell you their name and badge number. Before the police search your house, your car, your belongings or your body, you can insist that they show you a search warrant, or explain clearly why they are searching you and what they are looking for. You can insist that a strip search be private and seen only by officers of the same sex. You can leave unless you are being arrested or detained. Legal Aid Society of Alberta Toll-free in Alberta: 1-866-845-3425 Direct from Edmonton (780) 644-7777 Legal Services Board of the Northwest Territories Telephone: (867) 920-3160, Yellowknife residents only Toll Free: (888) 920-3160, NWT wide. Legal Services Society of British Columbia Telephone: (604) 408-2172, Lower Mainland Toll Free: 1-866-577-2525, outside the Lower Mainland Nova Scotia Legal Aid Commission Telephone: (902) 420-6578 Toll-free: 1-877-420-6578 Saskatchewan Legal Aid Commission Telephone: (306) 933-5300 Toll-free: 1-800-667-3764 Yukon Legal Services Society Telephone: (867) 667-5210 Toll Free: 1-800-661-0408 ext. 5210 Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada, nor those of Health Canada. The Canadian AIDS Society thanks Solvay Pharma for their contribution to this project. 2 v

Cannabis and HIV/AIDS: Included in this series of fact sheets on Cannabis and HIV/AIDS: 1. The Medicinal Use of Cannabis 2. How to Apply to Use Medicinal Cannabis Legally 3. How to Speak to your Doctor about Medicinal Cannabis 4. Information Sheet for Physicians 5. Where to Find Cannabis for Medicinal Purposes 6. A Few Tips for Safer Use and Better Health 7. Cooking with Cannabis 8. Tips for Growing Cannabis Safely 9. How to Deal with the Stigma and Discrimination of Cannabis Use Contact Information: These fact sheets have been prepared by the Canadian AIDS Society, in consultation with a National Steering Committee and a Legal Consultant. They are easily photocopied. We encourage you to distribute them widely. For updates on these fact sheets, or for more information, please visit our web site at <www.cdnaids.ca/cannabis> or contact us at: Canadian AIDS Society 190 O Connor Street, Suite 800 Ottawa ON, Canada, K2P 2R3 Tel: 1-613-230-3580 Toll free: 1-800-499-1986 3. How to Speak to your Doctor about Medicinal Cannabis How to Approach Your Doctor about the Medicinal Use of Cannabis You may have already discussed your use of cannabis for medicinal purposes with your doctor, or you may be hesitant to do so for a variety of reasons. It is a good idea for all your health care practitioners to be aware of the therapies you are using to manage living with HIV and AIDS. Your relationship with your doctor, and how well you talk with each other, affects your care. Be prepared for your appointment. Doctors may not have much information about cannabis use for medicinal purposes as it is not an approved drug. See below on how to prepare for your appointment. Speak up. You will need to raise the issue with your doctor. If you are concerned about your doctor s reaction, remember that doctors are there to work with you to help make the best decisions about your health. Legal Access Your Doctor s Role They may have negative attitudes toward cannabis use in general, but if you are prepared to explain how it helps you, they will most likely be understanding. Luckily, many doctors who treat people living with HIV/AIDS are familiar with the use of cannabis for managing symptoms. Bring someone with you for moral support if you are nervous and want to make sure you can bring up the subject of cannabis with your doctor. In order for you to have legal access to cannabis for medicinal purposes in Canada, you must apply for an Authorization to Possess cannabis, according to the Marihuana Medical Access Regulations (MMAR). Please refer to the fact sheet on How to Apply to Use Medicinal Cannabis Legally on how to get the application form. Your doctor will need to fill out Form B1 as part of your application. You will therefore need to make an appointment with your doctor before you can send in your application for consideration. 3 i

How to Prepare Before Your Appointment It is a good idea to do your homework before your appointment with your doctor. Here are some things to consider: Bring in the B1 Form for your doctor to fill out, and ONLY this form. If you bring in the whole stack of forms for the MMAR, your doctor will not likely have time to sift through them all to determine which one to complete. Bring in the two copies of your passport photographs for your doctor to sign, as required by the MMAR. Please refer to the fact sheet on How to Apply to Use Medicinal Cannabis Legally for more information. Clearly identify the symptoms you feel you can better manage with cannabis. For people living with HIV/AIDS, the symptoms included in the MMAR are: severe pain, wasting, appetite loss, weight loss and severe nausea. Explain how you are using cannabis (or want to use cannabis) to manage your symptoms. Your doctor will want to understand how you are using or plan on using cannabis and what effect this is having or will have on your symptoms and well-being. Tell your doctor whether you are smoking it, eating it, or using it in some other form, how much and how often you are using cannabis. Be prepared to explain how cannabis is relieving your symptoms and to say how much cannabis you use, in grams per day. If you have never used cannabis before, get informed. Speak to others who do use it to manage their symptoms. Make a list of medicines and therapies you have tried for these symptoms, and identify which has worked and which has not worked. Present your doctor with the fact sheet on Information for Physicians, from this series. Consider signing the Release Form for Medical Practitioner from the Canadian Medical Protective Association (CMPA). The CMPA is the medical professional s insurer and signing this form may alleviate some of your doctor s concerns about liability. Note: This form is not valid in Quebec. The form is available on the CMPA s web site at <www.cmpa-acpm.ca> (just search for Release Form for Medical Practitioners ). This is NOT a Health Canada form and is NOT required to obtain an authorization to possess cannabis. It may however be useful in getting your physician to support your application. Useful Resources: Health Canada Medical Use of Marihuana: <www.healthcanada.gc.ca/mma> Medical cannabis program information: <www.medicalmarihuana.ca> Medical Marijuana Information Resource Centre: <www.medicalmarijuanainformation.com> Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada, nor those of Health Canada. The Canadian AIDS Society thanks Solvay Pharma for their contribution to this project. 3 ii

Cannabis and HIV/AIDS: 4. Information Sheet for Physicians Included in this series of fact sheets on Cannabis and HIV/AIDS: 1. The Medicinal Use of Cannabis 2. How to Apply to Use Medicinal Cannabis Legally 3. How to Speak to your Doctor about Medicinal Cannabis 4. Information Sheet for Physicians 5. Where to Find Cannabis for Medicinal Purposes 6. A Few Tips for Safer Use and Better Health 7. Cooking with Cannabis 8. Tips for Growing Cannabis Safely 9. How to Deal with the Stigma and Discrimination of Cannabis Use The Marihuana Medical Access Regulations The Marihuana Medical Access Regulations (MMAR) came into effect in 2001 to enable compassionate access to cannabis for medical purposes for seriously ill Canadians. Applications to obtain an Authorization to Possess cannabis legally and to obtain a License to Produce cannabis for medical purposes require that the physician complete Form B1 for Category 1 applicants, or B2 for Category 2 applicants. Currently, Category 1 of the MMAR includes the following medical conditions and related symptoms: Contact Information: These fact sheets have been prepared by the Canadian AIDS Society, in consultation with a National Steering Committee and a Legal Consultant. They are easily photocopied. We encourage you to distribute them widely. For updates on these fact sheets, or for more information, please visit our web site at <www.cdnaids.ca/cannabis> or contact us at: Canadian AIDS Society 190 O Connor Street, Suite 800 Ottawa ON, Canada, K2P 2R3 Tel: 1-613-230-3580 Toll free: 1-800-499-1986 MEDICAL CONDITIONS Cancer; or AIDS, HIV Infection Multiple Sclerosis; Spinal Cord Injury; or Spinal Cord Disease Severe Arthritis Epilepsy Compassionate End of Life Care (Palliative Care) SYMPTOM Severe pain, cachexia (wasting), anorexia (appetite loss) weight loss, severe nausea Severe pain, persistent muscle spasms Severe pain Seizures People with symptoms related to a medical condition other than those stated above fall under Category 2 of the MMAR. 4 i

Amendments to the Marihuana Medical Access Regulations In June 2005, the MMAR were amended, allowing family physicians to sign all applications. For Category 2, the family physician must consult a specialist. The wording of the applicant s declaration and the medical declaration were changed to shift of responsibility from the physician to the patient. The new MMAR no longer require physicians to recommend the daily dosage of cannabis, the form, nor the route of administration, though physicians must still indicate the daily amount, form and route of administration the patient intends to use. Physicians are no longer required to state that the benefits of cannabis use outweigh the risks, though the applicant must declare that he or she has discussed the risks with a physician. The physician must declare that conventional treatment(s) for the Category 1 symptom(s) have been tried or considered and have been found to be ineffective or medically inappropriate for the treatment of the applicant. Concerns Expressed by the Canadian Medical Protective Association: In response to concerns regarding medical liability, the CMPA has made available a Release Form for Medical Practitioners. The CMPA recommends that physicians ask their patient to sign this release and that physicians keep a copy on file. This form is available at <www.cmpa-acpm.ca>. Practical Information about Cannabis and Cannabis Use Potency Cannabis contains over 60 active compounds known as cannabinoids. The main cannabinoid is delta-9- tetrahydrocannabinol (THC). There are hundreds of varieties or strains of cannabis, each with different cannabinoid profiles. Anecdotal reports claim that some strains are more efficacious than others at relieving symptoms. Potency refers to the amount of THC found in cannabis. Health Canada s cannabis is a standardized and tested source of supply produced under contract. It contains 12.5% + 1.5% THC. According to the RCMP s data, based on 3,160 THC analyses of street samples requested by Canadian police forces, the average potency of street cannabis is 5.7%. Of these samples, 133 tested over 15 percent, while eight reached over 20 percent. 1 Forms Cannabis can be consumed in its herbal form, in tinctures, oils, capsules, sprays and concentrates such as hashish. However, the MMAR do not apply to any derivatives of cannabis such as hashish or hash oil. Routes of Administration The route of administration of cannabis determines the speed of onset of clinical effects. Each patient will need to determine the route that is best for them. Inhalation has the most rapid onset, with clinical effects within seconds, and a peak effect after a few minutes. Smoking is the most widely used method and it allows for effective dosage titration as patients can quickly determine when they have consumed enough 1 Royal Canadian Mounted Police. Marihuana Cultivation in Canada: Evolution and Current Trends November 2002. Available at <www.rcmp-grc.gc.ca/crimint/cultivation_e.htm#levels> 4 ii

cannabis to relieve their symptoms. An interesting and promising alternative route is inhalation through a vaporizer. Vaporization consists of heating the cannabis just below the point of combustion, thereby vaporizing the cannabinoids without producing combustion by-products. Vaporizers are widely available wherever cannabis smoking devices are sold. Baking or cooking with cannabis is a good way to reduce the amount smoked. However, bioavailability through ingestion is complex. The onset of the therapeutic effects can take from 30 minutes to 2 hours. In addition, ingesting THC orally is subject to the first pass effect of hepatic metabolism, yielding 11-hydroxy-THC, which is considerably more psychoactive than THC itself. This said, the effect may last up to several hours longer. Eating cannabis can be a challenge for someone who is using it to alleviate nausea and vomiting. Each patient will need to determine the route that is best for them. Tinctures and spray are used through sublingual and oromucosal absorption. Amounts A joint (cannabis cigarette) usually contains about 1 /2 gram to 1 gram of cannabis, depending on how it is rolled and whether it is mixed with tobacco. According to Health Canada s Daily Amount Fact Sheet 2, the average daily amount approved for over 90% of persons authorized under the MMAR is 5 grams or less per day. Accordingly, 5 grams a day will result in approximately 5 to 10 joints. When cannabis is ingested orally, the strain of the cannabis, the potency, the part of the plant that is used (leaves or flowers), the body size of the person consuming, and the experience of the person consuming all come into play when considering a dose. Here are some guidelines for starting doses OUNCES GRAMS 1 oz 28 grams 1 /2 oz - a half 14 grams 1 /4 oz - a quarter 7 grams 1 /8 oz -an eighth 3.5 grams when eating cannabis for a person of about 68kg (150lbs) who has some experience with cannabis: Toxicity cannabis leaf (shake): 1 /2 gram to 2 grams cannabis flowers (buds) with seeds: 1 /4 gram to 1 gram sinsemilla flowers (buds with no seeds): 1/8 gram to 1 /2 gram There is no known LD 50 for cannabis or its major components in humans. The ratio of fatal to therapeutic has been estimated to be 40,000. Theoretically, one would have to consume 682 kg (1500 pounds) of cannabis in 15 minutes to overdose. There has yet to be a welldocumented case of human fatality attributable to an overdose of cannabis or its components, and as such, no LD50 can be attributed. 3, 4, 5, 6, 7 2 Available on Health Canada s web site at <www.healthcanada.gc.ca/mma> 3 Grinspoon L, Bakalar JB. Marihuana, the forbidden medicine. Rev. and exp. ed. New Haven: Yale University Press; 1997. 4 Mikuriya TH. Historical aspects of Cannabis sativa in Western medicine. New Physician.1969;18(November):902-908. 5 Loewe S. Studies on the pharmacology and acute toxicity of compounds with marijuana activity. Journal of Pharmacology and Experimental Therapeutics. 1946;88:154-161. 6 Loewe S. The active principals of cannabis and the pharmacology of the cannabinols. Archiv fur Experimentelle Pathologie und Pharmakologie. 1950;211:175-193. 7 Ethan Russo. LD50 Figures for Cannabis. Personal Communication, January 20, 2006. 4 iii

State of Scientific and Medical Knowledge For the latest research on cannabis and cannabinoids from international literature, please visit the Canadian Consortium for the Investigation of Cannabinoids in Human Therapeutics Electronic Newsletter: available at <www.ccicnewsletter.com>. As there is no Notice of Compliance for cannabis, Health Canada provides Information for Health Care Professionals Marihuana at <www.healthcanada.gc.ca/mma>. Some key studies related to HIV/AIDS: Abrams DI, Hilton JF, Leiser RJ, Shade SB, Elbeik TA, Aweeka FT et al. Short-Term Effects of Cannabinoids in Patients with HIV-1 Infection. Ann Intern Med. 2003;139:258-266. Beal JE, Olson R, Laubenstein L, Morales JO, Bellman P, Yangco B et al. Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage. 1995 Feb;10(2):89-97. Beal JE, Olson R, Lefkowitz L, Laubenstein L, Bellman P, Yangco B et al. Long-Term Efficacy and Safety of Dronabinol for Acquired Immunodeficiency Syndrome-Associated Anorexia. J Pain Symptom Manage. 1997 July;14(1):7-14. Chang AE, Shiling DJ, Stillman RC, Goldberg NH, Seipp CA, Barofski I et al. Delta-9-THC as an antiemetic in cancer patients receiving high-dose methotrexate. Ann Intern Med. 1979;91:819-830. de Jong BC, Prentiss D, McFarland W, Machekano R, Israelski DM. Marijuana Use and its Association with Adherence to Antiretroviral Therapy Among HIV-Infected Persons with Moderate to Severe Nausea. J Acquir Immune Defic Syndr. 2005;38(1):43-46. Jones SE, Durant JR, Greco FA, Robertone A. A multi-institutional phase III study of nabilone vs placebo in chemotherapy-induced nausea and vomiting. Cancer Treatment Rev. 1982;9;Suppl B:45-48. Kaslow RA, Blackwelder WC, Ostrow DG, Yerg D, Palenicek J, Coulson AH et al. No evidence for a role of alcohol or other psychoactive drugs in accelerating immunodeficiency in HIV-1-positive individuals. JAMA. 1989;261:3424-3429. Orr LE, McKernan JF. Antiemetic effect of delta-9- THC in chemotherapy-associated nausea and emesis as compared to placebo and compazine. J Clin Pharmacol. 1981;21:76S-80S. Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada, nor those of Health Canada. The Canadian AIDS Society thanks Solvay Pharma for their contribution to this project. 4 iv

Cannabis and HIV/AIDS: Included in this series of fact sheets on Cannabis and HIV/AIDS: 5. Where to Find Cannabis for Medicinal Purposes 1. The Medicinal Use of Cannabis 2. How to Apply to Use Medicinal Cannabis Legally 3. How to Speak to your Doctor about Medicinal Cannabis 4. Information Sheet for Physicians 5. Where to Find Cannabis for Medicinal Purposes 6. A Few Tips for Safer Use and Better Health 7. Cooking with Cannabis 8. Tips for Growing Cannabis Safely 9. How to Deal with the Stigma and Discrimination of Cannabis Use Where to Get Cannabis Legally: In order to legally possess cannabis for medicinal purposes, you must first obtain an Authorization to Possess from Health Canada. Please refer to the fact sheet on How to Apply to Use Medicinal Cannabis Legally. When you apply for your authorization, you have 3 legal options from which you can obtain cannabis: You can buy the cannabis produced under contract for the government. You can apply for a license to produce your own cannabis. The government has some seeds available to get you started. You can designate someone to grow cannabis for you and only you. Contact Information: These fact sheets have been prepared by the Canadian AIDS Society, in consultation with a National Steering Committee and a Legal Consultant. They are easily photocopied. We encourage you to distribute them widely. For updates on these fact sheets, or for more information, please visit our web site at <www.cdnaids.ca/cannabis> or contact us at: Canadian AIDS Society 190 O Connor Street, Suite 800 Ottawa ON, Canada, K2P 2R3 Tel: 1-613-230-3580 Toll free: 1-800-499-1986 The Government s Cannabis The cannabis produced for the government has received significant attention in the media and you may have heard some negative criticism about it. The government has made some changes to address these concerns and the product has improved better. It is tested to ensure that it is not contaminated, unlike cannabis that is available on the street. It is also gamma-irradiated to ensure that it does not contain any harmful mould spores. It is sold for $5 a gram, plus GST. You can order up to one month s supply at a time. It is delivered to your door or to your doctor s office. Your best bet is to give it a try to determine whether it works for you. Please refer to the fact sheet on How to Apply to Use Medicinal Cannabis Legally for more information. 5 i

Licenses to Produce Whether you apply for a license to produce or designate someone to grow for you, the number of plants you or your designated grower are allowed to grow is determined by the daily dose that you require. This information is required on your application for an authorization. You or your designated grower will need to follow the guidelines set out in the Marihuana Medical Access Regulations. Please refer to the fact sheet on How to Apply to Use Medicinal Cannabis Legally for more details. Compassion Clubs and Cannabis Clubs In Canada, there are clubs that provide a variety of strains of cannabis, as well as other cannabis products such as baked goods and other edibles, tinctures, oils, concentrates, capsules, and sprays, as well as organic 1 (not certified) cannabis. These clubs are referred to as compassion clubs, cannabis clubs, or buyers clubs. They vary in size, organizational structure and the services they provide. Some clubs are very well established and are registered as not-for-profit societies. It is important for you to know that the clubs are NOT LEGAL in Canada. Their status and their potential role in the distribution of medicinal cannabis are still being debated. They are NOT part of the federal medical cannabis program. This is NOT a legal source of cannabis. The people who run clubs are usually quite knowledgeable about the use of cannabis for medicinal purposes. Some clubs have developed standards of operations by which they self-regulate, though at this time there are no uniform standards by which all clubs operate. These clubs usually require membership, which you obtain by filling out a quick form to fill out and getting your doctor to sign it, or providing a letter from your doctor to confirm your diagnosis. There are not many clubs and providers in Canada. We are providing a list for your information. Please visit our web site at <www.cdnaids.ca/cannabis> for an updated list. 1 A note on organic cannabis: Some of you may be seeking an organic source of cannabis. Currently there is no certified organic cannabis available to authorized persons in Canada. The government s cannabis is gamma-irradiated for safety purposes, to ensure no harmful mould spores are present. Under national standards for organic agriculture, irradiation is not permitted. Compassion clubs often offer organic cannabis as an available product, though this cannabis is not certified as organic. There is one exception. Island Harvest in BC produces organic cannabis which is certified by the province of British Columbia. However due to Health Canada s regulations, Island Harvest s certified organic cannabis is only available to two authorized people, as restricted under the MMAR. 5 ii

British Columbia Compassion Club Society Vancouver, British Columbia Tel : (604) 875-0448 E-mail: <info@thecompassionclub.org> Web site: <www.thecompassionclub.org> Cannabis As Living Medicine (C.A.L.M.) Toronto, Ontario Tel: (416) 367-3459 E-mail: <info@cannabisclub.ca> Web site: <www.cannabisclub.ca> Cannabis Buyers Club of Canada Victoria and Coombs, British Columbia Halifax, Nova Scotia Tel: (250) 381-4220 on the west coast (902) 497-3941 on the east coast E-mail: <normlns@hotmail.com> Web site: <www.cbc-canada.com> Cannabis Common Inc. Toronto, Ontario Tel: (416) 400-3134 E-mail: <cannabiscommon@sympatico.ca> E-mail: <cannabiscommoninc@hotmail.com> Web site: <www.toronto420.com/cc> Island Harvest BC Certified Organic Medical Cannabis Vancouver Island, British Columbia Tel: (250) 748-8614 E-mail: <info@medicalmarihuana.ca> Web Site: <www.islandharvest.ca> Montreal Cannabis Club Montreal, Quebec Tel: (514) 521-8764 Fax: (514) 845-0263 E-mail: <contact@marijuanahomedelivery.ca> Web site: <www.clubcompassion.org> Hemp Users Medical Access Network Toronto, Ontario Tel: (416) 253-1021 Fax: (416) 253-1428 E-mail: <info@humanhemphealth.ca> Web site: <www.humanhemphealth.ca> London Compassion Society London, Ontario Tel: (519) 850-5221 E-mail: <info@londoncompassionsociety.com> Web site: <www.londoncompassionsociety.com> Marijuana Home Delivery Montreal, Quebec Tel: (514) 521-8764 Fax: (514) 845-0263 E-mail: <contact@marijuanahomedelivery.ca> Web site: <www.marijuanahomedelivery.ca> The Mid-Island Compassion Club Vancouver Island, British Columbia Tel: (250) 954-0363 E-Mail: <MidIslandCompassionClub@Shaw.ca> Web site: <www.members.shaw.ca/midislandcompassionclub> Mobile Access Compassionate Resources Organization Society (M.A.C.R.O.S.) Edmonton, Alberta Tel: (780) 457-6824 E-mail: <admin@macros.ca> Web site: <www.macros.ca> Nelson Cannabis Compassion Club Nelson, British Columbia Tel: (250) 354-4206 E-mail: <nelsoncompassion@yahoo.ca> Web site: <www.community.netidea.com/compassionclub> Vancouver Island Compassion Society Victoria, British Columbia Tel: (250) 381-8427 E-mail: <info@thevics.com> Web site: <www.thevics.com> remarcable foods Vancouver British Columbia Tel: (604) 721-7461 E-mail: <info@remarcable.ca> Web site: <www.remarcable.ca> Toronto Compassion Centre Toronto, Ontario Tel: (416) 668-6337 E-mail: <postmaster@torontocompassioncentre.org> Web site: <www.tccentre.org> Treating Yourself.Com Inc. Canada E-mail: <weedmaster@treatingyourself.com> Web site: <www.treatingyourself.com> 5 iii

Friends or Someone You Know Many people tell us they get their cannabis from friends or someone they know. There are some advantages to doing this, as this may be someone they trust and have developed a relationship with, and who may also provide more information about how the cannabis is grown. Of course, getting cannabis from an unlicensed producer is illegal. Discretion is a must in this situation in order to protect both yourself and the person who is supplying you. Once again, there are no controls over the quality of these products. Street Dealers Sometimes the only way you may find cannabis is through a street dealer or through a friend of a friend. There are inherent risks with getting your cannabis from a dealer. You don t really know what you are getting, where the cannabis comes from, or how it was grown and harvested. Dealers can also be unreliable or disappear if they run into trouble, leaving you to search for another one. There may also be risks to your personal safety when dealing with a street dealer, especially if a deal goes bad, or if you are in the wrong place at the wrong time. You may also face arrest if caught during a transaction. A Few Safety Tips to Protect Yourself and Your Health Know your source: It is a good idea to find out about your source of cannabis and ask questions about what you are getting. Do you trust the source? Are they reliable? Do you know how the cannabis is being grown? Are they using pesticides? Chemicals? Use your judgment. Some people may not want to provide too much information, or may not know the answers to your questions. Be Discreet: The fewer people who know you have cannabis around, the less likely you are to attract unwanted attention from others seeking cannabis or from the police. This is especially important if you are growing cannabis. Do not keep your cannabis, paraphernalia, plants or grow equipment in plain view of the doors or windows. 5 iv

Tips on Storing Your Cannabis THC, the main active ingredient in cannabis, is found in the glands or trichomes, attached to the surface of the leaves, stems and buds of the plant. You can visibly see the trichomes, which give cannabis that frosty look. THC deteriorates when it is exposed to light, oxygen and heat. Ensure that the cannabis is properly dried before storing it. Storing wet or damp cannabis will encourage the growth of moulds, fungi and bacteria, which could result in serious health problems. There should not be any condensation on the inside of your container. If there is, dry out the cannabis in a paper bag for another day or two before storing it, just to make sure. Store your cannabis in a wood, hard plastic or metal container, in a cool and dark place. You can refrigerate or freeze cannabis in a sealed container to slow down its deterioration. For longterm storage, place the cannabis in a Mason jar, a sealed glass jar or a vacuum-sealed bag or container in the freezer. NEVER EVER smoke mouldy weed! If you see the presence of white, greyish, black or blue-green sometimes fuzzy looking moulds on your cannabis, throw it out, just as you would mouldy food. Please refer to the fact sheet on The Medicinal Use of Cannabis for more information. Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada, nor those of Health Canada. The Canadian AIDS Society thanks Solvay Pharma for their contribution to this project. 5 v