Requirements for Medical Marijuana Certification in California
First I have to tell you that this must be done correctly
. While certification is widely available under California law, there are doctors and "clinics" who take shortcuts. This puts your certification in possible jeopardy. Here in Santa Rosa one of the clinics (C.H.A.D.) simple disappeared overnight.
Here are the requirements for medical marijuana certification in California. Please read carefully. It is a bit tedious, but it is also important that you understand all of this:
- 1. A condition which is benefitted by medical marijuana. California law allows a very wide scope of conditions, essentially whatever you and your doctor find to be benefitted.
- 2. To satisfy the California Medical Board, documentation from a licensed treating health professional stating your diagnosis. This would be a copy of a page out of your medical record which states your diagnosis, or a simple note from your doctor, chiropractor, nurse, or other health care provider or a lab or radiology report stating your diagnosis. Do not fax this and do not ask a doctor to fax it. You must bring it in yourself. A previous certification or prescription of a medication meant to treat your condition will work. A proper history and physical exam will ensue.
- 3. You must be at least 18 years of age and a resident of California. You must (1) present a picture ID proving your age of at least 18 and (2) submit proof of residency in California. A California driver's license or California ID card will suffice for both requirements. If you do not have one of these, a picture ID proving your age (for example a driver's license from another state, or a passport) and proof of California residency (for example a lease agreement or a PG&E bill) together will suffice.
The certificate you will receive from me entitles you to shop at medical marijuana dispensaries throughout California. Your certificate will be valid for one year (the maximum allowed by state law), unless there is a really outstanding reason to make it for a shorter period of time. Once you have the certificate I issue to you, the state of California can issue you a card, however it has no real meaning as it does not entitle you to any additional benefits. It is a voluntary program which costs money, puts you on a government list and does nothing else.
Knowing all this, if you are ready for an appointment, please write me at firstname.lastname@example.org
. I will respond with all necessary information including day, time, address (in Santa Rosa), etc. When you write, give me your phone number
for my records and whether you need me as the diagnosing physician
. If you have limitations on when you can come to the office, please let me know what they are and I will try to accommodate your schedule.
Here is the address and phone number of the clinic:
The Anti-aging Medicine Clinic
2448 Guerneville Rd., Ste. 800
Santa Rosa, CA 95403
Phone: (707) 591-4088
Further information to prepare yourself for your appointment
Your evaluation for medical marijuana will be in the context of the fact that you have a documented diagnosis from another state licensed health professional or that I am the diagnosing physician. Unless we make another agreement, I will serve as the evaluating and certifying, but not the diagnosing, physician. Therefore, I will not be making a diagnosis but rather I will be certifying the diagnosis of your health care professional. Therefore, I must have documentation of your diagnosis from that person. This could be a simple note from your doctor, or a copy of a page out your medical record stating your diagnosis, or even a medical test which proves your diagnosis. A previous certification or prescription of a medication meant to treat your condition will work.
You must bring in the document yourself, literally in your own hands. Do not rely on anyone to fax, mail, or email your documents. This may mean that you will visit your health professional's office and ask for the documents. For your information, licensed health professionals are required by California law to hand over your medical records upon your request. You may need to remind your doctor of that fact.
If you do not have this documentation, I can become the diagnosing physician. This may involve additional lab tests, although in most cases the history and physical exam will suffice. If you bring documentation of your diagnosis, the cost is $125. If not, and I am to render a diagnosis, there is an additional charge of $125 for that service. That additional charge does not apply to the yearly renewals.
Barring complications, you will be at the clinic about 30 minutes. You will fill out a medical history form and I will do a physical exam as required by law.
Thank you, and I look forward to our appointment.
Ron Kennedy, M.D. Santa Rosa, California
Further Reading About Marijuana, Cannabis, as a Medicine.
A "brief" history of the use of medicinal marijuana is not possible since the medicinal use of this herb (yes, it is a herb) goes back thousands of years, perhaps even to before recorded history. It is harvested from the flowering tops, stems, and leaves of two members of the Hemp family of plants, Cannabis sativa
or Cannabis indica
. Sativa is limited to warmer climates whereas Indica can withstand colder climates. It is one of the most commonly used drugs in the world, following only caffeine, nicotine, and alcohol in popularity, all of which are surely dangerous to human health but also available in every city, town and village in the U.S. and most of the civilized world. Most marijuana grown in the U.S. since the late 1980s, are hybrids of the two and yield a more potent product than other forms. The resin found on flower clusters and top leaves of the female plant is the most potent source of cannabinoids
(a blend of related compounds) and is used to prepare hashish
, the highest grade of cannabis. The bud of the female plant, called sinsemilla
, is the part most often smoked as marijuana.
A lot is known about the science of cannabis. Cannabinoid receptor 1 (CNR1)
is one of the two known receptors in the endocannabinoid (EC) system
and is associated with the intake of food and also with tobacco dependency. Blocking CNR1 may reduce dependence on tobacco and the craving for food. The gene encoding CNR1 is located in chromosome region 6q14-q15. It is also called the CB1 receptor or CB1. Cannabinoid receptor 2 (CNR2)
is the other designated receptor in the EC system. The gene encoding CNR2 is located on chromosome 1. It is also known as the CB2 receptor
or simply as CB2
The same genus of plants (Cannabis
) which produces "reefer" also produces hemp
(spelled with a lower case "h" whereas the family of plants is spelled with an upper case "H") and this was the primary source of material to manufacture rope. This made civilization possible. Try to imagine Columbus sailing to America without rope. The recreational and therapeutic uses of MJ were not in question until the last 80-90 years. How this came to be is an interesting story in itself, properly recorded elsewhere. Suffice it to say here that it had to do with racial prejudice and fear involving Mexicans and African Americans, the influx of Mexican farm workers into the U.S. in the early 20th century and the recreational use of MJ by black jazz musicians in the southeastern U.S. through the 20s and 30s. As a mere example of the mind-set of the times, it is said that when Montana outlawed marijuana in 1927, the Butte Montana Standard reported a legislator's comment: "When some beet field peon takes a few traces of this stuff... he thinks he has just been elected president of Mexico, so he starts out to execute all his political enemies" and in Texas, a senator said on the floor of the Senate: "All Mexicans are crazy, and this stuff [marijuana] is what makes them crazy." The Mormon influence in Utah led the way for several states to criminalize MJ.
In 1930, the Federal Bureau of Narcotics was created and one Harry J. Anslinger was named director. This marked the beginning of the all-out war against marijuana. Anslinger was an ambitious man, and he recognized the Bureau of Narcotics as an opportunity to define both a problem and a solution. He immediately realized that opiates and cocaine wouldn't be enough to help build his agency, so he latched on to marijuana and started to work on making it illegal at the federal level. Anslinger retired in 1962 and was succeeded by Henry Giordano, who was the commissioner of the FBN until it was merged with the Bureau of Drug Abuse Control to form the Bureau of Narcotics and Dangerous Drugs in 1968 which was renamed the Drug Enforcement Administration (DEA) in 1971 under then President Richard Nixon (who I happened to meet back in 1961 - yes, I am that old ! ).
Anslinger drew upon the themes of racism and violence to draw national attention to the problem he wanted to create. Some of his quotes regarding marijuana...
"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."
"...the primary reason to outlaw marijuana is its effect on the degenerate races."
"Marijuana is an addictive drug which produces in its users insanity, criminality, and death."
"Reefer makes darkies think they're as good as white men."
"Marihuana leads to pacifism and communist brainwashing"
"You smoke a joint and you're likely to kill your brother."
"Marijuana is the most violence-causing drug in the history of mankind."
Then there was the most ridiculous movie ever made titled Reefer
, a shameless attempt to poison the American psyche against
a natural herb. Three people were depicted as having smoked MJ at
a party. One became insane, another became a murderer, and the third
became monumentally stupid. If you want a deep belly laugh while having
pity for human prejudice, see that film. It was directed by Louis
Gasnier and starred a cast of unknown bit actors. The actor who played
the lead never worked in another film. It was financed by a church
group and made under the title Tell Your Children
. The film
was intended as a morality tale attempting to teach parents about
the dangers of cannabis use. Soon after the film was shot, it was
purchased by producer Dwain Esper who re-cut the film for distribution
on the exploitation film circuit. It never gained an audience until
it was rediscovered in the 1970s and gained new popularity among cannabis
smokers as a piece of unintentional comedy. Today, it is considered
a cult film.
More politically correct, but nevertheless wildly prejudicial and unsubstantiated opinions are still frequently tossed out into the news media by government officials. This kind of rhetoric weaves together the use of an ancient herb, violence, inappropriate sexuality, and puts fear into the American psyche. Understanding these kinds of events (of which this is only a small accounting) makes the present day struggle over the use of medicinal marijuana understandable. This violent prejudice against an herb has only one small chink in its armor, namely that it is not the truth. Nevertheless, this prejudice runs deep in the American psyche and may require "surgery" to remove it. That "surgery" may be "medical marijuana." To the chagrin of those who are trapped in prejudicial fear regarding marijuana, the cannabis plant produces some of the most effective medicines in nature, a related group of compounds called "cannabinoids." They fit like a key in a lock into receptors located on the cell membrane of every cell in the human body. These receptors are termed, naturally, "cannabinoid receptors." THC (tetra-hydro-cannabinol) is one of these compounds, but like vitamin E which comes as eight different related molecular structures, the cannabinoids are most effective when consumed together. This makes the pharmaceutical preparation of THC (called "Marinol") a relatively weak sister compared to the cannabinoid complex of compounds. The cannabinoids have been used as an herbal medicine for thousands of years and, like most medicinal herbs, represents serious competition to pharmaceutical industry profits; but that is a conversation for another time and place.
The 1937 Marihuana Tax Act, and the establishment of the Federal Bureau of Narcotics marked the beginning of the present controversy regarding marijuana. In the 1950s, strict mandatory sentencing laws greatly increased federal penalties for marijuana possession, but these were removed in the 1970s. In 1964, the Single Convention on Narcotic Drugs entered into force, placing the U.S. under treaty obligations to control marijuana production and distribution thus, in effect, encroaching on our national sovereignty to deal with this problem within our borders in accordance with the will of the people. In the 1980s, mandatory sentencing laws were reinstated for large-scale marijuana distribution. Three strikes laws were enacted and applied to marijuana possession, and the death sentence was enabled for marijuana drug kingpins.
However, in the 1960s and 70s there came a greater acceptance of the view that marijuana should not be considered in the same class as narcotics and that U.S. marijuana laws should be relaxed. The Drug Abuse Prevention Act of 1970 eased federal penalties somewhat, and 11 states decriminalized possession. However, in the late 1980s most states rewrote their drug laws and imposed stricter penalties. Opponents of easing marijuana laws have asserted that it is an intoxicant less controllable than alcohol, that our society does not need another accepted intoxicant, and that the U.S. should hue to globalized United Nations' policies, which are opposed to the use of marijuana for other than possible medical purposes.
As a doctor, I have nothing to say about the recreational use of marijuana, however the medicinal uses of marijuana are too extensive to ignore. The Institute of Medicine's 1999 report on medical marijuana stated, "The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation." Examining the question whether the medical use of marijuana would lead to an increase of marijuana use in the general population the report concluded that, "At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential." The report also noted that, "this question is beyond the issues normally considered for medical uses of drugs, and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids." The report continued "Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications." The report concluded that, "the short-term immunosuppressive effects are not well established but, if they exist, are not likely great enough to preclude a legitimate medical use." There is much more which could be reported about official studies of the medicinal use of marijuana, but I will not go into them here. Suffice it do say, that absent the fear and prejudice surrounding the cannabinoids, any pharmaceutical company would pay millions, even billions, to be able to come up with a pharmaceutical compound with the potential of the cannabinoids.
As of this writing, Thirteen states have legalized medical marijuana, beginning in 1996. They are Alaska, California, Colorado, Hawaii, Maine, Maryland, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Doctors are placed in the uncomfortable position of not being able to prescribe medical marijuana due to federal law, but are limited to recommending it. Most doctors simply avoid the issue. Among those who do not avoid the issue, there are a few who hand out marijuana certificates like candy. This irresponsible behavior should be attended to by state medical boards. Strict guidelines should be followed by any doctor involved in the evaluation of the need for medical marijuana.
When a licensed physician recommends medical marijuana, patients then obtain their medicinal marijuana by growing their own, buying from coops, or from "care givers" who grow for a number of people. The limitations of these activities are in no way uniform and are regulated by states, cities, and counties into what amounts to a patch-work quilt of regulations across the U.S.
There is no doubt that marijuana, medical or recreational, changes the sensorium when taken in sufficient quantity. There is surely, as with all drugs, a potential for abuse, although unlike many pharmaceuticals, the incidence of permanent damage or death is witheringly small. Due to its intoxicant qualities, like alcohol, it should not be used in situations like driving a car, riding a motorcycle or horse, flying an airplane, operating machinery or any activity in which a clear sensorium is required to maintain reasonably safe conditions. For medical use, the bare minimum amount should be used to produce the desired result (usually the relief of pain, stimulation of appetite, or control of nausea).
While Cannabis does not cure anything (and neither do pharmaceutical medications by the way), here are some of the medical conditions the symptoms of which are often benefitted by medical marijuana:
- Hepatitis C
- Multiple Sclerosis
- Tourette's Syndrome
- Sleep Apnea
- GI Disorders
- Rheumatoid Arthritis
- Many different pain syndromes, including those from trauma and cancer
- Anorexia and Weight Loss
Anyone using or considering medical marijuana must understand that, unjust as it may be, it is still against federal law and that there are within the law prescribed serious penalties for such use. It is not in the purvue of state, county or city agencies, law enforcement or otherwise, to take any action other than those to uphold the laws of the state in which they are located.
Properties of the compounds in Marijuana
At least 66 cannabinoids have been isolated from the cannabis plant. All classes derive from cannabigerol-type compounds and differ mainly in the way this precursor is cyclized.
cannabidiol (CBD) and cannabinol (CBN) are the most prevalent natural cannabinoids and have received the most study. Tetrahydrocannabinol (THC) is the primary psychoactive component of the plant. It appears to ease moderate pain (analgetic) and to be neuroprotective. THC has approximately equal affinity for the CB1 and CB2 receptors. Its effects are perceived to be more cerebral. Delta-9-Tetrahydrocannabinol (Δ9-THC, THC) and delta-8-tetrahydrocannabinol (Δ8-THC), mimic the action of anandamide, a neurotransmitter produced naturally in the body. The THCs produce the high associated with cannabis by binding to the CB1 cannabinoid receptors in the brain.
is not psychoactive, and was thought not to affect the psychoactivity of THC. However, recent evidence shows that smokers of cannabis with a higher CBD/THC ratio were less likely to experience schizophrenia-like symptoms (disorganization of thought). This is supported by psychological tests, in which participants experience less intense psychotic effects when intravenous THC when co-administered with CBD. It has been hypothesized that CBD acts as an antagonist at the CB1 receptor and thus alters the psychoactive effects of THC. It appears to relieve convulsion, inflammation, anxiety, and nausea. CBD has a greater affinity for the CB2 receptor than for the CB1 receptor. CBD shares a precursor with THC and is the main cannabinoid in low-THC Cannabis strains. Two NIH scientists secured a patent on CBD in 2003 when they realized that it is the main cannabinoid which producse an analgesic (pain relieving) effect. Most strains of marijuana in the U.S. have had most of the CBD bred out of them in favor of the psychoactive component (THC). This necessitates getting high to deal with pain and leads most users to favor dosing at bedtime and sleeping through the psychoactive aspects and thus also taking advantage of the soporific (sleep inducing) effects of THC. It appears that the pain relieving aspects mediated by CBD endure longer than the psychoactive effects of THC and thus are still active the next day after bedtime dosing.
is the primary product of THC degradation, and there is usually little of it in a fresh plant. CBN content increases as THC degrades in storage, and with exposure to light and air. It is only mildly psychoactive. Its affinity to the CB2 receptor is higher than for the CB1 receptor.
is non-psychotomimetic but still affects the overall effects of Cannabis. It acts as an α2-adrenergic receptor agonist, 5-HT1A receptor antagonist, and CB1 receptor antagonist. It also binds to the CB2 receptor.
is prevalent in certain South African and Southeast Asian strains of Cannabis. It is an antagonist of THC at CB1 receptors and attenuates the psychoactive effects of THC.
is non-psychoactive and does not affect the psychoactivity of THC.
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