Informed Consent.
I am being evaluated for a medical cannabis certification in the state of Massachusetts as set forth in the Massachusetts State law for medical cannabis. Sharon Reif, NP will make this certification based, in part, on the medical information I have provided. I have not misrepresented my medical condition in order to obtain this recommendation and it is my intent to use marijuana only as needed for the treatment of my medical condition. I understand that it is my responsibility to be informed regarding state and federal laws regarding the possession, use, growing of, sales/purchase and/or distribution of marijuana. I have been informed and understand the following:
The federal government has classified marijuana as a Schedule I controlled substance. Schedule I substances are defined, in part, as having (1) a high potential for abuse; (2) not currently accepted medical use in treatment in the US; and (3) and lack of accepted safety for use under medical supervision.
Marijuana has not been approved by the Food and Drug Administration for marketing as a drug. Therefore the “manufacture” of marijuana for medical use is not subject to any standards, quality control, or other oversight by the FDA.
The Nurse Practitioner and/or representative are neither providing, dispensing nor encouraging me to obtain or use medical cannabis.
The Nurse Practitioner and/or representative are in no way establishing themselves as my primary care provider.
My continued approval for medical cannabis use, and the state issued card, may be revoked at any time for inappropriate use as determined by Sharon Reif, NP.
The use of marijuana can affect coordination, motor skills and cognition, i.e. the ability to think, judge and reason. While using marijuana, I should not drive, operate heavy machinery or engage in any activities that require me to be alert and/or respond quickly. I understand that if I drive while under the influence of marijuana, I can be arrested for “driving under the influence.”
Potential side effects of marijuana include, but are not limited to, the following: dizziness, anxiety, confusion, sedation, low blood pressure, impairment of short-term memory, euphoria, abnormal sleep, irregular heartbeat, decrease of blood pressure in the vertical position, difficulty in completing complex tasks, suppression of the body’s immune system, inability to concentrate, impaired motor skills, paranoia, psychotic symptoms, general apathy, depression and/or restlessness. Marijuana may exacerbate schizophrenia in persons predisposed to that disorder - such as having a parent or sibling that has experienced psychosis. In addition, the use of marijuana may cause me to talk or eat in excess, alter my perception of time and space, and impair my judgment. All acute side effects are dose dependent and generally disappear within hours or 1 - 3 days without specific treatment.
I understand that using marijuana while under the influence of alcohol and/or sedatives is not recommended. Additional side effects may become present when using both alcohol and/or sedatives and marijuana.
Women should not consume cannabis products while planning to become pregnant, during pregnancy, or while breastfeeding.
Smoking marijuana may cause respiratory problems and harm, including bronchitis, emphysema, and laryngitis. In the opinion of many researchers, marijuana smoke contains known carcinogens and smoking marijuana may increase the risk of respiratory diseases and cancers of the lung, mouth and tongue. In addition, marijuana smoke contains harmful chemicals known as tars. If I begin to experience respiratory problems when using marijuana, I will stop using it and report my symptoms to my medical provider.
The risks, benefits and drug interactions of marijuana are not fully understood. If I am taking medication or undergoing treatment for any medical condition, I understand that I should consult with my treating physicians(s) before using marijuana and that I should not discontinue any medication or treatment previously prescribed unless advised to do so by the treating physician.
Individuals may develop a tolerance to and/or dependence on marijuana. I understand that if I require increasingly higher doses to achieve the same benefit or if I think that I may be developing a dependency on marijuana I should seek treatment with my primary care doctor or addiction medicine specialist.
Withdrawal symptoms have been observed in recreational cannabis users and include anxiety, restlessness, insomnia, and diarrhea.
Symptoms of marijuana overdose include but are not limited to nausea, vomiting, hacking cough, disturbances in heart rhythm, numbness in hands, feet, arms or legs, anxiety attacks and incapacitation. If I experience these symptoms, I agree to immediately go to the nearest emergency room.
Therapy should always start with low doses, slowly increasing, so that the individual dose can be determined and unwanted side effects can be avoided.
I have had, or will have, the opportunity to discuss these matters with Sharon Reif, NP and to ask questions regarding anything I may not understand or that I believe needs to be clarified. I acknowledge that Sharon Reif, NP has not provided a recommended treatment of my condition with medical marijuana. This document outlines and informs me of the risks, complications of any recommended treatment I choose to undertake under my own judgment after obtaining the certification.
I, for myself, my heirs, assigns, or anyone acting on my behalf, hold Sharon Reif, NP and her agents, free of and harmless from any responsibility for any harm resulting to me and/or other individuals because of my Medical Marijuana use. I certify that I fully understand the potential risks and side effects related to the use of Medical Marijuana as described above. In using Medical Marijuana, I fully accept responsibility and assume the risks and side effects associated with its use.