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Standards of Practice for the Clinical Use of Marijuana [hr]
“Physicians should use the same standard of care in recommending medical marijuana to patients as they would when recommending or approving any other medication.” — Dr. Frank Lucido, M.D

The Michigan Medical Marijuana Act protects doctors from legal or civil sanction by state professional and licensing boards and bureaus for recommending medical marijuana to their patients. Michigan Medical Marijuana Act Sec 4(f)

The U.S. Supreme Court ruled in Conant v. Walters, 309 F.3d 629, 2002 that doctors may discuss and recommend medical marijuana with their patients. Doctors may not assist patients in acquiring medical marijuana.

Medical marijuana recommendations must be signed by an M.D. or D.O. Other medical professionals in MI may not recommend medical marijuana.

Qualifying Conditions
The Michigan Medical Marijuana Act allows physicians to recommend medical marijuana to patients suffering from cancer, HIV/AIDS, glaucoma, hepatitis C, amyotrophic lateral sclerosis, Crohn's disease, agitation of Alzheimer's disease, and nail patella syndrome.

Additionally, a chronic or debilitating disease or medical condition, or its treatment, that produces 1 or more of the following; Cachexia or wasting syndrome, severe and chronic pain, severe nausea, seizures including but not limited to those characteristic of epilepsy, severe and persistent muscle spasms including but not limited to those characteristic of multiple sclerosis.

Obtaining a medical marijuana recommendation
Recommendations must be written on physician’s or clinic letterhead and include a description of the patient’s debilitating medical condition and a statement that reads; “In my professional opinion, the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient's debilitating medical condition or symptoms associated with the debilitating medical condition.” That document must then be signed by the physician.

Side effects
Medical marijuana is generally tolerated well by patients. Any side effects tend to be mild and transitory, lasting one week or less, as patients adjust. Common side effects include irritated throat/dry mouth, elevated heart rate, mild time and space disorientation, mild euphoria/general sense of well being, and in some instances drowsiness and motivation.

Special considerations
Patients being treated for respiratory ailments should consider alternative modes of ingestion other than smoking. Minor children require a second recommendation and a parent or guardian must be appointed as the primary caregiver.

Alternative treatment methods
Smoking medical marijuana is the most efficient method of ingestion in terms of introducing the maximum therapeutic dose into the blood stream in the least amount of time. However, doctors most often recommend alternative methods that do not harm the lungs and airways. There are alternative, safer methods of ingestion:
Vaporization: A device heats the plant material, volatilizing its therapeutic elements without the toxic by products of combustion.
Eat & drink: Medical marijuana can be cooked into foods and brewed into a tea.
Tincture: Vegetable oil based medical marijuana tinctures may be daubed on skin or mucus membranes.
Suppository: Medical marijuana can even be made into suppositories.

California Medical Board Standards
In January 1997 the California Medical Board published standards for physicians when recommending medical marijuana. Any reasonable and prudent physician would follow these accepted standards when approving any other medication.

Standards include:
The history and good faith examination of the patient
Development of a treatment plan with objectives
Provision of informed consent including discussion of side effects
Periodic review of the treatment's efficacy
Consultation as necessary
Proper record keeping that supports the decision to recommend

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