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New York State Practitioner Education Medical Use of Marijuana 2-hr Required Course
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Section 3.0: The Use of Cannabis-based Products in Specific Patient Populations and Drug Interactions
The current medical and scientific research literature does not support the use of cannabis as a first line therapy, nor does the literature suggest that cannabis or cannabinoid therapies should replace an FDA-approved effective therapy for any condition.Note: New York State does NOT require failure on conventional therapy as a criterion to obtain product. Practitioners must review their patients’ past treatments when determining if they will benefit from the primary or adjunctive treatment with medical cannabis for their serious condition.
Before considering the recommendation of cannabis-based therapies, clinicians should be aware of the significant negative impact that cannabis use may have on certain patient populations, and clinicians should be aware of the known drug interactions associated with cannabis. Furthermore, clinicians should consider that cannabis-based products have not been studied to the same extent as FDA-approved medicines, and therefore there may be unknown risks to cannabis use, and there may be unknown drug interactions associated with cannabis use.
Part 1
The Use of Cannabis and Cannabinoids in Specific Patient Populations
The New York State qualifying conditions are as follows:
cancer
positive status for human immunodeficiency virus or acquired immune deficiency syndrome, provided that the practitioner has obtained from the patient consent for disclosure of this information that meets the requirements set forth in sections twenty-seven hundred eighty and twenty-seven hundred eighty-two of the public health law
amyotrophic lateral sclerosis
Parkinson’s disease
multiple sclerosis
damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity
epilepsy
inflammatory bowel disease
neuropathies
Huntington’s disease
chronic pain, defined as any severe debilitating pain that the practitioner determines degrades health and functional capability; where the patient has contraindications, has experienced intolerable side effects, or has experienced failure of one or more previously tried therapeutic options; and where there is documented medical evidence of such pain having lasted three months or more beyond onset, or the practitioner reasonably anticipates such pain to last three months or more beyond onset,
post-traumatic stress disorder
pain that degrades health and functional capability where the use of medical marihuana is an alternative to opioid use, provided that the precise underlying condition is expressly stated on the patient’s certification
substance use disorder
The patient must also have a condition or symptom that is clinically associated with, or is a complication of the condition noted above:
cachexia or wasting syndrome
severe or chronic pain resulting in substantial limitation of function
severe nausea
seizures
severe or persistent muscle spasms
post-traumatic stress disorder
opioid use disorder, but only if enrolled in a treatment program certified pursuant to Article 32 of New York State Mental Hygiene Law
In cannabis, THC is the main CB1 agonist that causes psychoactive effects in humans. Based on large-scale epidemiological studies of the recreational use of cannabis in young adults, THC has been shown to have an association with aggravating or precipitating a psychotic episode in persons with a susceptibility to such effects (1). Therefore, any patient with a history of psychotic illness including schizophrenia should avoid using cannabis, unless there is a clear indication and active engagement and collaboration of a treating psychiatrist. Also, a patient with a family history of a first degree relative with schizophrenia may be at increased risk of developing a psychotic illness, if the patient were to use THC-containing cannabis-based products.