Date:

I, ______________ (clinician name) am treating. _______          _____   (name of patient) for chronic pain.

1. I acknowledge that in medical school I learned nothing about the body’s endocannabinoid system or cannabis as medicine.

2. I began approving cannabis use by patients in _________________ (year)

3.. To educate myself about medicinal cannabis I have

• taken CME courses (please list)

• read relevant books and periodicals (please list)

• attended conferences on medicinal cannabis (please list)

4. I belong to a group of clinicians who share findings and observations re cannabis, and keep abreast of the emerging scientific and clinical evidence.

5. In treating pregnant women, I follow the “Best Practices Guidelines” developed by Wilson-King and Sexton for the Society of Cannabis Clinicians.

6.  I am familiar with the findings of Tashkin et al showing that cannabis smoking does not cause lung cancer or exacerbate COPD.

7. In general, I consider whole plant cannabis extracts more efficacious than single-molecule formulations.

8. Facilitating socialization is one of the major benefits of cannabis use. I support on-site consumption at cannabis dispensaries.

9. I strongly urge patients not to get behind the wheel when they’re stoned —an assessment only they can make.

10. Annual re-evaluations are required by medical board guidelines though in many cases they place an unnecessary, costly burden on patients.

11. I consider it unfair and UnAmerican that patients who do not use cannabis at work and who have shown no signs of impairment on the job can be fired on the basis of metabolites in their urine.

12. I am familiar with the extensive Clinical Evidence showing that pain patients can reduce or eliminate use of opiates, sedative-hypnotics and/or alcohol by using cannabis instead.