I understand that Dr. Kenneth Zahl is helping me with the treatment of my chronic medical problem.
In considering the possibility of using medicinal cannabis, it is important to recognize that the risks of medicinal cannabis may be impacted by specific medical conditions and patterns of use. I understand what has been explained to me and agree to the following conditions of treatment:
1. I must prevent children and adolescents from gaining access to medicinal cannabis because of potential harm to their well-being. I will store cannabis in locked cabinets to prevent anyone else from using it.
2. I know that some people cannot control their use of cannabis. One example is using cannabis for reasons other than for the indication for which it was prescribed, like "getting stoned." This may lead to not going to work, or not doing my household chores. I agree to discuss this with my doctor if this happens.
3. I realize that unless specifically recommended by my doctor, I should abstain from medicinal cannabis if:
-----a. I am pregnant or if I am of child-bearing age and don't use effective birth methods.
-----b. I am middle-aged or older and have a heart disease or heart rhythm problem
-----c. I have a history of serious mental illness (e.g., schizophrenia, mania, or a history hallucinations or delusions)
4. In order to reduce the risk of lung disease, I will avoid smoking cannabis with tobacco, avoid deep inhalation or breath-holding, and use a vaporizer rather than smoke or use a water pipe.
5. I will not drive a car or operate heavy machinery for 3-4 hours after use of medicinal cannabis, or longer if larger doses are used or the effects of impairment persist. I will use a designated driver for automobile transportation if I have to go out sooner than 3-4 hours after taking this medicine.
6. As the potency of cannabis varies widely I will use the minimum amount of medicinal cannabis needed to obtain relief from pain or other symptoms. When trying a new strain of cannabis, I will start with a very small amount and wait at least 10 minutes to see how it affects me.
7. If thought advisable by my health care provider, I might want to substitute one of the Food and Drug Administration (FDA) approved medicines containing THC rather than take natural cannabis.
8. I might notice a withdrawal syndrome for two weeks if I stop cannabis abruptly. Trouble getting to sleep and angry outbursts might require that I withdraw from the cannabis slowly.
9. I understand that the course of treatment will have to be re-evaluated regularly after I start the medicinal cannabis.
10. I will not use medicinal cannabis in public places.
11. I know there is no legal precedent to help me if I am terminated from employment if a urine toxicology screen is positive for cannabis.
12. I know that I may be asked to reduce or stop my intake of opioids (narcotics), sedative-hypnotics (benzodiazepines), and/or alcohol. This will be done to reduce the risk of side-effects from a combination of medications that affect the central nervous system.
I am of full age, I certify that I am a legal resident of the Commonwealth of Pennsylvania and been truthful in representing my medical condition to Dr. Zahl and his staff. I realize if any statements I made were willfully false that I am subject to punishment.
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