An overview of the Arizona Medical Marijuana Certification Process
Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) are qualifying conditions with adequate records showing the results of lab tests.
ALS is a progressive neurologic disease, in which the motor neurons that control skeletal muscles deteriorate. Since all skeletal muscles require nerves for stimulation, the loss of the nerves leads to atrophy or wasting of the muscles.
Crohn’s Disease is a chronic inflammatory disease of the intestinal tract, more often in the small intestine. The precise cause is unknown, but many researchers regard this as an autoimmune disorder – one in which your own immune system fails to recognize cells and tissues as “self.” Several factors will increase the risk of developing Crohn’s including a high fat diet and smoking.
Diagnosis of Crohn’s requires a comprehensive evaluation that includes a physical exam, lab work and an endoscopy or colonoscopy. It cannot be diagnosed in a primary care office or an MMJ certification center.
MMJ may help with the very severe pain that is associated with Crohn’s. However, since smoking is a recognized risk factor for making Crohn’s worse, a person with Crohn’s should NEVER consider smoking marijuana for pain relief.
A condition very similar to Crohn’s Disease is Ulcerative Colitis. These diseases share some characteristics but have significant differences, too, such as the nature of the lesion (ulcer) and locations. Ulcerative Colitis is not on the list of qualifying conditions, but a patient may qualify if they can demonstrate severe and chronic pain because of the disease.
Cancer is a very broad term, encompassing many types of disorders. Medically, cancer is the transformation of a normal, healthy cell into an unhealthy cell because of the loss of certain, specific cell growth signaling features. In short, the cell never stops growing. Medical marijuana is thought to induce "programmed cell death" in these cells.
In order to qualify for Medical Marijuana use, a patient must have a diagnosis of cancer - which can only be made by a Board-certified cytopathologist, based on examination of a tissue specimen.
One of the first recognized benefits of marijuana use was the improvement in the vision of some people with Glaucoma, a condition in which the pressure of the eye increases and causes a distortion of vision. The eye is a sphere filled with fluid. In fact, there are two chambers and two types of fluid in the eye. The fluid is not static; that is, the fluid in your eye now is not the fluid you had last year or even last month. It has to be constantly replenished. The fluid in the front chamber of the eye, aqueous humor, is made in the rear chamber of the eye and must pass into the front chamber by one of two passageways. One of these is narrow and one is open or wide. When one or both of these is blocked, the pressure increases in the rear chamber. This leads to distortion of the shape of the sphere, and changes the focus on the retina (at the back of the eye). The type of glaucoma is based on which chamber is obstructed, hence a person may be diagnosed with Open-Angle Glaucoma or Narrow-Angle (sometimes also called acute-angle) Glaucoma. Medical Marijuana is most appropriate for open-angle glaucoma because narrow-angle glaucoma is a medical emergency, requiring immediate treatment to prevent blindness. However, please understand there are many highly effective medications available for treating glaucoma.
Diagnosis is made by an ophthalmologist
Hepatitis C is one of several forms of viral hepatitis, or an infection of the liver. Formerly, it was called non-A, non-B Hepatitis because, although it showed characteristics of both Hepatitis A and Hepatitis B, it is clearly different. The virus is designated as the Hepatitis C Virus, or HCV. Untreated, Hepatitis C can lead to deadly outcomes preceded by horrific pain.
Hepatitis C is diagnosed by detecting the antibodies to the virus, anti-HCV.
Besides medical marijuana to control Hep C, there are now medications that cure Hep C.
Severe and Chronic Pain is the most common qualifying condition for a medical marijuana user in Arizona, accounting for more than three of four certified users. The reason for this is obvious to physicians – it is the broadest category. Unfortunately, to regulators and politicians opposed to the use of medical marijuana, it is regarded as the qualifying condition most likely to be abused. When certifying physicians are investigated for fraud, it is usually associated with this category – especially in younger patients. Therefore, this qualifying condition requires the greatest level of scrutiny by the physician.
Pain is totally subjective. Every person interprets severity of pain differently. High pain to one may be moderate pain to another. There are numerous pain scales (called visual analog scales) which attempt to provide some standardization between patients. I always ask patients to provide a number between one and ten to represent their pain level, then try to correlate that number to mild, moderate or severe.
The other element of this qualifying condition is that the pain is chronic. The medical expectation is that if a condition continues to invoke pain beyond a normal healing time, it becomes chronic; however, the most commonly accepted “rule of thumb” is that pain that last more than 3 months is chronic.
Post-Traumatic Stress Disorder, PTSD, is a form of anxiety brought about by witnessing or experiencing an event or circumstances that are traumatic or life-threatening. Traumatic events are wide-ranging; what is traumatic to one person may be a thrill to another. The key is how a person reacts to the trauma. Obvious types of traumatic events which may evoke PTSD include combat, sexual assault, or life-threatening accidents/events.
Medically, whenever a person encounters or experiences an event that id life-threatening, the body goes into a heightened state of activity, often referred to as “fight or flight.” The brain uses a different part of the nervous system to respond to or be prepared to respond to the event; different neurotransmitters respond; the heart, lungs, digestive system, immune system, even reproductive system change to respond to the threat. Unfortunately, even years after the trauma, there can be a triggering event that sends the brain and body into this protective mode. This is “post” (after the event) traumatic stress.
Some researchers estimate that at least 7 million people in the US have PTSD, but less than have have ever been evaluated or treated. While medical marijuana does not help with all forms of anxiety, it can be highly effective as a treatment for PTSD.
The requirements for becoming certified for medical marijuana based on PTSD are more rigorous than for other qualifying conditions. In short, the requirement is that the diagnosis of PTSD must be made by a specialist (some interpret the law to require a Board-certified Psychiatrist make the diagnosis; others do not agree with this interpretation) and the patient must be undergoing continuing treatment by a specialist.
Alzheimer’s disease is a progressive neurologic disease resulting in dementia, and frequently characterized by loss of recent memory. A very high number of people with Alzheimer’s disease (some sources estimate as high as 80%) will show symptoms of agitation or aggressiveness – sometimes even before a diagnosis of dementia. Currently, there are no recognized treatments for this condition, although physicians will prescribe several different classes of medication in attempts to reduce the severity of the agitation.
Agitation in Alzheimer’s disease is commonly associated with “Sundown Syndrome.” People with Alzheimer’s disease generally progress through several stages of cognitive deterioration (one authority uses a five-stage scale; another uses a seven-stage scale). As confusion worsens during the middle stages, the person is more likely to become more agitated in the evening or at night. This has been called “Sundown Syndrome.”
For purposes of medical marijuana, it needs to be noted that a diagnosis of dementia or even a diagnosis of Alzheimer’s disease is inadequate. There must be a diagnosis of Sundown Syndrome or Agitation.
Cachexia or Wasting Syndrome is a complication seen in the late or end-stages of most of severe and chronic diseases. According to one source, cachexia occurs in more than 20% of people with heart failure, 30% of people with chronic obstructive pulmonary disease, 60% of people with kidney disease and more than 80% of people with cancer. More than 9 million people have cachexia.
Cachexia is now defined clinically as 5% or more loss of body mass in a 12 month period – despite best efforts to promote adequate calorie intake – along with loss of muscle mass. Cachexia is associated with extreme fatigue, great difficulties in doing the activities of daily living, and significantly increases the risk of infection and other disease complications.
The underlying cause of cachexia is not well-understood, although recent research strongly suggests it is an inflammatory response to chronic disease, in which certain genes are “turned on” and targets diseased cells to be targeted for destruction. At the present time, there are no known effective treatments for cachexia.
Nausea is usually thought of as part of the clinical picture in patients with another condition, including (but not limited to):
As a qualifying condition for medical marijuana, severe nausea is very challenging to document. While the term “nausea” can be defined clinically as the feeling of the need to vomit, classifying the nausea as severe is more problematic, especially if vomiting is not part of the clinical picture. Ideally, the degree of severity would be identified as greater than mild or moderate. There are few validated analog scales for measuring the severity of nausea.
While the law does not specify the nausea as chronic (long term), in this practice we will expect to see past medical records adequately documenting patient reports of nausea and treatment failures.
Don't let all the paperwork for MMJ certification frighten you. In our office, we do most of the work for you - but you do have to do some yourself.
Most of the information required here is just like what you provide to other medical offices - name, address, contact information. You also consent for us to evaluate you for purposes of certification. It does not mean you are transferring your care to this office - unless you want to, of course.
We will also provide you with a written statement to advise you of the risks, as well as a warning about the risk to reproduction. Yes, even our 90 year old male patients get one.
This is one of the forms mandated by the State. When you sign it, you promise that the information you are providing is accurate, and promise not to sell or give away your lawfully-obtained medical marijuana.
This means you can not give a sample to a friend or relative.
All medical records are private, bu federal law. With this form, we promise you we will maintain your privacy.
This information lets us know about your qualifying condition, such as how it came about and how it affects you. We also need to know how it was diagnosed and when, and how it has been treated.
If you have seen a physician about your Qualifying Condition in the past 12 months, we need to have copies of the records. The law requires a certifying physician to review these records.
When you arrive for your appointment, we will have you complete some paperwork. Okay, a lot of paperwork. Sorry, but you should know. You should also know we are required to check the Board of Pharmacy Prescription Monitoring Program report on you. We'll show it to you to check for accuracy.
We need to take a picture of you - no hats, no glasses - so be prepared;
We need to have your Arizona Driver's License, or if unavailable, your U.S. passport. We will scan to upload to the state;
If you have a Supplemental Nutritional Assistance Program authorization, we need either the letter of award from the state, or a copy of your card with embossed name.
We will create digital copies of all of this, and upload it to the state.
There are provisions in the law for minors and caregivers to obtain Medical Marijuana cards.
Minors must also have a diagnosed Qualifying Condition; however, it must be certification from two qualified physicians that the patient is likely to benefit from the use of Medical Marijuana. Parents or legal guardians must agree to the minor having and using medical marijauna, and they need to obtain a special card. They are required to submit to a fingerprint check and pay a special fee.
The are are two fees - the fee for the State of Arizona and the office fee.
Arizona charges $150.00 for certification, unless you are homeless or on the Supplemental Nutritional Assistance Program - in which circumstance the fee is reduced to $75.00. Your card is good for two years.
I charge $135.00 for my services. That's all.
We see ads by some of the local "certification mills" with fees like "$10.00" or "$50.00." It's not true, but then again, they aren't reputable. They are charging one fee for the office visit, another for record review, another for certification. Don't go to a mill. The last thing you want is to have your card revoked by the state.
Assessment and certification for patients who qualify for medical marijuana.
4955 North Alma School Road, Chandler, Arizona 85224, United States
While we are happy to see "walk-in" patients, appointments are preferred to minimize waiting time.