Paul Weatherly MA, CDP
Focus of Training
1)
2)
3)
4)
To develop a better understanding of marijuana
and its use as a medication
To identify various dilemmas for CDP(T)’s working
with clients and patients who are using marijuana
for medicinal purposes.
To improve understanding of the pharmacology
supporting marijuana for medicinal purposes.
To begin the discussion for agencies and providers
regarding policy and procedures regarding clients,
patients and counselors using marijuana as a
medication.
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2)
3)
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7)
Medical Marijuana Law
CDP Law
Uniform Disciplinary Act
American’s With Disabilities Act
Uniform Substance Control Act
NAADAC Code of Ethics
Overview of Medical Marijuana
Pharmacology
1)
2)
3)
4)
Decriminalization of Marijuana
Legalization of Marijuana
Impact of Marijuana Use on
Adolescents and Adults
Treatment Methodology for
Marijuana Addiction
Intent:
1.
2.
There is medical evidence that some patients with
terminal or debilitating medical conditions may, under
their health care professional's care, benefit from the
medical use of cannabis.
Humanitarian compassion necessitates that the decision
to use cannabis by patients with terminal or debilitating
medical conditions is a personal, individual decision,
based upon their health care professional's professional
medical judgment and discretion.
Question:
Is medical marijuana legal?
Answer:
Marijuana possession is illegal in Washington. The medical
marijuana law provides protection from arrest or other
criminal sanctions for qualified patients and designated
caregivers who are complying with the law. People who
qualify have a valid reason to possess a 60-day supply of
marijuana. However, medical marijuana is not legal under
federal law. There is no protection for people who are
arrested or charged under federal law.
http://www.doh.wa.gov/hsqa/medical-marijuana/FAQmore.htm
Question:
Can a Patient be prescribed marijuana
for medical use?
Answer:
No!
Doctors may not "prescribe" marijuana
for medical use under federal law,
though they can "recommend" its use
under the First Amendment.
Question:
How is a patient allowed to use marijuana as a
medication if it is not prescribed?
Answer:
A Health care professional licensed in WA may not be
prosecuted for advising a qualifying patient about the
risks and benefits of medical use of marijuana or that
the qualifying patient may benefit from the medical
use of marijuana.
Question:
What kinds of health care professionals are eligible to
advise patients about medical uses of marijuana?
Answer:
 licensed physician
 licensed physician assistant
 licensed osteopathic physician
 licensed osteopathic physicians' assistant
 licensed naturopath
 licensed advanced registered nurse practitioner
Question:
What conditions must the health care professional meet prior to recommending
the use of marijuana as a medication?
Answer:
A health care professional may only provide a patient with valid documentation if
he or she has a newly initiated or existing documented relationship with the
patient related to the diagnosis and ongoing treatment or monitoring of the
patient's terminal or debilitating medical condition after:
 a physical examination of the patient as appropriate, based on the patient's
condition and age
 documented the terminal or debilitating medical condition of the patient in the
patient's medical record and that the patient may benefit from treatment of
this condition or its symptoms with medical use of cannabis
 informed the patient of other options for treating the terminal or debilitating
medical condition
 documented other measures have been attempted to treat the terminal or
debilitating medical condition that do not involve the medical use of cannabis
Question:
What does valid documentation mean (green card)?
Answer:
Recommendations must be written on tamperresistant paper. They must include an original
signature by the healthcare provider, a date, and a
statement that says in the healthcare provider's
professional opinion the patient may benefit from the
medical use of marijuana. The use of a copy of the
patient's medical records in lieu of a recommendation
is prohibited.
Question:
What does terminal or debilitating medical condition mean?
Answer:
 Cancer, human immunodeficiency virus (HIV), multiple sclerosis, epilepsy or
other seizure disorder, or spasticity disorders
 Intractable pain, limited for the purpose of this chapter to mean pain
unrelieved by standard medical treatments and medications;
 Glaucoma, either acute or chronic, limited for the purpose of this chapter to
mean increased intraocular pressure unrelieved by standard treatments and
medications
 Crohn's disease with debilitating symptoms unrelieved by standard treatments
or medications
 Hepatitis C with debilitating nausea or intractable pain unrelieved by standard
treatments or medications
 Diseases, including anorexia, which result in nausea, vomiting, wasting,
appetite loss, cramping, seizures, muscle spasms, or spasticity, when these
symptoms are unrelieved by standard treatments or medications
Question:
What are most researched medical conditions that are
illustrate the most credible uses of marijuana as a
medication?
Answer:
 Wasting syndrome associated with antiretroviral
drugs and chemo/radiation therapy
 Gastrointestinal disorders and diseases
Question:
How does an individual get a medical condition recognized
for treatment with medical marijuana?
Answer:
Anyone may petition the commission to add a condition to
the list. By law, the commission will consult with the Board
of Osteopathic Medicine and Surgery. For more information
about this process, you may contact the commission at:
Medical Quality Assurance Commission
P.O. Box 47866
Olympia, WA 98504-7866
http://www.doh.wa.gov/hsqa/medical-marijuana/FAQmore.htm#3
Question:
Can a person be arrested or prosecuted
for possession of medical marijuana?
Answer:
No, a patient in compliance with medical
marijuana law may not be arrested or
prosecuted.
Question:
What is non-compliance with this law?
Answer:
The investigating peace officer does not possess evidence that:
1.
The designated provider has converted cannabis produced
or obtained for the qualifying patient for his or her own
personal use or benefit
2.
The qualifying patient has converted cannabis produced or
obtained for his or her own medical use to the qualifying
patient's personal, nonmedical use or benefit
3.
The designated provider has served as a designated
provider to more than one qualifying patient within a
fifteen-day period
Question:
How much medical marijuana may a patient
or provider possess?
Answer:
A qualifying patient or designated provider
may have a 60-day supply of medical
marijuana. A 60-day supply is defined as 24
ounces and 15 plants.
Question:
What is the average daily dose based on
the definition of the 60 day supply?
Answer:
11.2 grams
Question:
What is considered a therapeutic dose?
Answer:
The law and literature on the use of medical
marijuana does not define a therapeutic dose.
1. A urinalysis test or blood test can not be used to
determine if a patient is using as recommended or
abusing marijuana.
2. The patient self doses based on achieving the
desired result to relieve symptoms.
Question:
Does the law recommend a particular route of
administration?
Answer:
No, the patient can use marijuana in anyway he or she
feels is the best to obtain the desired result.
1. Smoking or Inhaling
2. Oral Consumption
3. Transdermal Delivery
 Euphoria
 Paranoia
 Fatigue
 Loss
of Motivation
 Memory Loss
 Weight gain or loss
Question:
Do patients complain about the side effects of
medical marijuana or cannabinoid derivative
prescription drugs?
Answer:
Yes!!!!!
The number one complaint was
euphoria.
Dronabinol (Marinol)- synthetic form of delta-9-THC was
approved by the FDA in 1985
Nabilone (Cesamet): This drug is a synthetic, substituted
cannabinoid approved by the FDA in 2006
Delta-9-THC/Cannabidiol (Sativex): Sativex was
approved in Canada for treatment of neuropathic pain in
patients with MS and as an adjunct for pain in cancer
patients. It is currently undergoing clinical trials in the U.S.
for cancer pain.
Rimonabant (Acomplia): FDA approval was denied and
approval by the European Commission was withdrawn
due to the emergence of side effects, including depression
and suicidality.
Question:
What is a Schedule I drug?
Answer:
1.
The drug or other substance has a high potential for
abuse.
2.
The drug or other substance has no currently accepted
medical use in treatment in the United States.
3.
There is a lack of accepted safety for use of the drug or
other substance under medical supervision.
http://www.deadiversion.usdoj.gov/21cfr/21usc/812.htm
Question:
Why is marijuana a schedule I drug?
Answer:
Under the CSA, marijuana is classified as a Schedule I
drug, which means that the federal government views
marijuana as highly addictive and having no medical
value.
Question:
What is a schedule II drug?
Answer:
1.
The drug or other substance has a high potential for
abuse.
2.
The drug or other substance has a currently accepted
medical use in treatment in the United States or a
currently accepted medical use with severe restrictions.
3.
Abuse of the drug or other substances may lead to severe
psychological or physical dependence.
http://www.deadiversion.usdoj.gov/21cfr/21usc/812.htm
Question:
If marijuana is being considered a medication, will it
be moved to Schedule II?
Answer:
The AMA, NORMAL, and various state attorney
generals have petitioned the congress to do this but to
date congress has denied the petitions.
Dilemma occurs when laws and ethical
guidelines are in conflict. The following laws
create conflict for healthcare providers not
protected by medical marijuana law:
1. Uniform Disciplinary Act
2. Americans With Disabilities Act
3. Chemical Dependency Professional Law
Question:
Are Alcoholics and Drug Addicts qualified individuals
with a disability?
Answer:
No, A qualified individual with a disability shall not
include any employee or applicant who is currently
engaging in the illegal use of drugs, when the covered
entity (employer, school, treatment program, etc.) acts
on the basis of such use.
http://www.ada.gov/pubs/adastatute08mark.htm#12114a
Question:
Are Alcoholics and Drug Addicts qualified individuals with a disability?
Answer:
Yes, history of illegal drug use does not prevent an alcoholic or drug addict
from being a qualified individual with a disability who
1.
has successfully completed a supervised drug rehabilitation program
and is no longer engaging in the illegal use of drugs, or has otherwise
been rehabilitated successfully and is no longer engaging in such use
2.
is participating in a supervised rehabilitation program and is no longer
engaging in such use
3.
is erroneously regarded as engaging in such use, but is not engaging in
such use
It would not be a violation for a covered entity to adopt or administer
reasonable policies or procedures, including but not limited to drug testing,
designed to ensure that an individual described in paragraph (1) or (2) is no
longer engaging in the illegal use of drugs.
http://www.ada.gov/pubs/adastatute08mark.htm#12114a
Question:
Are there laws that govern the conduct, scope
of practice and consumption of alcohol and
drugs by CDP(T)’S.
Answer:
Yes!
There are stipulations regarding these areas
in RCW 18.130.180.
Three stipulations in RCW 18.130.180 have the potential
to create conflicts for CDP’s.
(7) Violation of any state or federal statute or
administrative rule regulating the profession in question,
including any statute or rule defining or establishing
standards of patient care or professional conduct or
practice
(12) Practice beyond the scope of practice as defined by
law or rule
(23) Current misuse of:
(a) Alcohol;
(b) Controlled substances; or
(c) Legend drugs
http://apps.leg.wa.gov/RCW/default.aspx?cite=18.130.180
Question:
What are the legally defined competencies of a CDP?
Answer:
(6) "Core competencies of chemical dependency counseling"
means competency in the nationally recognized knowledge,
skills, and attitudes of professional practice, including
assessment and diagnosis of chemical dependency, chemical
dependency treatment planning and referral, patient and
family education in the disease of chemical dependency,
individual and group counseling with alcoholic and drug
addicted individuals, relapse prevention counseling, and case
management, all oriented to assist alcoholic and drug
addicted patients to achieve and maintain abstinence
from mood-altering substances and develop independent
support systems.
http://apps.leg.wa.gov/RCW/default.aspx?cite=18.205.020
Question:
Does the code of ethics for the chemical dependency
field offer guidance regarding patients who use
marijuana for medical conditions?
Answer:
Yes!
Five of the nine principles in the code offer implicit
insight regarding medical marijuana but offer no
solutions.
Principle 4: Trustworthiness
I understand that effectiveness in my profession is largely based on the ability to
be worthy of trust, and I shall work to the best of my ability to act consistently
within the bounds of a known moral universe, to faithfully fulfill the terms of
both personal and professional commitments, to safeguard fiduciary
relationships consistently, and to speak the truth as it is known to me.
1.
I shall never misrepresent my credentials or experience.
1.
I shall make no unsubstantiated claims for the efficacy of the services I
provide and make no statements about the nature and course of
addictive disorders that have not been verified by scientific inquiry.
1.
I shall constantly strive for a better understanding of addictive disorders
and refuse to accept supposition and prejudice as if it were the truth.
Principle 5: Compliance with Law
I understand that laws and regulations exist for the good
ordering of society and for the restraint of harm and evil, and I
am aware of those laws and regulations that are relevant both
personally and professionally and follow them, while reserving
the right to commit civil disobedience.
1.
I understand that the determination that a law or
regulation is unjust is not a matter of preference or
opinion but a matter of rational investigation,
deliberation, and dispute.
2.
I willingly accept that there may be a penalty for justified
civil disobedience, and I must weigh the personal harm
of that penalty against the good done by civil protest.
Principle 6: Rights and Duties
I understand that personal and professional commitments and
relationships create a network of rights and corresponding duties. I
shall work to the best of my ability to safeguard the natural and
consensual rights of each individual and fulfill those duties required
of me.
1.
I understand that justice extends beyond individual relationships
to the community and society; therefore, I shall participate in
activities that promote the health of my community and
profession.
2.
I shall, to the best of my ability, actively engage in the legislative
processes, educational institutions, and the general public to
change public policy and legislation to make possible
opportunities and choice of service for all human beings of
any ethnic or social background whose lives are impaired by
alcoholism and drug abuse.
Principle 8: Preventing Harm
I understand that every decision and action has ethical implication leading either
to benefit or harm, and I shall carefully consider whether any of my decisions or
actions has the potential to produce harm of a physical, psychological, financial,
legal, or spiritual nature before implementing them.
1. I shall terminate a counseling or consulting relationship when it is
reasonably clear that the client is not benefiting from the relationship.
2. I understand an obligation to protect individuals, institutions, and the
profession from harm that might be done by others. Consequently, I am aware
that the conduct of another individual is an actual or likely source of harm to
clients, colleagues, institutions, or the profession, and that I have an ethical
obligation to report such conduct to competent authorities.
Principle 9: Duty of Care
I shall operate under the principle of Duty of Care and shall maintain a
working/therapeutic environment in which clients, colleagues, and
employees can be safe from the threat of physical, emotional or intellectual
harm.
1.
I respect the right of others to hold opinions, beliefs, and values
different from my own.
2.
I shall strive for understanding and the establishment of common
ground rather than for the ascendancy of one opinion over another.
3.
I shall maintain competence in the area of my practice through
continuing education, constantly improving my knowledge and skills in
those approaches most effective with my specific clients.
4.
I shall scrupulously avoid practicing in any area outside of my
competence.
http://www.ndbace.org/forms/NAADACCodeofEthics-2004.pdf
The Problem:
1. Marijuana is a schedule I drug.
2. The job of a CDP is to assist the patient in finding
ways to maintain abstinence and create a clean
and sober support system.
3. CDP’s are not identified as protected as health care
providers in the medical marijuana law.
4. The UDA requires CDP’s to follow all state and
federal laws related to the profession.
The foundation to the implementing a solution to the
dilemmas presented lies in:
1. Developing agency policy and procedure that
clearly identifies the criteria for accepting a
medical marijuana patient for addiction treatment
or for referring a medical marijuana patient to
another addiction treatment agency.
Policy and Procedure for Referral:
1. Create criteria to determine a medical marijuana
patient’s eligibility for assessment and evaluation
of a substance use disorder.
2. Create procedures for documenting assessment
outcomes that include marijuana abuse and
dependence for medical marijuana patient.
3. Create procedure for documenting diagnostic
impressions used to determine assessment
outcomes.
4. Document Urinalysis or Blood test results.
Policy and Procedure for admission to Treatment
1.
Develop policy defining the agency’s philosophy
regarding medical marijuana
2.
Develop policy defining the role of a CDP treating
medical marijuana patients.
3.
Create criteria to determine a medical marijuana
patient’s eligibility for assessment and evaluation of a
substance use disorder.
4.
Create procedure for documenting diagnostic
impressions used to determine assessment outcomes.
5.
Create procedures to determine patient’s use periods
prior to care, during care and post-care.
Policy and Procedure for admission to Treatment
(cont)
1. Create procedures to determine patient’s use
periods prior to care, during care and post-care.
2. Develop treatment planning guidelines that clearly
demonstrate the ongoing benefits of maintaining
the therapeutic relationship.
3. Create policies that define levels of acceptable
THC metabolites present in a UA and how to
address spikes in the THC creatinine ratio
Policy and Procedure for admission to Treatment (cont)
1.
Develop policies that define purpose and frequency of
urinalysis
2.
Develop policies to define relapse on medical
marijuana and procedures for documenting the
relapse.
3.
Develop policies that define expectations for
participation in treatment and mandatory reporting
responsibilities if a medical marijuana patient violates
the conditions that qualify them as a medical
marijuana patient.
Problem: Retaining a CDP using medical marijuana
Counselor in Recovery is recommended medical
marijuana for a medical condition.
1.
Develop agency philosophy defining “being in
recovery”.
2.
Develop agency definition of impaired professional
including acceptable times for use pre and post work
hours, UA tolerance levels and creatinine ratios.
3.
Develop policy defining duties in agency and
stipulations on serving different patient populations.
Problem: Zero tolerance for CDP using medical
marijuana and Counselor in Recovery is
recommended medical marijuana for a medical
condition.
1. Develop policy and procedure for documenting
termination and reporting use to DOH.
2. Develop policy and procedure for documenting
leave of absence and completion of WHPS
program.
Problem: CDP not in recovery who would not meet
diagnostic criteria for substance abuse or dependence
is recommended to use medical marijuana for a
medical condition.
Question:
Should agencies have different standards for CDP’s
who are in recovery from standards for CDP’s who do
not meet criteria warranting the need to be in
recovery?
Problem:
Medical marijuana patient leaves treatment and gets
in an accident
Question: Is the agency liable knowing a patient
potentially is leaving treatment under the influence.
Hint: Use of medical marijuana is not an affirmative
defense for driving under the influence.

Allows for the licensure and regulation of
marijuana production, distribution, and
possession for persons over twenty-one
Removes state-law criminal and civil
penalties for activities that it authorizes
Taxes marijuana sales
Earmarks marijuana-related revenues

Source: I-502
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The new law:
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
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Removes state-law prohibitions against producing,
processing, and selling marijuana, subject to licensing and
regulation by the liquor control board
Allows limited possession of marijuana by persons aged
twenty-one and over (up to one oz of processed marijuana)
Imposes 25% excise taxes on wholesale and retail sales of
marijuana, earmarking revenue for purposes that include
substance-abuse prevention, research, education, and
healthcare.
Laws prohibiting driving under the influence would be
amended to include maximum thresholds for THC blood
concentration.
Question:
What is the intent of the law?
Answer:




Create Regulations for the purchase and
possession of marijuana
Generate State Revenues
Create Protections for Public Safety
Creates Safeguards for Medical Marijuana Patients
Question:
What is the legal age to buy and
possess marijuana?
Answer:
Adults age 21 and older and selling
marijuana to minors will remain a
felony
Question:
How will legalizing marijuana protect our
youth?
Answer:



Selling marijuana to minors will remain a felony
Restricts advertising and bans advertising in places
frequented by youth.
New tax revenue is dedicated to proven community
and school-based prevention programs.
Question:
How will the state liquor board obtain marijuana to
sell to adults over the age of 21?
Answer:
 Washington farmers and businesses will be allowed
to apply for special licenses to grow and sell
marijuana. Washington farmers and businesses will
be allowed to apply for special licenses to grow and
sell marijuana.
 State employees will not be involved in growing,
distributing, or selling marijuana.
Question:
How will the State of Washington regulate the
growth and sales of marijuana?
Answer:
State agencies will regulate numbers of stores
per county, operating hours, security, quality
control, labeling, and other health and safety
issues.
Question:
How does the law regulate the advertising and
sales of marijuana?
Answer:
Marijuana will only be available in stores that
sell no other products, are located at least
1,000 feet from schools, playgrounds, and
parks, and do not display marijuana in a way
that is visible to the public.
Question:
How does the law regulate the use and growing
of marijuana?
Answer:
Prohibits public use and display of
marijuana.
 Does not allow home growing for
people who are not medical marijuana
patients.

Question;
How does the law make are roads safe from
marijuana users?
Answer:
 A new marijuana DUI standard that operates
like the alcohol DUI standard will be
established.
 Sets a science-based limit of 5ng/ml active
THC blood concentration.
Question:
Where will the revenue the law generates come
from?
Answer:
According to the state Office of Financial
Management, a new 25% marijuana excise tax,
combined with retail sales and B&O tax, will
generate more than half a billion dollars in new
revenue each year.
Question:
How will all of the revenue generated be
dispersed?
Answer:
 40% of the new revenues will go to the state
general fund and local budgets.
 60% will be dedicated to substance-abuse
prevention, research, education and health
care.






The problem with Reefer Madness.
The problem with Hemp for Victory.
The problem with medical marijuana.
The problem with legalizing marijuana.
 The problem with adolescents and young
adults.
Underdeveloped prefrontal cortex’s.
Adolescent defense mechanisms are
amygdala based.

Mixed messages are most commonly broken down and
evaluated for relevance in the adolescent brain by source
◦ Peers
◦ Siblings
◦ Parents
◦ Disciplinarians-Tell story of Silver Bow Sheriff and boys balls will fall off
◦ Teachers
◦ Coaches
◦ Counselors
 Youthful counselors say 20 to 30-cool aunts and uncles
 Older counselors say 45 to 65- grandparents
 Middle adult counselors 30 to 45- mom and dad
Question:
What is the most problematic aspect of doing
credible research on the short and long term
effects of marijuana?
Answer:
 DNA
 Complex biochemistry of marijuana
 A Dutch Dr. once described the biochemical
experience of using marijuana as being as
individual as a snowflake.
Thank you for your Time and
Interest in the topic!!!