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How to Apply for the Oklahoma Medical Marijuana Program

Oklahoma voted medical marijuana into law on June 26, 2018, and has since signed granted over 145,000 patient and caregiver licenses. Patients licenses are valid for up to two years, and unlike other states, applicant’s need not have a “qualifying condition” to be approved.

To apply for a patient license in Oklahoma, you will have to provide the following:

• Your full name
• Your place of residence and mailing address
• Your date of birth
• Your contact information, including telephone number and email address
• Your doctor’s information and recommendation
• Your signature, which must be dated within 30 days of the date of application
• A full color digital photo of your head and top of shoulders taken on a white, or off-white background. (The photo must have been taken within the past 6 months.)

Keep in mind that only Oklahoma residents will be approved for a regular state license, although temporary licenses are available for visiting patients from other states. Applicants for a regular state license must prove they’re residents by providing a valid driver’s license, utility bills, or other accepted documents.

There is an application fee of $100. Medicaid (also known as SoonerCare) or Medicare applicants pay a reduced fee of $20. You must use a MasterCard, Visa, or Discover credit or debit card for payments. Prepaid cards from stores are also accepted.

Your transaction may include additional processing fees, which are non-refundable. Unapproved applicants are not subject to a refund.

Additionally, the application must be submitted within 30 days of the doctor’s appointment to be valid.

After the Application is Submitted

The OMMA reviews all submitted applications. If it meets all requirements, the OMMA will issue an approval letter with your license. Then your card will be mailed within 14 days of the date you submitted your application.

Incomplete applications will receive an email which details the reason(s) the submission is incomplete. You can log back into your account to make the needed corrections.

If the Department denies your application, you will receive a denial letter listing why it was rejected within 14 days of the date of submission.

You Can Include a Caregiver if You Need Help

Caregiver licenses are available for those who wish to take care of certain patients who need assistance with their treatment. This documentation can be obtained by filling out the Adult Patient Physician Recommendation Form. An application can be provided when submitting your application, or at a later date. The form can be accessed online using your OMMA account. A patient is allowed one caregiver at any given time.

The caregiver must be 18 or older and must submit proof that they are a resident of Oklahoma. There are no other parameters to qualify.

You can change your caregiver. Patients must submit a Patient Withdrawal of Caregiver Form to withdraw the first person before designating another caregiver. The patient is required to sign and submit a new Adult Patient Caregiver Designation Form for their desired new caregiver.

What Conditions Qualify for Medical Cannabis Treatment in Oklahoma?

Unlike other states, there’s no list of qualifying conditions in Oklahoma – making it a rather unique and unrestricted program.

Oklahoma’s State Question 788, the initiative that legalized medical cannabis, says “There are no qualifying conditions. A medical marijuana license must be recommended according to the accepted standards a reasonable and prudent physician would follow when recommending or approving any medication. No physician may be unduly stigmatized or harassed for signing a medical marijuana license application.”

While there are no qualifying conditions in Oklahoma, you must still be able to show that you will benefit from the use of cannabis. When visiting the doctor, be sure to have documents to demonstrate your medical needs. Documents include:

• Patient records and charts in detail
• Records of any physical therapy
• Current prescriptions being taken
• All hospital visits made by the applicant
• Medical test results

Once approved by their physician, applicants will need to apply through the state’s online system. Applications and payment are collected via omma.ok.gov. To login, applicants must use a valid email address which will be used to receive notices.

Submit Your Application at the OMMA Website

Applications are only being accepted at omma.ok.gov.

The following unexpired, valid documents can be used when submitting proof of residency online:

1) Proof of state residency – Digital, color copies of any of the following can be used:

• Oklahoma driver’s license (front and back is required)
• Oklahoma identification card (front and back is required)
• Voter I.D. license
• Certain utility bills. The calendar month must precede the date of the application. This excludes cellular telephone and internet bills
• A deed to any residential property in Oklahoma
• A current in-state rental agreement for residential property

2) Proof of identity – Digital, color copy of any of the following will suffice:

• Oklahoma driver’s license (front and back)
• Oklahoma state I.D. (front and back)
• U.S. passport or other U.S. government issued I.D.
• Tribal I.D. cards, which must be approved for identification purposes by the Oklahoma Department of Public Safety.
• U.S. Bureau of Indian Affairs identification card

3) A digital photograph of your full face

4) An Adult Patient Physician Recommendation Form that is dated 30 days or sooner than the application’s submission. NuggMD will provide users with the form.

5) SoonerCare (Medicaid) or Medicare I.D. card or enrollment documentation if you’re applying for the discounted registration rate of $20.

The NuggMD Process

When applying with NuggMD, applicants take the following steps:

1) Create a NuggMD account at nuggmd.com.

2) Choose the state in which you wish to apply.

3) Enter your required information, including age, name and address.

4) Fill out your medical history. Provide as much detail as you can to ensure your doctor will have all the information they need to evaluate your condition.

5) Input your payment info while waiting in the NuggMD virtual waiting room.

6) Once available, the physician will begin the medical evaluation using NuggMD’s telemedicine platform. The session can be as long or short as needed. Don’t hesitate to ask questions about your prognosis, how cannabis will fit into your treatment plan or anything else related to your visit.

A few of the more common questions asked during consultations include:

• Should I take CBD as well?
• What’s the best method of ingestion for me?
• Should I use more than one method of ingestion?
• What dosage should I use?
• How often should I consume?
• Will any other medications or herbs I’m using affect my cannabis treatment?
• Are there any health risks I should be concerned about?

Give your doctor a complete understanding of your health. Tell them about every medicine, supplement and vitamin you are taking. Doing so will allow them to warn you of any possible adverse drug interactions to be aware of.

NuggMD patients only pay $99. This is in addition to the cost of the online application.

Those who are approved receive instructions on how to complete the state registration. The instructions will arrive via email.

Don’t worry if you get confused during the process. Our expert customer service team is here to help you through the process.

What Cannabis Consumption Methods Are Available in Oklahoma?

All methods of consumption are available. This includes:

• Smoked or Vaporized Cannabis: The effects typically take moments to minutes and can last two to three hours at a time.
• Concentrates: These oils are versatile in usage. They can be added to smoking flower, used in edibles or even done in a dab. Keep in mind that extracted cannabis oil is much more potent than dried flower. When smoked, the effects should appear in a few minutes.
• Edibles: Often taking a half hour to two hours to kick in, edibles are longer-lasting options. They are incredibly potent, but due to their delayed onset effects, many overconsume. Be sure to start on a low dose and go slow from there.
• Topicals: Cannabis can penetrate the muscle but not into the blood with creams and balms. Taking near immediate effect, topicals are a popular choice among many users with body pains.

What Does Cannabis Feel Like?

If you’ve heard that cannabis will make you giggly, happier and relaxed, then you have a broad understanding of how marijuana feels. Depending on the strain, these effects and others can be more or less prominent in the experience. Other common effects of cannabis include:

• Changed perception of time
• Decreased energy, colloquially called “the couch lock”
• Giggles
• Happiness
• Increased energy
• Loss of concentration
• Relaxation
• Temporary memory loss

There’s also the occasional horror story depending on tolerance and/or dose. If you’ve had a little too much, you may feel somewhat disconnected from reality or experience some paranoia, possibly even hallucinate on a rare occasion. You may find yourself becoming more introspective and less outgoing. This may be coupled with a burst of creative energy.

In truth, both positive and negative effects vary from person to person. Until you know how you’ll react to cannabis, plan pleasant activities. Be around people you are comfortable with when you consume. Consider being in a place that makes you feel happy and comfortable as well.

And do NOT drink alcohol. It’ll most likely create an unpleasant effect of being way too intoxicated, resulting in a headache, room-spinning and even vomiting. Some may know it as being crossfaded.

What to Do if I Consume More Than I Should?

One of the most common and unpleasant side effects of marijuana overconsumption is anxiety. Individual levels vary by person, with stronger tolerances playing a factor. Remember, just because one friend can consume 25mg or more doesn’t mean you need to in order to feel the same effect. If you consume more cannabis than your tolerance allows, you’re very, very likely to become anxious.

Do your best to remain calm if you find yourself in this situation, and don’t be embarrassed. You aren’t alone. Many cannabis patients can tell you exactly what it feels like to have a panic attack after consuming a heavy dose.

Once you’re back to your normal self, call your doctor and have your dosage adjusted. Believe it or not, some people get extremely high from doses as small as 2.5mg THC. Each person metabolizes cannabinoids at varied rates. At the same time, consider having some CBD oil on hand. For some, it can help offset the effects of THC during these rare occasions.

Be sure to use the old cannabis adage “start low and go slow”! We can’t say this enough. You can always consume more, but you can never consume less. So, don’t rush it. Be patient. Listen to your physician’s instructions for ideal results.

Let’s Discuss Cannabis Hyperemesis Syndrome

It’s true that no one has died of an overdose from cannabis. However, you run a chance of developing Cannabis Hyperemesis Syndrome. If you experience symptoms such as severe vomiting, be sure to seek medical attention. Excess vomiting can cause dangerous dehydration and metabolic imbalances, so this really is a medical emergency.

And not to state the obvious, but if you’re under the influence of cannabis, get a ride to seek medical attention. Never attempt to drive yourself.

Cannabis Hyperemesis Syndrome is on the rise as more consumers take more significant doses of THC. The cause of the condition is unknown. It’s believed by some that CHS is the result of the over-stimulation of the body’s CB1 and CB2 receptors brought on by large doses of THC.

Cannabis Hyperemesis Syndrome seems to happen in three stages:

• The Prodromal stage is most mild nausea and pain in the stomach. In some cases, this can lead to a brutal cycle where patients consume more cannabis thinking it will relieve the condition. This is a process that can last for months, even years.
• The Hyperemesis stage is where the patient begins vomiting in larger amounts. They may suffer from dehydration and malnourishment due to an inability to hold anything down. A hot shower is often considered the only temporary source of relief from the nausea. See a doctor right away if this occurs.
• The Recovery stage begins after cannabis use ceases. Relief tends to come in days once the person stops consuming. That said, it can take months to fully recover. If cannabis use is reintroduced, the symptoms run a high probability of returning.

It is not certain why some consumers develop the condition and others do not. Meanwhile, some continue to dispute its validity.

That said, this is the state of cannabis today. It is a biphasic drug that offers varying effects at different dosages, and that threshold varies from person to person. This is  why it is vital to consume cannabis cautiously and responsibly.

Scientists can’t yet pinpoint who is likely to develop cannabis hyperemesis, as it can be a months-long process to develop. So, again, be sure to start low and go slow, listen to your body, and contact the doctor as soon as possible if you start to notice nausea or stomach discomfort.

Following the Law in Oklahoma

Oklahoma has the highest prison population per capita. Not just in the U.S., but the world. So, it’s best to remain on the right side of the law.

The state’s medical marijuana laws say that if you don’t have a patient license, but can show that you have a medical condition, then possession of up to 1.5 ounces without a valid card is a misdemeanor offense with fines not exceeding $400. Possession of any more can result in possible jail time. That said, drug paraphernalia remains illegal for non-card holders, who could face jail time. Card holders are exempt from the law.

Counties are allowed to determine how they prioritize non-violent cannabis offenses, which means people can still end up in jail for marijuana. In some cases, DAs have reportedly refused parolees the right to use medical cannabis, even if they have a card. Reports have also claimed that some DAs are instead steering offenders towards opiate-based options.

According to H.B. 1441, those driving under the influence of a Schedule 1 substance will be jailed for anywhere from 10 days to over a year, with their license possibly suspended for up to three years. This prohibition against driving under the influence applies to medical cannabis users as well. So your card won’t save you if you’re driving while high. Oklahoma also allows for property and vehicles to be seized in cannabis cases.

Additionally, while employers can’t discriminate against patients, consumption at work can still be restricted by the employer. The same goes for consumption in public places, just like tobacco and alcohol.

You cannot buy your cannabis anywhere but from an OMMA licensed medical marijuana dispensary, and you can’t sell your cannabis to anyone unless you’re a state-licensed dispensary. You also can’t give away your cannabis, not even for free to another patient, as unfair as that seems. And don’t even consider taking it out of state, whether or not that state allows cannabis use. It’s a federal crime to transport medical marijuana across state lines, and the penalties are very severe.

Need Help? Nugg’s Here for You

Nugg’s eager customer service team answers hundreds of questions each and every day via live chat and email. They think outside the box to help solve your cannabis problems. If there is a solution, they’ll find it to the very best of their abilities.

On the rare chance that Nugg is unable to help, the list below has information and links to Oklahoma legislators, regulators and some of the more active cannabis advocacy organizations. If you know of any other organizations we could add to this list, we’d love to hear from you.

Also, consider using this list to become more active in medical marijuana legislation. We’ve made great strides with legalization, but the battle for freedom of choice still rages on. It’s not time to rest on our laurels at this point. Please consider joining the marijuana community as we endeavor to end the War on Drugs once and for all.

Additional Resources

Medical Marijuana Registry

Oklahoma Medical Marijuana Authority

PO Box 262266

Oklahoma City, OK 73125-2600

OMMAGrower@ok.gov

OMMAProcessor@ok.gov

OMMADispensary@ok.gov

OMMACompliance@ok.gov

OMMAPhysicians@ok.gov

http://omma.ok.gov/

Legislators

State Legislature contacts

State Senate members

Governor Kevin Stitt

Activist Organizations

• Oklahomans for Health
• Oklahoma Cannabis Association
• Green the Vote
• Oklahomans for Cannabis
• New Health Solutions Oklahoma
• Americans for Safe Access
• American Trade Association for Cannabis and Hemp
• Law Enforcement Against Prohibition
• Marijuana Policy Project
• NORML
• Project CBD

Frequently Asked Questions About Medical Cannabis in Oklahoma

Where can I read the law for myself? 

Visit here for the full text: http://omma.ok.gov/Websites/ddeer/images/SQ%20788.pdf

How long does my patient’s license last?

Your license can last for up to two years before it needs to be renewed, unless your doctor establishes a shorter timeline for use.

Can I use my medical marijuana card from another state?

Out of state patients can obtain a temporary license for up to a month. The out of state license will cost $100, regardless of participation in public health programs or financial need. Do not make the mistake of using cannabis in Oklahoma without this license. The penalties for unlicensed possession can include jail time. It may seem unreasonable to pay the state $100 for the right to legally use cannabis for a short trip, but this expense is nothing compared to legal costs of defending yourself against illegal possession charges. To apply for your temporary card, go to the state’s website here and follow the instructions: http://omma.ok.gov/temporary-adult-patient-application-information1

How do I find a medical cannabis doctor?

You can find a list of approved physicians on this list provided by the OMMA, or simply head over to NuggMD to complete the entire process online: http://omma.ok.gov/Websites/ddeer/images/MM%20Registered%20Physicians.pdf

Is home growing allowed?

Yes, all licensed patients are able to cultivate at home. For specifics on amounts, check the question below.

How much cannabis am I allowed to possess for medical purposes?

Under Oklahoma laws, qualified patients or caregivers can legally possess up to three (3) ounces of medical cannabis. Approved patients are allowed to own six (6) mature plants as well as one (1) ounce of cannabis concentrates. They can also possess up to 72 ounces of edibles in addition to having up to eight (8) ounces of cannabis at their house.

What are the requirements for a minor to obtain a license?

Minors can obtain their medical marijuana license to possess, use and grow cannabis in Oklahoma. The minor must have signed recommendations from two different physicians as well as the signature of their parent or guardian. To learn more, visit http://omma.ok.gov/minor-patient-application-information1.

Will my information be kept private? 

Both your patient records and all inventory tracking records containing your patient information must comply with federal and state laws, including HIPAA, and inventory tracking records can’t be retained for more than 60 days. You can read the full text of protections provided under HB 2612 here in Sec. 7.

Will every dispensary sell the same products?

No, unlike other stores, dispensary supplies will vary. If you’re looking for a specific product, consider calling ahead to make sure the dispensary has the product you need.

What documents do I need to fill out my Oklahoma medical marijuana card application?

To apply for a medical marijuana card, you’ll need:

1) Proof that you’re an Oklahoma resident, which can be one of the following:

• Oklahoma driver’s license or ID
• Oklahoma voter ID card
• A utility bill from the month just before your application (cell phone and internet bills excluded)
• A deed to residential property that you own in Oklahoma
• A current residential rental agreement in Oklahoma (your name must be on the agreement)

2) Proof of your identity, which can be one of the following:

• Oklahoma driver’s license or ID
• Oklahoma identification card (front and back)
• U.S. passport or other photo ID that’s been issued by the U.S. government
• Tribal ID that’s approved by Oklahoma for identification purposes, including US Bureau of Indian Affairs ID or Oklahoma tribal photo IDs.

3) A clear digital, full color picture of your full face on a white or off-white background
4) Your Patient Physician Recommendation form that has been signed within 30 days of your application submission
5) Proof of SoonerCare or MediCare enrollment or 100% disabled veteran status if you’re applying for the discounted application fee of $20.

How long does it take to receive a state medical card?

It can take up to 14 days for your application to be approved after completing your online application. You should check your email frequently during this time as the OMMA may need additional documentation to complete the process. If you do not provide any missing information within the time limit, your application would be denied and you’d have to begin the process again. There is no refund for the application fee.

How much does a state card cost?

The application fee is $100. SoonerCare and MediCare patients and 100% disabled vets can apply for a discounted fee of only $20.

Is there a discount for purchasing medical marijuana in Oklahoma?

Unfortunately, no. Most states that offer recreational cannabis do have a tax discount, or no taxes, for medical marijuana purchases. Oklahoma is a medical marijuana only state though, and the state taxes all sales at the rate of 7%

Am I required to register with the state to become a medical marijuana patient?

Yes. You must first register with, and receive approval and a license from the Oklahoma Medical Marijuana Authority before using cannabis for medical purposes: “Patient”or”Qualified patient”means a person that has been properly issued a medical marijuana license pursuant to Title 63 O.S. § 420 et seq. and these rules. (Emergency Rules page 4)

Can employers still fire me for testing positive for cannabis on drug tests?

According to HB2612 page 23, your employer can’t fire you solely for your status as a medical marijuana patient unless:

• they are required to by federal law in order to obtain federal funding,
• the employee doesn’t have a valid medical marijuana license,
• they consume medical marijuana while at work, or
• the position involves a “safety sensitive” job.

The OMMA defines a safety sensitive job as “any job that includes tasks or duties that the employer reasonably believes could affect the safety and health of the employee performing the task or others including, but not limited to, any of the following:”

1. the handling, packaging, processing, storage, disposal or transport of hazardous materials,
2. the operation of a motor vehicle, other vehicle, equipment, machinery or power tools,
3. repairing, maintaining or monitoring the performance or operation of any equipment, machinery or manufacturing process, the malfunction or disruption of which could result in injury or property damage,
4. performing firefighting duties,
5. the operation, maintenance or oversight of critical services and infrastructure including, but not limited to, electric, gas, and water utilities, power generation or distribution,
6. the extraction, compression, processing, manufacturing, handling, packaging, storage, disposal, treatment or transport of potentially volatile, flammable, combustible materials, elements, chemicals or any other highly regulated component,
7. dispensing pharmaceuticals,
8. carrying a firearm, or
9. direct patient care or direct child care

(H.B. 2612 page 24, section K)

Does the state provide electronic cards immediately with applications?

Unfortunately no. Your state application can be submitted online, but the state then has up to 14 days to review your application. If your application is missing any pertinent information, the state will email you requesting the corrections, which you can also submit online. Those who fail to complete all requirements of their application will receive a rejection letter after 14 days explaining why their application was denied.

Can I use medical marijuana in public?

Not only can you not smoke cannabis in public, but you can’t vaporize it either. All smoking and vaporizing is subject to the same restrictions as cigarette smoking.

(OMMA Regulations Sec. 310:681-2-11)

Can I use cannabis while on parole?

Oklahoma’s state law doesn’t prevent medical marijuana patients from using cannabis while on parole, but the district attorney in your county may still prevent it. The only way to know if you’re safe to use cannabis while on parole is to ask your parole officer what your county’s rules are.

Does Oklahoma law provide parental protections to MMJ patients?

The state recently passed SB 811, which will be in effect on Sep. 20, 2018. Sec. 425 says:

1. No medical marijuana license holder may be denied custody of or visitation or parenting time with a minor, and there is no presumption of neglect or child endangerment for conduct allowed under this law, unless the person’s behavior creates an unreasonable danger to the safety of the minor.

What is the Oklahoma Medical Marijuana and Patient Protection Act?

HB 2612, which is named The Oklahoma Medical Marijuana and Patient Protection Act is also colloquially known as the Unity Bill, and it both clarifies some ambiguous areas of SQ 788 (the MMJ legalization bill) and makes changes that were necessary to conform with other laws. For instance, employers are still prevented from firing or refusing to hire medical marijuana patients, but there’s an exception now for so called ‘safety sensitive jobs.’ The bill can be read in full here: https://legiscan.com/OK/text/HB2612/id/1956047

 

 

How Do I Become a Medical Cannabis Patient in Missouri?

Becoming a medical marijuana patient in Missouri is the only way to legally use cannabis in the state. Fortunately, it isn’t hard to qualify and the process of becoming a patient is simple.

1) Find out if you qualify for cannabis treatment

2) See a doctor who can give you a recommendation

3) Apply for your card with the state

It’s that easy!

NuggMD has Missouri-licensed physicians available 7 days a week so you can see a doctor today.

 

Who Qualifies for Medical Cannabis in Missouri?

To find out if you qualify for medical marijuana card in Missouri, you’ll need to examine state residency, medical condition and age.

 

Residency

You must be a resident of Missouri in order to get a medical marijuana card there. To prove your residency, you’ll need:

1) A statement that the qualifying patient resides in Missouri and does not claim resident privileges in another state or country, and

2) One of the following:

• a copy of a valid Missouri driver’s license,
• a Missouri Identification Card,
• a current Missouri motor vehicle registration, or
• a recent Missouri utility bill;

If none of these proofs are available, the director of the program may accept “some other evidence of residence in Missouri, which shall be approved or denied by the director of the medical marijuana program as sufficient proof of residency.” Be aware that this denial or acceptance is at the sole discretion of the director though.

 

Qualifying Conditions

Missouri has a list of qualifying conditions, but the list is very open:

(A) Cancer;

(B) Epilepsy;

(C) Glaucoma;

(D) Intractable migraines unresponsive to other treatment;

(E) A chronic medical condition that causes severe, persistent pain or persistent muscle spasms, including, but not limited to, those associated with

• multiple sclerosis,
• seizures,
• Parkinson’s disease, and
• Tourette’s syndrome;

(F)  Debilitating psychiatric disorders, including, but not limited to, post-traumatic stress disorder, if  diagnosed by a state licensed psychiatrist;

(G)  Human immunodeficiency virus or acquired immune deficiency syndrome;

(H)  A chronic medical condition that is normally treated with a prescription medication that could lead to physical or psychological dependence, when a physician determines that medical use of marijuana could be effective in treating that condition and would serve as a safer alternative to the prescription medication;

(I) Any terminal illness; or

(J) In the professional judgment of a physician, any other chronic, debilitating or other medical condition, including, but not limited to,

• hepatitis C,
• amyotrophic lateral sclerosis,
• inflammatory bowel disease,
• Crohn’s disease,
• Huntington’s disease,
• autism,
• neuropathies,
• sickle cell anemia,
• agitation of Alzheimer’s disease,
• cachexia, and
• wasting syndrome.

Under these rules, most residents of the state who are over 18 and seek cannabis treatment will qualify.

 

Age

A medical marijuana patient must be 18 or older to apply to the program. Parents or guardians who have a minor child who needs cannabis treatment, such as a child with Dravet’s or epilepsy, will need to be their child’s caregiver, and the card for a minor patient will only be issued to the patient’s parent or guardian.

 

How to Find a Doctor for an Evaluation

It’s not necessarily easy to find a physician who’s willing to talk about marijuana as a medical option. Fortunately, you do have options if your family physician is unwilling to discuss the issue. It’s important to find a legitimate doctor for your medical marijuana recommendation.

NuggMD works with state-licensed Missouri medical marijuana doctors who can give you an honest evaluation of your condition and help you decide if cannabis is an option worth trying.

Whichever doctor you choose for your evaluation, it will be helpful, although it’s not required, to have your medical records on-hand for your medical evaluation. This will ensure you receive the most appropriate evaluation and recommendation for your condition. The records you might want to gather include, but aren’t limited to:

• Patient charts
• Current prescriptions
• Physical therapy records
• Medical test results
• Hospital records

If you dread the thought of sitting around at the doctor’s office, or you just don’t have enough time in your day, you can conduct your medical marijuana evaluation entirely online. Simply enter getnugg.com/md/Missouri in your web browser and relax while you get your evaluation from the comfort and privacy of your own home.

 

The NuggMD Process

Here’s the NuggMD process:

1) Create an account at NuggMD

2) Input your basic information, including your name, age and address

3) Enter your medical history with as much detail as possible

4) Enter your payment information while you wait in your virtual waiting room. Your wait shouldn’t be long

5) When your new physician is available, they will conduct your evaluation via NuggMD’s online telemedicine platform.

Once you’re approved, the doctor will complete your recommendation and email it to you via the NuggMD platform along with specific instructions to complete the registration process. You won’t need to worry that it will be a confusing process because NuggMD’s support staff can help if you get stuck  along the way.

 

What to Expect When Talking to the Doctor

Your video consultation can be as long or short as you need it to be, so don’t be afraid to ask your new doctor any questions you may have about your condition and how medical marijuana might fit into your treatment plan.

NuggMD’s physicians are passionate about cannabis as medicine and want to work with their patients to achieve the best treatment plan.

Here are a few questions you might like to consider asking your doctor:

• Which form or forms of delivery should I consider?
• Should I use higher CBD strains?
• What dose and frequency should I use?
• Will cannabis interact with any other medications or herbs I’m currently taking?
• What side effects, if any should I watch for?

Be sure to tell your new physician about all herbs and supplements you’re taking as well as your medications so they can assess any possible interactions.

As a NuggMD patient in Missouri, you’ll pay only $99 for your medical cannabis evaluation. If you’re not approved, your evaluation is free, so you’ve got nothing to lose!

 

How to Apply for Your Missouri State Medical Marijuana Card

Once you’ve been evaluated and approved for medical marijuana treatment by your doctor, your physician will email your recommendation to the address you provided, along with instructions for how to apply for your card using the state’s online application system. You must fill out your state application within 30 days of receiving your recommendation from your doctor.

• First, make sure you’ve entered your CORRECT SSN and date of birth during your NuggMD registration process. Your doctor will need this to complete your recommendation. You can’t go back and fix this yourself if you or your doctor make a mistake on your state application paperwork or recommendation. Instead, you’d have to submit a help ticket to request the Department to fix it, causing a delay in your application. So make absolutely sure you’ve entered the correct number.
• Wait for your doctor to send your recommendation to you via email. It should only take between 24 and 48 hours to receive it.
• Next, you’ll create an account at the state’s application portal.
• Fill out the requested information.
• Once you read the terms and conditions and confirm that you’re not a robot, you’ll finish up your registration and wait for your verification message in your email. It shouldn’t take long.
• Once you verify your email, you can click the link to sign in and complete the rest of your application. You can find detailed walk-through instructions here.

If you get stuck on your application or have any questions about the process, feel free to reach out to our customer service team.

VERY IMPORTANT: YOU MUST SUBMIT YOUR STATE APPLICATION WITHIN 30 DAYS AFTER RECEIVING YOUR DOCTOR’S RECOMMENDATION

 

Missouri’s Cannabis Cultivation Rules

During the application process, you’ll notice under the “Questions” tab that it asks if you wish to cultivate your own cannabis. Qualifying patients can cultivate their own cannabis in Missouri if they want to. The rules are very strict and must be followed to the letter to avoid problems with the law.

• Patient cultivation MUST take place in an enclosed, locked facility.
• Under no circumstances is a patient allowed to cultivate, or have someone cultivate for them, more than 6 flowering marijuana plants. 6 plants per patient is the absolute limit.
  • A patient may only cultivate up to 6 flowering plants, 6 non-flowering plants up to 14 inches tall, and 6 clones under 14 inches tall at any given time.
  • Two qualifying patients may share the same enclosed, locked facility for up to 12 flowering plants, 12 non-flowering plants and 12 clones.
  • If one of the qualifying patients is also a primary caregiver for another qualified patient, they may cultivate up to 6 more flowering plants, 6 more non-flowering plants, and 6 more clones for a total of 18 each.
• A patient can’t cultivate in a place where they are prohibited by state law or private contract.
• The plants must be clearly labeled with the qualifying patient’s name.
• The cultivation authorization must be displayed in close proximity to the plants and list the name of the qualifying patients or primary caregiver they are being cultivated for, and the address of the facility in which the plants are being cultivated.

You do not need additional certifications or paperwork from your doctor, but you will be required to answer extra questions on your online application and allow the Department to access your growing facility if and when they request to see it.

To apply for the additional cultivation certificate, go to the “Questions” tab and click “Yes” on the cultivation question. Below it, you’ll fill out the information required. You’ll need to describe the cultivation area you will be using, what security measures it will have, and who will have access to the area. You’ll also need to indicate whether others will be sharing the cultivation facility with you and provide details about them if applicable.

The state will require an additional $100 fee if you’re approved for a cultivation certificate.

 

What Types of Marijuana Consumption Methods are Available in Missouri?

Different states have different rules about the types and concentrations of marijuana that can be made available to patients. For instance, in New York patients are prohibited from smoking marijuana, but are allowed to “vape” marijuana concentrates or flower. Some states only allow low THC products, while others allow very high potency products. Each state’s laws are different.

In Missouri, your consumption methods aren’t limited. You can smoke it, eat it, use concentrates, tinctures, topicals or whatever method you and your doctor think is appropriate.

There are 3 main consumption methods to consider when deciding which method or methods are best:

• Inhalation
• Oral ingestion
• Topical application

Let’s explore each in more detail.

Inhalation

This is the most common, and fastest form of ingestion. Inhaled cannabis enters your bloodstream directly through your lungs. This can be accomplished by smoking joints, blunts or bongs, or by using vape pens, dab rigs or table top vaporizers. There are dozens of ways to inhale cannabis. You can discuss with your doctor which method is best if you choose this route.

The effects of inhaled cannabis usually peak around 30 to 90 minutes and wear off within a few hours, depending on metabolism and tolerance. This makes it one of the more preferred methods for pain because of its rapid effect. It’s also preferred by novices because inhaled cannabis usually has a less potent high than eating it and wears off faster if the user accidentally ingests more than they are comfortable with.

Note that no one has ever died from a cannabis overdose, but being too high can be a very uncomfortable experience for a new user. In such a case, the faster it wears off, the better.

So, inhaling cannabis is an ideal method of ingestion for many patients because of its quick onset and shorter half-life. But there are a few notable downsides and risks. It’s hard to look at the news today without hearing about the vaping crisis. Currently, the CDC believes that additives in illegal vape cartridges, namely Vitamin E Acetate, are causing severe lung injuries.

So far, more than 2,506 people have been hospitalized  and 54 people have died from these vaping lung injuries. Therefore, you should NEVER buy a vape pen from a black market source. It’s very difficult to know what additives are in the oils and they may be dangerous.

This has many patients turning back to smoking flower, but even if this is legal in your state (and it is in Missouri) smoking is not entirely without risk either. Those with asthma, COPD or other lung disorders might not be able to tolerate smoke and it’s generally agreed that smoking anything isn’t good for anyone.

There is another alternative. Dry herb vaporizers come in desktop and handheld models, and they’ve advanced a lot over the past few years as cannabis users have increased demand for this option. Some even allow users to heat both concentrates and flower.

Dry herb vaporizers heat cannabis flower to temperatures just below combustion. This allows the cannabinoids in the plant to heat up and be inhaled without adding the chemicals and tar that result from combustion. If you think this might be a good alternative form of ingestion for you, ask your doctor during your visit.

 

Oral Ingestion

Eating cannabis results in a very different high than inhaling it. When we inhale cannabis, we absorb delta-9 THC into our lungs and then our bloodstream, but when we eat it, the THC is converted to 11-hydroxy-THC in our livers before it is absorbed into our bloodstream through our guts. 11-hydroxy-THC induces a much more potent and longer lasting high. Even people who’ve smoked cannabis for years can be surprised by the potency of an edible.

And if you take too much, it will take a very long time to wear off. Generally, the onset of the effects of edibles will be felt between 30 and 90 minutes and will last up to 8 hours or even longer for a particularly potent dose.

In other words, edibles are extremely unpredictable.

Tolerance for edible doses is extremely varied as well. 10 mg is a commonly recommended first time dose, but many first timers find that as little as 2.5 mg is more than enough. If you don’t know what your tolerance for edibles is, then the motto is “go low and slow.”

This means that you may need to take a few days to find your dose. Many a novice cannabis user has taken a 10 mg dose, and when it didn’t kick in after waiting an hour, they took more. If they are one of those people that metabolizes cannabis more slowly, it usually ends up in a very unpleasant high or even vomiting and delirium.

So, if you’re inexperienced with edibles, be patient. You might want to consider trying just 2.5 mg and then waiting five or six hours before taking a larger dose.

Remember this always when trying a new ingestion method: you can always take more, but you can never take less.

 

Topical Application

Topicals are a great option for patients who want to use medical marijuana without experiencing the psychoactive effects. Topicals deliver cannabinoids through the skin, but very little THC absorbs into the bloodstream.

Be aware that transdermal patches are the exception to this rule because the cannabinoids are combined with agents to make them more easily absorbable through the skin. So you can actually get high from some transdermal patches. Be sure to ask before you use a new kind of patch or topical if this is a concern.

 

What Does Marijuana Feel Like?

If you’ve never had marijuana, it’s a bit hard to describe. You’ve probably heard stories about food cravings, euphoria and giggle fits. Most of these stories are true. As a matter of fact, it’s a good idea to keep some healthy munchies on hand so you don’t end up devouring an entire bag of potato chips or a box of Twinkies. Most people find it to be a pleasant experience, although there are some who dislike the feeling and can’t tolerate it well enough to derive a medical benefit from cannabis.

Until you know how you’re going to react to cannabis, plan pleasant and distracting activities during use. You might even want to have someone sit with you for the first time. This is because if you take more than you can tolerate, you can feel disconnected from reality or paranoid. You can even hallucinate, although this is very rare. Everyone is different.

Do NOT drink alcohol with marijuana.

Common side effects of marijuana are:

• Changed perception of time
• Loss of concentration
• Relaxation
• Giggles
• Happiness
• Increased energy
• Decreased energy (A.K.A. couch lock)

 

What if My Dose is Too High?

The side effect of cannabis that no users enjoy is anxiety. Anxiety is almost inevitable if you take a dose that’s too high for your tolerance. Some people get anxious on doses as low as 5mg, while others can chow down 100mg candy bars and barely feel it. This means you can’t use your friends or local budtender as a compass for your own tolerance. And having a tolerance that high is very rare unless you’re a long-time cannabis patient.

A new cannabis patient who ate a 100mg, or even a 50mg edible would likely feel like they need a padded room and be turned off from the prospect of ever taking cannabis again. In fact, many people who mistakenly say they’re allergic to cannabis just took too much their first time.

If you find that you’ve taken more cannabis than you can comfortably tolerate, stay calm. Remember that no one has ever died of a cannabis overdose. Also, don’t be embarrassed. You’re not the first person, and you won’t be the last, to suffer a panic attack or anxiety from consuming too much cannabis.

If you do experience this problem, be sure to call your doctor as soon as possible to have your dose adjusted. Remember, 5mg or even 2.5mg is a perfectly reasonable dose for a first time consumer. It’s ok to break those commonly-found 10mg doses in half or even quarters. And if you can find microdose products available in 2.5mg, 3.7mg or 5mg doses for your first time use, try them out! You may be surprised to find that this is more than enough.

 

START LOW AND GO SLOW! PATIENCE IS THE KEY! 

*While no one has ever died of a cannabis overdose, you can develop a condition called Cannabinoid Hyperemesis Syndrome. If you start to experience any abnormal symptoms like severe vomiting that will not go away, call 911 or head to the nearest emergency room.

 

What is Cannabinoid Hyperemesis Syndrome?

People are using larger and more potent doses of THC. Lately, a poorly understood syndrome has occurred with cannabis users called cannabinoid hyperemesis syndrome. No one knows what causes cannabinoid hyperemesis syndrome, but current theories are that it results from over-stimulating CB1 and CB2 receptors with very high doses of THC.

According to current medical understanding, this condition only appears to affect people who have been using cannabis at least once a day for years, and is very rare even in this small subset of people. But because this condition can lead to death due to dehydration in very rare cases, it’s appropriate to warn all cannabis users of this condition.

The condition seems to occur in three distinct stages:

Prodromal: This stage can last for a few months or even years. During this stage, the patient will suffer mild nausea and stomach pain. Unfortunately, this tends to lead to a person taking more cannabis to relieve the symptoms. If you begin to notice this type of persistent nausea, notify your doctor immediately because you may need to quit using cannabis for a while.

Hyperemetic: During this stage, the patient will vomit profusely and can become dehydrated and malnourished as a result of the constant nausea. Some patients may find relief from a hot shower. It’s absolutely vital to see a doctor if this happens if the patient hasn’t seen a doctor already because this is a very serious and potentially fatal condition.

Recovery: The only known treatment that works for cannabinoid hyperemesis syndrome is to quit smoking marijuana. The symptoms generally go away in a day or two after the patient stops using marijuana. If cannabis use starts again, the symptoms will almost certainly return.

No one knows yet why some people get CHS. Most people don’t. It’s still a very rare condition. There’s no way to tell ahead of time who can develop the condition and who won’t. So, be patient. Use the minimum amount of cannabis necessary to treat your condition according to your doctor’s instructions. And always, always call your doctor and report any unexplained symptoms of nausea, belly pain or vomiting.

 

Need Help? NuggMD’s Here for You

NuggMD’s knowledgeable customer service team is here to answer your questions every day via email and live chat. It’s their mission to think outside the box and creatively solve problems so you can have the best experience possible.

Of course, the laws aren’t perfect, so there are some things that can’t be fixed (yet). In those cases, we can reach out to advocacy organizations, state and local legislators and our communities. Below, we’ve included a list of local advocacy organizations that you can reach out to. If you know of any other organizations we can add to this list, we’d love to hear from you.

Missouri Norml
15 N. 10th St.
Columbia, MO  65201
573-443-6866
facebook.com/MissouriNORML
MONORML.org

Marijuana Policy Project
P.O. Box 21824
Washington, D.C. 20009
202-462-5747

New Approach Missouri
2025 Zumbehl Rd, #291
St. Charles, MO 63303
info@newapproachmissouri.com

Missouri Cannabis Industry Association
15 N. 10th St.
Columbia, MO 65201
membership@mocia.org

Missouri Medical Cannabis Trade Association
1015 Grupp Rd, #31674, St. Louis MO, 63131
Phone: (800) 766-0599
Email: director@mocanntrade.org
Andrew Mullins, Executive Director
PR – Media Inquiries: Jack Cardetti (573) 680-4009

 

Frequently Asked Questions

 

Is it legal to possess cannabis even though there are no dispensaries yet?

Yes, but only if you have a medical marijuana card.

 

How much cannabis am I allowed to possess?

You can purchase and possess up to four ounces, or the equivalent in concentrates. If you are cultivating cannabis (with permission from the Department) you may possess up to a 90 day supply at one time so long as the cultivated cannabis stays on the cultivator’s property and in their possession.

 

How much is the state card application?

The application is $25 for patients and caregivers. There is an additional charge of $100 for those who wish to cultivate their own.

 

How long does it take for the state to process a medical marijuana card application?

As provided by Amendment 2, Sec. 3(19), the state has up to 30 days to process your application. If they don’t finish processing it within that time, then your physician recommendation would serve as your card. This is highly unlikely to happen though because the Department’s been processing cards very quickly. In some cases, patients are receiving their state certifications via email within 48 hours. And since you will print out your patient identification card instead of waiting for it to arrive in the mail, the process is even faster.  As applications begin to pick up at the beginning of 2020 in anticipation of the first dispensaries opening, it may take a bit longer.

 

How long does my certification last?

A patient must recertify at least annually. A physician is also within their rights to require their patient to return for certification more often if they feel the patient’s condition requires closer monitoring.

 

Will my health insurance cover my certification?

Amendment 2 states: “Nothing in this section shall be construed as mandating health insurance coverage of medical marijuana for qualified patient use.” Because cannabis is still federally prohibited, it’s unlikely that insurance companies will be covering it soon. Some insurance carriers make an exception for Epidolex, which is approved at a federal level.

 

Is there a tax on cannabis sales?

Yes, your retailer will be required to charge an additional 4% tax for your purchase. There may be other applicable local taxes as well.

 

Can I purchase cannabis in Missouri with an out-of-state card?

No. Missouri doesn’t have reciprocity with any other state cannabis program. The only way to legally purchase cannabis in Missouri is to present a Missouri Department-issued patient identification card. However, if you have “equivalent identification card or authorization issued by another state or political subdivision of another state,” you are not subject to arrest for possession of less than 4 ounces or the equivalent. You should talk to a lawyer before attempting to possess cannabis in the state with out out-of-state card because your out-of-state authorization may not be considered equivalent.

 

Can I get a card if I have a criminal record?

Yes. Criminal records don’t disqualify applicants from getting patient identification cards. However,  your card can be denied if you:

• Lie or provide false or misleading information on your application,
• Provide incomplete information on your application, or
• Don’t apply for a state card within 30 days of your certification date.

Your card can be revoked if you:

• Violate any provisions of the program’s rules,
• You possess more marijuana than your card allows (likely 1 year suspension),
• You sell or traffic any drugs (guaranteed permanent removal from the program).

 

Can a nurse practitioner or dentist recommend cannabis?

No. Only a state licensed physician or osteopath can write a cannabis recommendation.

 

I have a caregiver who cultivates for me. Can I cultivate also?

No. Only your caregiver or you can cultivate for you. You can’t both cultivate at the same time.

 

Can I be fired for using marijuana if I have a Missouri Patient Identification Card?

Amendment 2, Sec. 7(1)(d) states that a cannabis patient can’t “bring an action against any employer, former empoyer, or prospective employer for wrongful discharge, discrimination, or any similar cause of action or remedy based on the employer, former employer, or prospective employer prohibiting the employee, former empployee, or prospective employee from being under the influence of marijuana while at work or disciplining the employee or former employee, up to and including termination from employment for working or attempting to work while under the influence of marijuana.”

 

Can my landlord prohibit marijuana use in my residence?

Missouri’s laws didn’t just concentrate on protections for patients. The built in protections for landowners and employers as well. Just as Missouri’s rules allow employers to fire or not hire cannabis patients, the rules allow the barring of cannabis use by contract. If your lease prohibits use or cultivation, this is a contract. If you agree to the contract, then you can be evicted for breaking this contract. Therefore, you need to ensure that your potential or current landlord will approve this use first.

 

Can I be denied an organ transplant if I become a medical marijuana patient?

Not in Missouri. Amendment 2 provides specific protections for organ transplant patients. Specifically, the law says “No patient shall be denied access to or priority for an organ transplant because they

hold a Qualifying Patient identification card or use marijuana for medical use.”

 

How many patients can a primary caregiver have?

“No individual shall serve as the Primary caregiver for more than three Qualifying Patients.” (Amendment 2 Sec. 7)

 

How many plants can be cultivated in a single locked patient cultivation area?

A single patient may have 6 seedlings, 6 immature plants, and 6 flowering plants to provide a continuous supply. Two patients may cultivate together for a maximum of 12 seedlings, 12 immature and 12 flowering plants. If a patient is also a caregiver, they may grow an additional six plants  of each type for their patient. Under no circumstances can a single, enclosed, locked facility cultivate for more than three people. That’s a maximum of 18 seedlings, 18 immature and 18 flowering plants.

 

Can I use cannabis in public?

No. Amendment 2 Sec. 7 (7) says “No Qualifying Patient shall consume marijuana for medical use in a public place, unless provided by law. Violation of this prohibition shall subject the violator to sanctions as provided by general law.”

 

Can I make extracts with butane or other volatile materials?

No. Only those with a state-issued manufacturing license can use flammable gasses or dangerous materials for extraction.

Drug Tests Are Becoming More Invasive

Standard drug tests aren’t nearly as effective as they used to be because it’s so easy to circumvent them. A simple search on Google will reveal dozens of tried-and-true tactics. When there’s a will, there’s a way. Probably one of the most inventive is the Wizzinator.

For those who’ve never heard of this brilliant little device, it’s a contraption designed to look like a genuine human penis with a urine container which is attached to the body and designed to look as if you’re actually urinating when you pinch the valve to drain it. And there are similar female devices, although their use is a bit more involved.

In response to devices like these, drug testing procedures have been adapted to include checking for them. And in most cases the invasion of privacy involved in doing so is beyond extreme. Some employers, such as those involved with the Department of Transportation, require direct observation of the person’s genitals, and then observing the testee as they urinate. Direct observation is always required of all follow up and return to work tests for the Department of Transportation; meaning, to put it bluntly, if you’re injured on the job and have to take a few weeks off, they get to look at your junk before you’re allowed to come back to work.

For those who’ve never been subjected to a ‘direct observation’ drug test, it’s difficult to imagine the indignity that a person goes through in order to comply with regulations. So, here are the exact procedures for a ‘direct observation‘ drug screening from the Department of Transportation’s website:

• The observer must be the same gender as the employee.
• If the collector is not the observer, the collector must instruct the observer about the procedures for checking the employee for prosthetic or other devices designed to carry “clean” urine and urine substitutes AND for watching the employee urinate into the collection container.
• The observer requests the employee to raise his or her shirt, blouse or dress / skirt, as appropriate, above the waist, just above the navel; and lower clothing and underpants to mid-thigh and show the observer, by turning around, that the employee does not have such a device.
• If The Employee Has A Device: The observer immediately notifies the collector; the collector stops the collection; and the collector thoroughly documents the circumstances surrounding the event in the remarks section of CCF. The collector notifies the DER. This is a refusal to test.
• If The Employee Does Not Have A Device: The employee is permitted to return clothing to its proper position for the observed collection. The observer must watch the urine go from the employee’s body into the collection container. The observer must watch as the employee takes the specimen to the collector. The collector then completes the collection process.

Failure of the employee to permit any part of the direct observation procedure is considered a refusal to test.

That Sounds Unconstitutional!

According to the Supreme Court, it’s not. It may be outrageous, but courts have ruled that such invasive testing is allowable when there’s a reasonable expectation that drug use would result in a danger to public safety. And this might even be a reasonable course of action if urinalysis was more likely to show current intoxication than off duty drug use–but of course we all know it’s not.

So where does one draw the line, considering the likely uselessness of private testing on one hand, and the outrageousness of observed testing on the other. Apparently, JetBlue hasn’t just crossed the line–they forgot it even existed. A recent lawsuit accuses the company of forcing a flight attendant to lift her shirt and bra up to her armpits, drop her pants to her ankles, and then urinate into a cup while an observer squatted two feet away at the level of her genitals to observe the process.

Then, she had to go through the entire process again because common medications she was taking for a bladder infection caused discrepancies in the test. This time, it was even worse. According to the complaint, the observer “squatted six inches away from Reese while she urinated and at one point ‘reached out and physically spread plaintiff’s legs wider by pushing against the inside of plaintiff’s left knee with the back of her right hand.’”

Who Are These “Observers?”

Most of the time when a person is submitting to the drug test, they make the mistaken assumption that the person observing their genitals and watching them urinate is a nurse or an otherwise trained medical professional. That is not a requirement. From Samhsa’s handbook on urine specimen collections, these are the requirements for a person who wishes to become a direct urine specimen observer. The person must:

• Be knowledgeable of the direct observed collection procedure as described in the Mandatory Guidelines
• Be knowledgeable of any guidance provided by the federal agency or by HHS relating to the direct observed collection procedure described in the Mandatory Guidelines
• Receive training on the following subjects:
  • The steps necessary to perform a direct observed collection correctly
  • Maintaining the integrity and security of the specimen throughout the collection process by maintaining visual contact with the collection container
  • Ensuring the privacy of the donor
  • Ensuring that the observation is done in a professional manner, to minimize discomfort of the donor
  • Avoiding conduct that can be interpreted as offensive or inappropriate
  • Be the same gender as the donor. There are no exceptions to this requirement. An observer is not required to be a trained collector.

  As you can see, these observers are not trained medical professionals. They aren’t even required to be a trained collector. There is also no mention of a requirement that the person undergo a background check to ensure they are not a sex offender–merely the requirement that the person is of the same gender as if this somehow insulates the testee from the possibility of assault or inappropriate behavior.

  Privacy Violations In The Private Sector

  Even more outrageous is that this type of testing method isn’t just used for very safety sensitive jobs (although it’s extremely arguable how “safety sensitive” a flight attendant’s job is). A recent court case in Ohio, LUNSFORD v. STERILITE is addressing the case of four women who were forced to produce their urine samples under direct observations at a plastic container plant. In the private sector, there’s little to no regulation of drug testing at all. Lunsford’s type of situation is far from unique.

  If you don’t know your company’s drug screening guidelines yet, you can ask for a written copy of their policy. You may be surprised at the extent of invasion which they allow to maintain a drug free workplace. More importantly, if you’re ever subjected to a drug test and the testing procedures violate the written policy provided to you by your employer, you might have a good lawsuit on your hands. It doesn’t matter who administers the test by the way. Whatever company does it is acting as your company’s agent, and therefore, your company is responsible for their actions–a lesson that JetBlue is learning all too well at the moment.

  Privacy Isn’t The Only Concern

  Discrimination against medical marijuana users is rampant despite the mounting evidence that medical marijuana may be a safer alternative to both opiate pain treatment and recreational alcohol use.

  Recently, Dish Network received severe public backlash for firing a paraplegic employee who was using medical marijuana to treat intractable muscle spasms. The case, which happened in Colorado of all states, went all the way to the state Supreme Court.

  The court documentation notes that Brandon Coats, who is confined to an electric wheelchair and has only limited use of his hands, was a model telephone customer service representative. But after he obtained a license to use medical marijuana and informed his company that he was using it, he was fired despite his exemplary performance. Keep in mind that Coates was not engaged in a safety sensitive job by any means, and that he performed indisputably well at his job. Yet the Colorado Supreme Court ruled that he was not wrongfully terminated after a 5-year battle.

  What benefit does society as a whole gain from Brandon Coates’ unemployment? Does he simply serve as a precautionary tale to those suffering from the same disorder that they must turn to addictive pharmaceuticals for their pain lest they join the unemployment line?

  More importantly, this man clearly qualifies for disability, yet he found a way to earn a living and contribute to society despite his physical limitations. What are the implications here for taxpayers who already face massive burdens? How can this possibly be considered a socially responsible viewpoint or policy?

  Yet this scenario is not uncommon.

  In response to these outrageous situations, states are adopting guidelines to prevent discrimination against medical cannabis users who ingest on their own time, but we have a very long way to go. Meanwhile, what’s a medical cannabis user to do?

  How Do I Pass A Drug Test?

  This is one of the most common questions we see. In fact, an adventurous Nugg blogger wrote a piece that actually provided some pretty sage advice in this area. The answer?

  Stop smoking cannabis.

  Well, he’s not wrong. It’s great advice if your employment depends on it because it’s the only way to actually avoid testing positive for cannabis use.

  But maybe we’ve been asking the wrong question. When we truly examine the considerable indignities we are exposed to with drug testing procedures, the invasion of privacy, and the outrageous assumption that an employer has the right to regulate what we do when we aren’t on the clock, why are we subjecting ourselves to this draconian treatment at all?

  Are we mice or are we men? Our cannabis use shouldn’t be the topic of conversation here. Casual cannabis use is no more an employer’s business than the decision to crack open a beer and watch football on your day off.

  Becoming A Drug Test Conscientious Objector

  No, the appropriate topic of conversation here is why employers feel they are justified to examine employee’s genitals on demand and investigate what they do in their free time. Even employees who don’t use cannabis or any drugs at all should be reasonably outraged by such a request.

  So what would happen if the pool of applicants willing to subject themselves to such indignities simply dried up?

  The answer to this question is already apparent. The employers would change their policies, and many already have. But finding these forward-thinking employers can be challenging. It’s not always easy to find a company’s full drug testing policy on Google–not to mention the time it takes to research all of these places before we apply.

  In response to the hassle, a very helpful Redditor began this thread to let people enter information about their company’s drug testing policies in a database. There are only 175 entries so far, but it contains information from companies like Walmart, K12 and Target.

  A preliminary check shows that the information isn’t 100% accurate. For instance, the chart says that Walmart never drug tests, but they actually do for safety sensitive jobs like driving a forklift or for management positions. It’s a good effort though as long as the user is willing to double check the information before applying too. And the database is sure to improve as more people enter information.

  Indeed is another source of information that looks a little more accurate. Prospective employees can ask questions as well as rate the company’s work environment, and fellow employees are usually happy to share the details.

  States That Protect MMJ Users’ Rights

  Some states are also taking action to prevent abusive drug testing policies altogether, or at least diminish the harms that result.

  Connecticut, Iowa, Maine, Minnesota, Montana, Nevada, Vermont and New York City have all passed laws that restrict drug testing to one extent or another. This is an important win for citizens who are concerned with the loss of our Fourth Amendment rights against unreasonable search. The Supreme Court has done very little to protect these rights in recent decisions, so it’s very clearly up to our legislators to uphold our constitutional values.

  The legislators in California tried to pass a similar law the 2019 season, but the proposed bill was defeated. AB 882 would have prevented employers from terminating an employee for testing positive for a drug that is being used as a medical-assisted treatment under the care of a physician or licensed treatment program. It was quickly defeated due to concern that the bill would hurt companies that rely on federal funding.

  And of course, it’s been making the news lately that some states are moving very far in the other direction. For instance, Wisconsin now requires drug testing for all food stamp recipients. Alabama, Arkansas, Arizona, Florida, Georgia, Kansas, Michigan, Mississippi, Missouri, North Carolina, Oklahoma, Tennessee, Utah, and West Virginia have varying drug testing requirements for public assistance as well. These programs come at a hefty price tag and produce positive results in very few cases.

  The Takeaway

  Drug testing policies are in flux, and there’s still very little common sense exercised in the public debate. The current argument in style is that if employees need to be tested for jobs, then welfare seekers should be tested too, and maybe politicians while we’re at it. What we’re not hearing is that maybe these tests aren’t really worth it at all. Very few people are considering the cost to human dignity, our 4th Amendment rights and our health and safety.

  But there are employers out there who forego drug testing because they understand that such policies only give lip service to public safety concerns, and in some cases drive employees to much more dangerous pain treatment and recreational alternatives in their off-time. We just have to do a little work to find them.

  If you’re looking for employment right now, perhaps it’s time to consider one of these more forward-thinking companies in the best interest of freedom. More importantly, it might be time for all of us to consider who deserves our business as well. Perhaps if companies like Dish Network saw a loss in revenue, they would reconsider their draconian anti-medical cannabis policies.

  We all know it’s darkest before the dawn. As big pharma begins to lose its grip on our over-medicated and unhealthy nation, people are finding better alternatives to treat their ailments. Dietary changes, exercise, meditation and social support are all playing a huge role in our health revolution; and for some, medical marijuana is playing a big part in this change too as we work to overcome pain and addiction to opiates, cigarettes and alcohol. It usually takes years for laws to change bad policies, but change they will.

  Let’s help them get there faster.

  The opinions of the author are not necessarily the opinions of Nugg, NuggMD or Nugg Club.

What We Currently Know About Vaping Illness

As of September 25th, there are 805 reports of this illness in 46 states. There have been 12 confirmed deaths in 10 different states. So far, none of the deaths have occurred in New York.

The one thing that all of the victims seem to have in common is that they’ve vaped in the past 90 days. From there, there are many variations. Some report only smoking e-cigarettes and some have smoked counterfeit cannabis cartridges, and some have smoked both.

The length of time between exposure and the illness developing has been varied as well. The illness, now called VAPI–vaping associated pulmonary illness–tends to develop over the course of a few days, but can take weeks.

What Are The Symptoms Of VAPI?

The main symptoms of VAPI are coughing and shortness of breath sometimes accompanied by nausea and vomiting, diarrhea, fever, fatigue and weight loss. Most victims are hospitalized, with some requiring intensive care or even respirators. Most cases resemble lipoid pneumonia.

It’s vital to note here that regardless of the speculations, the FDA hasn’t actually found a common thread between the different illnesses. Mitch Zeller, director of the Food and Drug Administration’s Center for Tobacco Products says that it looks like many cases involve THC, but not all. Some cases involve oils and some involve CBDs. A few reportedly involve nicotine only, but Zeller is eyeing those cases dubiously.

The latest death was a Georgia man who reported heavy nicotine vape use, but reported no THC use. Zeller is doubting the veracity of these reports though, as investigators are relying on self-reported data in states where THC products are highly illegal. Patients would obviously be reluctant to report THC use. Possession of one ounce or less in Georgia can result in a year in prison, and possession of more than an ounce is a felony charge carrying up to 10 years.

So it’s easy to understand that high criminal penalties are hampering investigations into the source of the problem. This means it will probably take a little longer to get to the bottom of this puzzle–especially if it involves black market or counterfeit vape pens.

Alternatives To Vaping Cannabis

For those who currently vape and wish to use other methods until the source of the illness is clear, there are several alternatives available.

The non-vape oil products currently allowed in New York are:

• Tinctures,
• Solid and semisolid preparations like capsules, tablets and lozenges,
• Ground, non-smokable plant preparations,
• Ground, vaporizable plant preparations, and
• Topical applications and patches.

The Difference Between Oral and Inhaled Cannabis

Oral cannabis and inhaled cannabis are very different. They even involve different psychoactive compounds. When cannabis is smoked, delta-9-THC is absorbed into the lungs. When cannabis is ingested, much of the THC is converted to 11-hydroxy-THC in the liver.

11-hydroxy-THC crosses the blood-brain barrier much more easily because it’s more water-soluble. So, even though it takes longer for the high to hit from eating–up to 90 minutes or more–it lasts longer and is much more potent.

This is one of the main reasons many people prefer inhaled cannabis. It’s easier to titrate the dose. Inexperienced patients tend to take too much oral cannabis because of the delayed onset. If they take too much because they mistakenly believe it’s not working, they will get an unpleasant surprise when it all kicks in at once and it will last for hours.

With inhaled cannabis, the effects are felt much more rapidly–usually within about ten minutes. This makes it much easier to find the best dose. It also mitigates the discomfort if they take more than they’re comfortable with because the effects usually peak in about 15 to 45 minutes and wear off in a couple hours.

Inhaled cannabis’ fast onset also makes it the preferred method of administration for pain patients, who are the vast majority of medical cannabis users in New York.

This is why the recommendation to avoid vaping will have a powerful impact on New York cannabis patients. Those who need to switch to oral cannabis will need to take their time adjusting their dose for the best comfort and symptom relief.

A Closer Look At Vaping Alternatives

Tinctures

Tinctures are sometimes called cannabis oral solutions. Whatever the name, they’re a liquid solution that’s held under the tongue. This helps your system to absorb the THC faster through the network of large blood vessels there.

Just like with vape pens, you’ll find tinctures from low to high CBD to THC ratios designed to treat different conditions.

Like all oral cannabis, it’s easy for patients to assume a tincture isn’t working if the effects take longer than they expect. It’s very important to wait at least 90 minutes, if not longer before attempting to adjust the dose. Don’t take more than your doctor recommends.

Oral Sprays

Oral sprays work like tinctures do, but they make microdosing easier. This makes it simpler for first-time users to start with small doses and experiment until they find the right amount.

You might see ads that say oral sprays mimic smoking. That’s not to say that you should inhale them. That will hurt your lungs. Oral sprays are meant to be sprayed on the mucous membranes inside your mouth and held there for about 30 to 60 seconds without swallowing. They work much the same as tinctures in this way, and should be dosed in the same way with the same waiting period before trying more.

Capsules

Capsules may be a more comfortable dosing method for patients who are used to taking pills. They come in a wide variety of dosing options and THC to CDB ratios. The downside is that it’s harder to adjust the dose if you find that your capsules are more potent than needed.

Also, make sure you let your pharmacists know if you have any allergies, such as to gluten or wheat. They may need to check the inactive ingredients to ensure you can take them safely.

Hard-Pressed Tablets

Tablets work in basically the same way as capsules. Their advantage is that it’s easier to split your dose if you find that the option you purchased is too potent for your needs. Again, make sure to check the inactive ingredients for any possible allergens that can affect you.

Ground Flower Pods

This is a very new option that’s only recently become available with Curaleaf–although other retailers are sure to follow soon. Ground flower pods are simply cannabis buds that have been pre-ground for easy vaping. The flower is inserted into a specially designed vaporizer that heats the herb to just under the combustion level. This releases the cannabinoids for inhalation without creating smoke and tar.

So far, ground flower pods are only available in a 20:1 THC to CBD ratio.

Health authorities have not weighed in yet on whether vaping dry herbs may be a safe option to vaping oil during the investigation, so it’s best to ask a doctor if this method is advisable.

If your doctor decides this is a good option, you’ll need a special device called a dry herb vaporizer to use the flower pods. These devices come in desktop or handheld units and can run on household electricity or batteries. Your dispensary and doctor can recommend the best make and model to suit your needs and show you how to use it.

What If A Dose Is Too Strong?

Those who’ve never taken oral cannabis might experience some anxiety if they take a strong dose. If you haven’t found your sweet spot yet, you might want to be with a comfortable friend or family member till you find it.

Some people experience palpitations, paranoia and panic attacks instead of the usual calming and pain-relief they experience with inhaled cannabis. If this happens to you, remember that no one has ever died from a cannabis overdose. Simply remain calm and call your doctor to have your dosage adjusted. Your doctor might want to consider a higher CBD to THC ratio as well.

Until you feel better, drink plenty of fluids and eat a snack if you feel hungry (which you most likely will). This can help to occupy your mind. Try to find something fun to do as well, like playing a game with friends, reading a good book or watching a favorite show or movie. It may seem like forever till it wears off, but it eventually will–usually within about 6-8 hours.

And of course, if you start to experience any very unusual symptoms like excessive vomiting, call your doctor.

How To Change Your Cannabis Administration Method In New York

Unlike most other states, New York requires that a doctor recommends the specific amount of cannabis a patient needs, the ratio of CBD to THC, and how to administer it. In other words, New York recommendations work a lot like medication prescriptions. Some doctors recommend a wide variety of options, and some are very specific.

If you received your recommendation from a NuggMD doctor, chances are you already have access to other forms of cannabis besides vaping. Their doctors recommend many types and strengths to allow room for trial and error. Other doctors may have recommended only one specific method and strength.

If you have one of those recommendations that only allow vaporization oil, you will need to see a doctor to get this changed. NuggMD doctors are available from 8AM to 10PM daily via NuggMD’s state-of-the-art telemedicine platform. You can see a new cannabis doctor with them from the comfort of your own home today.

Conclusion

As stated above, it could take months to discover the cause of the recent illnesses. Meanwhile, patients and recreational cannabis users will need to weigh the risks versus benefits of their particular form of cannabis use.

There will likely be unintended consequences of the bans and precautions as well. Some states are considering banning all vape products, not just flavored liquids. Most notably, the governor of Massachusetts declared an emergency ban of all vape products for 4 months. This is leading to speculations that more problems will occur as vapers turn to black market products instead. Others are questioning why e-cigarettes are banned after 12 deaths when legally-sold regular cigarettes kill nearly half a million people a year.

Regardless of whether the current illnesses are simply media hype or something more serious, those who choose to use inhaled forms of cannabis should monitor their lung health carefully and report any new breathing problems to their physician.