Credits: 5 CME/CE credits.
Mobile-friendly: Yes
Course Access: 12 months

The Iowa Comprehensive Medical Cannabis Course Bundle introduces the reader to the endocannabinoid system and its interaction with the components of the cannabis plant, and addresses various aspects of medical cannabis, including administration, therapeutic use, drug metabolism, physiologic and cognitive effects, potential risks, and drug interactions.

The use of marijuana in obstetric patients, pediatric patients, adolescent patients and elderly patients is discussed in detail. Important considerations for patients with ischemic heart disease, hepatic disease, psychotic illness, and those with a history of drug dependence are provided.

This course bundle also addresses the use of cannabidiol (CBD) in clinical care, and the information will assist clinicians in effectively treating and counseling CBD consumers. The physiological effects of CBD, CBD drug interactions, CBD’s side effects, and the conditions for which CBD has been shown by evidence-based clinical studies to be efficacious are all discussed in this course bundle.

This bundle includes two multi-accredited (ACCME, ANCC, ACPE, AANP, APA and AGD PACE credits) courses:

• A Nationally Approved CME/CE Medical Marijuana Course – 3 credits
• CBD in Clinical Care – 2 credits

In addition, Iowa state-specific resources can be viewed at the bottom of this page. Look for the “State-Specific Resource Section.”

Subscribers can complete the curriculum and refer back to the content at any point during their 12-month subscription period.

Table of Contents:

A Nationally Approved CME/CE Medical Marijuana Course is comprised of 5 lessons:

• Lesson 1: The Endocannabinoid System and Phytocannabinoids
• Lesson 2: Marijuana Products, Modes of Administration and Pharmacology
• Lesson 3: Precautions: The Use of Cannabinoid-based Drugs in Special Patient Populations
• Lesson 4: Precautions: Cannabinoid-based Drug Metabolism and Potential Cannabinoid-based Drug Interactions
• Lesson 5: Physiologic and Cognitive Effects of Marijuana

CBD in Clinical Care is comprised of 4 lessons:

• Lesson 1: CBD Interacts with Multiple Signaling Systems
• Lesson 2: Drug:Drug Interactions, CBD Pharmacology, and CBD Products
• Lesson 3: Clinical Applications
• Lesson 4: The CBD Consumer Should Know

Information for Iowa Practitioners:

• This information can be viewed at the bottom of this page.

Editor-in-Chief:
Meredith Fisher-Corn, MD

This course has been planned and implemented in accordance with the accreditation requirements and policies of multiple accreditation boards. This curriculum offers up to 5.0 hours of ACCME, ANCC, ACPE, AANP, APA and AGD PACE credits. This activity is jointly provided by Global Education Group and The Answer Page, Inc. ACCME, ANCC, ACPE, and AGD accreditation expires May 21, 2023. APA and AANP accreditation expires May 21, 2023.  Full accreditation information is available upon purchase.

Educational Objectives

After completing this activity, the participant should be better able to:

• Describe the endocannabinoid system
• Discuss the components of the endocannabinoid system 
• List some of the many functions of the endocannabinoid system
• Define cannabis
• Define marijuana
• Define hemp
• Define phytocannabinoid
• Describe some of the phytocannabinoids
• List a variety of marijuana products
• Describe various modes of marijuana administration
• Describe the pharmacokinetic profile of marijuana for several modes of administration
• Discuss the use of cannabinoid-based drugs in patients with a history of psychotic illness
• Discuss the use of cannabinoid-based drugs in patients with ischemic heart disease
• Discuss the use of cannabinoid-based drugs in patients with hepatic disease
• Discuss the use of cannabinoid-based drugs in patients with a history of drug abuse
• Discuss the use of cannabinoid-based drugs in patients with a hypersensitivity to cannabis-based products
• Discuss the use of cannabinoid-based drugs in obstetric patients 
• Discuss the use of cannabinoid-based drugs in pediatric/adolescent patients
• Discuss the use of cannabinoid-based drugs in elderly patients
• List the enzymes responsible for the metabolism of three phytocannabinoids (THC, CBD and CBN)
• Identify clinically significant drug interactions that may occur with cannabinoid-based drugs
• List multiple factors that influence the physiologic and cognitive effects of marijuana
• Discuss the physiologic effects of marijuana
• Discuss the cognitive effects of marijuana
• Describe how marijuana affects CNS function
• Describe how marijuana affects appetite and metabolism
• Describe how marijuana affects gastrointestinal function
• Describe how marijuana affects cardiovascular function
• Describe how marijuana affects the reproductive system
• Describe how marijuana affects the eyeDescribe how cannabidiol (CBD), a cannabis product, interacts with the endocannabinoid system and other receptor systems
  
• Describe the metabolism of CBD
  
• List some of CBD’s potential drug:drug interactions
  
• List the potential adverse events associated with CBD consumption
  
• Explain the current scientific evidence supporting the clinical use of CBD

Instructions for Obtaining Credit

In order to receive credit, participants must complete all course lessons. Participants must also score at least 70% on each chapter quiz. Upon completion of all lessons and quizzes, you must also complete the evaluation form. Your certificate will be available to download upon completion of the evaluation.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and The Answer Page do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities

What are the qualifying health conditions for participation in Iowa’s Medical Cannabidiol Program? 

An Iowa resident may qualify for Iowa’s Medical Cannabidiol Program if their healthcare practitioner certifies that the patient has one of the following qualifying debilitating medical conditions:

• Cancer – if the illness or its treatment produces one or more of the following: severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting
• Seizures
• Crohn’s disease
• Chronic pain
• Multiple sclerosis with severe and persistent muscle spasms
• AIDS or HIV (as defined in Iowa Code, section 141A.1)
• Amyotrophic lateral sclerosis (ALS)
• Parkinson’s disease
• Post-Traumatic Stress Disorder (PTSD)
• Any terminal illness with a probable life expectancy of under one year – if the illness or its treatment produces one or more of the following: severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting
• Ulcerative colitis
• Severe, intractable pediatric autism with self-injurious or aggressive behaviors
• Severe, intractable autism with self-injurious or aggressive behaviors
• Cortico-basal degeneration

Which type of clinicians can write a cannabis recommendation? 

• MD/DO
• Advanced Registered Nurse Practitioner (ARNP)
• Physician Assistant (PA)
• Podiatrist (DPM)

Can pediatric patients participate in the program or does the patient have to be at least 21 years old?

A patient of any age can be certified. Patients under 18 must have a designated caregiver who is authorized to purchase and possess products for the patient.

What are the allowable forms of medical cannabinoid products in Iowa?

Iowa’s manufacturers produce medical cannabis products in different forms and strengths.

The allowable forms of medical cannabinoid products in Iowa are:

• Oral forms- tablets, capsules, liquids, tinctures and sublingual forms
• Topical forms- gels, ointments, creams, lotions and transdermal patches
• Nebulizable inhaled forms
• Suppositories- rectal and vaginal
• Vaporization

How much THC can a patient purchase at one time?

• Patients are able to purchase 4.5g THC per 90-days
• If the health care practitioner determines that 4.5 grams of total tetrahydrocannabinol in a 90-day period is insufficient to treat a patient’s qualifying debilitating medical condition and the patient has participated in the medical cannabidiol program, the health care practitioner may recommend a higher total THC cap. The health care practitioner shall indicate the higher total THC cap on the written certification.  Note: Other than for patients who are  certified as terminally ill, this waiver can only be completed for patients who have participated in the program; newly-certified patients are not eligible for this waiver. This form and information about the process can be found at: https://idph.iowa.gov/omc/Patient-Registration

How does a clinician register a patient in the cannabis program?

• A physician must certify that the patient has a qualifying condition during a consultation
• The physician must discuss the patient information sheet with the patient, and complete the healthcare practitioner certification form
• These documents, in conjunction with a completed patient application, are then submitted to IDPH by the patient (either by mail or online) 

Can an individual grow cannabis at home?

No

How does a patient obtain cannabis from a dispensary? What documents are needed? Can a caretaker purchase the cannabis? 

Patients must check-in to the dispensary with a valid registration card issued by IDPH, which is dual-verified by a patient’s government issued ID.  Dispensary staff are required to verify the patient’s card using a web-based portal provided by IDPH.

If a patient is immobile or otherwise unable to visit a dispensary, the patient may qualify for a designated primary caregiver as certified by the patient’s healthcare practitioner. Information on the caregiver process can be found at: https://idph.iowa.gov/omc/Caregiver-Registration

What is the phone number for the Iowa Office of Medical Cannabidiol?

The phone for the Iowa Office of Medical Cannabidiol is  515-725-2076.

More information about the Iowa medical cannabis program can be found at can be found at:  https://idph.iowa.gov/omc.

Legal Considerations

What Affirmative Defenses do Iowa laws provide for certifying practitioners?

• A healthcare practitioner and their agents and employees are not subject to (1) criminal prosecution, or (2) any civil or disciplinary penalties by the Board of Medicine or other licensing board for activities related to certification, possession, or use of medical CBD in the treatment of a patient as authorized under chapter 124E.
• These affirmative defenses broadly cover a health care practitioner’s certification of a patient’s debilitating medical condition to receive a registration card, certifications required to exceed the 4.5g/THC purchase limit, and designation of a total THC cap deemed appropriate by the practitioner.

How may a certifying practitioner encounter license sanctions?

• Disciplinary action against a health care practitioner is authorized only when a provider acts inconsistently with chapter 124E or violates other laws, for example – writing certifications for persons whom they have never examined.

Will my DEA Registration be impacted?

• The Federal government will not revoke a DEA registration for a physician’s involvement in state medical cannabis programs, if the physician complies with state law (2013 DOJ guidance)
• A related case is Conant v. Walters (2000), where a ruling was made that the federal government cannot revoke a DEA registration, when a physician recommends marijuana to a patient, if the recommendation was based on sincere medical judgment

Are there malpractice concerns?

• There are no reported US cases of malpractice brought against physicians for activities related to medical cannabis
• Legal experts view the legal risk as minimal because physicians are merely certifying that the patient has a qualifying condition; they are not prescribing. Physicians who choose to participate should discuss their role in certifying patients with their legal counsel and malpractice carrier.