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

The Massachusetts Marijuana-thon®: Comprehensive Medical Marijuana Course Bundle introduces the reader to the endocannabinoid system, addresses many aspects of the therapeutic use of marijuana, and also assists clinicians with the treatment and counseling of CBD consumers.

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, Massachusetts state-specific resources can be viewed at the bottom of this page. Look for “Information for MA Practitioners Wishing to Certify Patients.”

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 MA Practitioners Wishing to Certify Patients:

• 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 eye
• Describe 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

Information for MA Practitioners Wishing to Certify Patients

Some FAQs about the Massachusetts Medical Marijuana Program

• Which clinicians may register as a certified provider in the state of Massachusetts?
• What are the criteria for registering with the Massachusetts Medical Use of Marijuana Program?
• What are the rules for writing certifications for qualifying patients?
• For how long does the healthcare provider’s registration last?
• What are the qualifying debilitating medical conditions for which a healthcare provider can certify a patient?
• What modes of medical marijuana administration are allowed?
• What is the contact information for the Massachusetts Cannabis Control Commission?

Which clinicians may register as a certified provider of the Massachusetts Medical Use of Marijuana Program?

Physicians (MD and OD), Certified Nurse Practitioners, and Physician Assistants.

What are the criteria for registering with the Massachusetts Medical Use of Marijuana Program?

Generally, an active full Massachusetts license with no prescribing restrictions, and a Massachusetts Controlled Substances Registration. In addition, the registrant must have at least one established place of practice in Massachusetts. The Commission may also request additional information.

Certified nurse practitioners (CNP) must also provide 2 documents:

• An attestation by the supervising physician that the CNP is certifying patients for the medical use of marijuana pursuant to mutually agreed upon guidelines between the CNP and the physician supervising the CNP’s prescriptive practice
• Board Authorization by the Massachusetts Board of Registration in Nursing

Physician assistants (PA) must also provide 2 documents: 

• An attestation by the supervising physician that the PA is certifying patients for the medical use of marijuana pursuant to mutually agreed upon guidelines between the PA and physician supervising the PA’s prescriptive practice
• Board Authorization by the Massachusetts Board of Registration of Physician Assistants

What are the rules for writing certifications for qualifying patients?

There are multiple rules by which the certifying health care provider must abide:

• A certifying healthcare provider may not issue a written certification until completion of designated programs explaining the proper use of marijuana, including side effects, dosing, and contraindications, as well as with psychotropic drugs, and also on substance abuse recognition, diagnosis, and treatment related to marijuana. For physicians, this requires a minimum of 2.0 Category 1 continuing professional development credits; for CNPs a minimum of one program meeting the requirements for nursing continued education; and for PAs, a minimum of 1 program meeting the requirements of the Board of Registration of Physician Assistants.
• Certifying healthcare providers must comply with generally accepted standards of practice in their respective fields.
• Diagnosis of a patient as having a debilitating medical condition may not be delegated to any other person. 
• A written certification may be issued only if there is a bona fide healthcare provider-patient relationship.
• Before issuing a written certification, a certifying healthcare provider must review the qualifying patient’s prescription history in the Massachusetts Prescription Monitoring Program, unless otherwise specified by the Commission.
• A patient with a past diagnosis of a debilitating medical condition, but the condition is not active, is not considered to be suffering from a debilitating medical condition, unless symptoms of the condition are mitigated by medical marijuana and the patient is not undergoing treatment for such condition.
• An initial written certification may not be written before a clinical visit. A renewal certification may be submitted following a clinical visit or telephonic consultation. However, a clinical visit must occur no less than once per year.
• A certification must indicate the period for which it is valid, from 15 days to 1 year.
• A 14 day supply of marijuana is 2.5 ounces and a 60 day supply is 10 ounces. A certifying healthcare provider may determine and certify a different amount and must document the amount and rationale in the medical record and in the written certification.
• A qualifying patient younger that 18 years may receive a written certification upon diagnosis by 2 Massachusetts licensed certifying physicians, at least one of which is a board-certified pediatric subspecialist or a board-certified pediatrician, of a debilitating life-limiting illness. If the illness is not life-limiting those physicians must determine that the benefits of medical marijuana outweigh the risks. There must be a discussion of the potential negative impacts on neurological development with the parent or legal guardian and their written consent. The rationale must be recorded in the medical record and the written certification.
• There are conflict of interest restrictions on a certifying healthcare provider and co-workers, employees, and immediate family members. – They may not: directly or indirectly exchange anything of value with a Registered Marijuana Dispensary (RMD), or anyone associated with the RMD, nor with a personal caregiver; offer a discount or anything of value to a qualifying patient based on the patient’s choice of RMD; deal with a patient at an RMD; have a financial interest in an RMD; or benefit from a patient obtaining a written certification, save for charging an appropriate fee for a clinical visit.
• Certifying healthcare providers may not issue written certifications for themselves or immediate family members. They may do so for employees or co-workers in accordance with all regulations, including a clinical visit, documentation of a full assessment of the patient’s medical history and condition, explaining the potential benefits and risks of marijuana use, and maintaining a role in the ongoing care and treatment of the patient.

For how long does the healthcare provider’s registration last?

Once issued, a registration can be retained indefinitely except in cases of license, authorization or controlled substances registration revocation; voluntary agreement not to practice in Massachusetts; fraud; failure to timely complete required continuing professional development credits; or surrender of registration.

What are the qualifying debilitating medical conditions for which a healthcare provider can certify a patient?

Cancer; glaucoma; positive status for human immunodeficiency virus (HIV); acquired immune deficiency syndrome (AIDS); hepatitis C; amyotrophic lateral sclerosis (ALS); Crohn’s disease; Parkinson’s disease; and multiple sclerosis (MS) when such diseases are debilitating; and other debilitating conditions as determined in writing by a qualifying patient’s healthcare provider.

Note: Debilitating means causing weakness, cachexia, wasting syndrome, intractable pain or nausea, or impairing strength or ability, and progressing to such an extent that one or more of a patient’s major life activities is substantially limited.

What modes of medical marijuana administration are allowed?

Medical marijuana patients can consume the medical marijuana products via multiple modes of administration, including vaporization, smoking, topical, oral (pills, tinctures, and edibles) and suppository. 

What is the contact information for the Massachusetts Cannabis Control Commission?

If you have questions about the Massachusetts Medical Marijuana Program, you can contact MedicalMarijuana@State.MA.US or (833) 869-6820.