ADVANCED CERTIFICATE OF MEDICAL CANNIBIS · 2018. 4. 30. · MEDICAL MARIJUANA PROGRAM 35 Glaucoma...

MEDICAL MARIJUANA PROGRAM

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ADVANCED CERTIFICATE OF MEDICAL

CANNIBIS

STUDENT HANDBOOK


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Course objectives

At the conclusion of this course, the student will have a basic to solid

understanding of the key aspects of the a-z of medical cannibis.

TOPICS

WHAT IS MEDICAL CANNIBIS?

WHO NEEDS IT?

AIMS & GOALS

STATISTICS

TYPES OF CANNIBIS PLANT

HOW CANNIBIS WORKS

THC LEVELS

END PRODUCTS MADE

CONSUMING PRODUCT


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RECREATIONAL USE

MEDICAL CONDITIONS HELPED

METHODS OF TAKING

DANGER & RISKS

CONTROVERSY

THE FUTURE


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MEDICAL CANNIBIS STUDIES

INTRODUCTION

What is cannibis?

Cannibis is a preparation of the Cannabis or Marijuana plant intended for use as a

psychoactive drug

spiritual drug

medicine

herbal remedy

This usage generally requires a prescription, and distribution is usually done within a

framework defined by local laws.


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Medical cannabis can be used

to reduce nausea and vomiting during chemotherapy

to improve appetite in people with HIV/AIDS

to treat chronic pain and muscle spasms

THC in cannibis

The main psycho-active part of cannabis is tetra-hydro-cannabinol (THC)

There are at least 65 other cannabinoids in cannibis.

THC and its major (inactive) metabolite, THC-COOH, can be measured in

blood

urine

hair

oral fluid

sweat


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Police use it for forensic investigation of a

traffic offense

other criminal offense

The concentrations obtained from such analyses can often be helpful in

distinguishing active use from

passive exposure

elapsed time since use

extent or duration of use

These tests cannot, distinguish authorized cannabis smoking for medical purposes

from unauthorized recreational smoking.


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THC-COOH vs THC

Urine contains predominantly THC-COOH.

Whereas THC is contained in

Hair

oral fluid

sweat

Blood may contain both substances, with the relative amounts dependent on

recency

extent of usage


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Using cannibis

Cannabis can be used by smoking, vaporization, within food, or as an extract.

Cannabis is often used for its mental and physical effects, such as

a high feeling

a change in perception

euphoria (heightened mood)

an increase in appetite


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Aims

The main goals/aim is to deliver medical benefits to a patient in a way which is:

safe

legal

timely

economical


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Statistics

Intro

Cannabis is by far the most widely used illicit substance.

The typical age of first-use is 16, similar to the typical age of first-use for alcohol but

lower than the first-use age for other illicit drugs.

50% of the people in western countries had tried cannibis,

232 million people use cannabis

4.9% of the global population use cannabis between age 15 and 65

12% had used it in the past year

7.3% had used it in the past month

Men are over twice as likely to use cannibis as women

18-29 year-olds are six times more likely to use as over 65-year-olds

44% of the westerrn population has tried cannibis in their lifetime

44% of 12th graders in the west have tried the drug at least once


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Medical conditions helped

Intro

There is evidence supporting the use of cannabis or its derivatives in the treatment

of

multiple sclerosis, above

chemotherapy-induced nausea and vomiting

neuropathic pain


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Other conditions

Some also say it helps with

AIDS wasting syndrome, above

epilepsy

rheumatoid arthritis

glaucoma

schizophrenia

psychosis


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Types of cannibis

Intro

There are 4 main types of cannibis plant.

2 of the main ones are:

Sativa

Indica

Hybrid

Ruderalis

Skunk


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2 of the main ones are:

Sativa

Indica

Sativa

The effects of sativa are well known for their cerebral high, hence its daytime use as

medical cannabis.


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Indica

The indica is well known for its sedative effects and preferred night time use as

medical cannabis

Skunk

What is known as skunk accounts for between 70 and 80% of samples seized by

police

Similar to other varieties of marijuana, skunk weed is commonly produced inside,

under specific grow lamps

in a greenhouse environment

Skunk weed differs from traditional marijuana as it is often created by combining two

different forms of the cannabis : Sativa and Indica.

The combination of these two strains are considered to produce unique and

conflicting effects that separate skunk from other types of marijuana.


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Additionally, this particular strain of cannabis is considered to be a more potent form

of the drug as it contains 2-3 times more THC than standard marijuana.

THC is thought to be the main active ingredient in cannabis, and its higher

concentration in skunk weed has raised concerns regarding its potential negative

psychological effects

Skunk can sometimes be incorrectly mistaken for all types of herbal cannabis.


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Cannibis plant end products

Intro

The 3 main forms or end products of cannabis products are

the flower, above

the resin (hashish)

hash oil, below


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Parts of the cannabis plant

Intro

The 4 main parts of the plant are:

pistil/buds

stem/stalks

seeds

Fan Leaves


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Buds & leaves

The buds (flowers) of the female cannabis plant contain the highest concentration of

THC, followed by the leaves.


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Stalks & seeds

The stalks and seeds have much lower THC levels.

The leaves can contain ten times less THC than the buds, and the stalks one

hundred times less THC


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Risks & dangers

Intro

In this section we will have a look at the risks and dangers.

Contaminants

Cannibis or hashish may contain:

Contaminants

adulterants

Other substances may be added to cannabis to add weight to the product (lead has

been used in some cases) to

increase its psycho-active effects


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as part of the cultivation and processing of the cannabis (fertilizer)

Hashish obtained from soap bar-type sources.

The dried flowers of the plant may be contaminated by

the plant taking up heavy metals and other toxins - from its growing

environment

the addition of glass

In the Netherlands, chalk has been used to make cannabis appear to be of a higher

quality.

Increasing the weight of hashish products in Germany with lead caused lead

intoxication in at least 29 users.

Despite cannabis being generally perceived as a natural product.

Some consider cannabis grown indoors under hydroponic conditions to be a greater

health risk due to increased contamination, added to the plant during cultivation to

enhance the plant growth and quality.

Drug dealers may spike or lace cannibis with other chemicals such as PCP, creating

a product known as wet cannibis; this enhances the effects of smoking it and it can

be used to make low-grade, low-potency cannibis seem more effective.


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Recreational use

Cannabis has psychoactive and physiological effects when consumed.

The immediate desired effects from consuming cannabis include

relaxation

euphoria (the high or stoned feeling)

a general alteration of conscious perception

increased awareness of sensation

increased libido

distortions in the perception of time and space

At higher doses, effects can include altered body image, auditory and/or visual

illusions, pseudohallucinations and ataxia from selective impairment of polysynaptic

reflexes.

Some say cannabis can lead to dissociative states such as

depersonalization

derealization


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Some immediate side effects include

a decrease in short-term memory

dry mouth

impaired motor skills

reddening of the eyes

Aside from a subjective change in perception and mood, the most common short-

term effects include

increased heart rate

increased appetite and consumption of food

lowered blood pressure

impairment of short-term and working memory

psychomotor coordination

concentration


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Some users may experience an episode of acute psychosis, which usually abates

after 6 hours, but in rare instances, heavy users may find the symptoms continuing

for many days.


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MORE ON MEDICAL USES

Intro

In this section we will have a further look at the medical uses of medical cannabis.

Medical use

As stated, medical cannabis can be used

to reduce nausea and vomiting during chemotherapy

to improve appetite in people with HIV/AIDS

to treat chronic pain and muscle spasms


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Its use for other medical applications is insufficient for conclusions about safety or

efficacy.

Short-term use increases the risk of both minor and major adverse effects.

Common side effects

Dizziness

feeling tired

vomiting

hallucinations

Long-term effects of cannabis are not clear.

Concerns include

memory and cognition problems

risk of addiction

schizophrenia in young people

risk of children taking it by accident


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Intro

In medicine, cannabinoids have been shown to exhibit some good effects.

Medical cannibis is the use of cannabis and its cannabinoids to

treat medical disease

improve medical disease symptoms

Let’s look at some of the main ones.


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Cancer

Cannabinoids have been shown to exhibit some anti-cancer effects in laboratory

experiments, although there has been little research into their use as a cancer

treatment in people.

Laboratory experiments have suggested that cannabis and cannabinoids have anti-

carcinogenic and anti-tumor effects, including a potential effect on

breast

lung-cancer cells

there have been no clinical trials on the use of cannabis to treat cancer in people,

and only one small study using delta-9-THC that reported potential antitumoral

activity.

Claims that cannabis has been proved to cure cancer are misleading.

There is no good evidence that cannabis use helps reduce the risk of getting cancer.


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Whether smoking cannabis increases cancer risk in general is difficult to establish

since it is usually smoked mixed with tobacco – a known carcinogen – and this

complicates research.

Cannabis use may be linked to an increased risk of a type of testicular cancer.

The association of cannabis use with head and neck carcinoma may differ by tumor

site, with both possible pro- and anticarcinogenic effects of cannabinoids.

Additional work in this area is needed.


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Dementia

Cannabinoids have been proposed to have the potential for lessening the effects of

Alzheimer's disease.

Some say evidence is either inconclusive or still missing.


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Diabetes

There is emerging evidence that cannabidiol may help slow cell damage in diabetes

mellitus type 1.

There is a lack of meaningful evidence of the effects of medical cannabis use on

people with diabetes

The potential risks and benefits for diabetic patients remain unquantified at the

present time.


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Epilepsy

Although there is a lot of hype and anecdotes surrounding medical cannabis and

epilepsy, studies are limited, and no conclusions can be drawn.

The mechanisms by which cannabis may be effective in the treatment of epilepsy

remain unclear.

Lack of clinical research

Some reasons for the lack of clinical research have been

the introduction of new synthetic and more stable pharmaceutical

anticonvulsants

the recognition of important adverse side effects

legal restrictions to the use of cannabis-derived medicines.


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Glaucoma

While cannabis can help lower intraocular pressure, it recommended against its use

because of its side effects and short duration of action, coupled with a lack of

evidence that its use alters the course of glaucoma.

Relatively little research had been done concerning therapeutic effects of

cannabinoids on the eyes.


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Tourette syndrome

Cannabinoids show potential therapeutic value in treating Tourette syndrome (TS).

A study said that controlled research on treating TS with dronabinol showed the

patients taking the pill had a beneficial response without serious adverse effects.

Other studies had shown that cannabis has no effects on tics and increases the

individuals inner tension.

Cannabinoid medication might be useful in the treatment of the symptoms in patients

with TS

there is not enough evidence to support the use of cannabinoids in treating tics and

obsessive compulsive behaviour in people with Tourette's syndrome.


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Studies on other conditions

Anecdotal evidence and pre-clinical research has suggested that cannabis or

cannabinoids may be beneficial for treating Huntington's disease or Parkinson's

disease, but follow-up studies of people with these conditions have not produced

good evidence of therapeutic potential.

A study argued that cannabis had properties that made it potentially applicable to

the treatment of amyotrophic lateral sclerosis, and on that basis research on this

topic should be permitted, despite the legal difficulties of the time.

A study said that bipolar disorder was not well-controlled by existing medications and

that there were good pharmacological reasons for thinking cannabis had therapeutic

potential, making it a good candidate for further study.

Cannabinoids have been proposed for the treatment of primary anorexia nervosa,

but have no measurable beneficial effect.

Some argue that cannabinoids might have useful future clinical applications in

treating digestive diseases.

Laboratory experiments have shown that cannabinoids found in cannibis may have

analgesic and anti-inflammatory effects.


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A study reviewed all available findings levering the use of cannibis to treat brain

diseases.

The result was that the scientific evidence is weak that cannabis in any form serves

as medicinal for curing or alleviating neurological disorders.

To ease multiple sclerosis patients' stiffness, which may be accomplished by their

taking cannabis extract by mouth or as a spray, there is support.

Cannabis is being investigated for its possible use in inflammatory bowel disease but

there is only weak evidence for its benefits as a treatment.

cannabidiol has shown potential to relieve convulsion, inflammation, cough,

congestion and nausea, and to inhibit cancer cell growth.

Preliminary studies have also shown potential over psychiatric conditions such as

Anxiety

Depression

psychosis


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Because cannabidiol relieves the aforementioned symptoms, cannabis strains with a

high amount of CBD may benefit people with multiple sclerosis or frequent anxiety

attack

Short term effects of cannabis use

Short-term use increases the risk of both minor and major adverse effects.

Common side effects include

dizziness

feeling tired

vomiting

hallucinations

Long-term effects of cannabis are not clear.

Concerns include

memory and cognition problems

risk of addiction


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schizophrenia in young people

risk of children taking it by accident.

The Cannabis plant has a history of medicinal use dating back thousands of years

across many cultures.

Its use is controversial.

Using cannabis

Medical cannabis can be administered using a variety of methods, including

liquid tinctures

vaporizing

oils

capsules

lozenges

dermal patches

oral/dermal spray


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Synthetic cannabis

Synthetic cannabinoids are available as prescription drugs in some countries;

examples include:

dronabinol

nabilone.

Cannabis vaporizers have gained popularity because of the perception among users

that less harmful chemicals are ingested when components are inhaled via aerosol

rather than smoke.

Cannabinoid medicines are available in

pill form

o dronabinol

o nabilone

liquid extracts formulated into an oromucosal spray

o nabiximol


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HIV/AIDS

Evidence is lacking for both efficacy and safety of cannabis and cannabinoids in

treating patients with HIV/AIDS or for anorexia associated with AIDS.

Pain

Cannabis appears to be somewhat effective for the treatment of chronic pain,

including pain caused by neuropathy and possibly that due to fibromyalgia and

rheumatoid arthritis.


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A study found it was unclear if the benefits were greater than the risks, while a study

considered it generally safe for this use.

In palliative care the use appears safer than that of opioids.

A study found limited and weak evidence that smoked cannabis was effective for

chronic non-cancer pain.

The review recommended that it be used for people for whom cannabinoids and

other analgesics were not effective.

A study found moderate quality evidence that cannabinoids were effective for chronic

pain.

A study found that inhaled medical cannabis was effective in reducing neuropathic

pain in the short term for one in five to six patients.

A study found limited evidence that medical cannabis was effective for neuropathic

pain when combined with traditional analgesics.


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Neurological problems

The efficacy of cannabis in treating neurological problems is not clear when it comes

to

multiple sclerosis

epilepsy

movement problems

Studies of the efficacy of cannabis for treating multiple sclerosis have produced

varying results.

The combination of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) extracts

give subjective relief of spasticity, though objective post-treatment assessments do

not reveal significant changes.


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Evidence also suggests that oral cannabis extract is effective for reducing patient-

centered measures of spasticity.

A trial of cannabis is deemed to be a reasonable option if other treatments have not

been effective.

Its use for MS is approved in ten countries.

A study found no problems with

tolerance

abuse

addiction


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Posttraumatic stress disorder

There is tentative evidence that medical cannabis is effective at reducing

posttraumatic stress disorder symptoms, but, there is insufficient evidence to confirm

its effectiveness for this condition.


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METHODS OF TAKING MEDICAL CANNIBIS

Intro

In this section we will have a look at methods of taking cannabis.


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Vaporizers

Studies have shown that vaporizing cannabis exposes the user to lower levels of

harmful substances than smoking cannabis

A vaporizer is a device used to vaporize the active ingredients of cannabis, for the

purpose of inhalation.

Vaporizers contain various forms of extraction chambers including straight bore,

venturi, or sequential venturi, and are made of materials such as

metal

glass

The extracted vapor may be collected in an inflatable bag, or inhaled directly through

a hose or pipe.

When used properly, cooler temperatures due to lack of combustion result in more

efficient extraction of the ingredients.

Hence, the irritating and harmful effects of smoking are heavily reduced, as is

secondhand smoke.


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Vaporizers are considered medically sound devices for delivering THC.

The factors affecting output are:

Temperature

Specimen density

Weight, content of water and essential oils

Consistency of material in the filling chamber

Storage time of the vapor

Inhalation method (breathing technique)

Not all those have been scientifically tested.


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Suppository form

A suppository is a solid dosage form that is inserted into

the rectum (rectal suppository)

vagina (vaginal suppository)

urethra (urethral suppository)

There it dissolves or melts and exerts

local effects

systemic effects

They are used to deliver both systemically and locally acting medications.


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Capsules (Pills)

Capsules be taken orally or be used as suppositories.

The two main types of capsules are:

Hard shelled capsules

Soft shelled capsules

Lets have a closer look:


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Hard-shelled capsules

Hard-shelled capsules are made using gelatin and contain

dry, powdered ingredients

miniature pellets

These are made in two halves: a lower-diameter body that is filled and then sealed

using a higher-diameter cap.


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Soft-shelled capsules

Soft-shelled capsules, primarily used for oils and for active ingredients that are

dissolved

suspended in oil

Both of these classes of capsules are made from aqueous solutions of gelling

agents, such as animal protein (gelatin) or plant polysaccharides or their derivatives

(starch and cellulose).

Other ingredients can be added to the gelling agent solution including

plasticizers

o glycerin

coloring agents

preservatives

disintegrants

lubricants


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surface treatment

Since their inception, capsules have been viewed by consumers as the most efficient

method of taking medication

Hash oil

Intro

Hash oil is an oleoresin obtained by the extraction of cannibis and/or hashish.

One pound of cannibis yields from 1/5 to 1/10 of a pound of hash oil.

The oil may retain considerable residual solvent: oil extracted with longer-chain

volatile hydrocarbons (naphtha) is less viscous (thinner) than oil extracted with short-

chain hydrocarbons (butane).


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Colored impurities

Colored impurities from the oil can be removed by

adding activated charcoal to one third volume

mixing well

filtering

evaporating the solvent

The THC content of hash oil varies tremendously, since the manufacturers use a

varying assortment of cannibis plants and preparation techniques

The form of the extract varies depending on the process used; it may be

liquid

clear amber solid (shatter)

sticky semisolid substance (wax)

brittle honeycombed solid ( honeycomb wax)


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Hash oil is consumed usually by

smoking

ingestion

vaporization

Smoking or vaporizing hash oil is known as dabbing.

Dabbing devices include special kinds of

water pipes

vaporizers

Some users call their apparatus an oil rig that includes a glass water pipe and a

hollow metal tube (nail), with an indentation on the side which is sometimes covered

with a dome.

The pipe is often heated with a blowtorch rather than a cigarette lighter

Hash oil is produced by solvent extraction (maceration, infusion or percolation) of

cannibis and/or hashish.


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After filtering and evaporating the solvent, a sticky resinous dank liquid with a strong

herbal odor (remarkably different from the peculiar odor of hemp) remains.

Fresh, undried plant material is less suited for hash oil production, because much

THC and CBD will be present in their carboxylic acid forms (THCA and CBDA),

which may not be highly soluble in some solvents.

The acids are decarboxylated during drying and heating (smoking).

Fresh, undried plant material is best suited for concrete production.

A wide variety of solvents can be used for extraction, such as

Chloroform

Dichloromethane

petroleum ether

naphtha

benzene

butane

methanol

ethanol


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isopropanol

olive oil

Currently, resinoids are often obtained by extraction with supercritical carbon

dioxide.

The alcohols extract undesirable water-soluble substances such as

chlorophylls

sugars ( can be removed later by washing with water)

Non-polar solvents such as benzene, chloroform and petroleum ether will not extract

the water-soluble constituents of cannibis or hashish, and will yield a somewhat

more potent oil as a result.

Non-polar cannabis extracts taste much better than polar extracts.

Alkali washing further improves the

odor

taste


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The oil may be further refined by

alkali washing

conversion of CBD to THC

Alkali washing

Alkali washing or removing the heavy aromatic carboxylic acids with antibiotic

properties may cause

heartburn

gallbladder

pancreas irritation

resistance to hemp antibiotics


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Risks & dangers

Intro

In this section we will have a look at the dangers and risks including production.

Production

Most of the solvents employed are flammable, making the extraction process

dangerous.

Several explosion and fire incidents related to hash oil manufacturing attempts in

homes have been reported.


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Solvents used to extract THC are flammable and/or combustible and have resulted

in

Explosions

Fires

severe injuries

deaths


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Handling

The LD50 for THC (Delta 9 Tetrahydrocannabinol) is not exactly known.

Hash oil can contain up to 80% THC (wash with alkali) though up to 99% with other

methods of extraction.

While health issues of the lungs may be exacerbated by use of Hash oil, it is not

known to cause side effects not already found in other preparations of Cannabis

Hash oil is not very lipophilic and it may however ooze through and swell common

glove materials such as natural rubber, except maybe polar materials such as

cellulose film

neoprene

nitrile rubber


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Storage

Hash oil should be

stored in airtight containers

protected from light

When exposed to air, warmth and light (especially without antioxidants), the oil loses

its taste and psychoactivity due to aging.


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CONTROVERSY

Intro

In this section we will have a look at some of the controversies in the use of medical

cannabis.

There is insufficient data to draw strong conclusions about the safety of medical

cannabis.

Typically, adverse effects of medical cannabis use are not serious.

These include:

Tiredness

Dizziness

cardiovascular and psychoactive effects

Tolerance to these effects develops over a period of days or weeks.


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The amount of cannabis normally used for medicinal purposes is not believed to

cause any permanent cognitive impairment in adults, though long-term treatment in

adolescents should be weighed carefully as they are more susceptible to these

impairments.

Withdrawal symptoms are rarely a problem with controlled medical administration of

cannabinoids.

The ability to drive vehicle or operating machinery may be impaired until a tolerance

is developed.

Although supporters of medical cannabis say that it is safe,46 further research is

required to assess the long-term safety of its use.


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A study found that exposure to cannibis had biologically-based physical, mental,

behavioral and social health consequences and was associated with diseases of the

liver

lungs

heart

vasculature


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Cognitive effects

THC intoxication is well established to impair cognitive functioning on an acute basis,

including effects on the ability to

plan

organize

solve problems

make decisions

control impulses

The extent of this impact may be greater in novice users, and paradoxically, those

habituated to high-level ingestion may have reduced cognition during withdrawal.

Studies of long-term effects on cognition have provided conflicting results, with some

studies finding no difference between long-term abstainers and never-users and

others finding long-term deficits.

The discrepancies between studies may reflect greater long-term effects among

heavier users relative to occasional users, and greater duration of effect among

those with heavy use as adolescents compared to later in life.


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A second systematic review focused on neuroimaging studies found little evidence

supporting an effect of cannabis use on brain

A study found that any long-term cognitive effects were relatively modest in

magnitude and limited to certain aspects of learning and memory.

Psychosis

Exposure to THC can cause acute transient psychotic symptoms in healthy

individuals and people with schizophrenia.

A study found that cannabis use reduced the average age of onset of

psychosis by 2.7 years relative to non-cannabis use

A study found that adolescent use of cannabis increases the risk of psychosis,

and that the risk is dose-related

A study found that cannabis use is associated with a two-fold increase in the

risk of psychosis, but that cannabis use is neither necessary nor sufficient to

cause psychosis


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A study found that cannabis use, particularly that before age 15, was a factor

in the development of schizophrenic disorders

Some studies have suggested that cannabis users have a greater risk of developing

psychosis than non-users.

This risk is most pronounced in cases with an existing risk of psychotic disorder.

A study suggested an increased risk in the development of psychosis linked to

polymorphisms in the COMT gene.

However, a more recent study cast doubt on the proposed connection between this

gene and the effects of cannabis on the development of psychosis.

A study reported that cannabis was a causal factor in some cases of schizophrenia

and stressed the need for better education among the public due to increasingly

relaxed access to cannabis.


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The future

Cannabis research is challenging since the plant is illegal in most countries.

There are also other difficulties in researching the effects of cannabis.

Many people who smoke cannabis also smoke tobacco.

This causes confounding factors, where questions arise as to whether the tobacco,

the cannabis, or both that have caused a cancer.

Another difficulty researchers have is in recruiting people who smoke cannabis into

studies.

Because cannabis is an illegal drug in many countries, people may be reluctant to

take part in research, and if they do agree to take part, they may not say how much

cannabis they actually smoke


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As drugs has increasingly come to be seen as a health issue instead of criminal

behavior, cannibis has also been legalized or decriminalized in:

Canada

Czech Republic

Colombia

Ecuador

Mexico

Recreational use of cannabis is illegal in most parts of the world, but the medical use

of cannabis is legal in certain countries, including

Austria

Canada

Czech Republic

Finland

Germany

Israel

Italy

Portugal


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Spain

Netherlands (where it is also legal recreationally)

Some Australian States are doing medical cannibis trials

FINAL SUMMARY

Medical cannibis is not just one thing - it entails an understanding & knowledge of

many varied & different areas such as:

AIMS & GOALS


END PRODUCTS

TYPES OF CANNIBIS

THC LEVELS

PRODUCTS MADE


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METHODS OF CONSUMING

OILS

SAFETY GEAR

EFFECTS

DANGER & RISKS

CONTROVERSY

ADVANCED CERTIFICATE OF MEDICAL CANNIBIS · 2018. 4. 30. · MEDICAL MARIJUANA PROGRAM 35 Glaucoma...

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Transcript of ADVANCED CERTIFICATE OF MEDICAL CANNIBIS · 2018. 4. 30. · MEDICAL MARIJUANA PROGRAM 35 Glaucoma...