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Possible Benefits

We cannot promise you that medicinal cannabis will help with the management of your condition as every individual is different and there is still a lot of research into dosage, product types and the conditions for which medicinal cannabis may be safe and effective. There are both potential benefits and harms with using medicinal cannabis in your treatment. Administration of medicinal cannabis should always be viewed as part of a therapeutic trial and therefore Dr Matty Moore will collect a lot of information about you during treatment to guide us in your management.

The Therapeutic Goods Administration (TGA) has some very useful information on the various medical conditions for which medicinal cannabis has been trialed. Please use: https://www.tga.gov.au/commuity-qa/medicinal-cannabis-products-patient-information

Possible Risks and Risk Management Plan. The potential risks include:

Psychiatric disturbance

This has been reported to occur in some people who take recreational cannabis, 1 in 4 people who inhale cannabis (1 in 6 across all cannabinoids) which includes some conditions such as depression, anxiety, and psychosis. In some individuals taking cannabis there is a reported link to schizophrenia, but it is not known if this is causative or is associated with use in people already diagnosed with schizophrenia. Medicinal cannabis has been shown to cause euphoria (people feeling “high”), numbness, speech disorders and muscle disorders. It is important to note that psychiatric disturbance may vary with dose, potency, product and formulation (i.e. inhaled vs oral).

For Men

The effect the drug has on your fertility, including future fertility, is unknown. Because the medicinal cannabis may affect an unborn baby, you should not father a baby while on this treatment and for 3 months following the end of this treatment.
You must confirm to the doctor, to the best of your intention, you will not father a child during the treatment and for 3 months after the last dose of treatment.

Driving and/or Operating Machinery

Cannabis has been shown to be linked with driving impairment including reduced attention span and concentration. In addition, the drowsiness or clouded thinking which may result from medicinal cannabis use will make it dangerous for you to drive or operate machinery for several hours after taking your dose. You must agree to wait at least 8 hours after taking medicinal cannabis orally and to not drive or operate machinery if you feel impaired.

Random breath/Drug-testing

Driving with detectable THC (tetrahydrocannabinol) in body fluids is currently a criminal offense in Australia and please be aware of the relevant state legislation regarding driving and roadside testing.

Random roadside drug testing may identify cannabinoids in the saliva and impairment may last up to 8 hours and as long as 24 hours following ingestion of THC. Please note that if you test positive for THC (present in some medicinal cannabis products) on a roadside drug test or you are driving impaired you may be required to provide a blood or urine sample. The cannabinoid, tetrahydrocannabinol (THC) and its metabolites are excreted through feces and urine. It may take up to five days for 80-90% of the total dose to be excreted. Very small concentrations of THC may be detectable in the urine many days after ingestion and in the blood for up to several weeks after ceasing use.

Here are links to the relevant state legislation regarding driving and roadside testing:

Western Australia: https://www.wa.criminallegal.com.au/traffic-law/drug-driving-driving-faqs-wa/

There are numerous laws and regulations regarding medicinal cannabis that your doctor must adhere to. The following requests are considered standard best practice and help this healthcare practice and you comply with these laws and regulations. MODE HEALTHCARE PTY LTD Unit 4/7 Clark Street Dunsborough, WA 6281

Consent to be treated with Cannabis-Based Products

Mode Healthcare and associated Doctors has proposed using a cannabis-based product to help improve my health profile.

I understand:

- That the treatment is not guaranteed to work, as the scientific evidence of its effectiveness is limited.
- That I will be starting it as a trial, which we will stop or vary if there is not a significant benefit.
- That it may have some side-effects, which the doctor and I have discussed.
- Using cannabis-based products in combination with alcohol is not recommended.
- That it may or may not lead to a reduction in some of my other medications. - That the doctor will have to report on my progress to the Health Department.

The patient agrees:

- To reliably attend appointments with the doctor.
- To not use any illegal substances, such as methamphetamine or cocaine.
- To notify the doctor of any personal or family history of drug or alcohol abuse.
- To not use unregulated cannabis – only to use the supply authorized by the doctor.
- To not sell or give the prescribed/authorized medicinal cannabis to anyone else, including family members.
- To use medicinal cannabis as prescribed/authorized by the doctor and not in larger amounts or more frequently.
- To NOT drive/or operate machinery while being treated with medicinal cannabis containing THC or if

feeling impaired after taking a dose of medicinal cannabis.
- (For Women) To understand that you should not be pregnant/become pregnant during treatment and for 1 month following end of treatment.
- (For Men) To understand that you should not father a child during treatment and for 3 months following

the end of treatment.
- To other pain consultations/management strategies, including non-drug approaches, as advised.
- To safely store the medication (This is REALLY important as children can easily accidentally ingest these substances).
- To not take medicinal cannabis across state or international borders, patients should inquire with the relevant authorities regarding the legality of this.
- To periodic urine drug tests as requested by the doctor or clinic.
- To view medicinal cannabis as a trial, which will be discontinued if benefits or therapy are not seen, or harms outweigh benefits.
- To understand that if any of these conditions are broken, or harms begin to outweigh benefits, the doctor may refuse to provide future medicinal authorization for medicinal cannabis
- To report any beneficial effects or side-effects from using medicinal cannabis to my doctor as soon as possible.