Marijuana Term Research Project Survey

Hi fellow patients,
I am a college senior majoring in Community Health Education, and also a medical marijuana patient. I am doing some research on the medical application of marijuana for a term project. I am lucky enough to be a part of the California medical marijuana program, and know the benefits of using marijuana. I would greatly appreciate your participation in my survey. If you feel marijuana has helped you in any way, or even if not, please share your thoughts. Thanks and Be Well =)

edical Marijuana Survey

All answers are completely anonymous and for research purposes only. The purpose of this survey is to analyze the degree of relief marijuana provides to medicinal users, specifically in comparison to prescription medication, as well as the variety of conditions which it helps treat. If you would like to add any comments about the relief provided, please feel free to do so on the last page. Thank you for taking the time to participate in this survey.

1 . How long have you been using marijuana?________________________

2.Preferred Method: a. Glass Pipe b. Water Pipe c. Vaporizer d. Rolling- Joints/Blunts
e. Ingestion f. Topical

3. Daily Amount: a. Less Than 0.5g b. 0.5 g -1.0 g c. 1.0g - 2.0g d. 2.0g - 3.5 g
3.5 g - 7.0 g f. More than 7.0 g

4. Preferred Strain: a. Indica Dominant
b. 50/50 Hybrid c. Sativa dominant
d. I use all of the above

5. Reasons For Use (Check All That Apply) :
___ Muscle Pain ___ Eating Disorders ____Prescription Medication Side Effects
___Joint Pain ___ Anxiety ____ Medical Treatment Side Effects
___HIV/ AIDS ___ PTSD ____ Sleep Disorders
___Nausea ___ Depression ____ ADD/ ADHD

Please List Any Other Conditions Not Above :

6. Prior to the use of marijuana, how functional were you in daily life? Please note that “Functionality” includes both physical abilities and mental wellness, such as how motivated you are to seek out company of others, how you feel about yourself and your life, and attitudes towards furthering your life.
a. Very Functional - I was able to complete all desires activities without impact from condition
b. Moderately Functional - My Condition impaired my ability to do some activities
c. Barely Functional - My condition impacts me to the point where I struggle with daily life
d.Unable to Function Independently - I needed assistance in completing daily routines

7. On a Scale of 1 - 10, 1 being unable to care for yourself and 10 being at a state of total physical and mental wellness, how would you rate your daily life prior to use of marijuana? ___________

8. How as functionality increased or decreased since use?
Increased significantly b. Increased moderately c. No change
d. Decreased moderately e. Decreased Significantly

9. Using the same scale as question 7, how would you rate your overall wellness right now? _______

10. Do you currently, or have your ever, used prescription medications to treat the conditions for which you use marijuana?
a. Yes - Answer Questions 11 - 13 b. No - Skip to Question 14

11. Please indicate prescription drug use:
a. I replaced prescriptions with marijuana
b. I use marijuana to counteract side effects of prescription medication
c. I use marijuana because prescription medication aren’t sufficiently treating my condition
d. I had to stop using prescription medication in order to use marijuana

12. If you stopped using prescriptions, do you feel:
a. Condition has improved b. Condition has worsened

13. Please list any negative side effects of prescription medication: -___________________

14. Please list any negative side effects of marijuana: ____________

15. Please list any positive side effects of marijuana: _______

16. Do you work, go to school, or do volunteer work?
a. Yes b. No

17. If Yes to question 16, do you feel marijuana impairs your ability to participate in these activities?
a. Yes b. No

18. If No to question 17, do you feel you would be able to participate in these activities if not for marijuana?
a. Yes b. No

Please add any additional comments about the effects of marijuana on your life: ___________

Thank You for Participating!