The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

Working...

Working...

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Survey

Please complete the survey below.

Thank you!

Loading...

Welcome to the "Cannabis Use Survey".

You are eligible to participate if you have used Cannabis at least once in the past 90 days.

Your participation in this survey is completely anonymous. No information you provide can or will tell us who you are. You may skip any questions you do not want to answer. By continuing to complete this survey, you agree to have the information that you provide used for research purposes by the identified investigators at Bastyr University. It will take approximately 10-20 minutes to complete the survey.

The information you provide will help inform physicians, researchers, policy-makers, and patients about the potential risks and/or benefits of Cannabis as a therapeutic or recreational agent.

Please direct any questions or concerns you may have about this survey to lmischley@bastyr.edu.

Please direct any questions you have about your rights as a research subject to Lizbeth Adams, PhD at the Bastyr University Office of Research Integrity: irb@bastyr.edu.

We appreciate your time and honesty.

Investigators:
Laurie Mischley, ND, MPH
lmischley@bastyr.edu

Michelle Sexton, ND
msextonnd@cannabisandsocialpolicy.org

ELIGIBILITY

Have you used Cannabis at least once in the past 90 days?

Yes

No

In general, would you say that your health is:

Excellent

Very Good

Good

Fair

Poor

In general, would you say that your quality of life is:

Excellent

Very Good

Good

Fair

Poor

In general, how would you rate your physical health?

Excellent

Very Good

Good

Fair

Poor

In general, how would you rate your mental health, including your mood and ability to think?

Excellent

Very Good

Good

Fair

Poor

In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employees, friend, etc.)

Excellent

Very Good

Good

Fair

Poor

To what extent are you able to carry out your everyday activities such as walking, climbing stairs, carrying groceries, or moving a chair?

Completely

Mostly

Moderately

A little

Not at all

IN THE PAST 7 DAYS.....
How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?

Never

Rarely

Sometimes

Often

Always

How would you rate your fatigue on average?

None

Mild

Moderate

Severe

Very Severe

How would you rate your pain on average?

Change the slider above to set a response

What kind of user do you consider yourself to be?
(check all that apply)

Recreational user

Medically indicated, Recommended by licensed provider

Medically indicated, Self-prescribed

Religious (example: Rastafari)

Current legal status in your state:

Not legal in my state.

Medical only legal in my state.

Medical and recreational legal in my state.

I don't know.

MEDICAL USE
Do you use Cannabis for the management of any of the following conditions?

Multiple sclerosis

Cancer

Epilepsy

HIV

Glaucoma

Irritable Bowel Syndrome

Ulcerative Colitis/ Crohn's Disease

Tremor

Anxiety

Depression

Muscle spasticity

Nausea

Pain

Tics

Intractable pain

Anorexia (lack of appetite)

Other seizure or spasticity disorder

Headache/ migraine

Arthritis

Insomnia/ sleep disorder

Parkinson's disease

Other

If other, please list:

Overall, how does cannabis affect the symptoms you associate with MS?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect your epilepsy?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect the symptoms you associate with cancer?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect the symptoms you associate with HIV?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect your glaucoma?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your condition / symptoms?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect your irritable bowel syndrome?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your ulcerative colitis or Crohn's disease?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your tremor?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect your anxiety?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your depression?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect your muscle spasticity?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your nausea?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your pain?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your tics?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect your lack of appetite?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your other seizure or spasticity disorder?
Cannabis makes it:

Change the slider above to set a response

Overall, how does cannabis affect your headaches or migraines?
Cannabis makes them:

Change the slider above to set a response

Overall, how does cannabis affect your insomnia/ sleep?

Change the slider above to set a response

Overall, how does Cannabis affect your Parkinson's disease?

Change the slider above to set a response

Do you use Cannabis for medical indications beyond what you are licensed to use it for?

Yes

No

In selecting my Cannabis medicine I consider these to be important factors:

(select all that apply)

"indica" dominant

"sativa" dominant

"indica"/"sativa" blend

The way the flower smells

The way the flower looks

High THC content

Low THC content

High CBD content

THC: CBD equal mix

I don't know what CBD is

I rely on what dispensary staff tells me

The terpenoid profile

I rely on what I learn via the internet telling me what would work for my symptoms

I base my selection on what my doctor tells me

I have no idea how to select

There are too many varieties to know

By name

Terpenoid content

CANNABIS USE PATTERN

The method I use most commonly is:
(choose one)

Oral (edibles, tincture, capsule, etc)

Rolled into joints / blunts

Pipe (plastic, metal, glass)

Water pipe / Bong

Vaporizer

Other concentrate (oil, kief, hash)

Topical

Fresh juice

Other

How long does it take before you feel the effects of inhaled/ smoked Cannabis?

Other methods of Cannabis use that I sometimes use include:
(select all that apply)

Oral (edibles, tincture, capsule, etc)

Rolled into joints / blunts

Pipe (plastic, metal, glass)

Water pipe / Bong

Vaporizer

Other concentrate (oil, kief, hash)

Topical

Fresh juice

Other

How long does it take before you feel the effects of oral/ edible Cannabis?

How long (in hours) do the effects of inhaled Cannabis last?

How long (in hours) do the effects of edible Cannabis last?

Where do you get your Cannabis from?
(check all that apply)

Grow it myself

Medical dispensary

Recreational dispensary

Underground market/ dealer

Home delivery

Other

Why do you purchase through underground market? (non-legal channels)

I don't have legal access in my state.

Legal dispensaries are too expensive.

I don't want to be seen/ recognized at the Cannabis stores.

Transportation to dispensaries is not readily available.

Other

PERSPECTIVE:

This is what 1 gram of Cannabis looks like:

How much Cannabis bud or flower do you usually use per week?

Less than one gram

1-2 grams

3-5 grams

An eighth = 3.5 grams

A quarter = 7 grams

An ounce = 28 grams

More than an ounce (>28 grams)

INHALATION

How many hits do you take per smoking session?

1

2

3

4

5

6

7

8

9

10

More than 10

How freqently do you use Cannabis?

All day, every day

5- 10 times per day

1-4 times per day

3-6 times per week

1-3 times per week

2-3 times per month

1 time per month

1 time every 2-3 months

1 time every 4-6 months

Less than 2 times per year

At what age did you first use Cannabis?

At what age did you first use Cannabis?
(We know this is a repeat question.)

Under 10

11-13

14-16

17-18

19-20

21-25

26-30

31-35

35-40

Over 40

Since you first began using Cannabis, what is the longest consecutive period you have gone WITHOUT using Cannabis?

Please check all statements you believe to be true.

Cannabis:

Is addictive

Disrupts my sleep

Improves my sleep

Affects my dreams

Makes my lungs hurt

Is motivating

Disrupts my motivation

Is spiritual

SHORT TERM EFFECTS

Please tell us about your experiece immediately after Cannabis use.

What is your experience of 'being stoned?'

Check all that apply.

Desire to eat. (munchies)

Loss of appetite

Paranoia

Less anxious or fearful; increased confidence.

Loss of motivation.

Increased motivation.

More forgetful

Memory improvement

Word-finding becomes a challenge

More articulate or communicative

More 'inward' focused

More extroverted, 'outward' focused

Tired or sleepy

Stimulated or energized

Apathetic (lack of interest or concern)

Enthusiastic

Increased anxiety

More calm or peaceful

Altered sense of time

Hallucinations

Dry mouth

Dizziness

Increased sex drive

Diminished sex drive

Difficult concentration

Improved concentration

Desire to stretch/ exercise

Desire to be still (couch lock)

More creative

Less creative

Musical

Desire to clean

Poor balance (feel unsteady)

Lack of coordination

Short-term memory problems (lose track of thoughts)

Long-term memory problem (recall of previous events)

Confusion

Sense of clarity or perspective

The quality of my social interactions improves

The quality of my social interactions declines

Difficulty making decisions

Other

If other, please describe:

How long do you typically wait before driving following Cannabis use?

I wait more than 6 hours before driving.

I wait 4-6 hours before driving.

I wait 2-4 hours before driving.

I wait 1-2 hours before driving.

I drive within 1 hour after using Cannabis.

Do you believe Cannabis impairs your ability to drive safely?

Yes

No

Sometimes

Do you believe alcohol impairs your ability to drive safely?

Yes

No

How many drinks (1.5 oz liquor, 12 oz beer, or 5 oz wine) does it take before you feel your driving is impaired?

Have you ever been in an accident, or recieved a ticket, while under the influence of Cannabis?

Yes

No

What percentage of your driving time is spent driving under the influence of Cannabis?

Do you think the combination of Cannabis and alcohol poses a driving risk greater than either substance alone?

Yes

No

DISCONTINUATION OF USE
Some individuals report withdrawal symptoms for a few days after stopping routine Cannabis use.

Do you experience any of the following symptoms during the 72 hours after interrupting routine use?

Check all that apply.

Irritability

Insomnia / Interrupted sleep

Nausea

Loss of appetite

Sweating

Salivation

Tremor

Weight Loss

Tiredness

Vivid dreams

Anxiety

Loss of productivity

Improved productivity

N/A

How many alcoholic drinks do you consume per week?

(1 drink= 1 pint of beer = 1 glass wine = 1 oz liquor)

I don't drink alcohol.

Less than 1 per week.

1-3 drinks per week.

4-6 drinks per week.

1 drink per day.

2 drinks per day.

3 drinks per day.

4 drinks per day.

5 drinks per day.

More than 5 drinks per day.

Do you currently use tobacco products?

Yes

No

In the past month, have you used any other drugs, besides cannabis and alcohol? (Not including drugs for which you have a prescription from a doctor.)

Yes

No

List all the drugs, besides alcohol, tobacco and cannabis, used without a prescription in the past month:

Expand

Have you ever received treatment for substance abuse?

Yes

No

Have you ever had trouble stopping or reducing your Cannabis use?

Yes

No

In your opinion, do you believe that Cannabis is addictive?

No

Yes

I don't know

Do you believe you have a problem with Cannabis use?
(e.g. addiction, dependence, or side effects that interfere with your well-being.)

Yes

No

Please describe:

Do you currently attend 12 step recovery program meetings?

Yes

No

Have you ever used Cannabis as a substitute for alcohol?

Yes

No

Have you ever used Cannabis as a substitute for illegal drugs?

Yes

No

Have you ever used Cannabis as a substitute for prescription drugs?

Yes

No

Please list prescription drugs that you have substituted Cannabis for:

Expand

Age:

Gender

Male

Female

Current employment

Full time

Part time

Unemployed

Retired

Disabled

In which country do you currently live?

In which state do you live?

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Woming

In which province do you live?

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland & Labrador

Nova Scotia

Northwest Territories

Nunavut

Ontario

Prince Edward Island

Quebec

Saskatchewan

Yukon

Where in the UK do you live?

England

Northern Ireland

Scotland

Wales

Which best describes your relationship status?

Single

Married

Divorced

Domestic partnership

Other

Race/ Ethnicity:

Caucasian

Black

Hispanic

Native American

Asian / Pacific Islander

Other

Highest level of education completed:

Less than 8th grade

Grade 9-11

Completed high school/ GED

Technical school certification

Associate degree (AA)

Bachelor degree (BA, BS)

Master (MS, MBA, MPH, etc)

Doctor (PhD, MD, ND, DO, etc.)

Total family income over the past 12 months:

< Less than $20,000

Between $20-40,000

Between $40-60,000

Between $60-80,000

Between $80-100,000

Between $100-150,000

More than $150,000

Personal, private code

** We cannot identify you with this information. This code allows us to link future surveys (that you may or may not participate in) to this one. This code will improve our ability to track changes in use over time.

1st letter of your first name
1st letter of your last name
1st letter of your mother's maiden name
1st letter of your city of birth
Last two digits of your birth year

Example:
RDPG71

Our goal is to better understand the medical and recreational use of Cannabis. Please tell us anything that you think we should know.

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.