Tilray Medical Cannabis A General Guide for Health Care Practitioners

NOT FOR GENERAL DISTRIBUTION

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2 Introduction

3 About Tilray

4 Medical Cannabis: A Brief Overview

4 About the Endocannabinoid System

5 Varieties and Characteristics of Cannabis Plants

5 Consuming Medical Cannabis

6 Treatment of Specific Illnesses and Symptoms

8 How Patients Can Order Medical Cannabis Legally

8 Patient Stories

13 Tilray Medical Cannabis Products

14 Reasons to Recommend Tilray

15 Glossary

19 Medical Cannabis Legislation

20 Important Safety Information

Contents

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About TilrayTilray is a licensed producer of medical cannabis, including cannabis extracts.

Tilray’s team of PhDs, master horticulturists, botanists and extraction specialists applies the latest science and technology to reveal and harness the power of cannabis. The result is a selection of cannabis products that is quality controlled, rigorously tested and carefully labelled.

Tilray operates a Good Manufacturing Practices (GMP) certified medical cannabis research and production facility in Nanaimo, British Columbia. GMP is a globally recognized system that ensures that all products meet the highest standards of quality.

Tilray collaborates with renowned hospitals and universities around the world to conduct clinical trials, researching the safety and efficacy of cannabis in treating a range of diseases and conditions.

Introduction Why You Should Consider Adding Medical Cannabis to Your Treatment Options

Increasingly, medical cannabis is considered an effective treatment for a variety of symptoms and conditions. Use of cannabis flower and extracts has gained widespread acceptance over the past decade due to a fast-growing body of evidence suggesting it can be a valuable adjunct or alternative to traditional pharmaceuticals.

Hundreds of thousands of patients worldwide are reporting positive results of self-medication with cannabis. This anecdotal evidence is being supported by emerging clinical research being advanced in Canada, Australia, Israel, the United States and a number of European nations.

More than 70,000 Canadians have registered to legally obtain medical cannabis from licensed producers such as Tilray. Registration requires a document issued by an authorized health care practitioner (HCP). We hope you find the information presented here to be of value as you consider adding cannabis to your list of recommended treatments.

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Varieties and Physical Characteristics of Cannabis PlantsThere are three dominant varieties of cannabis:

Indica is generally believed to have originated in Central Asia. It usually grows shorter and bushier than other varieties and exhibits wide, deep green leaves.

Sativa usually grows taller than indica, and sports long, light green leaves.

Hybrids are the result of cross breeding two varieties or strains of cannabis to obtain characteristics of both.

Strains Strains describe cannabis plants that share the same heredity and appearance. Strains are often given unusual names (e.g., Cannatonic; Pink Kush).

Terpenes

Terpenes are fragrant essential oils that contribute to the complex aroma of cannabis. The eight terpenes most commonly found in cannabis are bisabolol, caryophyllene, humulene, limonene, linalool, myrcene, pinene and trans-nerolidol. (More details are provided in the glossary section of this resource document.)

Consuming Medical Cannabis There are three primary methods for administering cannabis: smoking, vaporization and oral ingestion. HCPs may want to explain the consumption options with their patients to determine the preferred mode of delivery.

Inhalation of smoke (not generally recommended) or vapor offers the benefit of rapid onset of effects, which may be important for patients seeking fast symptom relief.

Smoking requires the burning of cannabis (typically using a pipe or cigarette).

Vaporization utilizes a device (vaporizer) that heats the cannabis to a temperature high enough to trigger decarboxylation (see box on page 6) and release cannabinoids as vapour, but too low to ignite and burn the cannabis, producing smoke. The vapour is then inhaled. Vaporization may be preferred by those concerned with the potential risks and irritation associated with smoking. Relative to smoking, vaporization is practically odourless.

Oral consumption offers patients an application method that bypasses the respiratory system entirely. While the effects of inhalation of cannabis smoke or vapour are nearly immediate and typically last two to four hours, effects from orally ingested cannabis (e.g., drops or capsules) begin 60 to 90 minutes after ingestion, and can last eight to twelve hours. Research suggests that, to achieve a comparable concentration of THC in the bloodstream the dosage for orally ingested cannabis needs to be increased approximately 2.5 times relative to smoking or vaporization.

Medical Cannabis: A Brief OverviewThe use of cannabis and its derivatives as medicine has been traced back at least two thousand years. Up to the 1920s, pharmacies regularly stocked products with cannabis as a primary ingredient. However, by the 1930s, cannabis use was increasingly portrayed (unfairly, in modern opinion) as a dangerous drug and was eventually classified by governments as without medical merit.

In the early 1960s, Dr. Raphael Mechoulam isolated the cannabinoid THC. Thirty years of subsequent research was rewarded with the discovery of a system of receptors in the body that bind exclusively with cannabinoids. Finally, a physical mechanism—the endocannabinoid system—was revealed that showed how cannabis interacted with the body to cause physiological changes.

For a number of powerful reasons, including growing resistance to the social injustices inflicted by prohibition, citizens of many nations have effectively lobbied for changes in the laws regarding the use of cannabis. Not only has this resulted in liberalization of regulations regarding personal use, it has stimulated scientific research into the efficacy and safety of cannabis. And while this research is still relatively formative, the results achieved so far clearly indicate its value and the promising potential of cannabis as effective medicine.

About the Endocannabinoid SystemThe endocannabinoid system is a group of endogenous cannabinoid receptors present in all vertebrates (and some invertebrates). Located primarily in the brain and nervous system, it has been shown to regulate a number of physiological functions, including pain perception, sleep and appetite.

The system is named after the phytocannabinoids, first discovered in the cannabis plant, that trigger those receptors (the body itself also creates cannabinoids). So far, nearly all research has focused on the two most prevalent cannabinoids, THC and CBD. However, there are dozens of known plant-based cannabinoids that need further research to determine if and in what way they may affect human physical responses.

Delta-9-tetrahydrocannabinol (THC) and Cannabidiol (CBD)THC is the compound responsible for the psychoactive effects or “high” felt from cannabis. It has also been linked to the immunosuppressive, anti-inflammatory and analgesic properties of cannabis.

Research indicates that CBD produces a physiological effect without the psychoactive effects associated with THC. It has been shown that CBD may, in some cases, reduce the frequency of seizures in patients with certain forms of childhood epilepsy.

There is evidence CBD and THC work together to produce a synergy of effects and regulate each other. For instance, CBD may block anxiety provoked by THC.

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Arthritis and musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, fibromyalgia, osteoporosis)

Cachexia (wasting syndrome) and loss of appetite in AIDS and cancer patients and anorexia nervosa

Some forms of cancer

Chronic pain

Diseases of the pancreas (diabetes, pancreatitis)

Epilepsy

Gastrointestinal system disorders (Crohn’s disease, irritable bowel syndrome, inflammatory bowel disease, pancreatitis, metabolic syndrome/obesity, ulcerative colitis)

Glaucoma

Headache and migraine

Hepatitis C and diseases of the liver (fibrosis, steatosis, ischemia-reperfusion injury, hepatic encephalopathy)

HIV/AIDS

Hypertension

Inflammation

Inflammatory skin diseases (dermatitis, psoriasis, pruritus)

Metabolic syndrome

Movement disorders (dystonia, Huntington’s disease, Parkinson’s disease, Tourette syndrome)

Multiple sclerosis

Nausea and vomiting

Obesity

Palliative care (relief from pain and other distressing symptoms, and the enhancement of quality of life)

Post-operative pain

Psychiatric disorders (anxiety and depression, sleep disorder, post-traumatic stress disorder (PTSD))

Typical Doses

1 to 1.25 grams per day is the average use rate by Canadian patients as reported by Health Canada.

0.5 to 1.5 grams is the average daily dried flower cannabis use rate reported from medical cannabis programs in the Netherlands and Israel.

Treatment of Specific Illnesses and SymptomsAt this time, it appears the majority of medical documents authorizing medical cannabis are issued to treat patients with chronic pain.

Encouragingly, recent studies show a significant number of these patients reducing or even replacing their use of potentially addictive and dangerous opioids when they augment their treatment with medical cannabis. Compared to opioids, cannabis has a far lower incidence of addiction, and there have been no known fatalities attributable to cannabis overdose.

In addition, research has been published on the potential efficacy of medical cannabis in treating the following conditions or symptoms:

Alcohol and opioid withdrawal symptoms (drug withdrawal symptoms)

Alzheimer’s disease, dementia

What is Decarboxylation?Cannabis must be heated to a temperature high enough for a process called decarboxylation to occur. Specifically, decarboxylation converts the tetrahydrocannabinolic acid (THCA) contained in dried cannabis into tetrahydrocannabinol (THC), and the cannabidiolic acid (CBDA) into cannabidiol (CBD).

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How Patients Can Order Medical Cannabis LegallyThe first step for a patient to obtain cannabis legally is to consult with an authorized health care practitioner (HCP). HCPs are physicians or, in some cases, nurse practitioners.

If the patient and HCP together determine that cannabis is an appropriate treatment option for the patient’s ailments, the HCP issues a medical document to that effect.

The medical document is submitted to a licensed producer (such as Tilray).* LPs offer a legal method for obtaining medical cannabis in Canada. Alternatively, patients may register with Health Canada to grow their own supply of medical cannabis or designate a third party to grow it for them.

On approval and completion of registration with the LP, the patient can order cannabis—by phone or online—for postal delivery.

Patient StoriesOn the following pages, Tilray presents stories and comments of individuals who have used medical cannabis as a treatment option. These are just four voices among a growing chorus of patients who speak about obtaining relief with medical cannabis. We feature them in an effort to advance the conversation and encourage efforts toward further research.

* If the HCP and patient choose Tilray as the preferred LP, the medical document should be faxed to Tilray, at 1-888-783-1323.

Maria “I had to put myself through a process of re-evaluating my own values when it came to cannabis.”

Maria is a former Royal Canadian Mounted Police officer who was injured in the line of duty, resulting in chronic pain, a 60% loss of function in her left hand and the numbing symptoms of Raynaud’s disease.

Her doctors prescribed a regimen of opioid pharmaceuticals, including morphine and nortriptyline. She counted at least 23 side effects of the drugs, commenting, “It’s a part-time job managing chronic pain. The other part-time job is managing the side effects.”

Eventually, a doctor suggested cannabis. Maria was cautious but curious. “I had to put myself through a process of re-evaluating my own values when it came to cannabis.” This occurred at the same time Tilray opened its doors, and Maria became Tilray’s first patient.

Maria describes her first experience with Cannatonic (a high-CBD, low-THC strain):

Eight weeks into the new treatment, Maria stopped using morphine completely and was free of its side effects. “To see a small amount [of cannabis] kill the pain—stop the Raynaud’s. And I’m not high. I’ve got no side effects. I’m back to what I call myself.”

Maria’s husband adds, “The benefits to my spouse and the family are immeasurable… I got my wife back.”

Refer to page 23 for safety information discussing relevant warnings and precautions regarding patients who are taking central nervous system (CNS) depressants, and patients who are pregnant or breastfeeding, as well as drug interactions and dosing instructions.

“I don’t know how quite to describe it. The sense that it was just being washed away. All the pain just kind of faded.”

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StephanieThe frequency of her seizures has decreased by 90%.

Since she was four months old, Stephanie has suffered from a rare and severe form of epilepsy (Lennox-Gastaut Syndrome) that causes her to experience seizures as often as 20 times each day.

The seizures often cause her to fall, and she has twice broken her legs as a result. The conventional pharmaceutical treatments used by Stephanie proved either ineffective in reducing the frequency and intensity of her seizures or caused symptoms of psychosis.

Stephanie’s parents eventually decided to try medical cannabis as something that might provide relief for their daughter. They obtained a doctor’s authorization and placed an order with Tilray.

The family determined that the medicine was best administered through Tilray cannabis oil. Since Stephanie began this new form of treatment, her parents report that the frequency of her seizures has decreased by 90%—down to just a dozen or so per month. In addition, she no longer uses a wheelchair.

Refer to page 23 for safety information discussing relevant warnings and precautions regarding cannabis use in adolescent patients, as well as drug interactions and dosing instructions.

Natalie “It's just opened my life to so much more possibility.”

Natalie suffered from depression, anxiety and insomnia since adolescence. She was eventually diagnosed with Post Traumatic Stress Disorder (PTSD), and her symptoms warranted a decade of sessions with psychologists and psychiatrists. In addition to talk therapy, Natalie was prescribed a variety of sleeping pills and antidepressants, many of which she says made her feel worse. In her words, “everything just… it never felt level.”

Natalie came across an article about Tilray’s collaboration with the University of British Columbia, to study the efficacy of cannabis as a treatment of PTSD. She was intrigued.

Natalie called on Tilray to learn about available products and the ordering processes.

“The customer service has been beyond for me,” she says. “Every question was always either answered instantly or I was gotten back to within a reasonable time frame.”

She found a few strains that worked for her. The result? “Cannabis has replaced, almost completely, my antidepressants I was on. My sleeping pills I no longer take at all, as well as my ADHD medication.”

She continues, “My life is actually a life now. I have friends, I go out, I have family I enjoy doing things with. It’s just opened up my life to so much more possibility.”

“It’s got to be one of the most significant things that cannabis has helped me with—this idea of having hope.”

Refer to page 23 for safety information discussing relevant warnings and precautions regarding patients who are taking central nervous system (CNS) depressants, and patients who are pregnant or breastfeeding, as well as drug interactions and dosing instructions.

Encouraged by their experience, Stephanie’s mother and father are strong advocates for more clinical research into the potential of cannabis as a medicine.

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Braydon “I’m learning how to be a mom. Not a nurse, not a doctor—a mom.”

Braydon has suffered from childhood epilepsy since he was an infant, and after years of struggles using pharmaceuticals and surgery, his mother, Tasha, took the brave step of having him try medical cannabis as a new adjunct treatment. She tells the story:

“When Braydon was born, he spent six weeks in the neonatal intensive care unit. We later found out he had been seizing since birth, and he was diagnosed with Early Infancy Onset Childhood Epilepsy. Braydon would have up to 100 to 150 seizures a day. He took up to 42 pills a day.

“And that’s when we talked about cannabis. I gave him his first dose [of medical cannabis] at noon, and at 12:42, in the middle of a seizure, his seizures stopped. [The frequency of Braydon’s seizures has subsequently dropped significantly–Editor.] He’s learning how to ride a bike. He’s got life in him now.

“I’m learning how to be a mom. Not a nurse, not a doctor—a mom. And that feels really good.

“I’ve actually promised one of my friends who started me on this journey that I would help whoever I needed to help in my shoes, because I never want to see a mom bury her child because of epilepsy.”

“As a parent, I had nothing left to do for my son, and this was it. I knew my son needed cannabis to survive.”

Tilray Medical Cannabis Products

Whole-Flower CannabisCured and trimmed whole cannabis flower.

Ground CannabisPrecise blends of ground cannabis.

Full–Spectrum ExtractsContains cannabis oil extract with active ingredients refined to 80% purity, along with other natural plant compounds.

Clinical CompoundsPurified products contain an Active Pharmaceutical Ingredient (API) refined to 98% purity without other natural plant compounds.

Tilray Profiles Tilray Profiles are a set of nine color-coded product designations that each define a range of THC and CBD potencies. The presence and strength of these cannabinoids appear to be the most important factors for determining effects of medical cannabis products.

As a visual naming system, Tilray Profiles offer patients and health care practitioners a standardized approach to identifying and differentiating medical cannabis products, helping to ensure HCPs are recommending the right medicine for their patients.

Which Tilray Products Are Right for Your Patients? Patients and HCPs are encouraged to contact Tilray directly at 1-844-TILRAY1 (845-7291) for more information on Tilray’s products. Tilray’s customer service representatives are experienced in discussing the format, characteristics and availability of products with patients and HCPs. Tilray is proud to offer round-the-clock phone and online availability of its customer service representatives.

THC DOMINANT THC & CBD BALANCEDCBD DOMINANT

T100

LOW LOW LOWMID MID MIDHIGH HIGH HIGH

C100 TC100T200 C200 TC200T300 C300 TC300

Refer to page 23 for safety information discussing relevant warnings and precautions regarding cannabis use in minors, as well as drug interactions and dosing instructions.

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Reasons to Recommend TilrayMedical Grade QualityTilray’s production adheres to stringent GMP standards (which exceed the quality standard required by Health Canada). Every product is tracked and thoroughly tested to ensure it’s free of chemical and microbial contaminants. Every effort is aimed at creating the highest-quality medical cannabis products available.

SelectionTilray lets HCPs and patients choose from one of the industry’s widest selections of cannabis products, including whole flower and extracts.

Round-the-clock Patient Service AvailabilityTilray is renowned for delivering unparalleled customer service. Tilray representatives are available to assist in both English and French, and are trained to guide patients through registration, help them through the ordering process, and more.

e-PortalTilray’s secure online e-portal allows HCPs to easily and quickly manage patient records and issue medical documents.

Senior Discount

10% off for patients who are 65+ years old. No documentation is required to receive a Senior Discount.

New Patient CreditAll patients are provided a $50 credit upon medical document approval.

Annual Renewal CreditA $100 to $250 credit upon renewal of the medical document with Tilray. The amount of the credit is based on total orders at the time of the renewal, and is applied once the new medical document is reviewed and approved. Patients are eligible for a renewal credit every 12 months.

HCPs and patients are encouraged to visit Tilray’s website, tilray.ca, email us at tilray@tilray.ca, call: 1-844-TILRAY1 (845-7291) or reach us through our social media channels. Our Patient Services team is available 24 hours a day, 7 days a week, 365 days a year.

Glossary of Common Cannabis Related TermsACMPR

An acronym for Access to Cannabis for Medical Purposes Regulations, a system that, in August, 2016, replaced the MMPR (see below) in setting standards for medical cannabis authorization, production, distribution and access. Individuals now have a choice of how to access medical cannabis. After obtaining a medical document from their Health Care Practitioner, they may register to purchase medical cannabis from a licensed producer such as Tilray. Alternatively, they may use the document to register with Health Canada to grow their own supply of medical cannabis or designate a third party to grow medical cannabis for them.

Bisabolol

A terpene produced by the chamomile flower and other plants such as cannabis and Brazil’s candeia tree. While it has long been widely used in the cosmetics industry, Bisabolol has more recently become the subject of medical research.

Cannabinoids

Complex compounds occurring naturally in the cannabis plant that interact with the body’s endocannabinoid system. Over 85 cannabinoids have been identified, with the most prevalent being tetrahydrocannabinol (THC) and cannabidiol (CBD).

Cannabis

A genus that includes three primary varieties of plant: Cannabis indica; Cannabis ruderalis; and Cannabis sativa. Nearly all cannabis products are derived from indica, sativa or a hybrid of the two.

Caryophyllene (or β-Caryophyllene)

A terpene found in a number of edible plants. Among those are a variety of spices, such as black pepper, cinnamon and cloves, and herbs, such as basil, rosemary and oregano. Caryophyllene is also present in hops, the flavouring agent used in making beer.

CBD

Abbreviation for cannabidiol, one of dozens of cannabinoids found in the cannabis plant and, along with THC, usually the most prevalent. Regarded as having little or no psychoactive properties, CBD is being actively investigated as a treatment for a number of disease symptoms.

Clinical Compounds

Purified products containing an Active Pharmaceutical Ingredient (API) refined to 98% purity without other natural plant compounds.

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Decarboxylation

The process of heating cannabis to convert THCA (THC acid) to THC, and the cannabidiolic acid (CBDA) into cannabidiol (CBD). (Also see vaporization.)

Edibles

Foods and beverages infused with cannabis.

At the time of this writing, it is illegal for licensed producers to offer edibles. However, many patients choose to infuse their own foods and beverages with Tilray extracts or (with additional

“do it yourself” processing) extracts from dried cannabis.

Endocannabinoid system

A system of cannabinoid receptors located throughout the body, but most prevalent in the brain and nervous system. Involved in a variety of physical processes such as appetite, mood, memory and the sensation of pain.

Entourage Effect

The term created to describe how compounds in cannabis may interact to create a wide range of physiological responses.

Extracts

Essential compounds expressed from the cannabis plant by a variety of methods including heat/pressure, gas infusion and solvents. Extracts can contain a wide spectrum of cannabinoids and terpenes or be refined to a single pure cannabinoid, such as THC or CBD.

GMP

Acronym for Good Manufacturing Practices, a set of international standards intended to ensure consistency, control and the minimization of risks involved in the production of medicines.

Health Care Practitioner (HCP)

A person (a physician or, in some cases, a nurse practitioner) authorized to issue a Medical Document to a patient.

Humulene

A terpene naturally occurring in clove, basil, hops, and Cannabis sativa.

Hybrid

The result of crossbreeding two varieties or strains of cannabis to obtain characteristics of both.

Indica

A variety of cannabis. Usually grows shorter and bushier than other varieties and exhibits wide, deep green leaves.

Landrace

Strains of cannabis that have never been crossbred with other phenotypes. The original “wild” plants that naturally adapted to their native environment.

Licensed Producer (LP)

A legal source/producer of medical cannabis. LPs accept orders from authorized patients by phone or online. Cannabis is then delivered to the patient by mail.

Limonene

A terpene commonly found in the rinds of citrus fruit and also in the cannabis flower’s resin glands.

Linalool

A terpene naturally occurring in many flowers and spices, giving off a pleasant scent.

Liquid Capsules

Cannabis extracts packaged in capsule form, for oral administration.

Medical Document

A form issued by an authorized health care practitioner (a physician or, in some cases, a nurse practitioner) that allows a patient to legally obtain cannabis from a licensed producer or apply for personal production.

MMPR

Acronym for Marihuana for Medical Purposes Regulations. A set of rules for growing, buying and selling medical cannabis in Canada, which has now been superseded by the ACMPR (see above). One result of the MMPR was the creation of commercial growers and distributors (licensed producers, or LPs) such as Tilray.

Myrcene

A terpene that occurs often in highly aromatic plants such as mango, hops, bay laurel leaves and basil. It is also found in ylang ylang, a tropical flower valued in the perfume industry for fragrance extracts.

Pinene

A terpene produced naturally by a variety of plants and whose aroma of fresh pine needles gives it its name. In addition to being found in pine trees, pinene is produced by many herbs, such as basil, parsley and dill.

Sativa

A variety of cannabis. Usually grows taller than other varieties, sporting long, light green leaves.

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Terpenes

A class of organic compounds responsible for plant fragrance. Eight terpenes often found in cannabis include bisabolol, caryophyllene, humulene, limonene, linalool, myrcene, pinene and trans-nerolidol.

THC

Tetrahydrocannabinol. One of dozens of cannabinoids found in the cannabis plant, and usually the most prevalent. THC is attributed with triggering the feeling of euphoria associated with cannabis consumption.

Trans-nerolidol

A terpene found in nature in many strong aromatics such as ginger, jasmine, tea tree and lemongrass.

Trichomes

The hair-like protrusions from the mature cannabis flower that produce cannabinoid-rich resins.

Vaporization

The process (using a vaporizer) of heating cannabis or cannabis extracts to a temperature high enough to convert THC, CBD and other cannabinoids to vapour, but low enough so the material does not burn and produce smoke. Many health care practitioners advocate vaporization over smoking.

Varieties and Strains

There are three major varieties of cannabis: hybrid; indica; sativa. Strains designate plants that share heredity and general appearance. Strains often have unusual names, such as White Widow or Master Kush.

Whole Flower

Cured and trimmed whole cannabis flower.

Medical Cannabis LegislationHealth Canada’s Marihuana for Medical Purposes Regulations (MMPR) came into effect on April, 2014 and was succeeded by the Access to Cannabis for Medical Purposes Regulations (ACMPR) in August, 2016. Both the MMPR and the ACMPR allow the production and distribution of medical cannabis products (including whole flowers, oils and capsules) by licensed producers overseen by Health Canada. The ACMPR also allows patients to grow their own supply of medical cannabis or to designate a third party to grow medical cannabis for them, in each case by submitting a medical document and other registration materials to Health Canada.

Health care practitioners (i.e. physicians and certain nurse practitioners) are able to authorize use of medical cannabis without any special training or licenses. Patients who apply to Tilray for medical cannabis must submit a medical document signed by their health care practitioner, as well as an application form. This application process can be completed by mail, fax or through Tilray’s e-portal service.

All licensed producers under the ACMPR must produce, process and package medical cannabis in secure facilities like the one Tilray operates in Nanaimo, British Columbia. These facilities are regularly audited for compliance with applicable regulations.

Storefront distribution is not permitted under the ACMPR. Instead, medical cannabis shipments are sent via secure courier by licensed producers. Patients have the option to receive their cannabis at their personal residence or at their health care practitioner’s office, with the health care practitioner’s consent.

The ACMPR can be viewed in full at: http://laws.justice.gc.ca/eng/regulations/SOR-2016-230/

Health Canada’s Guide, Information for Health Care Professionals: Cannabis (marihuana, marijuana, cannabis) and the cannabinoids reviews existing academic research into the application of cannabinoids for different conditions. For the complete Health Canada document, please visit: http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/infoprof-eng.php

For more information:

1-844-TILRAY1 (845-7291) doctors@tilray.ca www.tilray.ca

1100 Maughan Road Nanaimo, BC V9X 1J2

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Important Safety Information Health Canada’s Information for Health Professionals states that cannabis should not be used for certain patients, including:

• Patients under the age of 18.

• Patients with severe cardiopulmonary disease.

• Patients with respiratory insufficiency (asthma, chronic obstructive pulmonary disease (COPD)).

• Patients who have a history of psychiatric disorders (especially schizophrenia).

• Patients with a history of substance abuse.

• Women who are pregnant or breastfeeding, or are likely to become pregnant.

• Patients with concomitant use of psychoactive drugs.

Other relevant warnings and precautions include:

• Cannabis may exacerbate the central nervous system depressant effects of alcohol.

• The adverse effects of cannabis use on mental health are greater during development, particularly during adolescence.

• Patients with mania or depression who use cannabis should be under careful psychiatric monitoring.

• Patients should be advised of the negative effects of cannabis on memory and to report any mental or behavioural changes.

• Dosing may be difficult to control and should proceed slowly and cautiously.

Please visit http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/infoprof-eng.php for additional information from Health Canada.

References to publications substantiating the medical claims in this brochure can be found at: https://www.tilray.ca/en/hcp-references. Enter password: tilrayhcpguide

Not for general distribution. For informational purposes only.

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For informational purposes only. © 2016, Lafitte Ventures, Ltd.