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Capstone Project Kapuna
University of Maryland School of Pharmacy
1.
MCST Student Representative
Alexis Muller
Jacob Szakal
Karen McNulty
Shoshanna Robinson
Steve Landuyt
2.
Initials of your name
Initials:
Full Name:
Prefer not to give:
3.
Age
65-70
71-75
76-80
81-85
86-90
90+
4.
Gender
Male
Female
Elect not to answer
5.
Ethnicity
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another race
*
6.
Do you currently live in a state with a medical marijuana program?
(Required.)
Yes
No
*
7.
Have you ever used marijuana? If yes when is the last time you consumed marijuana?
(Required.)
Yes
No
within the past month
< 6 months
1 year
2 years
3 years
4 years
> 5 years
*
8.
What is your preferred route of administration?
(Required.)
smoking/vaping
edibles/gummies
tinctures/drops
topical/cream
topical/patch
None of the above
*
9.
What route of administration are you willing to try?
(Required.)
smoking/vaping
edibles/gummies
tinctures/drops
topical/cream
topical/patch
*
10.
What are you trying to relieve or what issues do you have?
(Required.)
Chronic pain
Anxiety
Insomnia (trouble with sleep)
Cancer
Migraine headaches
Multiple sclerosis
Opioid use disorder
Post-traumatic stress disorder
Seizure disorder, including epilepsy
Terminal illness
Glaucoma
Inflammatory bowel disease, including Crohn's disease
Tourette syndrome
Depression
Other (please specify)
11.
Are you currently taking any of the following medications?
Blood thinners
Anti-anxiety
Anti-depressions
Hypertension meds
Pain relievers including opioids
Seizure medications
None of the above
Other (please specify)
12.
Are you familiar with THC and CBD?
Yes
No
*
13.
Do you know how THC & CBD are different?
(Required.)
Yes
No
Describe what you know about them:
*
14.
Are you familiar with terpenes (smells & aromas) naturally occurring in marijuana?
(Required.)
Yes
No
Myrcene
Limonene
Linalool
Caryophyllene
Pinene
I don't know any of these
*
15.
Do you know how to access or register for a medical marijuana card?
(Required.)
Yes
No
*
16.
What kind of educational support would you like?
(Required.)
Participate in an online education program on medical marijuana
Participate in an in-person community education program on medical marijuana
Educational material on how to access medical marijuana state programs
A reference guide on talking to your doctor about medical marijuana
Share your learning and experiences with a family member
A pocket guide of the top 3-5 questions to ask at a dispensary
None of the above
17.
What is the one thing you want to know about medical marijuana that we haven't asked?
Current Progress,
0 of 17 answered
