Medical Cannabis Discrimination Survey

This anonymous survey is being conducted by California NORML. To participate, you must be a medical cannabis patient in California. For questions, write info@canorml.org.

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* 1. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 2. What is your zip code?

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* 3. Have you been denied employment because you tested positive for marijuana?

Yes

Maybe/Unsure

You may enter a description of your experience.

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* 4. Have you been terminated from a job because you tested positive for marijuana?

Yes

Maybe/Unsure

You may enter a description of your experience.

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* 5. Are you looking for a job and afraid of losing an employment opportunity because you use cannabis/marijuana?

Yes

Maybe/Unsure

You may add comments.

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* 6. Have you been denied prescription drugs, including painkillers, because you tested positive for cannabis use?

Yes

Maybe/Unsure

You may add a brief description of your experience.

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* 7. Have you stopped using cannabis because of drug testing by your doctor or employer?

Yes

Maybe/Unsure

You may add a description of your experience.

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* 8. Have you increased your use of opioid or other medications because of drug testing for cannabis by your doctor or employer?

Yes

Maybe/Unsure

You may add a comment about your experience. Please specify which medications (e.g. opioids, anxiety or sleep medications, or NSAIDS such as ibuprofen and naproxen).

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* 9. Would you be willing to speak publicly or to your elected representatives about your situation? IF YOU ANSWER "YES", PLEASE BE SURE TO PROVIDE CONTACT INFORMATION AT THE NEXT QUESTION SO THAT WE MAY REACH YOU.

Yes

Maybe/Unsure

You may add a comment.

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* 10. (Optional): You may provide contact information to participate in our campaign for patients' rights.

your name

email address

phone number

street address

city