Marijuana Use Measure (MUM) Subject Number:______
*Please be as Honest as possible in all or your responses and fill this out to the best your knowledge
1. Have you ever used marijuana?
[ ] Yes (1) [ ] No (2) (DO NOT CONTINUE)
2. If so, approximately when was the last time you used marijuana?
[ ] Within the last few days (1) [ ] About 1 week ago (2) [ ] 2-3 weeks ago (3) [ ] 1-3 months ago (4) [ ] 4-6 months ago (5) [ ] 7-9 months ago (6) [ ] 10-12 months ago (7)
[ ] Over one year ago (8); Please list approximate month/year: __ __ / __ __
3. How often during the last three months have you used marijuana?
[ ] Not at all (0) (SKIP TO QUESTION 6) [ ] 3 days per week (6) [ ] Less than once per month (1) [ ] 4 days per week (7)
[ ] Once per month (2) [ ] 5 days per week (8)
[ ] 2-3 times per month (3) [ ] 6 days per week (9)
[ ] Once per week (4) [ ] Every day (10)
[ ] 2 days per week (5) [ ] More than once a day (11)
4. During the past 30 days, on how many days did you use any kind of marijuana? _______
(If you have not used marijuana in the last 30 days, please type in 0)
5. On those days that you use marijuana, how many times per day (on average) do you use?
__
6. When you’ve used marijuana, how do you typically use it?
[ ] Smoke as a joint (1)
[ ] Smoke in a small pipe (e.g., one-hitter, piece, bats, or glass pipe) (2) [ ] Smoke in a bong, water pipe, or bubbler (3)
[ ] Inhale in a vaporizer (4)
[ ] Eat in various baked goods or drink in tea (5)
[ ] Other (6), please describe: ________________________________
7. How old were you when you first tried marijuana? Age: ________
8. If you use marijuana once a week or more, at what age did you begin using marijuana regularly (e.g., more than once per week)?
Age: ______
___ Check if N/A
9. Have you ever been prescribed “medical marijuana?”
[ ] Yes (1)
[ ] No (2) (DONE WITH QUESTIONNAIRE)
10. Do you currently have an active medical marijuana prescription or card?
[ ] Yes (1)
[ ] No (2) (SKIP TO QUESTION 13)
11. For what health condition is the medical marijuana prescribed?
[ ] Pain, please describe: _______________________________ (1) [ ] Muscle spasms (2)
[ ] Nausea (3) [ ] Cancer (4) [ ] Seizures (5) [ ] HIV/AIDS (6) [ ] Glaucoma (7)
[ ] Other, please describe: _______________________________ (8)
12. Do you also use marijuana for recreational purposes?
[ ] Yes (1) [ ] No (0)
13. If you were prescribed medical marijuana in the past, for what health condition was the medical marijuana prescribed?
[ ] Pain, please describe: _______________________________ (1) [ ] Muscle spasms (2)
[ ] Nausea (3) [ ] Cancer (4) [ ] Seizures (5) [ ] HIV/AIDS (6) [ ] Glaucoma (7)
[ ] Other, please describe: _______________________________ (8)
