On this month’s episode, we are joined by the core C-suite of True Labs for Cannabis LLC: Sarah Ahrens, Founder and CEO and Carl Christianson, PhD, Chief Science Officer. 

Ep 8: An Insider’s Look at the First Woman-Owned Certified Cannabis Testing Lab on the East Coast

Check out our March/April issue focused on chronic pain

Cannabis Patience Care March/April

Cannabis Research for Chronic Pain

Check out our December issue focused on veterans and PTSD

Cannabis Patient Care December

Check out our October/November focused on breast cancer

Cannabis Patient Care October/November

In the United States, about 6.1 million children aged 2 to 17 have been diagnosed with attention deficit hyperactivity disorder (ADHD) (1). In one study by the National Child Traumatic Stress Initiative (NCSTI) involving children aged 16, more than two-thirds of these youths experienced at least one traumatic event (2). Furthermore, there were approximately 2.7 million children aged 3 to 17 who are diagnosed with depression (3).

Various therapy and behavioral treatment programs are available to help these children overcome these disorders.

For parents whose children are diagnosed with ADHD, post-traumatic stress disorder (PTSD), or depression, reading 

’s articles may help you become informed on how to help your kids (4).

Some parents have also considered giving cannabidiol (CBD) to these children. Many users claim that this cannabis-based compound may help manage anxiety and depression. However, is there sound scientific proof that CBD is effective for such disorders?

This article discusses how CBD may benefit children with ADHD, PTSD, and depression and the studies related to these claims. This article also explains how you can administer CBD to a child and what you must look for in these products before buying.

How Does CBD Benefit Children with Depression and Anxiety Disorders?

Studies have suggested that CBD, a naturally-occurring cannabis plant compound, is increasingly becoming a popular alternative to pharmaceutical medications for pediatric anxiety and sleep issues (5). Despite this growing trend, researchers still need extensive clinical trials to determine whether CBD is safe and effective for managing children’s anxiety disorders and depressive symptoms.

Individuals with anxiety and depression may have similar symptoms to ADHD. Additionally, someone with this disorder is likely to have difficulty sleeping. CBD has calming and antianxiety properties that may help one relax, thereby improving their sleep quality (7).

ADHD is a neurodevelopmental disorder that can manifest during childhood and continue until adulthood. Children diagnosed with ADHD are likely to be overly active or have difficulty paying attention or controlling their impulsive behavior (6).

In one study, researchers analyzed cannabis’ effectiveness in managing ADHD in three human male subjects aged 18, 22, and 23 (8).

The 23-year-old subject, who took cannabis medication containing a 20:1 CBD-to-tetrahydrocannabinol (THC) formulation, mentioned that the substance improved their demeanor and focus. The compound may have also helped lower anxiety. The study’s overall results showed that cannabis products with CBD and THC may have a complementary function in the patients’ therapeutic regimen.

THC is a cannabis plant compound that produces a “high” or psychoactive feeling, especially among marijuana users (9).

Individuals experiencing post-traumatic stress disorder (PTSD) may have intense and disturbing thoughts or feelings caused by a traumatic event they experienced or witnessed in the past (10).

One study on the effects of CBD oil on insomnia and pediatric anxiety was conducted on a 10-year-old patient diagnosed with PTSD (11).

The study mentioned that CBD may effectively reduce anxiety and insomnia associated with PTSD. The authors attributed these benefits to CBD’s potential anti-anxiety and sleep-inducing effects.

There are several ways individuals can administer CBD to help manage depression and anxiety disorders in children. These methods include the following (12):

: Ingestion involves taking CBD through the mouth. The drug passes through the digestive tract before spreading into the bloodstream. Ingested products include CBD gummies, candies, and chews.

: In this method, you apply CBD oil sublingually or under the child’s tongue. This method usually bypasses the digestive system, directly delivering the drug into the bloodstream. CBD oil tinctures are one type of sublingually administered product.

: Inhalation is a quick way to administer cannabis, wherein the inhaled substance enters the lungs, heart, and brain before spreading throughout the body. Inhalers are products that can help you administer CBD inhalation. While there are other inhalation routes, such as smoking or vaping, these methods are not appropriate for children. Furthermore, selling e-cigarettes (also called vapes or e-cigs) to children below 21 is illegal (13).

: This delivery route involves applying the CBD product to the child’s skin. CBD applied topically does not get absorbed into the bloodstream. Topical CBD products include balms, creams, lotions, and roll-on sticks.

If the child has existing medical conditions, parents should consult a doctor or therapist for a diagnosis and treatment before using CBD.

One essential thing to look for to ensure that you are getting a high-quality CBD product is the certificate of analysis (COA).

Reputable CBD brands typically have their products tested by independent third-party labs. Third-party testing is an industry-standard process to minimize the likelihood of falsely labeled products (7). Results of such testing appear on the product’s COA. Third-party labs can also check whether the product contains contaminants such as heavy metals, pesticides, or solvents. These impurities can cause a health risk to the child or anyone who takes the product.

Another essential thing to look for is whether the CBD products are categorized as full-spectrum, broad-spectrum, or isolate. Full-spectrum CBD oil typically contains all the cannabis plant extracts, including THC, flavonoids, and terpenes. Flavonoids are plant-based substances that may have antioxidant and antimicrobial properties (14). On the other hand, terpenes are essential oil components that give the cannabis plant its distinct scent (15).

Broad-spectrum CBD oil is almost similar to its full-spectrum counterpart. The difference is that broad-spectrum CBD oil does not contain THC.

Finally, CBD isolates contain only a purified form of CBD. This product does not have THC or any other cannabis compounds.

You should consider keeping away from CBD products with more than 0.3% THC, as these products are illegal under US federal law (16). The 2018 Farm Bill excludes hemp-derived products containing no more than 0.3% THC from the Controlled Substances Act’s “marijuana” definition (17). Meanwhile, the US Food and Drug Administration (FDA) approved Epidiolex, an oral medication containing purified CBD, in June 2020. This drug helps treat seizures linked to tuberous sclerosis complex (TSC), Dravet syndrome, and Lennox-Gastaut syndrome (18).

In the United States, 37 states have implemented regulated cannabis programs as of February 2022. These states include Arizona, California, New York, Washington, Colorado, and Nevada—among many others (19).

Before you purchase a CBD product for a child, check your local or state laws to determine whether this substance is legal in your area. The legality of CBD and medical marijuana often varies between states.

https://www.cdc.gov/ncbddd/adhd/data.html

https://www.samhsa.gov/child-trauma/understanding-child-trauma

https://www.cdc.gov/childrensmentalhealth/data.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101100/

https://www.cdc.gov/ncbddd/adhd/facts.html

Healing with CBD: How Cannabidiol Can Transform Your Health without the High (Ulysses Press, Berkeley, California, 2018) pg 177; pg. 260

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8832253/

https://www.sciencedirect.com/topics/neuroscience/tetrahydrocannabinol

https://psychiatry.org/patients-families/ptsd/what-is-ptsd

https://www.projectcbd.org/guidance/best-way-take-cbd

https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734

https://pubmed.ncbi.nlm.nih.gov/10924197/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763918/

https://www.projectcbd.org/guidance/cbd-thc-myths-and-misconceptions

https://www.fda.gov/news-events/congressional-testimony/hemp-production-and-2018-farm-bill-07252019

https://www.fda.gov/news-events/press-announcements/fda-approves-new-indication-drug-containing-active-ingredient-derived-cannabis-treat-seizures-rare#

https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

Stanley Clark is a community development volunteer and writer. He had worked on several commercials, events, and campaigns before writing full-time in the area of natural health and wellness. He has a particular interest in reviewing CBD brands for their safety and legitimacy. You can find his insights at CBD Clinicals.

Articles

This article discusses how cannabidiol (CBD) may benefit children with attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and depression and the studies related to these claims. It also explains how you can administer CBD to a child and what you must look for in these products before buying.

Can CBD Help Children With ADHD, PTSD, and Depression?

Madeline Colli is the Associate Editor for Cannabis Patient Care and Cannabis Science and Technology magazines at MJH Life Sciences.

How did using a cannabis app help you on your medical cannabis journey?

 What was cool about this particular app is that it was out of Canada and they had all the backend certificates of analysis for the products. You could literally type in the product you are using, for example, Blue Dream from producer A or you could type in Blue Dream from Producer B. Different chemical profiles may exist from the exact same strain name. What this app allowed me to do was log both of those experiences because I had assumed that Blue Dream from dispensary A and Blue Dream from dispensary B were going to have the same effect, but that isn’t always the case. That's why using the app was so powerful and having that data behind the scenes of what's in the plant and why it's working, it's ingenious. I mean, that's how you figure this out, my friends. If we can get that data and if these license producers—or in New York it's registered organizations—all manufacturers should have a responsibility of sharing what's in their products. I don't understand why cannabis is different from any other food or medication. Cannabis products are being tested, so why can't we have access to that information? It should just be readily available as part of every single state's law.

Hemp growers have to go through more testing requirements than our medical cannabis providers right now; I mean, that's just messed up, in my opinion.

Has the cannabis market in the United States become more affordable for medical cannabis users? What differences have you seen in various states?

 For the first part of your question, that all depends on what state you're in. Every single state has a different set of circumstances, laws, with different availability of products for medical patients in that state versus other states. It is hard to find states that offer reciprocity, such as Nevada, which recognizes all out-of-state medical cards and also allows out-of-state patients to obtain a medical cannabis card.

In most states, one must be a resident of that state and have a state-certified provider make the recommendation to give you a “medical card,” and most states do not offer reciprocity. In other words, me being a medical patient from New York, I can’t go to a dispensary in Pennsylvania, because they don’t offer reciprocity. That's not cool because I'm still a medical patient no matter what state I am in.

In contrast to the US, Canada has a universal program. Cannabis is federally legal in Canada for all provinces. We need to do better for patients in the US. I shouldn't be penalized, for example, if I'm in California, but I live in New York and I run out of my prescription of cannabis or Xanax or any other medication. I should be able to get any of my medications in California without much trouble. Can it happen? Yes, but it would take some effort.

Once we go from medical to recreational or adult-use, there is a difference in the market. Meaning, it becomes more about the money – selling the product – than doing what’s best for the patient.

I'm currently working with Americans for Safe Access (ASA). We have a New York State Patient Advisory Committee, and I'm working to bring awareness about the patient experience. We are tackling questions such as: which conditions are bringing patients to cannabis, and how do we not lose our access when we transition to adult-use? How can we include the pharmacists that have been there for the medical patients, who are knowledgeable about helping patients handling multiple pharmaceuticals and especially contraindications?

I'm very concerned about states just lumping their medical programs into their adult-use programs without some types of safeguards to allow patients to retain all their benefits. For example, medical patients are allowed higher purchase limits than those for adult-use customers. Being able to purchase more product during a visit usually saves money. It also means that I don't have to run to the dispensary every other day when I consume medicine all day. Another important benefit is product availability. Adult-use consumers generally buy different products than medical patients, and it’s important for medical patients to continue having access to the same variety of products after adult use is legalized. There are also tax breaks. Medical patients should continue to get tax breaks on their purchases after adult use is legalized.

Are you still having to travel to Canada to obtain your medical cannabis?

: I still travel to Canada, go to events, and things like that over there. I love Canada because I can try so many different products and I can learn what works for me, and in many cases this app still has that back-end information of various strains in Canada.

Different experiences and different retail outlets have been great. It's crazy how many stores there are now in Canada since the pandemic. I mean, before there was like one every 30 miles or so. Now it's like there's one every 2 miles. They're everywhere. It's amazing because there are so many options for patients, and I actually do feel it's gotten more affordable in Canada.

What are your opinions on the medical cannabis industry in New York? Are there things that you are seeing that aren’t working and would like to change (3)?

 We just recently changed management of our medical cannabis program. The Department of Health used to manage the program, but now the Cannabis Control Board, the CCB, of New York is in charge. There's been some growing pains in every way. There have also been improvements.

We've eliminated the limited number of qualifying conditions. Now, if a doctor sees fit for you to have medical cannabis, they don't have to jump through hoops anymore. This has made it much more accessible, which is a good thing. We’ve also legalized adult-use, but adults can't purchase cannabis in any of the current dispensaries.

We only have 38 in the entire state of New York. Think about that for one second. We have about 125,000 medical patients in New York state right now. But we have 38 dispensaries, the majority of which are upstate. I'm in upstate, and we have roughly nine dispensaries, I believe, in our region, but our region covers a large geographic area.

There are three dispensaries in the Buffalo area, the smaller region in which I live. However, people in more remote areas have like a three-hour drive to reach a dispensary. Access is still really limited for a lot of people. Another problem is that New York state has been talking about eliminating pharmacists. As I already mentioned, if we eliminate pharmacists for our medical program, how is that really going to work?

Currently, our 10 medical producers can open up an additional number of recreational stores as proposed under the law. How are we going to differentiate the medical stores from the recreational stores? If the recreational stores of the same name as the medical stores don’t have pharmacists, then patients could easily think they're getting the same helpful information from a pharmacist when they’re not.

Having reciprocity in New York state, for other state patients is another huge issue for me. And having access to certificates of analysis (CoAs), that's probably my biggest issue for New York state. There should be testing with public access to CoAs on each product that they're putting into our medical program. Period. End of story. It's not proprietary. List the ingredients. We're patients, we’re not just stoners. There needs to be better care of medical patients.

What would you like to see change in the cannabis industry over the next 5 years?

 One of the things I'd love to see is interstate commerce. When I find a product in California that works really well for me, why should I have to be in New York state and not have access to it? We can do a much better job.

I don't know how that looks or how that works, but I know we get drugs to different states with no problem. Why can't we have a similar system for cannabis? I totally believe products need to be grown in our state. Like I'm not suggesting we should be getting all our products from California. But what I'm suggesting is we should have access to products grown in California.

Also, all products with the same cultivar name should have a very similar chemical profile. If a product called Super Lemon Haze is in California and it's also in New York state, those two products should have very similar chemical profiles, not something completely different.

That's one of the things that I've found a lot in my travels. For instance, an edible brand that I used in Boston was the first edible that's ever worked for me. I was ecstatic. And I then saw the same brand in Canada and it absolutely had no effect. That was a very disappointing experience.

There are also still a lot of problems with the stigma of smoking cannabis. One of the things New York state did right was allowing cannabis consumption anywhere tobacco is consumed, such as outside or in consumption lounges. That was a huge win for medical patients.

Personally, I became so much more comfortable residing in New York state now that cannabis use is legal in certain public spaces. I use cannabis all day in small amounts, and now I can be outside downtown Buffalo and know that I don't have to be ashamed that I'm consuming cannabis in the same area as someone smoking a cigarette. I also love consumption lounges, where I can be with like-minded humans that just want to get to know each other or have events that are cannabis friendly.

Are you involved in any advocacy measures for cannabis?

 I am! I'm the Chair for Americans for Safe Access, New York State Patient Advisory Committee. It's quite the long title. That's a federal organization that I fully support. They're a nonprofit based out of Washington, D.C., that's been around for more than 20 years and they care about patients, which is what I'm all about. One of the things I've noticed through traveling is cannabis is not always safe, due to the stigma. The thought of having run-ins with law enforcement in less-cannabis-friendly states is frightening.

I'm also on the advisory board for Cannabis BPO [Business Process Outsourcing].They're an organization that puts the personal touch into cannabis call center work. So instead of getting that 1-800 annoying number with Press 1 for this and Press 2 for that, you actually get a live person, and they do all types of work in the cannabis space. They really care about the patient voice. They wanted me to be able to advise them on any kind of things that they might be able to improve, if they're helping patients directly.

Do you have any advice or guidance for beginner interested in using cannabis or getting involved in advocacy measures to encourage legal change?

 Research, research, research, learn, and ask questions. Don't be afraid of the plant. Come out of the cannabis closet and try to become educated instead of opinionated. I personally have changed so many people’s minds about the plant who would have never considered cannabis as medicine. I, myself, never considered cannabis as medicine before my injury.

So, when you find people that are passionate about the plant, learn from them. Educate yourself and don't judge a book by its cover. Just because some of them might have long hair and look a little hippie-ish doesn't mean that they're not true advocates and don't understand what the plant's about.

I encourage people to join other organizations. It's about working together and collaborating and working for the greater good as a group, rather than fighting over small pieces of funding that one group could make a much bigger difference than many little ones.

In the beginning of this interview, you mentioned you had experienced a lot of feedback or pushback from doctors. Are you still seeing medical professionals with these mindsets? Are their attitudes on cannabis changing and becoming more accepting, or are you still seeing the stigma towards cannabis?

 I am definitely still seeing the stigma, no question and it's frustrating. I'm not seeing all the doctors I was before because I'm no longer under Worker's Compensation care, but I'm seeing a small shift. Like my primary care doctor asked me, “hey, who can I send patients to, to learn about cannabis?” And so, I gave him a number. But the point is, he never would have thought of cannabis years ago as medicine. He's seen the transformation in me, but he also cares. Having a doctor that cares makes all the difference in the world from a standpoint of being able to change someone’s mind.

I've had some negative experiences at the Canadian-US border, but I've had way more positive experiences. One time, there was a joint that had slipped in the ‘fatal hole of death’ between the two seats in my car, and a dog found it when I was crossing into Canada. Basically, that landed me with a seven-year penance, meaning that I need to get pulled over and searched every time I cross into Canada. What's funny is cannabis is legal in Canada. The last time I crossed, my experience with the border patrol man was really classic. He said, “Why would you bring cannabis into Canada? It's like bringing your own sandwich into a buffet. How stupid is that?” I mean, it's really true. Why would you? After that experience, though, I would get post -traumatic stress disorder (PTSD) whenever I was crossing into Canada, because that one time I had been caught with this less than a gram of cannabis going into their country.

It's really PTSD-provoking every time I cross the border. Because what if something else slipped? But in 90% of the cases that I've crossed in, I've actually educated people while I get pulled over.

My point is, everything happens for a reason, and I truly believe I was injured for a reason to help educate, to help remove the stigma, and to be a true voice of cannabis as medicine.

For more with Nikki Lawley, please see part I of this interview series: 

https://www.cannapatientcare.com/view/cannabis-saved-my-life-an-interview-with-traumatic-brain-injury-survivor-nikki-lawley-part-i-journey-to-health

https://www.nikkiandtheplant.org/about-nikki-and-the-plant.html

https://www.youtube.com/watch?v=OKppk-gnIxc

https://www.syracuse.com/marijuana/2022/06/nys-medical-marijuana-program-suffering-as-state-focuses-on-a-recreational-market.html

When a patient isn’t able to access the care or medication that they need in their home country, they aren’t left with much of a choice but to travel to a country that will give them the treatment they need. In part II of this interview series, Nikki Lawley, founder of Nikki and the Plant, LLC, and retired licensed practical nurse (LPN), continues discussing her journey to health, the broken healthcare system hurting medical cannabis patients in the US, and what needs to change to make access better for patients.

“Cannabis Saved My Life:” An Interview with Traumatic Brain Injury Survivor, Nikki Lawley, Part II: Crossing Borders for Cannabis

Recently, Healer.com, a cannabis education and training resource and provider of cannabis products, joined nonprofit Leaf411 as its newest member (1). Both organizations aim to provide education and guidance on the use of cannabis and hemp products (1). Founded in 2019, Leaf411 is the US’s first cannabis nurse guidance call service. According to their website, their mission is “to provide education and directional support to the general public about the safe use of legal cannabis” (2).

“Now more than ever, we need as many voices and resources as possible educating patients and consumers on cannabis with evidence-based information and honest guidance,” said Katherine Golden, a registered nurse and CEO of Leaf411 (1). “Dr. Sulak and Healer.com are among the strongest voices helping people make well-informed decisions about cannabis consumption. We are thrilled to have them on board as a member and look forward to collaborating our efforts.”

Dr. Dustin Sulak, an osteopathic physician, began incorporating cannabis as medicine for his patients in 2009 and later founded Healer.com when he realized that a lack of cannabis knowledge was preventing people from getting the best results possible from products (1). Healer.com provides online medical cannabis training for patients, healthcare providers, and dispensaries. As a part of their member relationship, all Leaf411 nurses will become Healer Certified in Healer.com’s cannabis education programs (1).

“Cannabis possesses amazing healing properties for a wide variety of symptoms,” said Dr. Sulak (1). “But without knowledge of how it might work and which type of products might be best for any particular individual, its potential for consumers and the industry will never be realized. We applaud the work that Leaf411 is doing across the country and look forward to working together to ensure evidence-based cannabis education is available for all.”

Leaf411 and Dr. Sulak will also be regular contributors to 

 digital issues, covering both the nurse and doctor focus areas for a given issue, respectively. These contributions will begin with our July/August issue on auto-immune diseases.

For more information on Leaf411, please visit 

. For more information on healer.com, please visit 

https://www.globenewswire.com/news-release/2022/07/13/2479267/0/en/Healer-com-Joins-Leaf411-to-Amplify-Cannabis-Education-Efforts.html

Recently, Leaf411, the United States’ first cannabis nurse guidance call service, welcomed as its newest member Healer.com, a cannabis education and training resource founded by osteopathic physician, Dr. Dustin Sulak.

Two Major Cannabis Educational Organizations—Leaf411 and Healer.com—Form Collaborative Effort

In early July 2022, several cannabis organizations and retailers in Massachusetts joined forces and launched a research project to study veteran access to medical cannabis. Directing the project is the Cannabis Center of Excellence (CCOE), a “non-profit organization that conducts citizen-science-focused population studies and programs in the areas of community engagement, medical cannabis, adult-use cannabis, and social justice in the cannabis industry” (1).

“The results from the 2019 veterans medical cannabis study highlighted that regular access to cannabis was a barrier for many veterans,” said Dr. Marion McNabb, DrPH, MPH, president of CCOE. “Gibby's Garden has a strong passion to give back to veterans, and so we teamed up to launch a study that would increase access and help gather opinions and ideas from veterans for future programs. I am most excited to learn if this type of program is feasible at a pilot scale, and how veterans respond to cannabis use.”

According to the project description on the CCOE website, 450 qualifying veterans will complete a baseline survey and will then be able to purchase a cannabis product bundle consisting of Gibby’s Garden products at one of the four participating retail outlets in Massachusetts (1). Additionally, “as part of the research study, participating veterans will be asked to report on access to cannabis issues, products, and its impact on their health and wellness via paper-based forms or a mobile medical cannabis app called Tetragram (1).”

According to CCOE, the four participating cannabis retail outlets are:

This research study is reviewed and approved by the University of Massachusetts Dartmouth Institutional Review Board for human subjects research (1).

For more information on the study or to register, please visit: 

https://www.cannacenterofexcellence.org/veterans

For more information on Tetragram, please see our podcast: 

https://www.cannabissciencetech.com/view/ep-6-tetragram-how-patient-data-is-powering-research

To learn more about the 2019 Veterans study conducted by Dr. McNabb, please visit: 

https://www.cannapatientcare.com/view/the-2019-veterans-health-and-medical-cannabis-study

https://www.cannacenterofexcellence.org/our-history-1

On July 11, 2022, the Cannabis Center of Excellence (CCOE), Gibby’s Garden, Patriots Helping Vets, Tetragram, and several retailers united to study veteran access to medical cannabis. The research study will reportedly request feedback from 450 veterans to gather their firsthand experiences with access, products, and the impact on health. 

First-of-its-Kind Research Project Launched in Massachusetts to Study Veteran Access to Medical Cannabis

In early June 2022, the New York State Senate approved a bill which mandated public health insurance programs to cover medical cannabis expenses and defined how private insurers are allowed to handle these expenses as well (1).

New York State Senator, Diane Savino (D), sponsored the legislation that had to travel through two committees before passing in the Senate by a vote of 53-10. The bill titled, SB S8837, has been transmitted to the Assembly and is currently awaiting action in the Ways & Means Committee.

The new legislation reportedly amends state public health and social services to address the out-of-pocket costs medical cannabis patients have been left to figure out on their own. It is one of the most difficult barriers for patient access and will help provide relief for those who seek it for treatment.

Medical cannabis would be defined as a “prescription drug,” “covered drug,” or “health care service” under the relevant codes so that public health insurance providers, including workers compensation and Medicaid, would be mandated to provide coverage. Although this is a step in the right direction, private and commercial insurers would not be subjected to mandating cannabis coverage and instead have the choice to make coverage optional.

“For thousands of patients, medical marijuana is a safer and more effective medication than other drugs, especially opioids,” a justification memo attached to the bill stated (1). “While it can be prohibitively expensive for many patients, especially in the absence of insurance coverage, it may often be less expensive than what their insurance coverage pays for other medications.”

Savino addressed concerns from fellow lawmakers on the floor ahead of the vote about the potential costs of the legislation and stating that it was time for New York state to lead the way on this issue. “Some state is going to have to force this issue,” Savino said. “I believe that our state is the one that should lead the way on this.”

If the legislation is enacted, public health insurance programs such as, Medicaid, Child Health Plus, Elderly Pharmaceutical Insurance Coverage (EPIC), Essential Plan programs, and workers compensation, would be applicable to the proposed policy change.

“Cost is the primary barrier to patient access in New York’s medical marijuana program. Medicaid, other public health plans, and commercial health insurance plans do not cover medical marijuana, forcing patients to pay out of pocket,” the justification memo also stated (1). “Some patients begin treatment only to stop due to inability to pay, while others turn to the black market. Efforts by registered organizations to offer discounts have helped, but are inadequate for many low-income patients.”

While there “would presumably not be federal matching funds until the federal government changes its policies” for programs like Medicaid and Child Health Plus, the memo stated that “New York’s Medicaid and Child Health Plus programs have always covered people and services for which we do not receive federal match.”

https://www.marijuanamoment.net/new-york-senate-approves-bill-to-mandate-medical-marijuana-health-insurance-coverage/

Medical Cannabis Health Insurance Coverage Bill Approved in New York State Senate

Can you tell us a little bit about your background in the medical field? How did you become introduced to cannabis?

 I was a licensed practical nurse (LPN) working in a pediatric office, and my life changed literally in a second. I was helping a coworker restrain a child for a vaccine and the child headbutted me and I was thrown into a wall and back into his head. It was a double impact injury. That day was the last day I worked as a pediatric nurse.

I suffered a traumatic brain injury (TBI) and a whiplash injury resulting in cervical instability. I was suffering from a host of symptoms, including balance issues, significant depression, and anxiety. I was in such pain in my head and my neck that it was debilitating. On a scale of 1 to 10, it was roughly a 7 or 8 and it never went away. The day I got hurt, there was that headache that just literally never went away.

Because I was injured at work, it was a New York state worker's compensation case, which is not a patient-friendly system. I went from being a respected healthcare professional working with coworkers in a healthcare setting to becoming the patient. As a patient in the system, I became simply a number, where the system is designed to get the patient out of the system as soon as possible and back to work. I went to different doctors and specialists, had different independent medical exams, and I was getting nowhere. I was becoming more and more hopeless day by day.

The doctors were just giving me new drugs, new prescriptions, new therapies, telling me they couldn’t find anything wrong with me. I was truly treated like a crazy 46-year-old woman who had nothing wrong with her, despite having lost all basic functions of my life. There was just no break from the horrific side effects I was getting from my head injury. I felt like a burden to my entire family. All I did was cry.

So, how did I find cannabis? My husband thought going to Las Vegas would be a good way to cheer me up. Las Vegas had always been my most favorite place in the world, because before being a nurse, I had been a casino blackjack dealer. But at that time in Las Vegas, I was miserable. I had not left the hotel room in three days. All I did was cry in the corner. It was brutal.At one point, as I was looking over the balcony of the hotel we were staying at, I was thinking about throwing myself off the balcony. I was looking over the edge, thinking that I wasn't really high enough to completely kill myself, when a mobile billboard happened to drive by, advertising, “Get your medical marijuana card in Nevada today.” My husband had left the room and when he came back, I said jokingly, “well, we can go fry my brain on drugs.”

I was very skeptical. Sure, I had smoked pot during parties, but I never thought of cannabis as medicine. In fact, as a pediatric nurse, if you had told me your child was using cannabis for seizures or some other health condition, I literally would have been apt to call Child Protective Services (CPS) on you. I surely was never taught about the plant, nor was this the case for any of the medical professionals I saw during this time.

So long story short, my husband says, “Let's go get your weed card, let's go check it out.”

I stood in front of this bud tender sobbing, “I'm so depressed, I'm in so much pain.” He recommended tons of different products for me to try. I took them all and went back to the hotel room. I ate a bunch of gummies; I had a bunch of tincture. I tried everything that was edible, but none of it really had an effect on me. But I think I had taken so much that I went to sleep for a longer period of time. Actually, though, this was a huge benefit, considering that the pain from my brain injury always kept me awake. So, the fact that I had slept for more than an hour-and-a-half to three hours was huge.

The next morning, I hadn't noticed a huge difference, but then my husband said, “Well, why don't you smoke a joint?” I said, “Alright, but I really don't want to smoke, and my head hurts so bad.” I smoked that joint anyway, and soon after, I was actually feeling good enough to leave the hotel room. I actually wanted to go get breakfast. I wanted to eat. I was functioning and I smoked that second joint before we flew home, and only then was I able to tolerate the airport and plane ride home.

My experience with medical cannabis in Vegas was pretty life changing. I came home to New York thinking, “No problem, do the same thing you did in Vegas. Fill out the form. Get the card. You're good to go and you'll be able to go to a dispensary and get medicine.”

And at this point, I didn't understand the difference between medicinal and recreational cannabis and that it's all the same plant. I thought medical cannabis meant something super high tech, super high end, super different than all the rest. So, I thought this potion in Vegas was just magic at this point. But I couldn't bring it home. And then when I came home to New York, I discovered chronic pain was not a qualifying condition for medical cannabis in New York State at the time.

Shortly after, I began to feel hopeless again. I didn't really think about calling ‘Bubba’ down the street, because I thought what I had used in Vegas was magical medical cannabis, not regular cannabis that people were using recreationally. I didn't explore the illicit market at all.

I started to seek care outside of the New York state workers comp system. I literally spent tens of thousands of dollars trying to find answers, because I was not getting any in the system I was in. Furthermore, every single doctor I spoke to about my using cannabis as a relief for my TBI said, “Yeah, no, that's drug seeking behavior. We can't encourage that. That's illegal.”

The healthcare professionals did not understand any of the science behind cannabis, nor did I. I had nowhere to go at this point. Nothing was showing up on MRIs or special imaging, and so I was just feeling like it's got to just be in my head. That’s when I learned about support groups and found other patients suffering like I was from brain injury, and I started to reach out to them. I posted kind of a dark post on Facebook saying, “I'm such a burden and why am I still here? Doctors don't believe me. Maybe there really is nothing wrong with me. Maybe it is all in my head. Maybe I'm just a little too crazy.” I friend in Canada responded to the post, “Hey, why don't you come up here to Canada? We've got medical weed here. I'll get my card and try it and you can see how it works.” Since I live in Buffalo, New York, the Canadian border is literally 15 minutes from my house.

So again, thinking it's this magical medical weed, I go to Canada and about the third visit I started to really function. My quality of life was insanely better and I started to try and understand the products I was using. “Why does ‘Royal Purple Kush,’ make me feel like a zombie and more brain injured? Yet, this ‘Original Cheese’ makes me feel energized. What I say is that it connects my dots. It connects my brain chemistry in a way that no other pill has, that no other treatment had before. And I was like, there's got to be something to this.”

When I was in Canada, I was able to connect with other Canadians that were in the medical cannabis industry. I started going to events, I started meeting scientists, I started meeting people who really understood the plant. I started following all these Canadian cannabis groups because they had so much more knowledge than people in the United States seemed to. I mean, they had real data and had real studies, none of which I had known about when I had been a medical professional. I could only imagine how many other nurses, healthcare professionals, doctors, and so on also had no idea about the science of this plant.

I was just starting to learn about it in 2018, which is when New York State approved medical cannabis for chronic pain. I was able to get my New York State medical card, but I soon discovered that New York State, Nevada, and Canada, were each whole different worlds at that time.

We had no smokable flower in New York at the time. As I said, in Vegas, nothing had really happened when I had used the edibles or other absorption methods. The long and short of it is I learned that because of my various medical issues, I don’t process cannabis very well, and the only way I seem to absorb it is when I smoke flower. Learning this was a whole eye-opening experience because I had been told by doctors that if I smoke cannabis, it's not medicinal. I had been told by doctors that if I am using high tetrahydrocannabinol (THC), it's not medicinal. These are the doctors, the experts in my area of Buffalo, NY.

I would go to Canada, and I would meet these different groups of people who used cannabis as medicine and go to these different conventions, and I would hear stories so similar to mine, just maybe with a different body part or different condition.

I discovered that the Western medical system had failed us. We were never taught about how holistic plant medicine could potentially help us, instead of just having pills and prescriptions thrown at us. I thought, “How about we treat the whole human? How about we learn what the endocannabinoid system is and what real homeostasis is.” For me, I hadn’t understood any of that. Not at all.

Hearing about this and learning about it was so empowering. My journey has taken me from being the nurse to being the patient to now, being the passionate cannabis advocate that I am today.

Did you receive any guidance on how to approach your medical cannabis journey (1)? How challenging was it to experiment with different cannabis strains, terpenes, and so forth before finding what worked best for you?

 When I was in Canada going every other weekend and staying for longer periods of time, I began to try and really understand what the names meant because they were very strange to me. It didn't feel medical. Some of the strains were not professional names. At 48 or 49 years old, I was not comfortable saying, “hey, can I get some cheetah piss?” I mean, that's just gross. So, I had a real struggle with the name thing.

And even with the licensed producers, although their names weren't as gross, it was still really hard to understand what was working and why. Around this time, probably a year into my journey, say 2019, I discovered a journaling app that helped me understand what products worked and why.

I had no guidance. I just learned by trying different products.

When cannabis went to the recreational side in Canada, it was a real benefit for patients because there were more products entering the market. The thing that wasn't beneficial for patients is the fact that medical use sort of goes away, and that's what's happening here in New York as well.

In Canada, I happened to have been friends with a cannabis researcher who really took me under her wing and taught me a whole lot of things about the plant and why it works. She taught me the system in Canada, the supply chain, how to get to market, and things like that.

It was a real eye-opening experience to understand a system that worked. I mean, it had its flaws, but the Canadian system sure does a whole lot better than the American one. I mean, the difference in states literally is ridiculous. I mean, I feel like each state is a different country.

But when I can drive 15 minutes to a country where it's totally legal, and yet I'll go to jail if I bring it home to my country even though it's legal in New York state, that is a messed-up system. It's my medicine. I have had to experiment with hundreds and hundreds and hundreds of strains and products to find a product that works, and when I find a product that works for me, no matter what state or country I find it in, I want to be able to use it.

When I finally find a product that works, it's life-changing. It's like almost being normal again. It's being able to do a spreadsheet. It's being able to communicate thoughts that make sense instead of being all over the place like I used to be after my injury and before finding cannabis.Cannabis really does connect my dots.

I'm so passionate about cannabis. It's literally changed my life and I truly believe that I was injured back in 2016 to help other people, to make the experience going from a healthcare professional to a patient, to advocacy, a real thing. Because until you've been there, you really don't understand it. Brain injury is invisible. You can't see it. I don't walk around with a big bandage around my head. You don't know what it took me to be able to do this interview. You don't understand how much I struggle to just remember what to say and to stay on task. These are things that cannabis helps me with.

Learning what I was treating with cannabis was the first battle. You can't just say you're treating TBI or brain injury. You must narrow down the symptoms you are trying to improve your life with or the drugs you're trying to get off of that are creating the imbalance in your body in my case.

You have to find what's working and why. Journaling, that experience was super important, but knowing the chemical profile behind strains you’re consuming is even more important. If you don't have access to that certificate of analysis (COA) or that testing report, it's very difficult to understand what works and why or what you might be sensitive to or not. Unfortunately, I don't have access to COAs in New York state. It's ridiculous that that is not mandated on every cannabis product because that's how patients will become educated and learn what works for them.

For me, it's all about the terpenes and the minor cannabinoids and the entire synergistic effect. I don't feel anything with isolates. I don't feel anything with individual compounds. I don't like that I have to inhale whole flower and combust. But that is the only way I find the medicinal value.

And trust me, I have tried them all and it's been a whole thing. Trying to find something that's more discrete, that's easier, that's portable. Even though I’ve had bad experiences with some products, I don’t give up. Finding the right products makes it all worth it. The right products are totally life-changing.

And that's why I encourage people to really experiment. There's no magic recipe, unfortunately, that's going to treat your specific instance. Meaning what works for me may not work for you because I have a different endocannabinoid system than you. That doesn't mean there aren't similarities that you might be able to take from my experience, and maybe a portion of that might work for you. Again, we're all individuals and learning what works for us is key and understanding why.

Are you able to receive those products in your home state of New York?

 Honestly, I've been traveling a lot to different states and experimenting with different products. I was recently in Boston, Massachusetts, and I was a speaker at the New England Cannabis Convention (NECANN Convention) and I was able to experience so many different products and was able to have a really great experience there because of the adult-use market.

I had one experience in Boston where the bud tender was absolutely 100% clueless on what I was looking for and was of zero help. But then I had the most amazing experience at the second dispensary I went to, and they were so helpful.

It was such a cool thing to be able to talk to someone on this side of the border, meaning the American side, having someone with knowledge of terpenes, and understanding what I'm looking for.

In New York state, our medical program has improved. We now have whole flower, whereas before we only had ground flower, which is a huge step in the right direction. But the only information we can see as patients in our medical dispensaries is the cannabidiol (CBD) and THC percentage. They refuse to release certificates of analysis, terpene profiles, or anything.

The 10 registered organizations in our New York state market basically wrote the legislation years ago for how the medical program was going to go. Now there are more patients, there's more understanding, there's more science. And so, there's a whole other level of knowledge that wasn't there when these laws were enacted.

One of the things, I think, New York state is doing a poor job of is including patients in the legislation, including patients in the places where decisions are being made. Patient advocates that have gone through the medical program and understand its inadequacies due to having experienced programs in other states and in other countries are an invaluable asset. That's who you're doing it for at the end of the day.

How does cannabis help treat traumatic brain injuries (TBI)? Is it becoming a common therapy to recommend compared to opioids and other medications or surgeries?

 For me using cannabis to treat my TBI, understanding which specific problems I’m using cannabis to treat was a big thing. I treat my cognitive function, my anxiety, depression, my chronic pain in my head, and my neck. Those are the criteria I evaluate the product against. How much did it improve my pain in my head this morning? It might have been a seven when I woke up, but after I inhaled cannabis, this particular strain that I used and the pain was able to be dropped down to three, that's significant. Knowing what's in that product is so important. For traumatic brain injury, cannabis has been proven to reduce inflammation in the brain. It's also been proven to be a neuro protectant.

In Israel, all the medics carry cannabis spray on board their ambulances and in their kits, even in combat. As soon as anyone suffers a blast injury or a traumatic brain injury, they actually have a nasal spray that they administer at the time of the injury. It's been proven to reduce inflammation.

TBI is a big thing for professional sports players. I think of all the National Football League (NFL) players that are suffering from brain injuries, repeated blows to the head, the hockey players, and the other sports players.

Cannabis can replace opioids in many cases, and I just encourage people to really try for that. As far as the research goes, it's definitely up and coming. It's advancing quickly. They're also finding psychedelics being very effective in treating the same things that I've mentioned—the chronic pain, anxiety, depression, and cognitive function.

We need more research, more validation. There's research out there, but we need to make it more readily available for clinicians, for patients, and people to really understand why it's working.

I can tell you cannabis saved my life without hesitation from my traumatic brain injury symptoms. It didn't cure me. It's just allowed me to function and actually live instead of being alive.

What happens when traditional medicine fails a patient? When all recourses have been tried and the patient still suffers? In part I of this interview series, Nikki Lawley, founder of Nikki and the Plant, LLC, and retired licensed practical nurse (LPN), takes us through her journey from a medical professional in the healthcare industry to a brain injury survivor. Lawley also describes the medical cannabis industry from a patient perspective, learning about the medicinal properties of the plant, and finding what ways cannabis could be beneficial to her symptoms.

“Cannabis Saved My Life:” An Interview with Traumatic Brain Injury Survivor, Nikki Lawley, Part I: Journey to Health 

Recently, Khiron Life Sciences Corp., a global public health company based in Colombia, published the results of its first clinical study on the use of medical cannabis prescribed to patients in treating chronic pain. According to the article, published in the international peer-reviewed journal 

 in March 2022 (1), Khiron states, “Our results constitute the first real-world evidence on the clinical use of medicinal cannabis in Colombia and suggest that cannabis-based oral magistral formulations represent a safe and efficacious adjuvant therapeutic option in the management of chronic pain.”

The study was conducted at the Latin American Institute of Neurology and Nervous System (ILANS-Zerenia) in Bogotá, Colombia between May and September of 2021. It investigated the short-, mid-, and long-term impact of two well-defined, oral cannabis-based formulations on patient-reported outcome measures (PROMS) in adult patients diagnosed with chronic pain of diverse etiology. The patients received medicinal cannabis as part of an integrative care regime at ILANS-Zerenia. During this period, 2112 patients (out of 7874 of the patients receiving treatment) completed a PROMS questionnaire aimed at recording the degree of improvement of their primary symptom and any potential side effects (1).

Some of the results of the study included:

92.7% of patients reported some degree of clinical improvement in their chronic pain following medicinal cannabis treatment

Colombian-based public health company, Khiron Life Sciences Corp., published the results of its first clinical study on the use of medical cannabis prescribed to patients in treating chronic pain.

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