Check out our March/April issue focused on chronic pain

Cannabis Patience Care March/April

On this month’s episode, we are joined by Otha Smith III, the CEO and founder of Tetragram. We discuss Otha’s history in the industry as both a patient and an entrepreneur, obstacles he’s overcome, exciting research endeavors, and more.

Noid Knowledge, Ep 6: Tetragram: How Patient Data Is Powering Research

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

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

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/

Articles

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

71.7% of patients reported no adverse side effects associated to the treatment, and those most reported were mild and appeared to fade over time

Some of the side effects reported were somnolence (13%), dizziness (8.1%), and dry mouth (4.3%)

Furthermore, the study found that “males reported less effectiveness in the first 4 weeks of treatment. Sex-specific differences were also found in prescription patterns, with male patients increasing the intake of the balanced chemotype overtime.” In this study, 76.1% participants were female with an average age of 58.7 years old.

One of the conclusions from the study states that (1) “Considering the current lack of medical guidelines, evidence accrued through real-world clinical experience can help inform best medical practices in terms of chemotype selection and dosing regime [of medical cannabis] to maximize therapeutical effectiveness and tolerability.”

https://www.frontiersin.org/articles/10.3389/fpain.2022.854795/full

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.

Global Health Company Khiron Sciences Corp. Releases Outcomes on Study of Medical Cannabis Efficacy for Chronic Pain

Thai Health Minister, Anutin Charnvirakul, announced in a May 8 Facebook post that the Thai government will distribute 1,000,000 cannabis plants to households for free starting June 9 (1). Thailand residents will be able grow “as many cannabis plants” as they like in their own homes for medical purposes only, according to Charnvirakul (2). Reportedly, licensing will not be required for home cultivation, unlike commercial cannabis and hemp companies in the country. Large-scale enterprises will still need permission from the country’s Food and Drug Administration to make cannabis products (3).

In an additional Facebook post on May 10, Charnvirakul noted that Thai companies registered to do so could sell cannabis products that contained less than 0.2% tetrahydrocannabinol (THC). “This will enable people and the government to generate more than 10 billion baht ($288,846,200 per year) in revenue from marijuana and hemp,” Charnvirakul said. “Meanwhile, people can showcase their cannabis and hemp-related products and wisdom and sell their products nationwide” (1).

In 2018, Thailand became the first country in Southeast Asia to legalize cannabis for medical research and use, and last January it became the first country in Asia to legally allow cannabis. The intention is to redefine cannabis as a “household crop,” and is the latest step in Thailand’s plan to transform cannabis into a cash crop (2).

https://www.cnn.com/2022/05/11/asia/million-free-cannabis-plants-to-be-distributed-to-thai-households-intl-hnk/index.html

https://hightimes.com/news/thailand-to-give-away-1-million-free-cannabis-plants-for-home-cultivation/

https://abcnews.go.com/International/wireStory/thailand-providing-free-cannabis-plants-home-cultivation-84645779

Thai Health Minister, Anutin Charnvirakul, announced in a May Facebook post that the Thai government will distribute 1,000,000 cannabis plants for medical purposes to households across the nation for free starting in June.

Thailand to Distribute One Million Cannabis Plants for Medical Purposes to Households

Last week, CannMed held their 2022 annual conference in Pasadena, California from May 3–5. The event, fully in person, included a full-day medical practicum workshop, dozens of exhibitors, and thought-provoking keynote presentations in the four focus areas of medicine, science, cultivation, and safety. Attendees and presenters had the chance to network and mingle at the VIP dinner and the cocktail hour. Several presenters and guests were interviewed throughout the conference the at the CannMed Coffee Talk Lounge, including Megan L’Heureux, Group Editorial Director for 

A few interesting talks to note included the presentation by Jaime Brambila of Grace Health and Wellness titled “Raising Awareness: The Successful Implementation of Natural Plant Based Medicines Used as Adjunct Therapies with Standard Treatments for Metastatic Breast Cancer.” Brambila shared his wife, Nicole DiMonda’s, personal journey through cancer treatment and the success she had with medical cannabis and psychedelics. At the end, DiMonda shared a passionate statement about how this industry helped save her life. DiMonda and Brambila have partnered with several universities and research groups to expand their experience into clinical trials for others.

In addition, Dr. Marion McNabb of the Cannabis Center of Excellence highlighted some of the initial findings from her healthcare provider study in which her company surveyed healthcare professionals across the country on their knowledge and interest surrounding medical cannabis. The study is still open to healthcare providers through August 2022. Some of Dr. McNabb’s initial findings include:

354 healthcare providers responded, the majority of whom were nurses

42% of respondents also reported using medical cannabis themselves

37% believe cannabis can be a first line treatment

Alongside presentations on the medical aspects of cannabis, there were also many talks on the latest advancements in cultivation, testing, extraction, and research. Seth Crawford, co-founder of Oregon CBD, explained in his keynote address, “Cannabis 2022: The Golden Age of Discovery?” the methods of selective breeding of certain hemp plants on his farms, plus the potential innovations these seeds and plants can provide to farmers and researchers.

Grace Bandong, Scientific Strategy Leader for Contaminants for Eurofins Food Integrity and Innovations, gave another keynote presentation titled “Risk Based Hazards Analysis: A Tool for Building a Comprehensive Analytical Testing Program.” Bandong’s presentation explained how to create an effective yet economical risk-based framework of analysis of products, plus an explanation of the unexpected threats that hazards such as mycotoxins, heavy metals, and pesticides can pose to products.

For more information on CannMed or to learn more about the talks and speakers from this year’s event, please visit: 

https://cannmedevents.com/cannmed-schedule/

Last week, CannMed held their 2022 medical practicum and science conference in Pasadena, California from May 3 – 5.

CannMed’s 2022 Conference Further Promotes Mission to Inspire Science, Community, and Hope

Overview of Research on Cannabis for Chronic Pain

The Doctor Who Changed Her Patient–Doctor Paradigm Through Cannabis

Read the Research: What One Medical Writer Can Tell Us from Years of Compiling Data on Medical Cannabis Use for Chronic Pain Treatment, Opioid Addiction Management, and Enhancing Mindfulness 

Eyewitness: Cannabis Should Be the Chronic Pain Treatment Choice

Chronic Pain Advocacy: It’s Time to Testify! 

Cannabinoids in a Pill? One Company’s Research to Find the Next Cannabinoid-Based Medication

View our interactive March/April 2022 digital edition.

March/April 2022 Digital Edition

Recently, Medicare Plans, a patient support center that helps provide resources for understanding Medicare, conducted a survey of current Medicare recipients on their opinions of Medicare coverage for medical cannabis treatment and products (1). The survey was conducted online with 1250 Americans ages 65 and over surveyed. It covered topics such as past and current cannabis use, political affiliations, and how much patients spent on cannabis products per month. Medicare Plans released their survey results this month.

Some of the most prominent findings, according to Medicare Plans, included:

1 in 5 Medicare recipients currently use medical cannabis

23% have used medical cannabis in the past

66% of Medicare recipients “strongly agree” or “agree” that Medicare should cover medical cannabis

59% of those who support Medicare coverage for medical cannabis say it's because it can be effective where other treatments fail

38% of Medicare recipients who use medical cannabis do not want Medicare coverage because they fear it will increase the price

Medicare Plans pointed out that currently the use of medical cannabis is legal in 37 states, four territories, and the District of Columbia. However, because cannabis is both illegal at the federal level and, in most cases, not approved by the US Food and Drug Administration (FDA), health insurance does not pay for it. Medicare Plans also noted that with the recent passing of the Marijuana Opportunity Reinvestment and Expungement (MORE) Act in the House of Representatives, the question of whether insurance should cover medical cannabis may soon need to be addressed.

To see the survey results in detail, please visit: 

https://www.medicareplans.com/1-in-5-medicare-recipients-use-medical-marijuana/

Medicare Plans, a patient support center that provides resources for better understanding Medicare, recently conducted a survey about the idea of Medicare coverage for medical cannabis treatment and products. Here are some highlights from their results.

Medicare Plans Releases Survey Results Regarding Medical Cannabis Coverage

Meg is the Group Editorial Director for Cannabis Patient Care and Cannabis Science and Technology magazines at MJH Life Sciences.

The upcoming CannMed conference—taking place May 3–5 in Pasadena, California—will feature an exciting full-day medical practicum organized by Bonni Goldstein, MD, (the practicum’s originator); Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, NP, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics. 

This course is approved by the California Board of Registered Nursing for 9.5 contact hours.**

In this interview series, we speak to each of the organizers to learn more about them and what attendees can expect from the practicum. Here in Part III, Dr. Dustin Sulak shares some of the clinical applications for medical cannabis, dosing information, how cannabis can be used to stop opioid addiction, and more of his insight.

What are some of the clinical applications for medical cannabis?

: Chronic pain, insomnia, post-traumatic stress disorder (PTSD), nausea, and vomiting are certainly the most common, but a typical cannabis practice is full of refractory conditions from every other field in medicine, for example, psychiatry, gastroenterology, oncology, neurology, rheumatology, and so forth. Overall, cannabis is often an effective treatment when everything else has failed.

How is medical cannabis dosed and what methods are being used by patients?

: Cannabis is highly versatile and allows for individualized treatments that can often be fine-tuned to allow for all benefit and no adverse side effects. This fine-tuning includes delivery methods (oral, oromucosal, inhaled, topical), numerous varieties of cannabis with distinct properties. You can find more info at: 

https://healer.com/using-medical-cannabis-delivery-systems/

Can cannabis be used to get you off opioid addiction?

: Lots of data prove yes in chronic pain: 

https://healer.com/category/cannabis-and-opioids/

. Less data suggests it’s helpful in opioid use disorder, but I have seen this work in my patients.

How does cannabis interact with other prescription medications?

: Very few interactions except at high doses of cannabis. The blood thinner warfarin is a common one to watch out for—patients should have their blood checked after starting cannabis.

How is cannabis used to treat acute and chronic pain?

: Cannabis is very effective at treating chronic pain and associated symptoms. It can be useful in acute pain, but it also has the potential to intensify acute pain, especially in people who are new to cannabis. Despite this, one study showed that administering tetrahydrocannabinol (THC) to trauma patients in the hospital, including those with no prior experience using cannabis, improved their symptoms and decreased their requirements for opioids.

How is medical cannabis being used in pediatric patients? Is there clinical evidence for using cannabis to treat anxiety and attention deficit hyperactivity disorder (ADHD)?

: Small studies have shown benefit in anxiety and trauma-related disorders with THC, an analog of THC called nabilone, and cannabidiol (CBD). There’s even less data for ADHD. Anecdotally, I have seen cannabis help these conditions in hundreds of patients. These are both great examples of conditions cannabis clinicians successfully treat all the time but are lacking peer-reviewed clinical studies.

To find out more about CannMed’s medical practicum, please visit: 

**CONTINUING EDUCATION CREDITS: This course is provider-approved by the California Board of Registered Nursing, provider number 16845, for 9.5 contact hours.

In this interview series, we speak to each of the organizers to learn more about them and what attends can expect from the practicum. Here in Part III, Dr. Dustin Sulak shares his insights.

CannMed 2022: Medical Practicum Organizers Share Their Insight, Part III: Dr. Dustin Sulak 

Can you tell us about your background and your role with Americans for Safe Access (ASA)?

: At Americans for Safe Access, I am the Director of Government Affairs. I oversee our policy and advocacy in all 50 states as well as at the federal government level. It's our mission to provide safe, equitable legal access to medical cannabis for patients across the United States.

Prior to joining ASA in September 2021, I worked for almost four years at the Epilepsy Foundation, where I worked on a lot of access to care issues, including access to medical cannabis, in all 50 states and at the federal level. Before joining the Epilepsy Foundation, I worked at the state level in New York, where I was involved in passing the Compassionate Care Act.

I have about eight years of experience within cannabis policy and almost as many years in patient advocacy. I'm really enjoying my role at ASA, where I get to combine my passions for patient advocacy and cannabis policy to help ensure that patients across the country have access to treatment options.

What are ASA’s goals and plans for medical cannabis advocacy in the next few years?

 We have a lot of really exciting plans. First and foremost, our goal for the past 20 years has been, and will continue to be, getting access to patients. Not only access to medical cannabis, but access to legal protections and other measures that will help patients.

We've seen a majority of the states across the country pass medical cannabis programs, but that's really just the start of medical cannabis advocacy. It's not the end. We’ve achieved one goal, but we are continuously working to improve these programs and to improve the legal protections such as housing and custody protections within these programs.

We are striving to improve things like affordability and the financial obligations that patients are required to meet. We're also trying to ensure that underserved areas have access to medical cannabis. One of our top priorities is to continue to pass these programs where they don't exist, while also improving programs across the United States.

At the federal level, we're looking to pass legislation that will protect patients and that will fix some of the federal laws that conflict with state laws. For example, the fact that cannabis is a Schedule I drug means that through the Drug Free School Zone Act, children and adolescents who use medical cannabis cannot access their treatment on school grounds. We’re also focusing on employment protections for federal employees who are medical cannabis patients and on housing protections, particularly for those who receive housing through the Department of Housing and Urban Development (HUD).

We’re also looking to set up some sort of national coordinating entity or government agency that will be able to help coordinate access to medical cannabis across the United States to set the basic requirements for what these programs must provide for patients. The states will then be able to go above and beyond that while still making sure that no matter where patients are in the country, they can rely on a minimum standard of care when it comes to cannabis.

In terms of research, we are working to improve policies to make it easier for researchers to work with cannabis and get data that the United States is sorely lacking.

Can you tell us more about how ASA has helped improve access to cannabis for research?

 One of our top priorities at the federal level is to help remove some of the barriers for research, including removing cannabis from Schedule I to a different schedule to allow researchers to access it easier.

We’re also invested in helping to pass other policies such as the Feinstein/Grassley/Schatz bill (Cannabidiol and Marijuana Research Expansion Act) or the Blumenauer bill (Medical Marijuana Research Act) that can help researchers. Because one thing that I hear most from doctors, and also lawmakers, is that we need more data, but the data is extremely hard to get, so ASA is continuing to put priority on making medical research happen.

Right now, any cannabis policy on the federal level is slow moving, and so we're doing our best and hopefully something will pass soon to help alleviate those burdens for researchers.

ASA’s State of the States report for 2021 was released in February (1). What is the goal of this annual report?

 The biggest goal is to give people a snapshot of what medical cannabis access looks like across the country. Every year, we give all 50 states and five territories a letter grade based on how well the medical cannabis program serves and protects patients in that state or territory.

This year, we revamped the whole report based on a lot of feedback from patients, legislators, and other advocates around the country. We looked at our report from previous years and thought that it no longer accurately reflected the patient experience, and so we re-evaluated and reassigned points. We added categories and included a penalties category. We graded all states and territories on 120 different metrics that range from patient rights, civil protections, and affordability to consumer protections and health and social equity so you can see which states have the best medical cannabis programs and which states have the worst. We also provide each state with recommendations on things that they can do to improve their program.

The report cards are the main feature of the report, but the report itself is a great resource for policymakers, advocates, and patients across the country to learn why all 120 metrics are important to patients. There are also legislation models or regulation language in there for policymakers and other recommendations on things that they can do to improve patient lives. So, each year the report is published to help educate lawmakers on where we are, how we've improved since last year, but also how we can we keep improving in the future.

How the report is unique compared to other assessments of medical cannabis programs?

 We don't look at just one aspect of a medical cannabis program. I know that there are a lot of reports out there that look at equity within medical cannabis programs and we look at equity as well, but we really try to look at it from a 360° patient view. What are all of the things that a patient may experience or that may impact their ability to have access to cannabis? Every year we also release a patient survey to gather feedback from real patients about their state’s program and we incorporate that into our report as well.

How is the data for the report collected, organized, and analyzed?

 That is a big question. It's done over many, many months. We start by looking at the previous year's rubric to see if there's anything that we want to tweak, to reassign points for, or if there are any categories that we want to add. We check to see if there were any oversights left out the year before or if there’s an emerging issue that is important now.

Then we finalize the rubric and assign the points. Once we do all that, we dive straight into research. We have a giant Excel document that has all 50 states and territories and on each of those is all 120 metrics. We start by researching, reading the law, reading the regulations, and trying to find the provisions in the laws and regulations that correspond with our rubric.

And then we assign points to it based on another written rubric. You can find it on our website: 

 . For all 120 categories, we explain why this metric is important and how we graded it. In our other spreadsheet, we assign a grade to it and then leave a note on that spreadsheet with the citation or the legislative regulatory language as our source.

Then once that's done, we go back through and see if there's anything that we missed or anything that has passed while we were doing our initial research. That's something that happened a couple of times this year. We would give a state one grade, but while we were grading, the legislature passed something or the governor signed something and we went back and changed the grade.

Since the report came out, have any states been surprised by their scores, especially considering the new grading rubric you implemented?

 I'm not sure if any states have been surprised, but it seems like Colorado has been the most interested in their change of score. Just the change in grading alone lowered its score, but Colorado this year also passed a piece of legislation that is the single largest rollback of any state medical cannabis program that we've seen in the country. They lost a ton of points because of that rollback and as a result Colorado has been really interested in their new score considering the rubric and that legislation.

What most surprised or encouraged you about the results of the report?

I think what most surprised me was how the data we have on affordability matches exactly what patients tell us day in and day out. I have never doubted a patient who has told me that medical cannabis is expensive in their state and that they have trouble affording it because I know how much this can cost. I hear every day about affordability being a problem.

When we looked at policies that states can have to help patients with affordability, it's just crazy to me that it’s the lowest scoring category overall out of all of them. The highest scoring state in that category only received a 60%. I know the states hear every day about affordability being a problem, and yet they're not doing anything to help out with it. On the one hand, it was most surprising to me just because the scores in that category were so low. But on the other hand, it wasn't surprising because it just confirmed what our patient advocates are telling us. It is really hard to see that states are falling behind so far in that.

One other thing that has surprised me is the reactions we’re getting. Even though a lot of the grades for the states are lower than they have been in years past, we've been hearing a lot of positive things like, “I'm glad that you revamped the rubric because I think this grade is more accurate than last year's grade was.” That's made me feel great about our change in rubric. Our goal was to show what matters to patients. And what we're hearing from both policy makers and patients is that our new grading scale has achieved that and gives a more accurate insight into the program.

One thing that did encourage me about the report is that one of the highest categories overall is civil rights and patient protections. A lot of states are doing really well in providing for patients in that way. It's great that states are really working to legally protect patients because that was a big problem for a long time.

What would best help improve the affordability of medical cannabis? For example, do you think medical reimbursement will happen one day?

 It is my dream that medical reimbursement will not only happen one day, but one day soon. I think that might be a little bit of a stretch—at least the “soon” part. But I do think eventually medical reimbursement will happen for medical cannabis patients, especially when insurance companies can look to the fact that if medical cannabis is treating someone, it's keeping them out of a hospital and it's keeping them out of emergency rooms. It could keep them from needing additional surgeries or other treatments.

Helping patients to afford medical cannabis now could help insurance costs in the long run. States can and should right now help to provide financial assistance, real substantial financial assistance, especially to low income, elderly veteran individuals to help them afford the product.

Additionally, a lot of states allowed telehealth visits during the initial lockdowns of COVID-19, but a lot of states have since let that lapse and no longer allow telehealth. So, then patients also have the hurdle of actually traveling to a doctor to get that recommendation when it's something that they could easily do 15 minutes on their computer from home. And if you go to a doctor specifically for a cannabis recommendation, some insurance will not cover that visit.

Another important thing states can do is do away with their registration fees. It can be a big hurdle for patients to have to pay to even be able to access cannabis in the first place. That's especially true in states that have passed recreational adult use laws.

There's no need for patients to be paying for the same access that adults have. For example, Oregon charges patients $200 every year to register for their medical cannabis program, but because they also have recreational adult use, any adult in the state can walk into a dispensary for free. It's not the same to say, “Well, don't pay the $200, just go to a recreational dispensary,” because by being a registered medical cannabis patient, patients receive extra legal protections and other things that don't exist in the recreational market. Patients need the protections of the medical cannabis program, especially when Oregon is making hand over fist revenue on the recreational cannabis side. There's just no reason for them to also have the highest registration fee for patients in the country.

Have you seen an increased need for patient advocacy in states that have medical programs but have also legalized cannabis for adult use? Are you seeing less focus on medical protections in those states?

 Absolutely. One trap that a lot of states seem to fall into is thinking that passing recreational adult use cannabis replaces the medical cannabis program; that there's no need for medical cannabis if a state legalizes recreational adult use, but that is not the case.

A recreational adult use law can and should, in my opinion, coexist with a medical cannabis program. But they should remain separate because there are protections and other measures in medical cannabis programs that protect patients that are not present in recreational programs.

Furthermore, recreational adult use is only for individuals 21 and older. There are many children, adolescents, and young adults who do use medical cannabis. So, when states put all their regulatory effort in recreational adult use and let the medical cannabis program fizzle out, they're doing a big disservice to a lot of patients in the country. They're also adding another financial burden to patients because if they go through the recreational retailers, they have to pay the sales tax and the excise tax, which can be a huge amount that they wouldn’t have to pay in medical dispensaries.

Can you give us some examples of places where or how medical cannabis programs are growing?

This year in our State of the States report, every state—except four—and territory that has a medical cannabis program all grew. The vast majority of them are growing. These programs are still valuable, and the rights and protections afforded in the program are still necessary for patients. So, it's nice to see that all over the country, these programs are growing. In a lot of states, they are just growing naturally.

Other states passed additional legislation in the past year or so that expanded the qualifying condition list. We encourage states to continue expanding the qualifying condition list, to reevaluate their policies, and to look at the hurdles that patients have to jump over in order to register for this program to help facilitate this growth.

You noted the need for a national coordination agency for patient rights and protections. Can you tell us what that would look like and why it's so important to set up?

 This would be a national coordinating agency or a sub agency, probably under the Department of Health and Human Services (HHS).

I could ask five people what agency they think of for cannabis enforcement, and they could each say a different agency and still all be right. You could say Food and Drug Administration (FDA) because the FDA has jurisdiction over dietary supplements and pharmaceuticals. You could say Department of Justice (DOJ) because of cannabis prosecution. The Drug Enforcement Administration (DEA) is the one responsible for awarding the Schedule I research grants for researchers and does some cannabis enforcement too. The point is that each agency has a little piece of the pie. The agencies aren't the best at communicating with each other, so there's a lot of finger-pointing and delaying when you need to do anything with cannabis.

First and foremost, this national coordinating agency, an Office of Medical Cannabis Control or something of that sort, would take all those cannabis responsibilities from the other agencies and house them in one department and the people who work there would be the governmental experts on cannabis policy. It would not be an oversight agency for medical cannabis programs, but one that helps states coordinate nationally. This can include things like allowing interstate commerce and allowing products to travel from one state to the other to help fill dispensaries and ensure that patients have access.

What more needs to be done for patient rights, protections, and access to cannabis in the United States? In this interview, Abbey Roudebush, Director of Government Affairs for Americans for Safe Access (ASA), explains the goals of ASA and provides an in-depth analysis of their annual State of the States report. She explains why medical cannabis access is a pertinent issue, the myriad obstacles patients still face in securing protections, and how to advocate for the rights of medical cannabis patients.

Medical Cannabis Is Here and It's Here to Stay: How Americans for Safe Access, the Nation’s Largest Member-Based Cannabis Advocacy Organization, Protects Patient Rights

Featured Content

Cannabis Patience Care March/April

Noid Knowledge, Ep 6: Tetragram: How Patient Data Is Powering Research

Cannabis Research for Chronic Pain

Cannabis Patient Care December

Cannabis Patient Care October/November