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.
How did using a cannabis app help you on your medical cannabis journey?
Nikki Lawley: 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?
Lawley: 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?
Lawley: 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)?
Lawley: 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?
Lawley: 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?
Lawley: 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?
Lawley: 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?
Lawley: 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