Dispense MagazineFor many people dealing with mental health issues, to explore using cannabis as a treatment, it seems overwhelming because of two stigmas. First is the stigma of their condition, and second the stigma still lingering with medical cannabis in some communities. How can we reduce these stigmas? And what do patients with mental health issues need to do to begin that exploration?
Welcome to the Dispense Magazine podcast. I’m Sven Hosford.
In this episode, we bring you a panel discussion from a recent Mind Body Spirit Expo that explores these questions in some depth.
Our panelists include Sara Makin, of Makin Wellness in Pittsburgh. Her practice provides diagnosis and treatment for many mental health conditions, but especially anxiety and PTSD, which are qualifying conditions in PA. We’ll talk to Richard Greer, Pharmacy Director for Solevo Wellness, a dispensary in Pittsburgh. And we’ll hear from Chad Rodman of Medical Marijuana Solutions, which provides patient certifications in many locations across mid and western PA. He’s also a patient who treats his anxiety with cannabis.
Here’s how it sounded on September 28, 2019.
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Transcription
DM:
Welcome, everybody. My name is Sven Hosford. I'm the founder and publisher of Dispense Magazine, which hopefully you have picked up a copy here today. We cover the medical cannabis News here for Western Pennsylvania and all of Pennsylvania. I come from the world of holistic healing, so I've done holistic health magazines for about 25 years. So it was a natural extension for me to come right over here and start doing the cannabis because really, cannabis and holistic are very, very similar. A lot of the same principles and attitudes. So we've got a very interesting panel for you today. We're going to be recording this for a podcast. So if you have any questions, there's a microphone up here. Again, what we're gonna talk about today is mental health conditions - how to get a diagnosis, what the process is, what is considered, diagnosable, basically. And then what happens when you get to the dispensary? And we also have a patient perspective of somebody who's been down this road and is using cannabis to treat his mental health right now. So let me get started by introducing the panel right there in the middle, we've got Sara Makin. She's with Makin Wellness. She has an office in downtown Pittsburgh and New Kensington. And on her left is Richard Greer. Richard is the pharmacist - elite pharmacist - at Solevo Wellness, which is the first dispensary to open up in Pittsburgh and Allegheny County, I believe. And then on this side, we have Chad Rodman. Chad is with Medical Marijuana Solutions, so he is a patient. But he has also got a medical background and is very, very knowledgeable about medical cannabis. So a very interesting perspective. So, Sara, let's start with you. Can you describe your practice? What kind of mental health conditions do you treat overall?
SM:
Yes, I would love to. Thank you for asking. So, at Makin Wellness, we specialize in helping people heal and become happy again. We specialize in holistic mental health and addiction treatment. So any form of mental health or addiction condition - we're more than happy to help a person in their healing journey. And we have medical marijuana evaluations and have the only mental health practices in Pennsylvania that have medical marijuana as part of the anxiety, trauma, and opiate use disorder treatment.
DM:
And those are the three main mental health conditions that are the qualifying conditions for Pennsylvania?
SM:
Yes. As well as autism.
DM:
Autism too? And you diagnose for that?
SM:
Yes, we are able to. We mostly see patients with anxiety, trauma, and opiate disorder. But we do see patients with autism as well.
DM:
Is anxiety, probably your number one condition that you're treating right now?
SM:
Anxiety and PTSD are, yeah.
DM:
Okay, great. Thank you. Well, tell us a little bit about the process of getting a diagnosis - what people need to do. Most people who have PTSD and anxiety have never even been to any kind of mental health professionals. Is that true?
SM:
Yeah, that is true, and actually, this is very unfortunate, because anxiety is actually a highly treatable condition. And out of all of the mental health and addiction conditions,it has the best outcomes. So, as far as getting a diagnosis, the first step is taking a screening tool. We have screening tools for these conditions on our website and makinwellness.com, and if the screening tool says that you more than likely have it, and you would be a good candidate to have an evaluation done. And, for instance, like with the anxiety evaluation, in the beginning, we asked, is your anxiety more generalized, or is it something like, if specific, a phobia? Or is it something specific that makes you very anxious? And then based on that response depends on what kind of assessment we do.
DM:
Sometimes people have other conditions that are related to that like insomnia. Are people using cannabis for that? They get their card for anxiety or PTSD, but does it also help with things like insomnia and other mental health conditions?
SM:
That’s a great question. Actually, yes. Many patients that have anxiety or PTSD suffer from insomnia or have a really difficult time falling asleep. So using a CBD or medical cannabis at night is very helpful for increasing quality sleep and actually, patients that have PTSD, if they have a lot of nightmares at night it helps to reduce the severity and intensity of those nightmares.
DM:
Excellent. Well, let’s move over to Richard Greer, not Geere - don’t get excited ladies. You get that all the time, right?
RG:
Haha, yes.
DM:
Richard is really a top-notch pharmacist. He’s been on other podcasts of ours as well. Richard, describe exactly what you do as a pharmacist at a dispensary.
RG:
Ok, so, first of all, Sven, thank you for having me. Now, talking from the pharmacist’s perspective from Solevo as a dispensary - one thing we very much pride ourselves on is very pharmacist-focused care, so we do require when we see any new patient that they do actually sit down and have some sort of consultation with a pharmacist. The importance of that is many - especially if you’re talking about any mental health diagnosis. We understand the burden that that has on our patients, number one. Number two, we also understand as a medical marijuana dispensary that we’re kind of this foreign entity. You know, we’re not a doctor’s office. We’re not a traditional pharmacy. We’re this different thing that just off the bat, people are a little bit unsure about and a little bit anxious to even come to see us sometimes. We definitely want to take that into account - make our environment as welcoming as possible so that we’re in no way shape or form worsening someone’s anxiety or causing them some sort of negative issues from that standpoint. Our pharmacists at Solevo were very highly trained on kind of the academic and the general knowledge of marijuana as a medicine - getting down the cannabinoids, getting down to the terpenes - these basic parts of the plant that we want to know and understand fully so that when we do make a recommendation to a patient, we can very confidently and comfortably do so and know that were pointing them in the right direction. At Solevo, our intake paperwork - it actually feels very much like you’re going to a physician’s office. Our whole focus is on a patient’s health history. Yes, we want to get an established diagnosis, we want to know if it’s PTSD, we wanna know if it’s anxiety. Even if it is something else - even if it is chronic pain for example. Often times those patients are very stressed, very anxious - often times very depressed. All these kinds of things would fall under the umbrella of a mental health diagnosis anyhow. The pharmacists are gonna review that health history - we want to know what symptoms you have, where you’ve been, things you’ve previously tried to treat your condition. We want to know what medications you’re on - be sure there’s no serious interaction or any negative kind of expectation or anything we could potentially foresee and hopefully avoid. We also very much want to establish a repertoire with our patients on that one on one first consultation. We want to gain your trust. We want to prove ourselves - prove that we do know what we are talking about - that when we make a recommendation that we are confidently doing so. And pointing you in a direction that not only do we know from studying the medicine, but also from treating patients on the front lines every single day. We want to establish what a patient’s even comfortable with. If you don’t want to inhale marijuana, that is completely fine. We have plenty of other options we can talk you through. And all of them - walking through them, we can find something that will be appropriate. More often than not, actually our patients are kind of fed up with taking pills. They’re kind of sick of a traditional marijuana regimen. They’ll do anything else except another pill. That’s fine, we have plenty of options to talk them through. We want to set some goals of therapy and some expectations. We need to know when they’re taking this medicine, if they’re taking something solely at bedtime or if they’re taking it throughout the course of the day at work, those are going to be drastically different recommendations there. And as Sara was saying, we need to get a sense at the dispensary what they’re actually experiencing. My recommendation for someone with generalized anxiety or a generalized condition is gonna be very different than my recommendation for someone that has a specific phobia. It’s triggered by something maybe unexpected - a symptom I need to get them quick relief. Those are different considerations we’re going to take into account on that first meeting with the patient.
DM:
So there are a couple of things you said I want to just touch on and amplify. First is that you require patients to come in and have a meeting with a pharmacist. Not every dispensary does that. Is that right?
RG:
That is correct. So, in Pennsylvania, the law states there needs to be a health professional on staff. It must either be a physician or a pharmacist or potentially a physician’s assistant or nurse practitioner. The health professional is required to be there, however, it is not clearly spelled out as to what they should or should not be doing. As I said, Solevo’s standpoint is very pharmacist and patient-focused. That first consultation is really the core is what our business is built on. Again, we want to have that interface with the patient, start to build that relationship and that repertoire with them and just kind of go from there and make the best recommendation that we can and proceed with their treatment.
DM:
The other thing I think you said that is very important is that you want to ensure that you don’t create ore anxiety in people who are there to treat their anxiety. It can be pretty intimidating the first time - even for me who has had a little bit of experience with cannabis. When I first walked into a dispensary, it’s kind of intimidating and can create some anxiety. Are there specific things you do for people with a mental health diagnosis that is a little bit different from the pain diagnoses or something like that?
RG:
Certainly. We definitely recognize that patients do come to us not only with a diagnosis but actively experiencing some level of anxiety just walking through our doors. Again, we’re almost this foreign entity. The names of some of the products look strange to people. Just the number of varieties looks intimidating to people. Often times people walk through that door and they just feel this unneeded pressure, like they need to be the expert, they need to know what they are doing, they need to have some level of confidence of even what they’re talking about. With us recognizing that it’s very important that we kind of always reiterate to these patients we are there for them and with them. At Solevo, you’re never gonna be by yourself. We’re never gonna hand you a piece of paper with our inventory and say, “What do you want?” That is 100% not how we are going to operate. Some things that do set us a little bit apart - first of all, our consultations occur in a private office that is one-on-one with the pharmacist. So, very heavy on patient privacy. And again, we want to have a very transparent and open conversation with these people to get things started the right way. That’s one thing we initially offer to ease people into things. You’re not in a big room, trying to talk over a lot of noise or talk over other people with some kind of not fully level of privacy there. We actually have a sensory-friendly room that we can always use if we need to. So, if we are particularly busy, if there are a lot of people in the waiting room, if it happens to be noisy or a little more chaotic than any other day If we can pinpoint and identify someone who seems to be struggling a little bit, that room is always going to be an option to kind of get them isolated a little bit, get them comfortable, get them in a spot where they feel a little safer. Proceed to meet with the pharmacist and then proceed from there. But we’re always gonna bend over backward to keep that in the front of our minds to keep that a very comfortable and safe experience for the patient.
DM:
The other thing you said, and you know that it’s true that there are two, three, four pages of different products. What’s the process that you go through with each patient to find the right medicine and the right dosage?
RG:
So, as I’m walking through a health history with someone, part of that is gonna be a little bit of their social history. Have they used marijuana previously? Are they comfortable with these products and their names, with the dosing? Those kinds of things. If I can pinpoint and individual that is a little more experienced with marijuana compared to someone that is brand new, those are gonna be drastically different discussions. Even the people that are experienced more often than not, do want some level of guidance. And there’s always some level of new education we can provide for them. But oftentimes those patients just need a little less care. They don’t need to be followed quite as closely as someone who is brand new to this world. If someone has no experience whatsoever, we’re gonna start them at a very low dose on purpose. I tell this to every patient I consult with. For the first few days, if you feel no effect at all, I’ve actually done my job as I should. I need to make sure I introduce this medicine safely and appropriately to a patient’s system. And we can always build up from there. What I 100% need to avoid is a negative experience off the bat. I cannot have my patients overmedicated day one or day two or day three. We can always build a dose as seen fit. As I said a little earlier, time of day plays a little role in a recommendation in something a direction a patient possibly may go. Obviously, something that’s gonna make someone very sleepy, there not getting that while they’re at work or throughout the course of the day. If someone is using the medicine solely at night time, that’s a little easier recommendation. There are certain things I know I can go to automatically that should help not only with the mental health side of things but also just help them get a good night’s sleep and reap the benefits of what that can do alone. We’re gonna talk about ratios of cannabinoids. We’re gonna talk about building CBD into their regimen. We’re gonna talk about just kind of the practical administration. If someone has a really busy and hectic day, they might not have time to be kind of tied to their vape pen all day for example. These are all things we’re gonna walk through and sort of tease out through the course of the discussion. It’s a little cliche, but I always say every consultation is a little bit unique. It’s kind of depending on how the discussion goes. A recommendation could possibly lead in a few different directions.
DM:
Excellent. Chad! Chad Rodman. I like to say, “Don’t Get Mad, Get Chad.” Maybe I’m the only one that likes to say it.
CR:
I think so, yeah, haha.
DM:
You’re tired of hearing me say it. Chad, you’re here as a patient to describe things for us. Give us a little thumbnail of your biography and how you wound up here.
CR:
Sure! First off, thank you, Sven, for having me. And yeah, so, I’ll start with my college days I guess - my 30-second spiel, right? So, Undergrad, I have my bachelor’s degree in biology, went and got my masters in public health, both at WVU. After that, I went and worked as an epidemiologist for the Center for Disease Control where I was also published there. I went to med school for the first two years, decided that wasn’t the necessary path of medicine for me so I came back to Pittsburgh here, and was waiting around for the cannabis industry to take afoot. So, I went and worked and did some research at Hillman Cancer Center and it finally came. Then I started working actually at the healing center where I was part of opening up the Washington location as well as the Monroeville location. Now I am a cannabis specialist here with Compassionate Clinics of America.
DM:
And what are the conditions that you’ve been diagnosed with that you use cannabis to treat?
CR:
Right, definitely one is anxiety and I have some GI issues, so its more of an IBS but it’s aways chronic pain.
DM:
So, it’s safe to say that medical cannabis has made your life easier?
CR:
100%, yes sir.
DM:
And how do you balance the consumption of that with being able to stay focused and being able to work a job?
CR:
Honestly it’s all about the ratios right now, with the CBD and THC. For myself, I’m a little different, given my GI issues and the anxiety, I actually go with some strains that are a little heavier for your normal patients during the day. So, I am using a tincture or RSO, everybody knows about all that right? I use a little bit during the day and then if I have a spike or anything or anxiety trigger, I’ll go and vape, but usually, I’m pretty good with the RSO throughout the day.
DM:
Has your medical background made you a better patient?
CR:
Significantly. I put my love of working with people and my love of cannabis and I put them together and this is what I do every day. So, absolutely Learning all the mechanisms and intrinsic factors of the human body, and when you combine that with the endocannabinoid system. I love it. It’s fantastic.
DM:
So here’s a question, we’re gonna ask everyone here. What strategies do you have for overcoming the stigma of cannabis and the stigma of mental health issues? Let’s stay with Chad on that.
CR:
I’d have to say, if I wasn’t in this field, it would be extremely difficult as I was an epidemiologist before or even at the Hillman Cancer Research Center there. I couldn’t come clean and say, “Yeah, I’m a medical cannabis user.” And now that I jumped over that fence, you know and now I’m in it full for the all-time, right? So, yeah.
DM:
Sara, you’re a mental health professional. How do you overcome those dual stigmas of both the mental health stigma and the cannabis stigma?
SM:
It’s a really great question. One of the things that we always do is if we hear patients say I have anxiety or I am anxious or I am schizophrenic, we always let them know, you are a person who sometimes suffers from symptoms of anxiety, we really encourage patients to not internalize or label themselves with the condition. I also feel like, you know, being open and honest and talking about it and sharing your experiences with other people is important as well because this is something that is extremely common and the more we talk about it the more comfortable people are gonna feel comfortable with getting help. I feel like getting help is also another very important aspect of that as ell. Because more people get help and they start to feel better, they’ll want to talk about their positive experience.
DM:
I think that’s a very important thing you said there that you don’t use that as a label like you don’t say I’m an anxiety patient like you would say, hey, I’m a diabetic. One of the things that you really impressed me with - full disclosure - I came to Sara to get my diagnosis for PTSD and one of the most important things I things you said is you know here’s your written diagnosis and we’re gonna put this away and we’re never going to need to bring up that topic or diagnosis again. We’re just gonna treat you, the patient. Is that your attitude?
SM:
Yes, definitely. Actually, the more someone thinks about their diagnosis and the mental health condition, the worse it gets. So, it’s important to start to focus more of your thoughts and energy towards healing and towards solutions and towards overcoming instead of thinking more about the condition.
DM:
Richard, how about you? Once people enter your dispensary, they’ve pretty much overcome a certain level of stigma just to walk in the door. But do you still deal with that issue? The stigma, both cannabis and mental health?
RG:
Absolutely. Believe it or not, almost daily even though people have seen a physician, gotten a diagnosis, gotten their card and come to see us, oftentimes people are still, the patients are still in need of a pep talk. They want that reassurance that this is ok. That this is a legitimate medicine to use for a serious medical condition. I’m always there and willing to give that pep talk, on a slightly, I guess, larger scale. I think, just a big gap in this industry that we’re definitely trying to and continuing to address is just the absolute lack of education, especially in a lot of healthcare practitioners. Unfortunately, some people already have their minds made up and no matter how much you try, no matter how hard you try or how persistent you are with educating someone, some people are just determined that they’re right no matter what you say. I will say the more medical marijuana can be talked about, from many standpoints, you could talk about the research, you could talk about the science, you can talk about the cannabinoids, the receptors, you can talk about this on a very clinical and medical level. Oftentimes the more impactful discussions and stories though are actually the success stories. I can tell you about my patient that was 14 months old. I can tell you about my 2-year-old patient. I can tell you about all kinds of different success stories, ranging all the way up until a geriatric population that is now off of their opioids that they had been on forever. I really think highlighting the successes is a very, very important thing. Sometimes its a chore though. We certainly do our best. I’ve liked to talk to people. I love to hear the successes. I like to hear criticisms too. We’re not perfect and we can do better. That’s what we’re always gonna try to do. But it’s just kinda having that courage to have the discussion. This doesn’t have to be like a negative. This doesn’t have to be like a hush-hush secretive type thing. If we’re gonna consider this a medicine, let’s consider it a medicine. Let’s compare it to an opioid or a Xanax or an antidepressant. Let’s stop the comparison to alcohol. That’s not the same thing. Let’s stop trying to pretend that it is. So, as I said, I try to do my best individually, I know SOlevo tries to do their best as an organization. But, more and more and more it is just getting that accurate, correct and appropriate information out there to the people that need it.
DM:
Chad, you were nodding quite a bit. Did you have anything you wanted to follow up with?
CR:
Absolutely actually. With success stories - sharing them, I think it’s a huge factor. Because people don’t hear enough about the goodness that comes from medical cannabis. Like he’s saying. We all have our stories that we’d love to share, but there are people that are here that went from 400 seizures down to 9 now, a day - 9 seizures. I mean that’s just…
DM:
That would be a big day for a lot of people that are used to having 400.
CR:
Right, right. Exactly.
DM:
Describe your quality of life before cannabis and today. Compare those two times in your life.
CR:
I mean, I was in school for the majority of it but honestly, with my GI issues, I would most likely not be able to work. It was that bad. Which causes anxiety as well. Like you said, like we discussed previously, they come together, so, yeah definitely not able to. I could study and sit around read by books all day and learn everything I could but in order to really work and come out, no, I wouldn’t have been able to.
DM:
Sara, let’s get back to you. Anxiety was just added to the list of qualifying conditions here in Pennsylvania. We saw a big spike in the number of patients that signed up with the state. You’ve told me that you’ve seen an increase in your business. Talk a little bit about what exactly is diagnosable anxiety, some of the common types, what makes it serious enough that we can come to get a diagnosis?
SM:
Yes, so with anxiety this is kind of like a persistent and irrational fear. You have a really hard time with controlling your thoughts, controlling the worrying. Typically, it’s lasting at least six months or longer. So this is something that is really debilitating. It can negatively impact different parts of your life, like your career, your personal relationships. And the biggest thing that makes it a diagnosable condition is you basically have to fit al the criteria for it. So, experiencing anxiety for the past six months or longer, having a hard time controlling the worrying, feeling irritable, having muscle tension, it not being caused by another medical condition, and it not being triggered by a substance.
DM:
And you’ve mentioned that is one of the most easily treatable conditions. What other kinds of other things do you do in your practice besides cannabis to help people deal with it?
SM:
So we have cognitive-behavioral therapy which is evidence-based practice, which basically helps you to become more mindful and see what your thoughts even are. And we help you to think more positively and think less anxious and more positive thoughts. We also have thought fuel therapy. If a patient would like to try that, it basically combines acupuncture with therapy. So basically you think about whatever is making you anxious and we helo to reduce the negative emotion attached to the thought. Cause its actually not the negative thoughts that make you feel anxious its the anxiety and emotions that uncomfortable. So by utilizing that, people become less anxious too.
DM:
And you do this without any pharmaceutical drugs too.
SM:
Yeah, and we have a holistic nutritionist on staff. You can meet with her and you know, get different nutritional adjustments made. Another thing too with our anxiety treatment and this is very not known, I feel like a lot of people need to know about this. Every time you have caffeine, your body produces and releases cortisol which is the stress hormone that’s released every time your anxious. So a lot of people don’t know this and they drink a lot of caffeine and they have a lot of Starbucks and they wonder why their anxiety is so bad. We’ve had so many patients cut down on their caffeine intake and their anxiety has gotten reduced significantly.
DM:
That’s amazing. Richard. How has the addition of anxiety to the state’s qualifying conditions affected your business?
RG:
I think it’s wonderful. Just from the standpoint of the program itself. The huge point with adding anxiety to the list, that definitely opens this list up to numerous, numerous people that can benefit from this. On a day to day basis, you figure for probably the first year and a half, chronic pain was easily the number one diagnosis we saw. I would normally say upwards of about 2.3 of our patients were just for chronic pain. Now that anxiety is added, some days it feels like its almost every single patient that comes in with that diagnosis specifically. So, it’s still new, but I think pretty obviously that we’ll overtake chronic pain as our number one patient diagnosis as long as we give it a little bit more time and keep seeing more of those patients. Sometimes it is difficult, I mean, all the 23 conditions are all very serious chronic conditions. So there all al little bit difficult to treat. Anxiety can be a little bit tricky. KInd of keeps us on our toes at the dispensary a little bit. You know we just wanna be a little bit more cautious with the recommendations, a little bit more supportive, a little bit more reinforcement to those patients specifically because they are so vulnerable. But overall, I’m very happy that the state added that condition From Solevo’s standpoint, er have been busy, we’re just a little busier now it feels like. But, from the day to day, its definitely only a positive up to this point.
DM:
Well it’s funny you say that it might be number one. According to Dispense Magazine, from their Releaf App, Shameless Plug Alert Here, Anxiety is, in fact, the number one condition being treated by Pennsylvanians and it lists out the top five products. Also, depression is on here, stress, agitation, irritability, fatigue, a lot of mental health conditions that are in some ways related. I’ve heard some people say, well you know I’ve tried cannabis for anxiety but it actually made me more anxious. Tell us what your strategies are to help people find the right dosage of the right product.
RG:
So if someone has tried any sort of medical marijuana previously with a negative experience, I want to do my best to figure out what that was and what caused it. That can be very tricky. If someone was using a product off of like the illicit street market, oftentimes the patient has no idea what they have. They don’t know what strain it was, they don’t know what potency it was, they literally have no information tied to that. Even more importantly, on the illicit market, you’re talking substantially more impurities. There’s no testing. Different fertilizers, the freshness of the marijuana. All these different things can play a part in worsening someone’s anxiety, so oftentimes its actually not even the marijuana itself. It may be some kind of chemical additive or some other issue again from a product that was not tested and did not come from a legitimate dispensary. If I am able to establish what the patient had used previously, obviously that’s a little simpler. We can avoid certain things then That’s gonna be my cue to head in a certain direction away from what they had tried before. If we have no knowledge other than hey I have tried something and it was really bad, I was incredibly anxious and couldn’t sleep, for example, there are certain directions we may go. There are always recommendations that are a little bit safer. Generally CBD as part of the marijuana plant or hemp plant, but we’ll talk about the marijuana plant. Generally, that’s a pretty safe recommendation. You’re talking little to no side effects as long as its the correct dose for most people. So we can always potentially explore a product that’s a little bit higher in CBD that’s always gonna be a little bit of a safer recommendation. Certain strains we’re gonna kind of automatically know to avoid. Again, at least to start, until we tease out a couple of things and see what the response of the patient is to our newest recommendations. I always find it interesting with the psychological diagnosis particularly anxiety more often than not I hate to overgeneralize it but patients can really oftentimes get relief from any kind of marijuana as long as the dose is appropriately minded. Even if I’m going in the direction of a recommendation of a strain that might be a little bit anxiety-inducing, yes, common sense is gonna say I’m gonna try to avoid those but if for some reason we are headed in that direction the thing I need to stress to the patient is to mind your own dose. We need to introduce that low dose, again to not overmedicate and then potentially worsen some problems. Unfortunately THC can be great for psychological, it can help with depression, it can help with anxiety, it can help with many things, it can help with stress. But, if you overdo it, one of the more common side effects is panic so again, we don’t want to overmedicate, it’s all about minding the intake, how much the patient is actually getting. If we can do that in a milligram, we’ll certainly start at the lowest possible milligram we can. Or if it’s an inhaled form, we’re gonna counsel the patient into how to do that appropriately and just start at that low dose.
DM:
Now, I know that in the state of Pennsylvania the law says that if you get a dry flower, a dried plant flower from your dispensary, you are supposed to vape it. However, I’ve heard a rumor, JUST A RUMOR, that some people may actually still smoke it. What’s your knowledge of the process of burning the plant. What I understand it actually burns off a lot of the terpenes and you can’t really absorb them when you smoke it as opposed to when you vape it and its the terpenes that actually help kind of smoothe out some of that possible anxiety-causing effect. Am I on track with that?
RG:
Yes. That’s a very dirty rumor you speak of. This is the first I’ve heard of such a thing.
DM:
I’m glad I brought you up to speed. Does burning it actually destroy the terpenes as opposed to if you get an oil or tincture?
RG:
That is correct. So, I don’t know the exact math, but I probably should. But when you actually ignite marijuana like actually take fire to it and combust it, a lot of the actual cannabinoids themselves and the terpenes, no pun intended, literally go up in smoke. They’re actually just kind of burned off into the atmosphere. So, that is a consideration in terms, if you’re talking about potency or even just a little bit more, just kind of getting your money’s worth out what you’re actually purchasing. I don’t want my medicine going to waste per se. Versus when you vaporize, there does tend to be a lot more of actual cannabinoids and terpenes consumed into the human body. The other thing about vaporizing dry leaf is you can set on many devices, you can set the device to a very specific temperature. So you can actually even on a particular strain of dry leaf, you can actually customize your own therapy. You can set a temperature where you know only certain cannabinoids will be released or certain terpenes will be released. And the more patient is willing to or able to play with that number of the actual vaporizing temperature, again you can kind of customize your own therapy a little bit. There’s certainly gonna be health considerations to take into account as well. When you actually smoke marijuana, you’re getting way more carcinogens, actual cancer-causing agents of the smoke, higher levels of CO2. Those kinds of considerations as well, but to just to be clear, legally, even if you have a card you cant actually smoke marijuana in the state of Pennsylvania in terms of flighting it on fire.
DM:
Chad, you have some medical background, history. Do you wanna expand upon that or add what you know about the whole situation.
CR:
Yeah, I always look at my terpene profiles. That is a big thing, especially you know with what we’re saying.
DM:
So the terms Sativa and Indica don’t mean as much as the actual terpene profiles?
CR:
Those are old terminologies anymore, I really feel like you know. You need to learn the terpenes. There’s what, over 113 of them now? Nd those are all with different molecules that are found within cannabis. So, for instance, everybody loves lavender, right? Lavender has a phenomenal type of terpene that’s called linalool. Well, guess what also is found in cannabis? Linalool. So, if you look at the benefits of lavender, you know it’s relaxing calming, that sort of thing. Well, there’s cannabis strains that have that in it - same effects. So the patients really have to pay attention to the terpenes that affect them, whether it’s positively or negatively. And this is a conversation that I also have to have with the patients that are coming to me with anxiety. Because it changed the conversation. If you’re looking at anxiety in general, I avoid particular terpenes. There’s pinene, for example, alpha and beta-pinene. When you see high levels of that particular terpene, I tend to avoid that because that terpene just for me, elevates my anxiety. Everybody is different but there are general rules of thumb with that being said, and pinene is one of those general rules of thumb to stay away from.
DM:
Now but that’s also, it’s true that everybody reacts to these terpenes differently. So, you can start with a general guideline but it’s really up to each patient.
CR:
One hundred percent. And what I always do like if they’re gonna try something that’s brand new, have your normal dose and cut it in half and try at that point and see.
DM:
Interesting. Well Sara, let’s get back to you. Let’s talk about some of the other mental health conditions. PTSD is a big one. We’ve done some podcasts in the past about this. Just give us a general outline of what causes PTSD and what are some of the symptoms that people might recognize in their behavior that maybe hey, I gotta go get some help with this?
SM:
Yeah, so PTSD occurs after someone witnesses, observes or learns about a traumatic event and they start to then experience flashbacks, they have hyper-vigilance which is trauma-induced anxiety, they can have a hard time sleeping, they can have GI issues.
SM:
Richard, you’ve said you’d love to share some success stories. Do you have any specific ones that you really like about people using cannabis with mental health issues?
RG:
Just generally, yeah, I mean, if you want to talk in more of a general sense, as a pharmacist, I don’t necessarily like to badmouth traditional pharmaceuticals necessarily.
DM:
Go ahead, we don’t care.
RG:
I’m never ceased to be amazed by when I see a patient that is exploring the medical marijuana route more often than not, they’re just frustrated with traditional healthcare. They have the med list that’s a page and a half long. Just their medication load is unrealistic. It literally affects their life, just the taking of their pills. I have numerous stories of people either reducing or completely eliminating - probably the biggest ones are benzos, so we’re talking like Xanax, Ativan, something like that for anxiety, numerous patients again see either a reduction if not complete elimination of those. Another huge one is sleep meds. Kind of similar discussion, but again, a lot of people are on very high doses of very serious medications with very serious side effect profiles. So, more often than not a patient is verbalizing to me I just want off of my medicine altogether. I very much want to support them in that and tell them that’s a realistic goal, but again, we have to keep things realistic. I’m not gonna eliminate your traditional medicine in one day. Ee might never totally eliminate something. But if we can cut your medication load in half or cut a pill in half or something like that, that is going to be a win. It never ceases to amaze me that when a patient starts on medical marijuana, that almost inevitably happens. If you’re talking mental health again you’re taking the antidepressants, the anti-anxiety meds, the sleep meds. We’ve also seen it with opioids, we’ve seen it with anti-inflammatory drugs. There’s a whole list you could go through. Although I’m a pharmacist, oftentimes I love to see and hear about those success stories because so much of the time, that’s the patient’s goal. They just want a little bit of freedom from their traditional medicine. We’ve had patients come in on disability. We’ve got them back to work. Even if not full-time, if we can get them back on a part-time basis that can be a win. Substantial reductions in depression. People are willing to leave their house, they’re willing to engage, they’re willing to go to social events, they’re willing to do different things and just kind of gain some level of just functionality, just general quality of life back, and its always, like I said Its always amazing for me to see it unfold in front of my eyes.
DM:
Chad, as a patient, what do you think the most important questions that patients should ask their family doctor about cannabis?
CR:
You know, it’s sad, but some of them just aren’t informed enough. And to ask them, I would have to maybe say, ask all your practitioners, so not even the PCP, and also the cannabis specialists as well to really dive into that.
DM:
Do you have any strategies for when a doctor says, well I don’t believe in cannabis? I always love that one. It’s like saying I don’t believe in gravity, or there’s not enough research.
CR:
I mean, granted, there isn’t enough research on certain facts, ok, but yes. The majority of them are facts. Like you were saying before, it’s hard if somebody just does not wanna change their mind and listen to the facts. What do you do at that point But to have an educated conversation with a person is always the greatest idea to me because everybody learns. I learn every single day. If you can learn one thing and especially if its about medical cannabis, I think that’s always gonna be a positive outcome there.
DM:
Sara, I’ll ask you the same two questions, What are important questions for patients to ask their doctors and if the doctor says I don’t know anything about it, do you have any strategies to help patients out?
SM:
Yeah, definitely. So, it’s really important to be open and honest with your health care providers and let them know what’s going on. If you’re interested in using medical cannabis and your health care provider doesn’t support it, you are able to get a new healthcare provider. You are empowered to choose whoever you want to see and you’re paying your doctor or your health care providers paycheck every single time you go so you have the right to get a new health care provider. You can always have your medical records faxed or sent to the new provider.
DM:
There have been, just a rumor, but there have been circumstances where physicians say they won’t release medical records if it’s going to go to a certifying physician. That’s not legal, correct?
SM:
Yes. But we see clients every single day who have previously seen healthcare providers who do not want to release those medical records.
DM:
Richard, do you have any good strategies for that? How do you deal with difficult doctors?
RG:
Yeah, so, I’m gonna kind of echo what they both said, that the transparency is important. Again, you should not be ashamed to be using medical marijuana and pursuing that route for your own therapy. Have a discussion with your providers, your health care providers and have a discussion with all of them. If it’s a PCP, if its a specialist, if you’re going in for surgery, it’s just very important that people know this, not only for the patient’s actual health but again, we’re really starting to chip away at that stigma. I actually gave a presentation about two weeks ago to a group of dentists. They were kind of joking about it. Marijuana use isn’t new. What is new is people actually disclosing it. So often we treat marijuana like its this different, new thing. People have been using marijuana for thousands and thousands of years. People have been self-medicating all the time if we’re going to be honest. Again, think transparency. You don’t have to be ashamed about this. All your health care providers should know. If you’re dealing with a particularly difficult physician, the first thing I would say is those are your medical records, they’re not the doctors. By law, they do have to release them to you. So, just being practical, let’s say you had a PCP who was being particularly difficult because they didn’t want to send the records to a medical marijuana certifying physician. OK, that’s unfortunate and it’s actually illegal but fine, give ME my records then. What I’d do with them, I’m physically gonna take them to the certifying doctor. simple as that. You’re almost cutting out that issue or that discussion. There is no way shape or form that you should not be able to get your hands on the records from any sort of health care provider. The other thing I always tell people, use the resources that you have as a patient. What I mean by that, if you’re under UPMC’s umbrella, log on to MyUPMC and print or download your records from there yourself. The same with Allegheny Health Network, they also have a patient portal where you can do the same thing, so again, you can, to some extent, if needed, you can take control of the direction of this yourself as the individual patient.
DM:
Well, we’re just about out of time and I wanted to give everybody a chance to close with letting each of you tell us what kind of wors of encouragement do you have for patients dealing with mental health issues, you know, like always is looking much more difficult. What are some words of encouragement you would have to say yes, there is a light at the tunnel and it’s not just a train coming at you? Chad, do you wanna start?
CR:
I have one saying. Life is ten percent what happens to you and ninety percent how you react to it. It’s about your attitude and your perspective on everything and medical cannabis helps with that.
DM:
Great. Sara, what are your words of encouragement?
SM:
There definitely is hope and its mich more painful to not seek out help and to not seek out treatment than to seek it out. You deserve to feel better and you deserve to heal. Please move forward in the healing journey and find a mental health provider that you feel comfortable with.
DM:
Excellent. Richard? Last words of advice?
RG:
My biggest words of encouragement or advice is you’re not alone. Mental health is a huge topic in healthcare right now. It’s a huge problem in our society overall. Again, I’m not gonna bash traditional pharmaceuticals they have a role. Medical marijuana has a role. Even those individually are not the cure-all though. I encourage people to use any and all resources you can. Get counseling. You can work on your nutrition. You can do something social. You can try to work out if possible to improve your mood. There are all kinds of avenues that you can possibly pursue to improve your mental health. That’s one thing oftentimes there’s a lot of pressure, people come to us and say I’m at the dispensary cause this is my last resort. It might feel that way, but there are always options, there’s always support, You’re not alone. People with mental health issues, they don’t need to be stigmatized, they don’t need to be demonized. They need our support. Honestly, we all need each other’s support. So my biggest thing is you’re never alone, there’s always gonna be an avenue for some level of improvement overall.
DM:
Excellent. Richard Greer, Sara Makin, Chad Rodman. Thank you so much for being with us today.
DM:
Welcome, everybody. My name is Sven Hosford. I'm the founder and publisher of Dispense Magazine, which hopefully you have picked up a copy here today. We cover the medical cannabis News here for Western Pennsylvania and all of Pennsylvania. I come from the world of holistic healing, so I've done holistic health magazines for about 25 years. So it was a natural extension for me to come right over here and start doing the cannabis because really, cannabis and holistic are very, very similar. A lot of the same principles and attitudes. So we've got a very interesting panel for you today. We're going to be recording this for a podcast. So if you have any questions, there's a microphone up here. Again, what we're gonna talk about today is mental health conditions - how to get a diagnosis, what the process is, what is considered, diagnosable, basically. And then what happens when you get to the dispensary? And we also have a patient perspective of somebody who's been down this road and is using cannabis to treat his mental health right now. So let me get started by introducing the panel right there in the middle, we've got Sara Makin. She's with Makin Wellness. She has an office in downtown Pittsburgh and New Kensington. And on her left is Richard Greer. Richard is the pharmacist - elite pharmacist - at Solevo Wellness, which is the first dispensary to open up in Pittsburgh and Allegheny County, I believe. And then on this side, we have Chad Rodman. Chad is with Medical Marijuana Solutions, so he is a patient. But he has also got a medical background and is very, very knowledgeable about medical cannabis. So a very interesting perspective. So, Sara, let's start with you. Can you describe your practice? What kind of mental health conditions do you treat overall?
SM:
Yes, I would love to. Thank you for asking. So, at Makin Wellness, we specialize in helping people heal and become happy again. We specialize in holistic mental health and addiction treatment. So any form of mental health or addiction condition - we're more than happy to help a person in their healing journey. And we have medical marijuana evaluations and have the only mental health practices in Pennsylvania that have medical marijuana as part of the anxiety, trauma, and opiate use disorder treatment.
DM:
And those are the three main mental health conditions that are the qualifying conditions for Pennsylvania?
SM:
Yes. As well as autism.
DM:
Autism too? And you diagnose for that?
SM:
Yes, we are able to. We mostly see patients with anxiety, trauma, and opiate disorder. But we do see patients with autism as well.
DM:
Is anxiety, probably your number one condition that you're treating right now?
SM:
Anxiety and PTSD are, yeah.
DM:
Okay, great. Thank you. Well, tell us a little bit about the process of getting a diagnosis - what people need to do. Most people who have PTSD and anxiety have never even been to any kind of mental health professionals. Is that true?
SM:
Yeah, that is true, and actually, this is very unfortunate, because anxiety is actually a highly treatable condition. And out of all of the mental health and addiction conditions,it has the best outcomes. So, as far as getting a diagnosis, the first step is taking a screening tool. We have screening tools for these conditions on our website and makinwellness.com, and if the screening tool says that you more than likely have it, and you would be a good candidate to have an evaluation done. And, for instance, like with the anxiety evaluation, in the beginning, we asked, is your anxiety more generalized, or is it something like, if specific, a phobia? Or is it something specific that makes you very anxious? And then based on that response depends on what kind of assessment we do.
DM:
Sometimes people have other conditions that are related to that like insomnia. Are people using cannabis for that? They get their card for anxiety or PTSD, but does it also help with things like insomnia and other mental health conditions?
SM:
That’s a great question. Actually, yes. Many patients that have anxiety or PTSD suffer from insomnia or have a really difficult time falling asleep. So using a CBD or medical cannabis at night is very helpful for increasing quality sleep and actually, patients that have PTSD, if they have a lot of nightmares at night it helps to reduce the severity and intensity of those nightmares.
DM:
Excellent. Well, let’s move over to Richard Greer, not Geere - don’t get excited ladies. You get that all the time, right?
RG:
Haha, yes.
DM:
Richard is really a top-notch pharmacist. He’s been on other podcasts of ours as well. Richard, describe exactly what you do as a pharmacist at a dispensary.
RG:
Ok, so, first of all, Sven, thank you for having me. Now, talking from the pharmacist’s perspective from Solevo as a dispensary - one thing we very much pride ourselves on is very pharmacist-focused care, so we do require when we see any new patient that they do actually sit down and have some sort of consultation with a pharmacist. The importance of that is many - especially if you’re talking about any mental health diagnosis. We understand the burden that that has on our patients, number one. Number two, we also understand as a medical marijuana dispensary that we’re kind of this foreign entity. You know, we’re not a doctor’s office. We’re not a traditional pharmacy. We’re this different thing that just off the bat, people are a little bit unsure about and a little bit anxious to even come to see us sometimes. We definitely want to take that into account - make our environment as welcoming as possible so that we’re in no way shape or form worsening someone’s anxiety or causing them some sort of negative issues from that standpoint. Our pharmacists at Solevo were very highly trained on kind of the academic and the general knowledge of marijuana as a medicine - getting down the cannabinoids, getting down to the terpenes - these basic parts of the plant that we want to know and understand fully so that when we do make a recommendation to a patient, we can very confidently and comfortably do so and know that were pointing them in the right direction. At Solevo, our intake paperwork - it actually feels very much like you’re going to a physician’s office. Our whole focus is on a patient’s health history. Yes, we want to get an established diagnosis, we want to know if it’s PTSD, we wanna know if it’s anxiety. Even if it is something else - even if it is chronic pain for example. Often times those patients are very stressed, very anxious - often times very depressed. All these kinds of things would fall under the umbrella of a mental health diagnosis anyhow. The pharmacists are gonna review that health history - we want to know what symptoms you have, where you’ve been, things you’ve previously tried to treat your condition. We want to know what medications you’re on - be sure there’s no serious interaction or any negative kind of expectation or anything we could potentially foresee and hopefully avoid. We also very much want to establish a repertoire with our patients on that one on one first consultation. We want to gain your trust. We want to prove ourselves - prove that we do know what we are talking about - that when we make a recommendation that we are confidently doing so. And pointing you in a direction that not only do we know from studying the medicine, but also from treating patients on the front lines every single day. We want to establish what a patient’s even comfortable with. If you don’t want to inhale marijuana, that is completely fine. We have plenty of other options we can talk you through. And all of them - walking through them, we can find something that will be appropriate. More often than not, actually our patients are kind of fed up with taking pills. They’re kind of sick of a traditional marijuana regimen. They’ll do anything else except another pill. That’s fine, we have plenty of options to talk them through. We want to set some goals of therapy and some expectations. We need to know when they’re taking this medicine, if they’re taking something solely at bedtime or if they’re taking it throughout the course of the day at work, those are going to be drastically different recommendations there. And as Sara was saying, we need to get a sense at the dispensary what they’re actually experiencing. My recommendation for someone with generalized anxiety or a generalized condition is gonna be very different than my recommendation for someone that has a specific phobia. It’s triggered by something maybe unexpected - a symptom I need to get them quick relief. Those are different considerations we’re going to take into account on that first meeting with the patient.
DM:
So there are a couple of things you said I want to just touch on and amplify. First is that you require patients to come in and have a meeting with a pharmacist. Not every dispensary does that. Is that right?
RG:
That is correct. So, in Pennsylvania, the law states there needs to be a health professional on staff. It must either be a physician or a pharmacist or potentially a physician’s assistant or nurse practitioner. The health professional is required to be there, however, it is not clearly spelled out as to what they should or should not be doing. As I said, Solevo’s standpoint is very pharmacist and patient-focused. That first consultation is really the core is what our business is built on. Again, we want to have that interface with the patient, start to build that relationship and that repertoire with them and just kind of go from there and make the best recommendation that we can and proceed with their treatment.
DM:
The other thing I think you said that is very important is that you want to ensure that you don’t create ore anxiety in people who are there to treat their anxiety. It can be pretty intimidating the first time - even for me who has had a little bit of experience with cannabis. When I first walked into a dispensary, it’s kind of intimidating and can create some anxiety. Are there specific things you do for people with a mental health diagnosis that is a little bit different from the pain diagnoses or something like that?
RG:
Certainly. We definitely recognize that patients do come to us not only with a diagnosis but actively experiencing some level of anxiety just walking through our doors. Again, we’re almost this foreign entity. The names of some of the products look strange to people. Just the number of varieties looks intimidating to people. Often times people walk through that door and they just feel this unneeded pressure, like they need to be the expert, they need to know what they are doing, they need to have some level of confidence of even what they’re talking about. With us recognizing that it’s very important that we kind of always reiterate to these patients we are there for them and with them. At Solevo, you’re never gonna be by yourself. We’re never gonna hand you a piece of paper with our inventory and say, “What do you want?” That is 100% not how we are going to operate. Some things that do set us a little bit apart - first of all, our consultations occur in a private office that is one-on-one with the pharmacist. So, very heavy on patient privacy. And again, we want to have a very transparent and open conversation with these people to get things started the right way. That’s one thing we initially offer to ease people into things. You’re not in a big room, trying to talk over a lot of noise or talk over other people with some kind of not fully level of privacy there. We actually have a sensory-friendly room that we can always use if we need to. So, if we are particularly busy, if there are a lot of people in the waiting room, if it happens to be noisy or a little more chaotic than any other day If we can pinpoint and identify someone who seems to be struggling a little bit, that room is always going to be an option to kind of get them isolated a little bit, get them comfortable, get them in a spot where they feel a little safer. Proceed to meet with the pharmacist and then proceed from there. But we’re always gonna bend over backward to keep that in the front of our minds to keep that a very comfortable and safe experience for the patient.
DM:
The other thing you said, and you know that it’s true that there are two, three, four pages of different products. What’s the process that you go through with each patient to find the right medicine and the right dosage?
RG:
So, as I’m walking through a health history with someone, part of that is gonna be a little bit of their social history. Have they used marijuana previously? Are they comfortable with these products and their names, with the dosing? Those kinds of things. If I can pinpoint and individual that is a little more experienced with marijuana compared to someone that is brand new, those are gonna be drastically different discussions. Even the people that are experienced more often than not, do want some level of guidance. And there’s always some level of new education we can provide for them. But oftentimes those patients just need a little less care. They don’t need to be followed quite as closely as someone who is brand new to this world. If someone has no experience whatsoever, we’re gonna start them at a very low dose on purpose. I tell this to every patient I consult with. For the first few days, if you feel no effect at all, I’ve actually done my job as I should. I need to make sure I introduce this medicine safely and appropriately to a patient’s system. And we can always build up from there. What I 100% need to avoid is a negative experience off the bat. I cannot have my patients overmedicated day one or day two or day three. We can always build a dose as seen fit. As I said a little earlier, time of day plays a little role in a recommendation in something a direction a patient possibly may go. Obviously, something that’s gonna make someone very sleepy, there not getting that while they’re at work or throughout the course of the day. If someone is using the medicine solely at night time, that’s a little easier recommendation. There are certain things I know I can go to automatically that should help not only with the mental health side of things but also just help them get a good night’s sleep and reap the benefits of what that can do alone. We’re gonna talk about ratios of cannabinoids. We’re gonna talk about building CBD into their regimen. We’re gonna talk about just kind of the practical administration. If someone has a really busy and hectic day, they might not have time to be kind of tied to their vape pen all day for example. These are all things we’re gonna walk through and sort of tease out through the course of the discussion. It’s a little cliche, but I always say every consultation is a little bit unique. It’s kind of depending on how the discussion goes. A recommendation could possibly lead in a few different directions.
DM:
Excellent. Chad! Chad Rodman. I like to say, “Don’t Get Mad, Get Chad.” Maybe I’m the only one that likes to say it.
CR:
I think so, yeah, haha.
DM:
You’re tired of hearing me say it. Chad, you’re here as a patient to describe things for us. Give us a little thumbnail of your biography and how you wound up here.
CR:
Sure! First off, thank you, Sven, for having me. And yeah, so, I’ll start with my college days I guess - my 30-second spiel, right? So, Undergrad, I have my bachelor’s degree in biology, went and got my masters in public health, both at WVU. After that, I went and worked as an epidemiologist for the Center for Disease Control where I was also published there. I went to med school for the first two years, decided that wasn’t the necessary path of medicine for me so I came back to Pittsburgh here, and was waiting around for the cannabis industry to take afoot. So, I went and worked and did some research at Hillman Cancer Center and it finally came. Then I started working actually at the healing center where I was part of opening up the Washington location as well as the Monroeville location. Now I am a cannabis specialist here with Compassionate Clinics of America.
DM:
And what are the conditions that you’ve been diagnosed with that you use cannabis to treat?
CR:
Right, definitely one is anxiety and I have some GI issues, so its more of an IBS but it’s aways chronic pain.
DM:
So, it’s safe to say that medical cannabis has made your life easier?
CR:
100%, yes sir.
DM:
And how do you balance the consumption of that with being able to stay focused and being able to work a job?
CR:
Honestly it’s all about the ratios right now, with the CBD and THC. For myself, I’m a little different, given my GI issues and the anxiety, I actually go with some strains that are a little heavier for your normal patients during the day. So, I am using a tincture or RSO, everybody knows about all that right? I use a little bit during the day and then if I have a spike or anything or anxiety trigger, I’ll go and vape, but usually, I’m pretty good with the RSO throughout the day.
DM:
Has your medical background made you a better patient?
CR:
Significantly. I put my love of working with people and my love of cannabis and I put them together and this is what I do every day. So, absolutely Learning all the mechanisms and intrinsic factors of the human body, and when you combine that with the endocannabinoid system. I love it. It’s fantastic.
DM:
So here’s a question, we’re gonna ask everyone here. What strategies do you have for overcoming the stigma of cannabis and the stigma of mental health issues? Let’s stay with Chad on that.
CR:
I’d have to say, if I wasn’t in this field, it would be extremely difficult as I was an epidemiologist before or even at the Hillman Cancer Research Center there. I couldn’t come clean and say, “Yeah, I’m a medical cannabis user.” And now that I jumped over that fence, you know and now I’m in it full for the all-time, right? So, yeah.
DM:
Sara, you’re a mental health professional. How do you overcome those dual stigmas of both the mental health stigma and the cannabis stigma?
SM:
It’s a really great question. One of the things that we always do is if we hear patients say I have anxiety or I am anxious or I am schizophrenic, we always let them know, you are a person who sometimes suffers from symptoms of anxiety, we really encourage patients to not internalize or label themselves with the condition. I also feel like, you know, being open and honest and talking about it and sharing your experiences with other people is important as well because this is something that is extremely common and the more we talk about it the more comfortable people are gonna feel comfortable with getting help. I feel like getting help is also another very important aspect of that as ell. Because more people get help and they start to feel better, they’ll want to talk about their positive experience.
DM:
I think that’s a very important thing you said there that you don’t use that as a label like you don’t say I’m an anxiety patient like you would say, hey, I’m a diabetic. One of the things that you really impressed me with - full disclosure - I came to Sara to get my diagnosis for PTSD and one of the most important things I things you said is you know here’s your written diagnosis and we’re gonna put this away and we’re never going to need to bring up that topic or diagnosis again. We’re just gonna treat you, the patient. Is that your attitude?
SM:
Yes, definitely. Actually, the more someone thinks about their diagnosis and the mental health condition, the worse it gets. So, it’s important to start to focus more of your thoughts and energy towards healing and towards solutions and towards overcoming instead of thinking more about the condition.
DM:
Richard, how about you? Once people enter your dispensary, they’ve pretty much overcome a certain level of stigma just to walk in the door. But do you still deal with that issue? The stigma, both cannabis and mental health?
RG:
Absolutely. Believe it or not, almost daily even though people have seen a physician, gotten a diagnosis, gotten their card and come to see us, oftentimes people are still, the patients are still in need of a pep talk. They want that reassurance that this is ok. That this is a legitimate medicine to use for a serious medical condition. I’m always there and willing to give that pep talk, on a slightly, I guess, larger scale. I think, just a big gap in this industry that we’re definitely trying to and continuing to address is just the absolute lack of education, especially in a lot of healthcare practitioners. Unfortunately, some people already have their minds made up and no matter how much you try, no matter how hard you try or how persistent you are with educating someone, some people are just determined that they’re right no matter what you say. I will say the more medical marijuana can be talked about, from many standpoints, you could talk about the research, you could talk about the science, you can talk about the cannabinoids, the receptors, you can talk about this on a very clinical and medical level. Oftentimes the more impactful discussions and stories though are actually the success stories. I can tell you about my patient that was 14 months old. I can tell you about my 2-year-old patient. I can tell you about all kinds of different success stories, ranging all the way up until a geriatric population that is now off of their opioids that they had been on forever. I really think highlighting the successes is a very, very important thing. Sometimes its a chore though. We certainly do our best. I’ve liked to talk to people. I love to hear the successes. I like to hear criticisms too. We’re not perfect and we can do better. That’s what we’re always gonna try to do. But it’s just kinda having that courage to have the discussion. This doesn’t have to be like a negative. This doesn’t have to be like a hush-hush secretive type thing. If we’re gonna consider this a medicine, let’s consider it a medicine. Let’s compare it to an opioid or a Xanax or an antidepressant. Let’s stop the comparison to alcohol. That’s not the same thing. Let’s stop trying to pretend that it is. So, as I said, I try to do my best individually, I know SOlevo tries to do their best as an organization. But, more and more and more it is just getting that accurate, correct and appropriate information out there to the people that need it.
DM:
Chad, you were nodding quite a bit. Did you have anything you wanted to follow up with?
CR:
Absolutely actually. With success stories - sharing them, I think it’s a huge factor. Because people don’t hear enough about the goodness that comes from medical cannabis. Like he’s saying. We all have our stories that we’d love to share, but there are people that are here that went from 400 seizures down to 9 now, a day - 9 seizures. I mean that’s just…
DM:
That would be a big day for a lot of people that are used to having 400.
CR:
Right, right. Exactly.
DM:
Describe your quality of life before cannabis and today. Compare those two times in your life.
CR:
I mean, I was in school for the majority of it but honestly, with my GI issues, I would most likely not be able to work. It was that bad. Which causes anxiety as well. Like you said, like we discussed previously, they come together, so, yeah definitely not able to. I could study and sit around read by books all day and learn everything I could but in order to really work and come out, no, I wouldn’t have been able to.
DM:
Sara, let’s get back to you. Anxiety was just added to the list of qualifying conditions here in Pennsylvania. We saw a big spike in the number of patients that signed up with the state. You’ve told me that you’ve seen an increase in your business. Talk a little bit about what exactly is diagnosable anxiety, some of the common types, what makes it serious enough that we can come to get a diagnosis?
SM:
Yes, so with anxiety this is kind of like a persistent and irrational fear. You have a really hard time with controlling your thoughts, controlling the worrying. Typically, it’s lasting at least six months or longer. So this is something that is really debilitating. It can negatively impact different parts of your life, like your career, your personal relationships. And the biggest thing that makes it a diagnosable condition is you basically have to fit al the criteria for it. So, experiencing anxiety for the past six months or longer, having a hard time controlling the worrying, feeling irritable, having muscle tension, it not being caused by another medical condition, and it not being triggered by a substance.
DM:
And you’ve mentioned that is one of the most easily treatable conditions. What other kinds of other things do you do in your practice besides cannabis to help people deal with it?
SM:
So we have cognitive-behavioral therapy which is evidence-based practice, which basically helps you to become more mindful and see what your thoughts even are. And we help you to think more positively and think less anxious and more positive thoughts. We also have thought fuel therapy. If a patient would like to try that, it basically combines acupuncture with therapy. So basically you think about whatever is making you anxious and we helo to reduce the negative emotion attached to the thought. Cause its actually not the negative thoughts that make you feel anxious its the anxiety and emotions that uncomfortable. So by utilizing that, people become less anxious too.
DM:
And you do this without any pharmaceutical drugs too.
SM:
Yeah, and we have a holistic nutritionist on staff. You can meet with her and you know, get different nutritional adjustments made. Another thing too with our anxiety treatment and this is very not known, I feel like a lot of people need to know about this. Every time you have caffeine, your body produces and releases cortisol which is the stress hormone that’s released every time your anxious. So a lot of people don’t know this and they drink a lot of caffeine and they have a lot of Starbucks and they wonder why their anxiety is so bad. We’ve had so many patients cut down on their caffeine intake and their anxiety has gotten reduced significantly.
DM:
That’s amazing. Richard. How has the addition of anxiety to the state’s qualifying conditions affected your business?
RG:
I think it’s wonderful. Just from the standpoint of the program itself. The huge point with adding anxiety to the list, that definitely opens this list up to numerous, numerous people that can benefit from this. On a day to day basis, you figure for probably the first year and a half, chronic pain was easily the number one diagnosis we saw. I would normally say upwards of about 2.3 of our patients were just for chronic pain. Now that anxiety is added, some days it feels like its almost every single patient that comes in with that diagnosis specifically. So, it’s still new, but I think pretty obviously that we’ll overtake chronic pain as our number one patient diagnosis as long as we give it a little bit more time and keep seeing more of those patients. Sometimes it is difficult, I mean, all the 23 conditions are all very serious chronic conditions. So there all al little bit difficult to treat. Anxiety can be a little bit tricky. KInd of keeps us on our toes at the dispensary a little bit. You know we just wanna be a little bit more cautious with the recommendations, a little bit more supportive, a little bit more reinforcement to those patients specifically because they are so vulnerable. But overall, I’m very happy that the state added that condition From Solevo’s standpoint, er have been busy, we’re just a little busier now it feels like. But, from the day to day, its definitely only a positive up to this point.
DM:
Well it’s funny you say that it might be number one. According to Dispense Magazine, from their Releaf App, Shameless Plug Alert Here, Anxiety is, in fact, the number one condition being treated by Pennsylvanians and it lists out the top five products. Also, depression is on here, stress, agitation, irritability, fatigue, a lot of mental health conditions that are in some ways related. I’ve heard some people say, well you know I’ve tried cannabis for anxiety but it actually made me more anxious. Tell us what your strategies are to help people find the right dosage of the right product.
RG:
So if someone has tried any sort of medical marijuana previously with a negative experience, I want to do my best to figure out what that was and what caused it. That can be very tricky. If someone was using a product off of like the illicit street market, oftentimes the patient has no idea what they have. They don’t know what strain it was, they don’t know what potency it was, they literally have no information tied to that. Even more importantly, on the illicit market, you’re talking substantially more impurities. There’s no testing. Different fertilizers, the freshness of the marijuana. All these different things can play a part in worsening someone’s anxiety, so oftentimes its actually not even the marijuana itself. It may be some kind of chemical additive or some other issue again from a product that was not tested and did not come from a legitimate dispensary. If I am able to establish what the patient had used previously, obviously that’s a little simpler. We can avoid certain things then That’s gonna be my cue to head in a certain direction away from what they had tried before. If we have no knowledge other than hey I have tried something and it was really bad, I was incredibly anxious and couldn’t sleep, for example, there are certain directions we may go. There are always recommendations that are a little bit safer. Generally CBD as part of the marijuana plant or hemp plant, but we’ll talk about the marijuana plant. Generally, that’s a pretty safe recommendation. You’re talking little to no side effects as long as its the correct dose for most people. So we can always potentially explore a product that’s a little bit higher in CBD that’s always gonna be a little bit of a safer recommendation. Certain strains we’re gonna kind of automatically know to avoid. Again, at least to start, until we tease out a couple of things and see what the response of the patient is to our newest recommendations. I always find it interesting with the psychological diagnosis particularly anxiety more often than not I hate to overgeneralize it but patients can really oftentimes get relief from any kind of marijuana as long as the dose is appropriately minded. Even if I’m going in the direction of a recommendation of a strain that might be a little bit anxiety-inducing, yes, common sense is gonna say I’m gonna try to avoid those but if for some reason we are headed in that direction the thing I need to stress to the patient is to mind your own dose. We need to introduce that low dose, again to not overmedicate and then potentially worsen some problems. Unfortunately THC can be great for psychological, it can help with depression, it can help with anxiety, it can help with many things, it can help with stress. But, if you overdo it, one of the more common side effects is panic so again, we don’t want to overmedicate, it’s all about minding the intake, how much the patient is actually getting. If we can do that in a milligram, we’ll certainly start at the lowest possible milligram we can. Or if it’s an inhaled form, we’re gonna counsel the patient into how to do that appropriately and just start at that low dose.
DM:
Now, I know that in the state of Pennsylvania the law says that if you get a dry flower, a dried plant flower from your dispensary, you are supposed to vape it. However, I’ve heard a rumor, JUST A RUMOR, that some people may actually still smoke it. What’s your knowledge of the process of burning the plant. What I understand it actually burns off a lot of the terpenes and you can’t really absorb them when you smoke it as opposed to when you vape it and its the terpenes that actually help kind of smoothe out some of that possible anxiety-causing effect. Am I on track with that?
RG:
Yes. That’s a very dirty rumor you speak of. This is the first I’ve heard of such a thing.
DM:
I’m glad I brought you up to speed. Does burning it actually destroy the terpenes as opposed to if you get an oil or tincture?
RG:
That is correct. So, I don’t know the exact math, but I probably should. But when you actually ignite marijuana like actually take fire to it and combust it, a lot of the actual cannabinoids themselves and the terpenes, no pun intended, literally go up in smoke. They’re actually just kind of burned off into the atmosphere. So, that is a consideration in terms, if you’re talking about potency or even just a little bit more, just kind of getting your money’s worth out what you’re actually purchasing. I don’t want my medicine going to waste per se. Versus when you vaporize, there does tend to be a lot more of actual cannabinoids and terpenes consumed into the human body. The other thing about vaporizing dry leaf is you can set on many devices, you can set the device to a very specific temperature. So you can actually even on a particular strain of dry leaf, you can actually customize your own therapy. You can set a temperature where you know only certain cannabinoids will be released or certain terpenes will be released. And the more patient is willing to or able to play with that number of the actual vaporizing temperature, again you can kind of customize your own therapy a little bit. There’s certainly gonna be health considerations to take into account as well. When you actually smoke marijuana, you’re getting way more carcinogens, actual cancer-causing agents of the smoke, higher levels of CO2. Those kinds of considerations as well, but to just to be clear, legally, even if you have a card you cant actually smoke marijuana in the state of Pennsylvania in terms of flighting it on fire.
DM:
Chad, you have some medical background, history. Do you wanna expand upon that or add what you know about the whole situation.
CR:
Yeah, I always look at my terpene profiles. That is a big thing, especially you know with what we’re saying.
DM:
So the terms Sativa and Indica don’t mean as much as the actual terpene profiles?
CR:
Those are old terminologies anymore, I really feel like you know. You need to learn the terpenes. There’s what, over 113 of them now? Nd those are all with different molecules that are found within cannabis. So, for instance, everybody loves lavender, right? Lavender has a phenomenal type of terpene that’s called linalool. Well, guess what also is found in cannabis? Linalool. So, if you look at the benefits of lavender, you know it’s relaxing calming, that sort of thing. Well, there’s cannabis strains that have that in it - same effects. So the patients really have to pay attention to the terpenes that affect them, whether it’s positively or negatively. And this is a conversation that I also have to have with the patients that are coming to me with anxiety. Because it changed the conversation. If you’re looking at anxiety in general, I avoid particular terpenes. There’s pinene, for example, alpha and beta-pinene. When you see high levels of that particular terpene, I tend to avoid that because that terpene just for me, elevates my anxiety. Everybody is different but there are general rules of thumb with that being said, and pinene is one of those general rules of thumb to stay away from.
DM:
Now but that’s also, it’s true that everybody reacts to these terpenes differently. So, you can start with a general guideline but it’s really up to each patient.
CR:
One hundred percent. And what I always do like if they’re gonna try something that’s brand new, have your normal dose and cut it in half and try at that point and see.
DM:
Interesting. Well Sara, let’s get back to you. Let’s talk about some of the other mental health conditions. PTSD is a big one. We’ve done some podcasts in the past about this. Just give us a general outline of what causes PTSD and what are some of the symptoms that people might recognize in their behavior that maybe hey, I gotta go get some help with this?
SM:
Yeah, so PTSD occurs after someone witnesses, observes or learns about a traumatic event and they start to then experience flashbacks, they have hyper-vigilance which is trauma-induced anxiety, they can have a hard time sleeping, they can have GI issues.
SM:
Richard, you’ve said you’d love to share some success stories. Do you have any specific ones that you really like about people using cannabis with mental health issues?
RG:
Just generally, yeah, I mean, if you want to talk in more of a general sense, as a pharmacist, I don’t necessarily like to badmouth traditional pharmaceuticals necessarily.
DM:
Go ahead, we don’t care.
RG:
I’m never ceased to be amazed by when I see a patient that is exploring the medical marijuana route more often than not, they’re just frustrated with traditional healthcare. They have the med list that’s a page and a half long. Just their medication load is unrealistic. It literally affects their life, just the taking of their pills. I have numerous stories of people either reducing or completely eliminating - probably the biggest ones are benzos, so we’re talking like Xanax, Ativan, something like that for anxiety, numerous patients again see either a reduction if not complete elimination of those. Another huge one is sleep meds. Kind of similar discussion, but again, a lot of people are on very high doses of very serious medications with very serious side effect profiles. So, more often than not a patient is verbalizing to me I just want off of my medicine altogether. I very much want to support them in that and tell them that’s a realistic goal, but again, we have to keep things realistic. I’m not gonna eliminate your traditional medicine in one day. Ee might never totally eliminate something. But if we can cut your medication load in half or cut a pill in half or something like that, that is going to be a win. It never ceases to amaze me that when a patient starts on medical marijuana, that almost inevitably happens. If you’re talking mental health again you’re taking the antidepressants, the anti-anxiety meds, the sleep meds. We’ve also seen it with opioids, we’ve seen it with anti-inflammatory drugs. There’s a whole list you could go through. Although I’m a pharmacist, oftentimes I love to see and hear about those success stories because so much of the time, that’s the patient’s goal. They just want a little bit of freedom from their traditional medicine. We’ve had patients come in on disability. We’ve got them back to work. Even if not full-time, if we can get them back on a part-time basis that can be a win. Substantial reductions in depression. People are willing to leave their house, they’re willing to engage, they’re willing to go to social events, they’re willing to do different things and just kind of gain some level of just functionality, just general quality of life back, and its always, like I said Its always amazing for me to see it unfold in front of my eyes.
DM:
Chad, as a patient, what do you think the most important questions that patients should ask their family doctor about cannabis?
CR:
You know, it’s sad, but some of them just aren’t informed enough. And to ask them, I would have to maybe say, ask all your practitioners, so not even the PCP, and also the cannabis specialists as well to really dive into that.
DM:
Do you have any strategies for when a doctor says, well I don’t believe in cannabis? I always love that one. It’s like saying I don’t believe in gravity, or there’s not enough research.
CR:
I mean, granted, there isn’t enough research on certain facts, ok, but yes. The majority of them are facts. Like you were saying before, it’s hard if somebody just does not wanna change their mind and listen to the facts. What do you do at that point But to have an educated conversation with a person is always the greatest idea to me because everybody learns. I learn every single day. If you can learn one thing and especially if its about medical cannabis, I think that’s always gonna be a positive outcome there.
DM:
Sara, I’ll ask you the same two questions, What are important questions for patients to ask their doctors and if the doctor says I don’t know anything about it, do you have any strategies to help patients out?
SM:
Yeah, definitely. So, it’s really important to be open and honest with your health care providers and let them know what’s going on. If you’re interested in using medical cannabis and your health care provider doesn’t support it, you are able to get a new healthcare provider. You are empowered to choose whoever you want to see and you’re paying your doctor or your health care providers paycheck every single time you go so you have the right to get a new health care provider. You can always have your medical records faxed or sent to the new provider.
DM:
There have been, just a rumor, but there have been circumstances where physicians say they won’t release medical records if it’s going to go to a certifying physician. That’s not legal, correct?
SM:
Yes. But we see clients every single day who have previously seen healthcare providers who do not want to release those medical records.
DM:
Richard, do you have any good strategies for that? How do you deal with difficult doctors?
RG:
Yeah, so, I’m gonna kind of echo what they both said, that the transparency is important. Again, you should not be ashamed to be using medical marijuana and pursuing that route for your own therapy. Have a discussion with your providers, your health care providers and have a discussion with all of them. If it’s a PCP, if its a specialist, if you’re going in for surgery, it’s just very important that people know this, not only for the patient’s actual health but again, we’re really starting to chip away at that stigma. I actually gave a presentation about two weeks ago to a group of dentists. They were kind of joking about it. Marijuana use isn’t new. What is new is people actually disclosing it. So often we treat marijuana like its this different, new thing. People have been using marijuana for thousands and thousands of years. People have been self-medicating all the time if we’re going to be honest. Again, think transparency. You don’t have to be ashamed about this. All your health care providers should know. If you’re dealing with a particularly difficult physician, the first thing I would say is those are your medical records, they’re not the doctors. By law, they do have to release them to you. So, just being practical, let’s say you had a PCP who was being particularly difficult because they didn’t want to send the records to a medical marijuana certifying physician. OK, that’s unfortunate and it’s actually illegal but fine, give ME my records then. What I’d do with them, I’m physically gonna take them to the certifying doctor. simple as that. You’re almost cutting out that issue or that discussion. There is no way shape or form that you should not be able to get your hands on the records from any sort of health care provider. The other thing I always tell people, use the resources that you have as a patient. What I mean by that, if you’re under UPMC’s umbrella, log on to MyUPMC and print or download your records from there yourself. The same with Allegheny Health Network, they also have a patient portal where you can do the same thing, so again, you can, to some extent, if needed, you can take control of the direction of this yourself as the individual patient.
DM:
Well, we’re just about out of time and I wanted to give everybody a chance to close with letting each of you tell us what kind of wors of encouragement do you have for patients dealing with mental health issues, you know, like always is looking much more difficult. What are some words of encouragement you would have to say yes, there is a light at the tunnel and it’s not just a train coming at you? Chad, do you wanna start?
CR:
I have one saying. Life is ten percent what happens to you and ninety percent how you react to it. It’s about your attitude and your perspective on everything and medical cannabis helps with that.
DM:
Great. Sara, what are your words of encouragement?
SM:
There definitely is hope and its mich more painful to not seek out help and to not seek out treatment than to seek it out. You deserve to feel better and you deserve to heal. Please move forward in the healing journey and find a mental health provider that you feel comfortable with.
DM:
Excellent. Richard? Last words of advice?
RG:
My biggest words of encouragement or advice is you’re not alone. Mental health is a huge topic in healthcare right now. It’s a huge problem in our society overall. Again, I’m not gonna bash traditional pharmaceuticals they have a role. Medical marijuana has a role. Even those individually are not the cure-all though. I encourage people to use any and all resources you can. Get counseling. You can work on your nutrition. You can do something social. You can try to work out if possible to improve your mood. There are all kinds of avenues that you can possibly pursue to improve your mental health. That’s one thing oftentimes there’s a lot of pressure, people come to us and say I’m at the dispensary cause this is my last resort. It might feel that way, but there are always options, there’s always support, You’re not alone. People with mental health issues, they don’t need to be stigmatized, they don’t need to be demonized. They need our support. Honestly, we all need each other’s support. So my biggest thing is you’re never alone, there’s always gonna be an avenue for some level of improvement overall.
DM:
Excellent. Richard Greer, Sara Makin, Chad Rodman. Thank you so much for being with us today.
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