Cannabis Education | 10.27.20
This week, we go back to school on cannabis education. And, we’re not just talking about understanding how to get your medical card and how the plant can help alleviate pain and discomfort or even, potentially, help a person kick an addiction to opiates. It also has to do with how much cannabis dispensary employees should know about medical conditions and advising patients on the proper strains and doses to take. We’ll walk you through the process from beginning to end and find out what kind of training requirements the experts say there should be in this burgeoning industry. (Note: Interviews for Growing Forward were all conducted via Zoom as a part of our COVID-safe practices. Originally our plan was to do interviews in person, but in order to maintain social distancing and to keep everyone involved safe and healthy, we decided to use the technology available to us.)
Episode Music:
Podington Bear – “Good Times”
Blue Dot Sessions – “Neon Drip”
Blue Dot Sessions – “Building the Sled”
Blue Dot Sessions – “Svela Tal”
Christian Bjoerklund – “Hallon”
Growing Forward Logo Created By:
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“Growing Forward” is a collaboration between New Mexico Political Report and New Mexico PBS, and is funded through a grant from The New Mexico Local News Fund.
FULL TRANSCRIPT
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Andy Lyman: I’m Andy Lyman with New Mexico Political Report.
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Megan Kamerick: And I’m Megan Kamerick with New Mexico PBS. This is Growing Forward, a podcast about cannabis in New Mexico.
Andy Lyman: In this series so far, we’ve covered a lot about the politics of cannabis, the plant itself, and we’ve talked to some producers. But what happens after you’re approved by a medical professional to use cannabis?
Megan Kamerick: How do you know how much to take? And what do you take? Exactly?
Jacob Candelaria: And I do think we could do a lot better as a state in making sure that those frontline workers are equipped with the knowledge and information that they need to provide that guidance to patients.
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Andy Lyman: How much does that dispensary employee actually know about your medical condition?
Shannon Jaramillo: He goes into the field and he walks in the door and then he goes, what the hell did I get myself into? Because now somebody’s grandmother approaches him. And she says, I have diabetes, and I take this medicine and this medicine, this medicine, this medicine, what strain do you suggest, 19-year-old Tim?
Megan Kamerick: And how do you actually use cannabis, to say… kick opiates?
Jeff Holland: It’s not the cure all. It’s not the be all end all just like cannabis isn’t. So, the more robust set of tools that we have to offer the people that are coming to us for help, the better off we are.
Andy Lyman: This week, we go in search of the answers to those questions as we head back to school on cannabis education.
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Megan Kamerick: Andy, one thing I keep coming back to as we work on this podcast is what happens once someone gets their medical cannabis card and what kind of medical knowledge do the people at these dispensaries have?
Andy Lyman: Those are really important questions, Megan that I think many first time patients may be a little nervous about asking. There are so many strains, profiles, and ways to take cannabis. You can look at it like asking your pharmacist about which over the counter medication is best for headaches, except you’re not talking to a pharmacist and all the products or cannabis or derivatives of cannabis. Through my reporting, I’ve had a lot of conversations with Shannon Jaramillo. She’s the founder and CEO of cannabis New Mexico Staffing, which is essentially a staffing agency and education center all in one.
Megan Kamerick: She was also on Governor Michelle Lujan Grisham’s legalization task force.
Shannon Jaramillo: I want us to be a resource for the entire country and a role model of education. We’ve never been one before. But we could be because we have such a history with this plant. And we have the ability to come together. And we’ve, we’ve had a lot of this information since the 70s about the therapeutic use of marijuana. And so, I feel like we could be proponents and learning from these models, creating an innovative streamline model, and then really speaking on the standard from New Mexico out into the country. That would be amazing.
Megan Kamerick: I asked Shannon if she could walk me through the process from first getting a medical cannabis card, to buying cannabis for the first time from a dispensary.
Shannon Jaramillo: So, I am new to cannabis, I get these calls all the time. And maybe a family member or a friend says “I want to get my card, what do I do?” And so, we have touch points in the community of doctors, cannabis doctors, cannabis card providers, that they can meet with and/or they can go to their primary care and have that conversation that’s a bit of a different coaching moment for somebody looking and people tend to want to go to these cannabis doctors. So, you start there and you go and you get an evaluation. The forms that that provider uses is from the department of health. You can find those forms yourself on the department of health website right now on the medical cannabis division sector of that website. And the potential patient has to go through and prove their qualifying condition against the list of qualifying conditions that we have in the state of New Mexico. And the advocate for that patient is the doctor that signs off. That form goes to the department of health and the department of health and evaluates and signs off and that card is mailed to the patient with a list of resources. So yeah, now you’ve got your card, you’re excited, you’ve got a list of resources department of health sent to you and they sent you all the dispensaries in your area and you can call. Well, you’ve got to go and you can either a) register yourself over the phone as a new patient because every single location, no matter if you’ve already registered with that with that brand, you’ve got to register as a new patient just walking in the door. That’s their way of tracking basically tracking you and your card has a number on it. So now you go to Andy’s dispensary and they’ll give you a clipboard and ask you to sign some paperwork, verify HIPPA that they are HIPPA-compliant. And then from there, they’ll give you a little tour of you know, come on in and some do it better than others and some are still learning and some are newer. And so, as you go through, they’re allowing you to choose a product. And I would say that as a patient, your first time can be very overwhelming. For sure.
Andy Lyman: Shannon wants to train future dispensary employees about cannabis and its uses. Here she’s using a hypothetical employee named Tim, to explain how overwhelming it can be for those employees helping patients.
Shannon Jaramillo: Like, he comes to me or he tells his mom and dad, “I want to do this.” And they’re like, “go for it, son.” And he goes into the field, and he walks in the door. And then he goes, what the hell did I get myself into? Because now somebody’s grandmother approaches him. And she says, “I have diabetes, and I take this medicine and this medicine and this medicine, this medicine, what strain do you suggest, 19-year-old Tim?” And Tim says, “let me get right back to you.” Or Tim says, “You know, I’m going to tell you about into Indicas and Sativas”. And that’s all Tim’s got, right? Tim’s doing his best. But those are the scenarios we’ve got to really get around. And we had a doctor. Dr. Avitea, I want to say, from the cancer center, came and spoke with the workgroup, and he validated what I was saying, I was like, yes, because he said, “you know what, I have cancer patients coming to me and stopping their treatments, because of some of the things are being told in our community. And we’ve got to stop telling people that this medicine cures their cancer, because then they’re coming to us. Right?” And so, he suggested to the state and to the working group that we put an actual doctor at the counter of every dispensary. $75 to $150,000 later, each dispensary could have that [laughs], right? Yeah. And so, what I’m saying is, it’s a big gap there of, you know, of how can we help these guys have the right tools to go in and have a good starting point?
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Megan Kamerick: another part of Shannon’s training is safety. But she says there’s plenty of work still to be done in terms of regulations and training.
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Shannon Jaramillo: I feel like it’s in just a couple of buckets really. Safety, we’ve got to mitigate their risk. If right now, we’re federally illegal, but we’ve got state regulations, they’ve got to know what they are. If we don’t have banking in place, and they’re having to shuffle cash around in their cars, do you want your son taking my dispensary cash and plant material from point a to point b without courier safety training, or robbery or active shooter training? We really have to address that. And we have a huge opportunity to do better by the workforce. So, safety is one of them. And then the other is just regulatory training, they’ve got to know the law, safety and law, right? And so I feel like I’m sorry… And then the third is the plant they have to know the updates of the plant. So how that plant are we learning about its medicinal value? How is it working with the human body? How is it working against the qualifying conditions? So those three things, you know, really in the way of training in kapusta, in a yearly updated certification process, seems to be the trend around the country that I want to bring here to New Mexico and just shed light on really.
Andy Lyman: But Shannon is also concerned that without a state approved education plan, a post legalization world can create more layers of miscommunication and confusion.
Shannon Jaramillo: Focusing in how we relay the information to the public, when the program splits up and starts to divide into different departments is certainly going to be key because the patient population historically in other states has gone down. And we’ve lost consumers and patient consumers to the adult use marketplace, in what I call a grey area or a big gap of where education can come in and public service announcements. And we can really just kind of come together and say “wait, this these are your processes and let’s show you your benefits of being in the program.” Without that educational bridge, I’m fearful that the program will take on the likeness of other medical programs that we’ve seen in other states and it will start to dwindle. So I’m again focused on creating those bridges. And I think that it will be important that the state of New Mexico and the department of health and regulation and licensing and any of the other departments that are involved, that they get involved in that educational piece.
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Andy Lyman: You may remember Rachael Speegle, the CEO of the Verdes Foundation from previous episodes. She says that at Verdes, they make a point to not even take part in the certification process.
Megan Kamerick: But, I thought patients get certified through their doctors?
Andy Lyman: Well, let’s do a quick reminder an explainer about how that process can work. State law says patients have to get a recommendation from a healthcare professional. So, there are a number of dispensaries that have a medical professional on site to do those recommendations. But Rachael told us she sees that as a possible conflict of interest.
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Rachel Speegle: You don’t go to Walgreens to get your script, you go to Walgreens to fill your script. So, it’s been really important to us to have that separation between the patient experience with their provider and then them filling their needs with our products. We do a lot of work with providers in the community because we want mainstream providers who are seeing patients in their spaces to be the ones to write these certifications or to yeah, to certify their patients that they see anyways that they already have a relationship with.
Megan Kamerick: Then there’s the issue of how each product works and how well it works.
Andy Lyman: I think people might be surprised to learn the number of different forms of cannabis they can buy. For example, some dispensaries offer cannabis suppositories, but Rachael who is also a registered nurse, so she doesn’t think suppositories are all that effective at delivering a dosage of cannabis.
Rachel Speegle: I think tinctures are great. My friends who live in recreational markets around the united states, when they call me for consultations, I make recommendations for the oil tinctures that are extremely medicinal. But these people are looking for anxiety help. They’re looking — they’re in recreational markets, but they’re looking for the exact same type of support that a medical patient would be looking for. So, I believe that we can continue to supply effective products that are more medicinal and a little less sexy. Putting oil under your tongue is really different than eating a fruit gummy. But if we as an industry can talk to people about the benefit, whether it be recreational or medical, the benefit of those low doses, the benefit of putting oil under your tongue and understanding how to titrate it yourself. I think that that can coexist in one program. But I do think that there are some pieces that need to be attended to as you pointed out.
Megan Kamerick: One of the more contentious issues surrounding education of cannabis use is as a tool to combat symptoms related to opiate withdrawals.
Andy Lyman: A few years ago, I wrote about the department of health under former Governor Susana Martinez going out of its way to keep opioid use disorder off the list of qualified conditions. Here’s Medical Cannabis Program Director Dominick Zurlo on the difference between curing a condition versus helping to alleviate symptoms of a condition.
Dominick Zurlo: At this point, medical cannabis has not been proved to cure any condition so far. It’s really something that helps to alleviate, whether it be pain or other conditions, to help relieve those symptoms, and the physical discomfort or pain that’s being caused by those symptoms. Now that can be different things in different ways. For example, it may help somebody who has issues with being able to keep food down, it may help them to you know, who have extreme nausea, for example, it may help them to be able to eat on a more regular basis and therefore be able to get the sustenance that we all need to live. It may help with regard to somebody who has seizures, and has issues with regard to epilepsy, for example. It may help to reduce those, and the frequency or the severity of them, but it’s not going to cure it. And so, we do have to be careful when we talk about this that the qualifying conditions are that medical cannabis will help relieve the problems and the issues that those conditions cause, but not actually cure the condition itself.
Andy Lyman: Considering trying to kick opiates can result in some pretty severe symptoms. It makes sense that advocates push so hard to add opioid use disorder to the list of qualified conditions. Jeffrey Holland, in addition to fighting powdery mildew, also runs a substance abuse treatment facility.
Jeff Holland: Let’s start off in the beginning instead of saying hey, you know what, here’s our deal, we want to throw you on 120 milligrams of methadone. It’s highly addictive, the half-life is insidious. If you’re, you know, not showing up to get it on a daily basis and paying to get it, then you’re probably going to go through severe withdrawal symptoms, which are much more intense than you would probably go through if you were trying to kick heroin on your own. You know, let’s start at the beginning and see if we can address it with things that are a lot more kind and compassionate. Before we just start over here on the other side of the spectrum.
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Jeff Holland: Look, I catch a lot of shit for this right? And to some people in my field, I’m a pariah or I’m a therapist. You know, I’m a clinical social worker. I’ve been in recovery for years. I don’t consume cannabis, right, I don’t drink and a lot of people say ”Oh, you’re just pooh poohing methadone and suboxone and all that.” It’s not at all there’s a place for it right? But it’s not the cure all is it’s not the be all end all just like cannabis isn’t. So, the more robust set of tools that we have to offer the people that are coming to us for help, the better off we are. And the way I like to phrase it is if you go out to eat to a buffet, do you want to go to a two-entree buffet or do you want to go to a 20-entree buffet? It’s really simple. You want to go and be able to experience you know the things that will work for you and custom tailor those things to your needs as opposed to this one size fits all model.
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Jeff Holland: What I’m saying is equivalent to if the check engine light comes on in your car, you don’t go immediately replace the engine. And I think that’s an approach that a lot of people have taken to dealing with addiction where you come to us, you say you’re addicted to x, y or z and we immediately want to put you on some kind of drug replacement therapy or medication assisted treatment that is just as addictive and just as you know, much of a set of handcuffs as what you were trying to get off of in the first place. So, using a Likert scale of like a, b, c or d where a are the less intense, less harmful, less addictive things. That’s where you want to start, right? And if we’re truly talking about client centered therapy and client centered services, if you ask somebody who’s dealing with and we’ll just say, opiate or benzo addiction, one, would you choose to be off everything, period? Would you choose to be on some type of medication-assisted treatment program where, you know, it’s still highly addictive and affects your body in a lot of negative ways? Or would you continue to just use the illicit drugs that you’re using and continue to face those consequences? I would bet that, and it’s been my experience that, 90 to 95% of the people would say, “look, if I could be my choice, I wouldn’t be on anything.” And so, going from that starting point, that’s what we should do is make the goal for them not to be on anything. And so, if you can start off with something, you know, being very informative about cannabis, what it does, you know, what it is what it isn’t versus maybe say, methadone versus something else. Like let’s start off in the beginning.
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Megan Kamerick: You know, Andy, before we talked to Shannon Jaramillo, I guess it had just never occurred to me that the people who are in these dispensaries, which are all over the state, may have some training, but there’s really not a standardization of what they have to know, in order to help people who are using medical cannabis.
Andy Lyman: Yeah, I think it develops or it creates this sort of room for error or deviation. The state does have a certification requirement, but it also it’s up to the dispensary owners on how much education they give to all these folks who are behind the counters helping patients, you may go into one place where somebody is really, really knowledgeable. Like we talked to Wiley Atherton. Somebody else may be on their second, third day and just on the bare minimum of standards, may not be able to provide the same sort of level that someone like Wiley can.
Megan Kamerick: In a later episode, we’ll go visit a dispensary. And we talked to them about that about how their folks are trained. And obviously a lot of people get into this because they’ve used cannabis, it’s helped them. They’re very passionate about it, which is great. But that’s not necessarily the same thing as helping someone who’s never used it before and may have multiple medical conditions. And they have a lot of questions.
Andy Lyman: Right, we spoke to a woman in the dispensary walking out and again, we’ll hear from that later, but she was a little bit knowledgeable from her, you know, previous life, somebody else may come in, in their 60s, never having touched it before. And there are, you know, some obviously some concerns of is this person behind the counter saying go ahead and smoke it, eat it, use a topical for somebody who may be sort of may freak out the first time they use it.
Megan Kamerick: So, I’m guessing that whatever happens in the legislature next year, if there is a bill about legalizing cannabis, this kind of education components gonna have to be part of it somehow.
Andy Lyman: It could be part of a full-on legalization effort course there’s also room for expanding the medical law. We’ve seen that happen in previous legislation. So, there’s also an opportunity to just do one bill that sort of tweaks education components separately from this discussion of legalization. But again, in an election year, everything is sort of up in the air and we don’t really know who might be crafting this legislation. It’s still too early to tell who is going to be sponsoring expansion for the medical program. We have an idea of folks who might run a recreational legalization bill, but it’s really hard to say where these bills are gonna pop up and when.
Megan Kamerick: I thought was really interesting that you kind of make this equation between well, you know, you go to your pharmacist and say, which over the counter medicine should I use for this. Which is fine, except pharmacists go to school for a long time, as do doctors, as do nurses. And I’m not trying to cut down the folks working in a dispensary, but they’re kind of in the same situation and right now they don’t get anywhere near that kind of training.
Andy Lyman: Right. And there’s an argument that, while this substance is sort of mind altering, that it’s not as dangerous as if you took, you know, whole bottle of Tylenol. But yes, it’s a decent point. And I think a lot of that comes down to it’s not legal across the country. So, we don’t have a standard of standard practice for this industry, as you do with the pharmaceutical industry.
Megan Kamerick: We’re like, it’s not like getting your real estate license or, you know, just name any other industry where there’s a continuing education credits in place. And part of it again, we keep coming back to is like this is still on a federal level, not a legal substance, which makes all these weird permutations in the industry.
Andy Lyman: Yeah, there’s not a lot of research done on the federal level. So, while there might be some, there’s not a ton so that we don’t have this across the board, this is you know, your federal qualifications. These are the standards and practices that you should be doing. And this is what you should not tell patients and this is what you should tell patients. It does remind me of being a pharmacist, but again, like you mentioned, it’s completely different in so many ways.
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Megan Kamerick: Growing Forward is a collaboration between New Mexico PBS and New Mexico Political Report, thanks to a grant from the New Mexico Local News Fund.
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Andy Lyman: Our production team includes Producer and Editor Bryce Dix, also New Mexico PBS Executive Producer Kevin McDonald, and New Mexico Political Report Editor Matthew Reichbach.
Megan Kamerick: We appreciate you listening. And if you like what you hear, leave us a review. It helps us out a lot. Join us next week when we discuss the wild and wooly tale of testing and regulation in New Mexico’s cannabis industry.
Heath Grider: We need to open up licensing, we need other options. Oklahoma has a very free market solution to medical cannabis. And they brought in 300 million last year. They have almost 300,000 patients in two years. Then New Mexico falls so far behind because we protect our existing businesses. They will not allow anybody — every time there’s a task force and I’ve been on several of them. They will not address this issue. They address it from the point of protectionism. And I don’t feel like that’s good for New Mexico business.
Duke Rodriguez: Here’s a situation where you can overreact and have such high testing standards, you get a lot of products fail that never gets in patients’ hands. But we’re willing to deal with that. All we said is whatever testing requirements you have, and we believe you should have them, they need to be based on science.
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