A Panel of Doctors Answer Your Medical Marijuana Questions
Dr. Lewis Jassey – Medical Director, Pediatric Medicine
Dr. Lewis Jassey has been a pediatrician over the last 25 years, run a practice of 15,000 patients and been on staff at five major hospitals for over two decades. Dr. Jassey has carved a niche for himself successfully working with patients on the spectrum, as well as patients with a variety of mental health issues. He lectures on a national level, with expertise in pharmacogenetics and pharmacology.
Dr. Steven Salzman, Medical Director, Adult Medicine
Dr. Steven Salzman has been a practicing trauma surgeon and trauma intensivist for over 20 years. He has gained unprecedented experience treating patients with traumatic brain injury, PTSD, and complex pain syndromes. He has integral faculty involvement in resident and fellow education at hospitals where he is on staff, and sits on a number of philanthropic and outreach boards.
Dr. George Gavrilos – Chief Pharmacy Officer
Dr. George Gavrilos is a practicing cardiac critical care pharmacist, specializing in mechanical circulatory support. He is adjunct faculty at schools of pharmacy in Illinois, Missouri, and Iowa, and currently serves as Director of Post-Graduate Year 1 Residency Training at the hospital where he is on staff.
Emily Fisher – Founder of Leafwell
Emily is an entrepreneur and senior executive in the internet industry, with extensive experience in business development, marketing, strategy and operations. In 2016 she began working with medical cannabis clinics in California and saw the opportunity of improving patient access to quality care through telemedicine.
All of these questions were pulled live from audience participation on youtube. This is a part of an ongoing series – if you would like to submit questions for the next panel click here.
Here are the Questions We covered:
- How many patients do you see a day in your practice?
- Can you Tell us About the process of obtaining a Medical Marijuana Card via Telemedicine?
- Can you Tell us About Some of the Experiences You’ve Had With Patients?
- What challenges do you face being a Doctor in this industry?
- If young people are exhibiting signs of anxiety due to the pandemic, what mode of cannabis would you recommend for a younger person?
- During COVID-19 is it still safe to use vape pens or joints or would you recommend something different?
- What are the long term effects of marijuana use on serotonin levels on depression?
- How Does Depression Relate to Other Conditions?
- Do you have any general recommendations for cannabis for insomnia?
- How significant of a role, if any, do terpenes play in the overall psychopharmacology of cannabis?
- How do you review a patient’s records via telehealth for certification?
- Many People don’t Think Getting a Medical Marijuana Card via Telemedicine is Real, What are the legal hurdles that you’ve had to deal with getting the platform launch?
- How much Does it Cost to get your medical card?
The Questions and Answers:
How many patients do you see a day in your practice?
The company and the practice morphed over the course of the past six to nine months. The influence of the pandemic and stay at home orders have shifted the focus of consultations from in-office visits to the telemedicine platform.
Generally in States where we were operating in the office setting most practitioners were evaluating between 15 to 25 patients per day per state. That number has stayed constant – though the shift has been to telemedicine and not so much a face to face. We are in 15+ markets and each of those markets are evaluating a similar number of patients per day. Several hundred patients per day come through the Leafwell.co platform in order to establish care and obtain certification for medical cannabis.
Can you just tell us a little bit about the process of obtaining a Medical Marijuana Card via Telemedicine?
We are a telehealth platform. For a lot of people, it’s new and we didn’t want it to be about technology. We wanted to create an experience that anyone, young, old, good with computers, not great with computers – can feel really comfortable with. It’s a really seamless experience.
We’re in 15 States today. We’re going to be in every single state with a medical program within the next one to four weeks. Every state has different regulations and qualifying conditions. So each state has a different process, that you need to go through to qualify for a doctor’s recommendation.
If you go to Leafwell.co and select your state it outlines everything you need to do, qualifying conditions, etc. so the patient is very prepared.
You can access our platform with a phone, tablet or computer. You first have to register and so it will ask you for your personal information.
It will ask you for your medical history and to upload your identity. This information is completely secure and HIPAA compliant. Depending on, depending on what state you’re applying for you’ll have to just make sure that you have qualifying conditions.
As soon as you’ve registered, which really only takes about three or four minutes, you’ll be seen by a doctor pretty much right away. The average time for a patient to speak to be seen by a doctor on our platform is three minutes. It’s really efficient and super convenient.
The actual interaction between the patient and the doctor is exactly the same as if he/she was sitting in his/her office. We have a network of incredible providers on the platform.
You’re also only billed if you are approved. So if you’re not approved and you just want to ask questions, you can do that.
We are all about quality interactions and won’t settle for anything less. We have critical care doctors, pulmonologists, pediatricians, I can go on and on with the kind of expertise that we have in our family.
Even though we get to you quickly, we don’t rush you. We feel like pseudo psychologists a lot of times.
Can you Tell us About Some of the Experiences You’ve Had With Patients?
After 20 years of being a trauma surgeon and a critical care doctor seeing gunshots and stab wounds – you see everything and you see the gamut of both mental and physical problems.
Many problems are overlooked because people are so focused on hyperacute things. Oh my God, I lost my leg, right? But now they have Phantom leg pain and there’s nothing out there for them. These are the problems we’ve tried cannabis for. And almost instantly, what did we see? We saw that cannabis was incredibly effective as an anti-inflammatory, dealing with pain, dealing with anxiety, dealing with sleep. So you were able to start literally repairing several things, build a solid platform for people.
From that you can implement lifestyle change. The better you feel, the better you’re going to want to feel. And that’s sort of what built everything. The marriage of bringing all of these experts together so we can tackle the various symptoms and patient problems that we encounter.
What challenges do you face being a Doctor in this industry?
When the practice started Steven and I realized that there was a gap in the medical community when it came to medical cannabis and we approached cannabis care from the medical model. In the infancy of our practice, there was apprehension from other physicians or healthcare providers. Very quickly once their patients returned to them after having seen us they realized the impact that cannabis had on patient care.
In the beginning, it was difficult for us to combat misinformation, fear, and ignorance. Now a lot of providers are seeing the positive impact that cannabis has on their patients. From a prescription use perspective, from a liability perspective, so many more physicians are like, ‘Oh my gosh, I no longer have to pick up a prescription pad and write for benzodiazepines and opiates because they’ve gone to see the providers at Leafwell. Now we’re off 70, 80, 90 plus percent of those medications. Please take more of our patients!’
My biggest struggle as a pediatrician – we instinctively are going to always be protective of our children. The biggest trepidation always lies within the pediatric population. It’s hard to get parents to agree to give their kids over the counter cough medicines or to try to explain to them the benefits of vaccinations.
I’ve seen stuff that autistic children who weren’t comfortable in their own skin and selective mutism patients who weren’t speaking and cancer patients with tumors – I’ve seen firsthand cannabis improve that. It still boggles my mind and I don’t take it for granted. So my challenge is trying to convince others what you’ve seen and that they should give it a chance for their children.
Also, how can we get that word out and make this more mainstream in the pediatric population? We’re not trying to get kids high! We’re trying to ameliorate a situation that has gone awry. Parents out there that are listening in who unfortunately are in these situations, you know exactly what I’m talking about. This is my biggest challenge as a pediatrician, but I’m trying to do everything I can try to help that out.
If young people are exhibiting signs of anxiety due to the pandemic, what mode of cannabis would you recommend for a younger person?
Anxiety can affect just about anyone during a crisis like this. Not just from an apprehension to treat pediatric patients with certain therapeutic modalities, but other patients with chronic conditions. A similar question comes up with patients who have lung disease or end-stage renal disease or liver disease or pediatric patients who don’t want to use inhalation modes of therapy.
We’ve had a lot of success in pediatric patients using high CBD, low THC products that don’t necessarily have to be introduced in any other form except oral. Tinctures, sublingual film, sublingual sprays, topicals, transdermals, all our therapeutic options, which mitigate any negative effects of the inhalation route of administration, and also mitigate any overexposure to THC components.
CBD, when dosed effectively can over time have effects on the ‘feel good’ molecules in the body, serotonin, and others. So you can get a lot of therapeutic benefits for the pediatric patient for a number of different conditions without introducing high amounts of THC and without having to expose pediatric patients to inflation routes of administration.
During COVID-19 is it still safe to use vape pens or joints or would you recommend something different?
The consensus is that there’s really not a lot of consensus, right? We do know that in the pathology of COVID-19, there are certainly implications with lung and lung tissue and, and respiratory complications often cause the worst of all the other organ complications.
So when we counsel patients, we first try to look for alternative options. One of the reasons that we found vape pens or combustion products to be very beneficial is that they have a very quick onset. So it’s great for patients who have acute symptoms and want something treated right away. They also have a shorter duration of action so you can get over the acute symptom and then go back to normal.
Vaping can be an on-off button, right? So a lot of people use vaporized product for those symptoms. But you can get that quick onset on-off button with a number of other options like sublingual administration, oral administration to a lesser degree. We recommend those first. If you have to use something from an inhaled perspective, I would trust a product from a dispensary, which has been tested, devoid of additives. Versus getting something elsewhere or using combustible flower product.
They’re doing a study out of Israel right now regarding COVID-19. There’s an overwhelming thought that the body goes crazy when it’s introduced to the virus and gets this cytokine storm – an overwhelming inflammatory reaction. Because CBD is such a potent anti-inflammatory agent researchers are trying to see if that anti-inflammatory process is able to help COVID-19 patients.
What are the longterm effects of marijuana use on serotonin levels on depression?
We know that cannabis and its components – cannabinoids – work in the body much like any other molecule or drug that we take. Cannabinoids interact with receptors in the body to elicit their effects, just like blood pressure medication or antidiabetic medication. The body is equipped with receptors that interact with those molecules and produce an effect. What’s unique about cannabis is that the endocannabinoid system is found everywhere in the body.
There are so many qualifying conditions in different States. Cannabis is effective in all of those qualifying conditions because there’s targets everywhere in the body.
The central nervous system when cannabinoids bind to some of those receptors over time, you have an increase in the levels of serotonin and a decrease in some other sort of excitatory or maladaptive molecules. In practice we’re able to decrease over a period of time the amount of SSRI or SNRI size, TCAs, et cetera, that patients are on or antidepressant medications patients are on by using cannabis and cannabinoids.
A lot of the questions that are science specific, we have preliminary data. Over time we’ll learn more as studies come out. Anecdotally in our practice we’re seeing tremendous effect in patients that have insomnia, anxiety, depression, and the ability to wean off those medications using cannabis.
How Does Depression Relate to Other Conditions?
For the last 3 years, every single patient that we saw – it didn’t matter what was wrong with them, back pain, neck pain, cancer, ALS, rheumatoid arthritis – Every single patient we saw had some form or another of insomnia, anxiety or depression. It was almost instantly obvious that the way to go after this was to go after it in a phased approach.
Phase one was sleep. We got patients sleeping six to seven hours a night. We reset their viral rhythms and circadian rhythms. Their response and perception of pain, the logic, critical and reasoning centers of the brain, stress hormones were kept in check.
That bled into phase two, symptom management, pain, anxiety, tremors. People started to feel better and it was clear that phases one and two were intimately linked. I also realized there was a base rate and if we did things correctly.
That’s when we built the entire practice. I called it the Take Back Your Life Phase because everybody had it, but it was unique to each individual.
If you had surgeries, you did physical therapy. If you were a veteran, you might need psychotherapy, diet, weight management, exercise, getting patients off narcotics and benzos and sleep meds and antidepressant and psychotic medication. All of this was in phase three because in the end, the formula turns out to be, if you sleep like shit and you feel like shit, nobody gets better and it doesn’t matter what else you do, and if you can intervene and fix anxiety and sleep and pain and you can get people back on their feet, you can rebuild them, right? The goal was to build a 2.0 version of a person with a toolbox to deal with relapse flare ups and stress.
Do you have any general recommendations for cannabis for insomnia?
These mantras start coming up that we need to be very careful about. Sativa for day, Indica for night. When we smoke it or vape cannabis, it works pretty quickly. When you take cannabis orally it might take an hour or two to work but then last four to six hours.
So typically what we try to do with our patients is we try to sleep train them. If they have very limited experience with cannabis, I’ll do it in a stepwise progression.
Everybody’s different. SO we start low and slow. If 2mg didn’t work, the next night take five and the next night seven and a half. The goal is to sleep six to seven hours a night. You don’t have to be super high. You don’t have to be high at all. The majority of our patients smoke prior to bed and took a gummy about an hour beforehand. Something of a mix like that would probably work very well in terms of getting them to sleep and keeping them to sleep.
How significant of a role, if any, do terpenes play in the overall psychopharmacology of cannabis?
As we research and observe the data from small trials looking at the effects of cannabis and a number of different conditions, it’s more and more apparent that the whole plant whole plant approach to therapy may be more beneficial than therapy with individual components.
In the traditional Western medicine sense I often bring up, um, treatment of heart failure because that’s what I do day to day. We know that in this patient population it is better to introduce several different medications which target different mechanisms in the pathology of heart failure than just one medication that had a maximum dose upfront. I think what we’re finding is true in cannabis. It’s that the whole plant, every component may be more beneficial as a sum than the individual compound.
The reality is it’s so individualized at this point. We just don’t know enough about what combination and what specific product works best, because it’s your own body chemistry as well. We’re committed to providing patients with education, helping them access and navigate this landscape.
How do you review a patient’s records via telehealth for certification?
I’m in the trenches everyday doing telemedicine in multiple States. The more information that you provide us, the better because we can decipher through your story and give information on not just whether you qualify, but additional information to help you out.
We are happy to try to give you insights and not just be “Pot Docs”, but to go beyond that and develop a relationship with our patients.
The platform is HIPAA compliant and allows for patients to either scan or take a photo to be able to upload records so that we have one compact medical file which can be accessed by both patient and provider. On the backend when a patient fills out their registration form, they will fill out demographic information, notes to the clinician that the clinician will observe before their interaction and a part where records can be uploaded additionally.
There will be a written summary of their interaction with that provider just like a chart note you would get from a regular visit.
Many People don’t Think Getting a Medical Marijuana Card via Telemedicine is Real, What are the legal hurdles that you’ve had to deal with getting the platform launch?
This industry has been under such scrutiny for so many years. Before this pandemic there were States where you could get your or your medical cards by telemedicine legally. Since COVID-19, a lot of States have submitted emergency bills that now allow for telemedicine. But it absolutely is legal.
Our platform is committed to education and reliable information, evidence based information. We provide 24 hour telephone support.
There are a lot of people out there that are running gimmicks. We have people with so much medical experience. We have a pulmonologist on our team who has run a high octane ICU. George has taken care of COVID-19 patients every day in the trenches. Steven has been in the trauma room saving people every day of his life. I’ve been a pediatrician for 25 plus years.
We don’t have to do this – it was a calling for us because we feel very passionate about it. The common thread here is we all really genuinely like to help people.
When we assembled the team, we realized that we needed to apply the same facets of care that you would get anywhere else. We have in house biostatisticians looking at the best way to provide care. We have a tech support team that supports us 24 hours a day. We have issued care coordinators throughout the United States in every state market that can be called with real time question and answer capability. We have follow up via email, via text, via call.
We are a small community that need to grow our numbers because this is life changing practice. Cannabis should not be a last resort, which was really the case in 2016.
How much Does it Cost to get your medical card?
State by state, it depends. One thing that I can say though is that Leafwell probably has the most competitive price in every single state. If you just go to our website and select your state. The price is one of the first things you see there.
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