Bringing Medicine to Cannabis MD 420 March 8, 2019 Medical My thirty year background as a medical entrepreneur, product development specialist and distribution/manufacturing consultant came in handy when I was first introduced into the medical cannabis world in Colorado, 2014. I was hired by a new medical cannabis company as a consultant to help them create more of a “healthcare friendly” cannabis line to be recommended by doctors. At the time, I knew absolutely nothing about medical cannabis industry, which looking back, actually helped me bring fresh eyes into an industry I knew nothing about. I had to do some serious market research and clinical research to get caught up to speed fast. I remember thinking “Could this really be medicine?” For the first thirty days, I devoured medical research about the endocannabinoid system (ECS), cannabinoids, terpenes, administration options (smoking, gel-caps, sublingual, topical, edible, suppository), raw material sources (flower, distillate oil concentrates, purified powdered isolates) – which I will explain in Cannabis 101. I also dug deep in the comparison to FDA approved Pharma drugs, as well as to recreational “drugs” like alcohol, tobacco, narcotics and other hallucinogens. My “on-site market research” consisted of going door to door, dispensary after dispensary, day after day just to see what products were being offered to patients in a medical (and somewhat recreational) manner. In Colorado, patients were approved by their doctors for a medical cannabis card allowing them to walk into any dispensary and purchase medical cannabis – which was usually located in a small cabinet in the corner of the dispensary with limited products available. Needless to say, I was very disappointed at the entire “dispensary” model and quickly understood why doctors were so skeptical of the entire medical cannabis industry. The branding was childish, the lack of consistent quality was unacceptable, the bud-tenders looked like something out of Waynes World, and almost every dispensary looked like a pot smokers head shop with bongs everywhere. It was definitely NOT a medical setting! What I realized was that the entire cannabis industry lacked any concept as to how medical cannabis needed to represent medical grade standards with pharmaceutical quality control, accurate standardized dosing, and proper dosing application. Then it hit me – “Cannabis is trying to break into medicine, and NOBODY is bringing medicine to cannabis!” I discovered two major issues that were keeping doctors away from medical cannabis. 1. Dispensary vs Pharmacy: There is a huge difference between a pharmacy model and a dispensary model. Clinicians are familiar and comfortable with the established Patient-Doctor-Pharmacy relationship. Doctors do not consider the dispensary equal to the pharmacy model for four main reasons: Control: Doctors want to have a certain amount of control over what their patients are taking so they can manage the outcome better. With a dispensary, doctors have no control of what the patient will be sold at a dispensary. Prescriptions written and sent to a pharmacy gives doctors the proper control of what their patient should get. Patient Compliance: In a dispensary, most patients have no clue as to what they need and could be sold something completely different from what the doctors wants. If it’s flower to smoke, what kind is it? If it’s edibles, what’s the standardized dose per item? Prescriptions from a compound pharmacy would allow doctors to be very specific on milligram dose, type of concentrate used (indica, sativa or hybrid), and the proper delivery system that would be best for their patient.Quality Control: Cannabis companies have no oversight in product development and quality control like a pharmacy does. A compound pharmacy is inspected by the State Board of Pharmacy to ensure product quality from medically trained, board certified pharmacy professionals.Professional Personnel: Dispensary bud-tenders lack medical training and have no medical certifications. In a dispensary, some tattooed bud-tender with nose rings and ear loops could be handling a patient’s medical cannabis recommendations. 2. Lack of Medical Cannabis Training: In the US, 9 out of 10 medical schools in the US do not include any courses on the endocannabinoid system (ECS). Texas made a huge mistake by granting the first three state licenses (two of which were not even Texas based) to grow high CBD low THC plants only for the specific use of children with rare forms of epilepsy, which also requires a prescription from two different doctors. The political leadership of Texas has been pitifully slow and ignorantly resistant in giving medical cannabis a “green” light, which explains why Texas has no state approved medical certification or CME training for doctors to responsibly prescribe/recommend cannabis products. This causes a huge problem for prescribing doctors since the DEA still considers “any cannabis compound”, even non-psychoactive CBD, a Schedule I drug. As of today, any doctor writing a medical cannabis prescription could theoretically loose their medical license for writing a prescription for CBD in the state of Texas. Recent changes in CBD legalization was made possible on a national level when President Trump signed the Hemp Farm Bill, but the DEA still has been reluctant to change their policy, and therefore could still come after doctors (not likely – but the possibility and the fear still exists). If Texas had a state approved CME certification on cannabis, and had a state approved pharmacy model for cannabinoid quality control, Texas could actually be leading all other states with the only true “Medical Model” in the United States. Dispensary vs Pharmacy Prescribing cannabis products through an approved cannabis pharmacy could solve the paranoia Texas medical professionals and politicians have about the cannabis industry. Texas is not ready to go recreational, and by keeping the cannabis control in the hands of doctors and pharmacists, the recreational market is kept in the closet (at least for now).