May 27, 2019
It’s a weekday morning at Restore Integrative Wellness Center in Fishtown. A few people are quietly waiting in the bright, stark lobby while an imposing yet friendly doorman checks in official cardholders, patients with ID cards from the state who are approved to purchase medical marijuana on site.
Currently under state law, six forms of medical marijuana are now available to patients in Pennsylvania, including pills, extracts, topicals, patches and flowers. For patients to be able to access these from a dispensary like Restore, they must first obtain a certification from a registered physician and complete an application to the Department of Health. If approved, a patient then receives a medical marijuana ID card. There are no age limits on applying (in fact, someone younger than 18 simply needs an approved caregiver to obtain medical marijuana once approved).
Ever since Gov. Tom Wolf signed Pennsylvania’s medical marijuana law three years ago, the program rollout has been reaching more patients, albeit slowly, with the ultimate goal of having as many as 150 state-certified dispensaries open for business.
Today, with several dispensaries breaking new ground in both Philadelphia and South Jersey, and a dedicated university hospital program welcoming new patients, the medical marijuana experience here at home is finally shedding its stigma and getting the product to the people.
“We see a lot of patients with many different qualifying conditions,” explains Megan McElhinney, assistant manager at Restore, which opened its doors last year. “A majority is dealing with chronic pain and opiate dependency. A lot of our patients have reduced their opiate intake and have successfully come off methadone.”
The promise of alternative treatment is poised to make the medical marijuana industry even more potent, especially as more patients learn how they, too, can be considered for the state-run program. It’s not always easy to track down a doctor or to await approval, but for those who have done so successfully, it’s become a legitimate alternative to “Big Pharma” and the opiates that have spawned a nationwide addiction epidemic.
A key driver of the local medical marijuana movement is not where you might expect it. When Thomas Jefferson University Hospital’s Lambert Center for Medicinal Cannabis Education and Research launched in spring 2016, it not only helped to legitimize the study and ultimate treatment of patients by alternative means, but it provided a platform for new doctors to explore this relatively new branch of study. Today, Jefferson is providing patients with guidance about medical marijuana and training a new generation of medical professionals to navigate what this means for the future.
Dr. Edmund Pribitkin, chief medical officer at Jefferson, said the goal of the center is to explore all avenues of care for patients by providing guidance on the use of legal medical marijuana in Pennsylvania and New Jersey. The impetus, of course, was due in large part to the legalization of the drug for medical treatment for wide-ranging ailments, like chronic pain, cancer and glaucoma.
“There are state-specific requirements for training and certification for physicians to begin recommending medical marijuana,” Pribitkin explained. “After satisfying these requirements, all Jefferson physicians pass additional screening before they begin to recommend medical marijuana. Here in Center City, we’ve seen 252 consultations thus far.”
For a patient to be considered for the program, they must be a resident of the state in which they seek the medical marijuana, must have been diagnosed with at least one of the specified qualifying illnesses, have past medical records available for physician review and be able to attend an in-person office visit.
“Jefferson has numerous doctors across the enterprise who are able to recommend medical marijuana to patients” with certain medical conditions as outlined by the state, Pribitkin says. But he admits there is a lot of misinformation about what this entails and how people ultimately access cannabis.
For example, doctors do not actually prescribe medical marijuana. Instead, he says, they recommend medical marijuana under very stringent guidelines that must be documented. These guidelines range from specific medical conditions outlined by the state to factors like whether a patient is likely to receive therapeutic or palliative care from marijuana.
The evaluation by a doctor coincides with an informed discussion about the possible uses and goals of medical marijuana, which takes into account each patient’s needs and goals. And while a doctor will recommend a form of cannabis, or even a dosage, the next step really takes place during a one-on-one consultation at a dispensary where pharmacists are available to make the best possible recommendations for patients who qualify and who may have unique issues or have suffered from addictions in the past.
One of the ways dispensaries are establishing themselves as legitimate resources for treatment is by focusing on customer service and support. A patient doesn’t just walk into a dispensary and make a purchase. The process is far more nuanced; it requires consultation and a plan of action that is custom to each patient.
“When patients arrive to our facility,” says Restore’s McElhinney, “our new patients will sit down with the pharmacists to go over their condition, medication lists and allergies. Then the pharmacist will create a care plan based on the medical needs of the patient.”
A pharmacist will have access to the patient’s doctor’s recommendations about why they may require the drug and what the ultimate goals are for using it. This process is pretty standard at most dispensaries throughout the region, all of which employ pharmacists who can make medical suggestions.
At Holistic Industries, with three dispensaries under the Liberty Cannabis name in Philadelphia, Steve Harrell has seen a wide range of patients, like parents of young children with epilepsy looking for alternative solutions, as well as patients who experience chronic pain well into their 90s.
“All Liberty patients have access to our on-site pharmacist and wellness guides on each and every visit to our dispensaries,” explains Harrell. “Our pharmacists and guides work with each patient to identify what they hope to achieve through medical marijuana and walk through the menu together to identify which specific strains, terpene profiles and form factors will work best for them.”
Holistic is somewhat unique in that it both cultivates and processes its own line of medical cannabis. “Our store menus typically have between 250 to 300 unique products on any given day," Harrell said. "Currently, we produce a variety of flower strains, oil cartridges, concentrates and capsules.”
In some ways, visiting a dispensary is a bit like accessing a pharmacy, but with a few important distinctions. “Since there are no prescriptions from the doctor,” McElhinney said, “the pharmacist helps decide what products are best for the patient. Also, our pharmacy team will follow up with our patients to see how they are doing.” This same process will extend to all six Restore dispensaries that will be opening in the region in the next year.
“With a lot of our patients being new to medical cannabis, we don’t want to give them their medicine and say, ‘see you next time,’” she said. “We want to ensure the patients have all their questions answered, even after they leave our facility.”
Harrell said that there’s been a mix of people coming into Liberty, including those patients familiar with cannabis – and those who have never tried it and probably never expected to. “While it’s normal for many inexperienced patients to have questions,” he explained, “even our most seasoned patients still have questions as new strains and products are released pretty frequently. There is always something new to learn about medical marijuana almost daily.”
It’s a lot to keep up on.
To make it easier for patients to take in all of the information, Holistic has created an inventive color spectrum by category (like vitality, clarity, harmony, tranquility and serenity) that extends through a range of sativas (the most energizing form of marijuana) to indicas (the most relaxing).
“While we do fulfill orders,” he says, “it’s the one-on-one conversation that happens before that, that makes our stores special. In many cases, our patients will come in and browse menus in-person or ahead of time on our website, and are prepared with questions about specific strain types and their effects. Our dispensaries are designed to be open and inviting so patients can truly either browse our product offerings around the store or relax on a couch with a magazine or watch educational content on our screens.”
But just like many medications, there can certainly be a period of trial and error. “What works for one patient,” Harrell admitted, “may not have the same effect for the next.”
A few important questions a patient should ask: Do I need to stay focused while relieving pain during the day? Or is chronic pain keeping me awake at night? The more a pharmacist knows about a patient’s goals, the better.
How a delivery method is selected for ingesting the drug is also dependent on a patient’s specific goals and health concerns.
“For instance,” McElhinney said, “many of our older patients like to utilize sublingual tinctures that they place under the tongue.” The oils are a great alternative to vaping in older patients who may be at risk for COPD.
The means in which marijuana is used can also have a bearing on how quickly and long acting it is, which are both key considerations for someone who may be treating, for example, chronic anxiety compared to the side effects of chemotherapy.
Flower is also big seller at Restore, says McElhinney, because it tends to be the most versatile product at a lower price point.
One of the biggest challenges for this burgeoning industry has less to do with the ins and outs of the local business model, and instead, hinges on the fact that the federal government still does not recognize this as legal. Even though states like Pennsylvania and New Jersey have legalized the medical use of marijuana on the state level, the federal guidelines prevent medical marijuana from being covered by insurance. It’s a strictly cash business. And this can pose challenges for patients with limited financial resources. It also means that VA hospitals currently have no way of providing medical marijuana to veterans who may benefit from it most.
“We understand the financial burden of medical cannabis not being covered by insurance,” said McElhinney. As such, Restore offers everyday discounts, like 20 percent to veterans, for example, along with 15 percent to patients older than 60, as well as those on SSI and SSDI, as well as SNAP recipients.
Said Harrell: “Most patients do hope we can someday take credit cards, but are understanding that we are prohibited by federal rules and regulations. In the meantime, we try to make it as convenient as possible by having an on-site ATM.”
There are also other payment resources that can be used.
“We encourage our patients to sign-up and use CanPay,” said McElhinney, “which allows them to purchase their medication without cash in a secure and safe way.” Think of it as PayPay for pot.
Jefferson also helps to streamline the financial burden on patients. “Our doctors do not charge for any services other than what they would charge for a normal office visit for the condition being treated," Pribitkin said. "There is no surcharge or special charge for a visit during which a doctor recommends medical marijuana.”
And while in Pennsylvania, medical marijuana is available in pill, oil and dry leaf form, he says at this point the most economical of these is the dry leaf form. “We cannot comment on the costs of the medication since dispensaries vary widely in what they charge and how they discount,” he explained. But doctors certainly can take financial challenges into consideration when making recommendations.
Additionally, Jefferson’s research into the use of medical marijuana will also likely have an impact on much more far-reaching and overall better understanding of its benefits, which could ideally lead to more legislators enacting laws in even more states.
“Research will help to determine where medical marijuana can be most helpful to patients and where it may pose risks — for example through interactions with other medicines," Pribitkin added. "In general, states that permit the dispensing of medical marijuana have seen increases in usage and decreases in price over time.”