I<\/span>n the classic 19th Century novel \u201cUncle Tom\u2019s Cabin,\u201d Topsy is a wild and wise slave girl who declares, \u201cI \u2018spect I grow\u2019d. Don\u2019t think nobody ever made me.\u201d This led to a colloquialism, \u201cGrow like Topsy,\u201d and, for this author at least, that describes the iconic medical cannabis dispensary.<\/p>\n Dispensaries in the late 1990s emerged from the culture of prohibition with no guidance and had the distinct look of hippie head shops with parachutes hung from the ceilings and pungent aromas from the \u201cmedicine\u201d in display cases and in use by the patients.<\/p>\n Today, for the most part, all that has changed, given way to more modern Apple-store-style establishments that are decidedly calmer and more business-like. Smoking cannabis on the premises is verboten. Indeed, \u201csmoking\u201d marijuana at all seems to be going the way of the 1996 dispensary. Today\u2019s preferred delivery systems include vape pens<\/a> and vaporizers,<\/a> tinctures,<\/a> patches,<\/a> salves,<\/a> edibles<\/a> and more. And just as the choices have become more complex, so have the patients.<\/p>\n Medical cannabis patients are increasingly older and often cannabis naive. Many are drawn to cannabis because nothing else is controlling their chronic pain,<\/a> diabetes, <\/a>fibromyalgia<\/a> or arthritis<\/a>, curing their cancer,<\/a> or stopping the horrible symptoms of Crohn\u2019s Disease<\/a> or other digestive illnesses. Cannabis, now known to be a principle player in the body\u2019s delicate balancing process called homeostasis, may well help with all of these conditions but the complexity of these illnesses requires constant care and medical attention. Yet too often these patients receive their \u201crecommendation\u201d from a doctor and, armed with a medical card and dozens of questions, they travel to a dispensary where they meet the budtenders who know their product (and their issue) but they don\u2019t know medicine or physiology \u2013 and that\u2019s where the problem begins.<\/p>\n Budtenders can tell you all about sativa, indica, edibles and dabs. They can help you understand the plant behind the cute names like AC\/DC or OMG Kush. But they can\u2019t, or perhaps it is better to say they should not, give medical advice. Yet they do so all the time. It is their job description as illustrated by a recent ad in the San Francisco area Craigslist employment section. Mixed among the ads for line cooks, office managers and hair stylists was an ad for \u201cBudtender in Medical Cannabis Dispensary,\u201d which began, \u201cHave you dreamed of sharing your knowledge of the healing power of cannabis?\u201d It goes on to say that applicants must possess a \u201cgood knowledge of medical cannabis\u2019 uses.\u201d<\/p>\n It is not this author\u2019s intent to disrespect budtenders. Their knowledge about the product is often phenomenal, but recommending a certain strain for, let\u2019s say, insomnia becomes more complex when the patient seeking a good night\u2019s sleep also has Type II diabetes with lower extremity neuropathy and hypertension. Such a patient may already be on five or six conventional pharmaceuticals (including sleeping pills). This is called \u201cpolypharmacy\u201d and is\u00a0one of the greatest prescribing challenges in general practice.<\/p>\n The beauty of cannabis is that it can often help patients reduce polypharmacy and there is a growing community of medical professionals who are solely focused on the medical utility of cannabis and helping patients achieve homeostasis.<\/p>\n<\/blockquote>\n There are numerous associations that are educating medical professionals, offering classes with continuing education credit. These include the Society for Cannabis Clinicians<\/a> and American Cannabis Nurses Association.<\/a> A short-lived association for pharmacists fell victim to the green rush as its organizers squabbled over ownership and profits \u2013 but in general pharmacists are undeniably interested in medical cannabis. In April 2014, a panel at the American Society of Health-System Pharmacists \u201cMidyear Clinical Meeting\u201d gave an excellent overview of the issue and one of the speakers counseled pharmacists to \u201cask themselves how they can foster an environment in which patients feel safe and comfortable discussing medical marijuana.\u201d<\/p>\n A growing number of cannabis-specific medical clinics are open and staffed with doctors and nurses who will meet with patients in a traditional fashion, take a complete medical history and tailor a cannabis regimen that \u201cplays well\u201d with other medications the patient may be using.<\/p>\n But in order to obtain supplies, patients still must go to a dispensary or, in some U.S. states, they can actually call a manufacturer\/grower and have supplies delivered. All too often budtenders or manufacturers will contradict the recommendation of the doctor or nurse when it comes to the product needed by the patient. Why? Unfortunately, it often comes down to supply and demand. Just like associates in a big box store, the budtender is in a position to steer the customer in another direction to make the sale. All too often the emphasis is on higher THC<\/a> content, an artifact of the recreational cannabis world. For the medical cannabis patient, however, it has been discovered that less is often better than more. \u201cStart low and go slow\u201d is the mantra of all medical cannabis professionals.<\/p>\n Another problem is \u201csamples.\u201d It is unlikely a patient would ever obtain free drug samples at a pharmacy and even physicians are more reticent about giving away free drug samples anymore. Yet dispensaries often have \u201cfree\u201d samples, usually edibles. Eloise Theisen, an Advanced Registered Nurse Practitioner (ARNP) who owns Green Health Consultants<\/a>\u00a0in Lafayette, California, is frustrated with the problem.<\/p>\n \u201cThese \u2018free samples\u2019 can be high in delta-9 THC content, not to mention sugar,\u201d she says. \u201cSome of my patients are diabetics who obviously should avoid cannabis edibles.\u201d<\/p>\n Another problem with ingesting cannabis is that THC is processed through the liver, which can be a serious problem for patients with liver disease or dysfunction. And Theisen notes, \u201cTHC and CBD can actually accentuate the action of regular pharmaceuticals that my patients must use in addition to cannabis, yet I find very few budtenders or dispensary owners who are aware of this potential problem.\u201d<\/p>\n Dr. Jeff Hergenrather, president of the Society of\u00a0Cannabis\u00a0Clinicians\u00a0(SCC), would love to see physicians playing a more prominent role in cannabis distribution but notes that federal law and various court decisions have created an environment that makes it impossible for physicians to actively ally themselves with dispensaries.<\/p>\n Says Hergenrather, \u201cUntil cannabis is removed from Schedule I of the Controlled Substance Act, the nurses will be the health professionals to work with patients at the source of cannabis and cannabinoid medicines \u2013 the dispensary.\u201d<\/p>\n So, for manufacturers and dispensary owners who are serious about medical cannabis and truly care about their clients, the time has come to consider a new staff position: a nurse. Or, at the least, have a nurse on retainer and available for consult. This is not to say that every customer who enters the dispensary must be seen by a medical professional. Most medical cannabis patients are capable of handling their own medication. But for those patients with multiple ailments, referred to as \u201cco-morbidities\u201d in the medical world, a nurse on staff can be an invaluable tool. These nurses will not only help patients, they can also educate the dispensary budtenders to better serve patients. And having a nurse on staff can help immensely with building a steady clientele that returns to a dispensary because the level of care is more in tune with their often complicated medical disorders.<\/p>\n While some worry about \u201ccreeping medicalization\u201d and view the entry of trained healthcare professionals as an unnecessary intrusion, the facts are simple: medical cannabis is here to stay and Big Pharma is definitely interested. These companies will do all that they can to quash the dispensaries and move cannabis into a new regulatory scheme, enslaving the plant just like poor little Topsy was enslaved. Dispensaries can stop this intrusion by acknowledging the need for professionals and making room for them in the medical cannabis tent. It is the old adage: take control or control will be taken.<\/p>\n Originally published in Issue 20<\/a> of Cannabis Now.<\/em>\u00a0LEARN MORE<\/strong><\/a><\/p>\n TELL US,<\/strong> do you talk to your medical provider about cannabis?<\/p>\n The post Beyond Budtenders<\/a> appeared first on Cannabis Now<\/a>.<\/p>\n
Dispensaries and patients alike could benefit from the growing community of medical professionals who are solely focused on the medical utility of cannabis. In the classic 19th Century novel \u201cUncle Tom\u2019s Cabin,\u201d Topsy is a wild and wise slave girl who declares, \u201cI \u2018spect I grow\u2019d. Don\u2019t think nobody everContinue Reading<\/a><\/span><\/p>\n","protected":false},"author":37,"featured_media":0,"comment_status":"false","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[50,85,504,53],"tags":[],"_links":{"self":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts\/17470"}],"collection":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/users\/37"}],"replies":[{"embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/comments?post=17470"}],"version-history":[{"count":1,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts\/17470\/revisions"}],"predecessor-version":[{"id":17471,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/posts\/17470\/revisions\/17471"}],"wp:attachment":[{"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/media?parent=17470"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/categories?post=17470"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cannabiscultivatornews.com\/home\/index.php\/wp-json\/wp\/v2\/tags?post=17470"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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\nRead More: Beyond Budtenders<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"