S3E5 - Healing Communities - Part 2

 In Part 2 Kirk leaves Vancouver Island and visits Gimli, Manitoba.  He discovers how a family doctor becomes a Cannabis consultant. Dr. Shelley Turner (@TheShelleyT) discusses how a deep interest in addictions directed her practice toward Cannabis.  Her new clinic, Ekosi, will teach patients and professionals alike to discover the harm reduction benefit of Cannabis. Dr. Turner's journey with her Cree and Settler heritage, her progression from ambulance driver to nurse to doctor is fascinating enough on its own.  But her passion for data, evidence and her patients in all things cannabis is something you'll want to hear.  From Newleaf Outreach and Victoria Cannabis Buyers Club in Part 1 to Ekosi in Part 2, the common thread in these three stories is how healing communities are people caring for each other. Is Cannabis an exit drug? Should peers and individuals direct their own Health Care? How can western medicine help with creating healing communities? Kirk and Trevor discuss these questions and offer up some canna-curious opinions.

 

 

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Thursday, 18 April 2019 20:26

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Episode Transcript

 

Dr. Turner:  So back in the day back in the day.  So this would've been 1984 85. We had a volunteer ambulance department here first responder training. We started out doing that for a few years and then I ventured into nursing and then went and did my degree in nursing and then started a Master's in community health science and thought I think I need to go to school even. I need to I need to further education just primarily around the ability to look after vulnerable populations. I had worked with the Winnipeg Regional Health Authority on the street connections van and STD team and saw some very heart wrenching situations for people living down on the low tract down in Winnipeg was pretty shocking and I decided then that I would go to medical school. Off I went to McMaster and did my residency in rural medicine out there and have been in Ontario since 2003 but have made my way back to Manitoba.

Dr. Turner:  OK. The name of our clinic is called Eksoi health center and it's spelled E.K.O.S I. And that is really an homage to my my maternal side. My mom is I was born in Cross Lake and moved to Winnipeg to live with an aunt when she was 8 years old didn't speak a word of English. Cree is her first language. Her aunt who is actually my grandmother was a translator for Health Science Center and she wrote in Solavicks and spoke Cree. And I picked up a bit but sadly I didn't learn to speak it fluently so the clinic is really about both sides really so EKSOI means this is good this is the way this is it. And this is about bridge building here as well. So with my settler heritage as well as my Cree heritage this is what we hope to do here Gimil.

So one of the challenges I think when you're working in addiction and I think Kirk you can kind of relate to people getting people not wanting to feel pain. People either are using illicit substances like opiates or whatever they can get their hands on to get rid of pain and working with that population of folks who are struggling with addiction. Really made me realize how limited we are in some of the medicines that we use now. Don't get me wrong I think you know there's absolutely a place for methadone and Suboxone and all those things for stabilization. But the question is really how long do these patients need to be on that medicine and working towards coming off without putting patients at risk for overdose. So always a fine line. One of the challenges with patients also you know most of them were using cannabis and when I decided that this one patient in particular who was struggling with pain was saying that she would find that she would get certain types of cannabis and she would be fine she wouldn't feel like she needed her methadone dose as quickly. She was withdrawing as quickly. So start doing more reading about this and really looking at some of the science in terms of the opiate spearing ability that cannabis has and how it works in her brain and I thought OK this possibly could be something true why not listen to the patient. What a novel, what a novel approach. So I provided access to medical cannabis for this patient and lo and behold she's doing you know doing better access to CBD and she she did better and was able to do some of her dose. That gives patients choices and I think when you're looking at the litany of medicines that some of these patients are taking something to help sleep something for anxiety something for pain you know just this whole laundry list of medications with that don't that have a ton of side effects and also some of the some that may potentiate the methadone. So when you think about benzodiazepines and gabpentins and all of these other medicines that are now being Abused some of those medicines will actually potentiate opiates potentiate alcohol so that the patient is at a higher risk for an overdose or are really negative event.

Kirk:  So those medicines also create their own pain. People that are long term morphine users actually the morphine creates the pain after a while.

Dr. Turner:  Challenges and challenges with dosing and but really it's it's about the relationship and developing that relationship with the patient so that the you know they have to be ready.

Kirk:   So how long did you when did you discover that you were your doctor about 11 years using. So how did you discover cannabis as an alternative. How did you. How did you stumble into cannabis.

Dr. Turner:   So again with the patient was one patient with those patients and really wanting to try it to to use something that you know it was their choice to try the other. The other piece too was, part of the addiction protocol when patients are coming in they have to have urine tests and one of the patients said that she was coming of cocaine positive because she was buying her cannabis from this dealer who obviously wasn't being very tidy in cleaning off the scale. So I said OK let's try that. Sure. Let's legalize you let's give you a safe clean source of cannabis. I'm sure enough. No cocaine and urine. And that works well for her so she had an option to try that and then the other piece that you're removing for those patients and the college really says we shouldn't be using this as harm reduction. We could get her hands slap. But really what we're putting patients at risk for to go to the black market is they don't know what they're getting and also putting them at risk for an arrest to the legal piece.

Kirk:  So cannabis has a source for you is in chronic pain management.

Dr. Turner:   So chronic pain management for sure. And patients that are already on an established regiment and that's generally the first comers that I see in consultation from other. Other places even from the pain clinics, the pain clinics are requiring more and more evidence based medicine to drive their practice.  But in terms of the first line if most patients are generally first line you know they're coming in and realizing so let's say you're patient living with migraine comes in and so what do you do that they're generally using triptans and all these things to get them over there. Their headache. So what we try and do kind of on an acute spot with us is start them on prophylaxis CBD so they start taking CBD. Generally what you see is a reduction in headache frequency and intensity. And then using a breakthrough THC and CBD is a vaporization. So some people have learned how to manage that you know acute and chronic.

So I got my license to practice here in 2017. I think it was April 20th 2017. That's actually the first time I laughed when I got there was quite funny. And again as with all the colleges they're very risk averse and they're worried. I mean you know we can say a pharma company like Purdue and we can mention Oxycodone and that's the worry right we worry that we're going to cause more harm. But again, I'm five years in and most patients of mine are doing very well. So in terms of that being risk averse. I was actually called in at the time I was doing some work with National Access Cannabis in Winnipeg and the registrar very very kindly said. And what is your purpose here and why are you doing this and so I said you know we're doing research and this is I think this is an important area of medicine that we need to. It's an emerging area of medicine that we need to focus on and. I've had success some this is what I want to do and now with opening this clinic here in my hometown I think it's been generally very positive. I think there's some concerns about you know potentially the types of folks that are going to be coming here and about what that's going to mean for the town but I think really this is about changing. And really disrupting the system about how we're going to practice medicine and you were there I am your family.

Kirk:  You Are here a licensed family doctor. You have hospital privileges not here. (No) Do you plan to get hospital privileges.

Dr. Turner: That's an excellent question. So one of the challenges here because I know I've hung up my emergency stethoscope. I want to sit right where you are and hope (you're an old medics you must help some emerge in some place) for the first six years I was on the Bruce Peninsula. So the sound doing all of that and I love emerg. But you know if you had a specialist moved your town that was a neurologist would you ask them to move. Would you ask them to do emerg. Good point. OK. So what I can do is I'm going to support the community in terms of the addiction and mental health. And really would love to develop a model to support that. So we have a registered psychiatric nurses who are masters prepared that are nurses and they've got that mental health piece which I think you can attest to that would be a super huge asset to a team so that you could support the folks that are going to emerg after hours that need. I need somebody either that night or I need to see somebody tomorrow. Can they wait. And when you when you have that capacity in a community I think it offers I think a smarter approach to what you actually need in the community. Do we need more physicians. You've bet we do. And we want to create a legacy for the community that way. Looking forward we want this to be a teaching site. We want this to be a place where we. Collect data. And. Do research are not limited to gimili or near.

Kirk:  Your practice extend your outside of Gimili obviously. (Yes.) Who would seek you out.  who should she should seek you.

Dr. Turner:  So generally I  will see patients that have kind of been around the block maybe two or three times. They've they're on maybe medication for anxiety depression maybe one or two medications they might be taking something for sleep. Sometimes they're taking something for pain. So, you look at chronic non cancer pain anxious people folks that aren't sleeping and autoimmune disorders and that can range from any age. So my youngest patient was a 5 year old with epilepsy. My oldest patient was 98. She just passed away last year. (So 98 year old woman on cannabis.) You bet. Wow. I have a little lady who was 86 couldn't tolerate the oil. We tried capsules. We tried decarbing she couldn't do that. So she said that's it I'm going to vaporize. So she would vaporize a one to one cannabis at night. 4% THC and 10%CBD.  She said she hadn't slept so well in years off her benzodiazepines. So, you look at that population of people. It's really all comers but generally I see patients and referral that are on a litany of medications with the with their goal of reducing their pillowed. I want to reduce my opiates I want them to feel better.

Kirk:  So if I walk in here with a full leg cast because I broke my leg injuries and pain relief would I be a candidate.

Dr. Turner:  Sure. Absolutely. So when you're looking at some of the research just in terms of bone healing CBD has a big part in that big part there is an active part. (what does CBD not do) Exactly, I think everybody should get Vitamin CBD. So I think in terms of the anti-inflammatory component and also if you've broken your leg probably on some sort of pain medication probably an opiate so and why not try and reduce that risk. Which brings me kind of to another interesting thing when you talk about the right medication for the right person. All of those things so I'm in the business of reducing harm.

If I could looking at addiction and all the stuff that we throw people primarily opiates Benzo all those kind of bad actors let's say Kirk you came into my office and you said you want show I really I'm really having a lot of pain. Got a little bit of a history here but I'm really concerned about the opiates because I really don't want to get addicted. Say hey why don't we just do a little swab. And why don't we look at your genetic expression your opiate receptors and see whether or not maybe you might be at risk for addiction because we know 50 to 75 percent of people that have addiction. It's genetically predisposed in your genes. So imagine if I could remove give you that information so you know what you're really a high risk and perhaps an opiate is not your best option right now. And if we decide to use an opiate let's really be careful.

So when we talk about. So that's a huge part of what I'm very interested in you talk about evidence based versus evidence informed I am a McMaster University graduate. I come from the school Gord Guyatt who is the evidence-based medicine guru. So I am really kind of outside the canoe right now and kind of floating in the water here and I'm looking to create a body of evidence that supports the work that I do and I'm looking to my colleagues in the other can do to try and throw me a lifeline and pull me in and continue doing that research right. So what we're doing with all this data collection we need answers like when people ask me why does this work. Well this is kind of how we think it works. And how does it work in your body. Well for Kirk your your genetic predisposition your genetic expression of CB1 and CB2 receptors and all the variants your cannabis might be different. Whereas Jackie my clinic manager here I look at her genetic expression she might require different cannabinoid profile. So when you start thinking about that. Could we talk about you as a man of a certain age with certain illness as a as a star in the sky or are you are you. Do you belong to a group of folks like you and a constellation. do I make medicine for that constellation or do you make medicine for you. It gives me answers and this is what we need. So when we talk about these patients coming to us that are you know they've been on a litany of medicines. They're there immobile their quality of life is the pits. What medicines are they on and are those medicines really working for them. Let's do a profile.

Kirk:  You can actually do a swab of somebody to get this to their genetic make-up of how any painkiller now and you it reacts to them. So, you're saying to me you can actually create a recipe for an individual on their pain management. Is that what I just hear you say.  That's fascinating. Why aren't they doing that with other analgesics.

Dr. Turner:   It's cost. Right. So you can have you know you can go online and have this whole genetic testing done for five for $499. OK. And they can look at 150 different medicines and you carry that profile for the rest of your life. And you can take every doctor and say hey.

Kirk:  So why why why isn't that part of the health care plan.  Doctors, I mean it's coming. I've got so many examples of where people have gone to doctors and walked out with scripts that are unbelievable. And like the amount of money spent on analgesics Tylenol 3, morphine, hydromorphone. So, if I could go in and just basically get a swab for 500 bucks and you can you can I mean you could save the health care system 1000s.

Dr. Turner:  Well that's the mind-blowing. Here's another mind-blowing question why can't patients go to a pharmacist to get their medical cannabis. Because another trusted member of your health team.

Kirk:  That’s Trevor’s rant.

Dr. Turner:  We're in the business of collecting data. So a patient comes in they're going to do scores on their anxiety or depression their pain scale how their sleep is that these are standardized tests that are all accepted within family medicine. This is not rocket science right. This is stuff that we should be doing all the time. And in fact, anybody that is anxious should be doing these tests we check for opiate risk tool anything that we can throw at that patient that they want to do because they're tired of me because I always say them when you come to see me we're doing science because I'm a McMaster grad and they have they've opened up a center for medical cannabis research and a study called data can and you can go online. My patients see me here. Every patient that is living with chronic noncancer pain over the age of 18 can register online with datacan study in education they get questionnaires and we hope to have them followed for five years. Ours are two sites Thunder Bay and Manitoba the highest volume this is going forward. This is going forward right now. It's happening right now. Okay. And then going forward. Red River College is really taking the leadership role and cannabinoid education is very likely to. Develop the Cannabis 101 course there as I said Dr. Faith Dielman who is my research assistant did all the heavy lifting and getting all that stuff done. But it's true that there's so many other things developing from that and looking at different research projects to to work kind of talking with talking about the genome mix and any OMICS metabolism is all of that potential to do that research when you have a database of patients who are willing participants so again you have to go through research ethic boards for those patients to participate.

I feel kind of like I'm riding a horse out west and I'm being you know, I mean there's many people in front of me. You know all of those big research Ethan Russo. I'm I learn every day in this in this practice. There is not enough reading that you can do to keep on top of things and to kind of get things straight in a system that isn't even fully developed in a in an emerging field of medicine. Like we're kind of building it as a kind of riding across. So exciting times challenging times.

Kirk:  What advice would you give a doctor that says I'm afraid to do that.

Dr. Turner:  Pick one patient pick one of your patients that you feel is stable that they know that you're concerned about the dosing of opiates that patient that you're thinking oh my gosh I'm going. Am I going to rotate that opiate. Can I add in some CBD and THC and see what happens that patient has to be motivated but have that conversation in the earlier days I used to have you know do a talk and then I give out my number and my email if you need somebody to walk you through this I will do it because I think if you just start with that one page it really you learn you learn from them learning together. I think that, when we talk about the dosing for cannabis I think people are really quite surprised at how little you're using. So patient rolls up a big joint outside and smokes what's in there like you could have 100 milligrams of THC versus most patients are using less than 20 milligrams and in divided doses and in oil or caps and vaporization and between maybe not everybody is over a day over 20 or 30 mgs maximum a in day for some people. For my elderly patients like me you have to be very cautious because one of the great side effects of cannabis those is you see a lot of patients come off their blood pressure medications a lot of these patients will their waistlines get a little slimmer and they're sleeping better. So (they're losing weight on cannabis.) It's shocking. You lose weight on cannabis. (How do you lose weight on cannabis). It's the great disrupter. You know so there's a lot of things going on there. I think it really has to do with endocannabinoid tone. And as I had said earlier you know we're living in a time where everybody's drinking life out of a fire hose and really don't have time to kind of reach up and turn the tap. I think what a healthy endocannabinoid system does is allows you to reach up and turn the top down so that you can drink freely and not be choking on life.

And I guess it's really about how you walk through life. You walk through life and you struggle to define life's tough in terms of managing. I mean there's other strategies. Do you need medication to do that. You know the first the first thing that you should do is look in the mirror and see you know where that resiliency needs to come from and use those strategies. But in terms of a healthy endocannabinoid system we make our own cannabinoids. I tell that to my patients I said we're sitting here making our own cannabis in our bodies. Can you believe that. Do you feel high. No. So but you know if you have a patient living with a chronic illness I don't think it would hurt to try. A trial on it. When you look at the World Health Organization releasing a paper in January 2017 on cannabis it is essentially a benign substance with low addiction. Right. So let's try it right. You have a low risk of 9 percent of the population will become addicted to cannabis. Look at the other numbers for alcohol tobacco opiates much higher and always alcohol tobacco.

Our focus is really to empower people through education. You know the strength is from within and I think we've forgotten that we've lost the ability to look after ourselves. When I was doing it when I first started out in practice I was working in a rural community you know doing all of it. And I moved into a kind of another practice where it was very family oriented and I thought if one more person came to me with a sore throat that they'd had for three minutes asking for antibiotics, I thought what has happened to us what has happened how can we how have we lost that ability to manage ourselves. But I think it's really I think there's many reasons why but I'm a bit of a butt kicker. I always tell my patients that's your meat wagon that you're driving. But I'm a great navigator so my patients will always I always say you can't see my feet under the desk but I have been fuzzy slippers and I'm going to powder your butt all the way down the road. If you decide to go in the ditch your choice.

Kirk:  Ultimately it's your choice to be the patient responsible for them. Absolutely. Where we're going to be five years from now because you talk about the early days are five years ago.

Dr. Turner:  I think I've posted something on Twitter saying remember remember when our lives when when cannabis was illegal and our lives were normal like it's it's a crazy area right now and everybody's trying to find their neach and really for the last five years have just kind of kept my head down and now I'm kind of lifting it up and looking around and seeing like-minded clinical researchers like-minded folks that are really wanting to get a better understanding. So five years from now Kirk you and I are going to be talking about psilocybin psychedelics and how we're going to change the way we care for people.

Kirk:  Through through the drugs that have been illegal for decades. Isn't that fascinating.

Dr. Turner:  It's amazing. Full circle. Here we go. I think that we need to continue to have this conversation about how we care for people how we perceive people that are living with addiction. And I think we really need to change our language about about addiction. I think we need to talk more in terms of people living with a chronic illness because that's essentially what it is rather than moralizing why patients are living with addiction and why they do the things that they do. I think we really need to change our language and we need to support those people with with the appropriate people and the appropriate tools. And we need to also, I never thought I would be a become a very political person and I realize that medicine is business hugely political and so here I am never in a million years would I ever say that but I think it's important that we can talk to our community leaders. Community leaders, provincial leaders and to open that dialogue and to talk about removing stigma from that population of folks as well as opening our minds to medicines that have been on this planet longer than we have medicines that we have receptors for that probably we should be using on some level. I think everything that we need is here but we just have to have the will and the right people.

Kirk:  No longer a family doctor are you?

Dr. Turner:  Well I I think always I'm always going to be an old nurse. I'm always going to be a family doctor. But really this is really lit. This is my mission.

Kirk:  To educate people. So you're open to it. If we do have other doctors and other specialists you're open to call me out. Check me out. Give me your shout counters. Absolutely. Thank you very much. Yeah it's been a pleasure. Thanks. Wonderful.

 

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