Episode Transcript

Video Transcript 

Trevor: Kirk we're back. Yeah so it is as you can see by the poppy on my lapel, November-ish when we're doing this recording anyway. Yeah and we talked to one Manitoban and one gentleman from Ontario So I guess an all Canadian four voice thing. What did you think of, and this is our second time with Apothacare, but I thought it was a nice spin on what they're doing. One, and you know, not everyone needs a trauma story. That Sean has been involved in the cannabis industry for a long time and has been, you know, done legal cannabis through like Canopy, he owns his own distribution company and two stores in Manitoba, one in Winnipeg and one in St. Anne, which we'll talk about, but he also has heavily involved in, interested in, sort of as a recreational guy. We'll call it that, but has lots of roots in the helping people out, you know. Cannabis may or may not have been involved in him helping deal with the trauma of his brother passing away at age 11. He now has elderly parents who have medical issues. Bringing medical cannabis stuff, clinical cannabis, helping people cannabis, into what would be traditional rec stores seemed to be a natural fit for him. And the other, and Ajay, another really interesting guy, pharmacist, I thought it was cool that he sort of kind of stumbled across cannabis education during his training and found out basically pharmacists have none of it. And started working on trying to do cannabis education and eventually just went well why don't I just talk to patients directly as I've got this education. Your standard pharmacist doesn't why don't I educate people directly right in the rec stores where they are now

Kirk: Yeah, it was E149 we first met Apothecare and they're an Ontario pharmaceutical company that are picking up with rec stores. So in episode 149 or the video number seven, Stoked for Apothecare is we discussed how they are joining partnerships with rec shops to meet a market need. I've often said that health care seems to be ignoring cannabis. Right now the Canadian Medical Association have pretty much told their members that cannabis is not medicine, although many doctors are prescribing cannabis. The nursing profession seems to one of the very few professions that actually have policies for their membership. So the College of Registered Nurses of Manitoba actually have policies of how to use cannabis as medicine and Whereas my search and someplace in the interview I think I mentioned it or maybe it didn't make it, but I did a quick search of colleges in Manitoba professional colleges in Manitoba. That's the pharmaceutical college that is nursing colleges. That is respiratory therapist colleges physiotherapist. Any of them that have policies view cannabis as a substance of misuse and many of the policies were developed in 2017-18-19 when rec cannabis became legal. So... What I like about this conversation is that there seems to be this pharmaceutical business in Ontario, that recognizes cannabis is being used as medicine and bought from rec shops. So this is what this episode is about. When we come out of it, I wanna talk a little bit about the ethics of this and the politics of it because although I appreciate what they're doing, I just feel a rant coming on about how cannabis is being ignored right now by healthcare. And I congratulate these guys for doing this. So yeah, I'm I'm being pushed and pulled on this on this episode Trevor. But I think maybe we should go on and talk to these guys and see what they have to say and then come out and discuss What they said to us? What do you think?

Trevor: Sounds good. Let's listen to Sean and Ajay.

Sean Stewart: Hello, everyone. Thanks, Trevor and Kirk for having us on here. My name is Sean Stewart. I'm the founder of Supercraft Cannabis, which has two licensed retail locations in Manitoba. I am also the president of 100 Pounds, which is a licensed retail distribution. What can I say? I mean, I've been involved personally in cannabis for over 30 years. As a daily user. Um, it's helped me through a lot and, um, you know, I really believe in the application as a medicine for certain people, not everyone, but, um certain people, uh, and yeah, I mean, we were, we came here, I actually, I'm from Toronto, I worked in the legal side of cannabis, uh I actually started working for a canopy growth, uh prior to legalization. So I've been involved, pre-legalization up until now, which is, would be, I think considering like a somewhat of a veteran in the legal side, at least. And then as I said, 30 years before, but we, we launched Supercraft St. Anne about four and a half years ago. We moved from Toronto during the height of, or the beginning of COVID. Uh, to a little town in Manitoba called Steinback, um, and the entrepreneur in me noticed the opportunity that there was really no, uh, licensed cannabis stores outside of Winnipeg to the Southeast. And so, yeah, started working on it took about nine months from start to finish, uh and then we launched in June of 2020. Uh, so, uh, you know, in terms of Super Craft, our focus has always been craft. Um, you, we, one of the things that I've been involved in heavily from the very beginning is I've always just been into super high end cannabis. It's kind of the groups that I hung out with when I was younger, up until university, et cetera, that's, that the one thing that we were always into. So. Was interesting because, and not to go on forever about this, but back to St. Anne, what was interesting is that the business model in terms of, you know, carrying craft only products or family owned business type products and really focusing on the ethical side as well as the high-end side. It really, it just worked. And There were a lot of doubters, honestly, particularly in that area, because it's very deeply rooted in the black market or legacy, whatever you wanna say. But yeah, it's worked. And I think one of the main reasons for our success in that location are exactly what we're gonna talk about today. So like the senior citizen population. Yeah. And so that that's kind of me in a nutshell.

Kirk: I like to get a little deeper. I'm a little bit of a nurse, right? So backstory, university, what's your university major and how did you get into the legal profession in the very beginning? Like what's, where's your passion? I mean, yeah, recreational user, but like are you business major? What's your University?

Sean Stewart: Yeah, I've got a kind of an interesting past, I would say. My degree, I went to McMaster, my degree is in economics and math. I'm an artist by, you know, so I, not to say that my degree was the foundation for why I'm doing what I'm now. Um that's just i i think it's innate like I'm an entrepreneur um but the one thing that i will mention in terms of the very beginning um you know when i was 11 my brother passed away and uh as you know all kids kind of or all adolescents within that age uh you know it it could go any which way. And for me, it started in cannabis. In fact, it started a little more broadly than that. But it was one of the things for me that has kept me, you know, calm, cool collected for the last 30 years, I would say. And to answer your first question about getting into legal I don't know it was weird it was for me I had a couple of different opportunities and, um, I was actually before I got into that, I worked for Holt Renfrew. So I was kind of like on the, on the fashion side, um. For a while and just never thought, I mean, again, going back to like smoking weed for, at that point, you know, almost 20 years, I never kind of put it together. And then when, you know, legalization was coming up and I had some friends of mine that got into it, they're like, Hey dude, like you should take a look. And honestly, at that point I was like, I don't know. I don't know if I could work for a legal company and yeah, fast forward, whatever, almost 10 years now. here I am.

Trevor: Thank you, Sean. Now that actually segues nicely, so for those who don't know and may talk about it a little more later, St. Anne's is a traditionally very French community in Manitoba, and like a lot of little communities like the one Kirk and I live in, a lot of seniors. Seniors have a large interest in cannabis. And I think that goes nicely to Ajay. You're a pharmacist and we have talked to your, uh, your, your co-founder Anusha before about what you guys are doing, your company's doing with, uh. With rec stores, but how about just a quick recap, uh who you are, what your company is and what you do. And then sort of we'll go into how you and Sean got linked up together.

Ajay Chahal: Yeah, absolutely. So my name is Ajay, pharmacist, graduated from U of T, co-founder of Apothacare, which is a pharmacist led cannabis consultation company, with the inspiration behind it being that healthcare professionals are not educated in any real way about cannabis. And given that. Patients were looking for information about cannabis, its therapeutic benefits, and there was a massive gap in care. That was the inspiration for founding Apothacare to address this gap. And what we noticed was that patients were going into retail stores, I don't even call them rec stores anymore because there's a massive breadth of products there. So they're going into retail stories, asking about cannabis what it can be used for, like insomnia, pain, anxiety. And they can't get essentially the medical expertise to ensure that it's safe, appropriate, getting dosing, medication interactions, and that's where we founded Apothacare. We made sure to educate ourselves with the clinical literature and worked with budtenders to try to accumulate as much information about cannabis and provide consultation services for any Canadian virtually across Canada. So we partner with different retailers who are wellness-oriented. To address that gap. So if a retailer is getting a customer or patient coming in asking all sorts of questions like, oh, can I take this with my medications? What can I use for the pain? I'm dealing with cancer and I want something for the insomnia that I'm experiencing with chemo. What can they do? They have a, the retailers now have a service where they can. Refer to Apothecare, we can do an in-depth consultation, make sure that cannabis is safe, appropriate. We don't diagnose, it's really focusing on doing a very careful history of what their current conditions are, what their medications are, see what products are available and what makes sense, what dosing makes sense. And then sending them back to a retailer to then purchase that product and ensuring that the products that they're buying are from retailers that are licensed because we've had a lot of consultations where patients come to us and they thought that the black market store that they were purchasing cannabis from was a legit store. So there's a lot education around that as well.

Trevor: Okay. And I, and after this, we'll, we will go into more interesting detail, but let's pretend I'm a, uh, a patient. Uh, so, you know, I'm, I am a 50 something year old pharmacist. Well, I will have a 50, something year-old accountant and I walk into your store, Sean, and you know I play fat old man hockey and my knees hurt. And one of my buddies said that, you know, something in your store might help me. Ah How does that start and how might you refer me off to Ajay and Apothecare?

Sean Stewart: Yeah, so, and I wanted to just go back to what Ajay said, you know, and emphasize this, is that even within the agreement that we have with the MGCL and other licensing authorities, we are not, like it's blatantly in bold letters, we are NOT to provide medical advice. And so A lot of people don't know that. I mean, everyone that comes in seeking medical advice, you know, they obviously don't know that. So in your situation, what we normally do is we can, there's a couple things we can do, we can provide general guidance based on Well, one is would be like anecdotal kind of analogies, or the other would be, you know, just narrowing down options based on symptoms, for example, sleep, CBN, right? And those two things, so that obviously takes a, you know, an educated person to be able to guide them to those specific areas, let's say. For me personally, what, if I were in that situation, I would, uh, you know, and it, it, I guess it really just depends on, um, what the symptom is again, but I normally go to, uh, an anecdotal story, um about my mom or my dad or, um you know just like past experiences we can somewhat travel into that realm because it's kind of it's teetering that fine line between you know medical advice and just like talking about my mom and where we would normally provide a connection with Apothecare there's a bunch of sorry my dog.

Trevor: No worries.

Sean Stewart: There are a lot of different reasons why we would, one example comes to mind that literally just happened yesterday. And that was a friend of ours have a son that was just recently diagnosed with cancer. So these are conversations that for me, that is not even a conversation that happens in the store. That's kind of like a direct connection. Um to a medical professional so there are some situations where um you know it's clear that it's not just like try this take it home and see if it works it's it's more or less you know what uh you know how should this be administered to this particular patient. My dad is another example. He's in palliative care right now with dementia. And he added CBD to his medicinal regimen. And that was, again, that was a consultation with a nurse, but kind of where we draw the line in the sand, again, are those anecdotal stories. And if we feel like that conversation is warranted beyond that, or if the customer could see some benefit in connecting with Apothecare, then we make that connection.

Kirk: Sean, you're your client demographic. You've got two stores. Do you find that there's a difference in demographics to community? And who do you see more of? Do you see young people? Are you seeing older people? What what are you seeing in your store?

Sean Stewart: Oh, totally. And I would say or I would argue that the there are vast differences in the demographic. Well, yeah, between the two stores, one being in Winnipeg, in Bridgewater and the other being in St. Anne, there are vas differences. I would also say that there are probably vast differences within different parts of the city or even different rural areas.

Kirk: But with your store, specifically, you see more seniors in the small environment or more seniors in the urban environment.

Sean Stewart: Definitely more seniors in the rural areas. Yeah, it's the, and don't get me wrong, there still are young consumers that we have. I mean, it was probably like a 50-50 split all over the place. But what is surprising are, for St. Anne. But what is surprising are the sheer amount of 60 plus that do come into the store.

Kirk: And do they have more questions than the young users? Like, do they come in with more, I know you can't prescribe, but do they kind of with more medicinal type questions than the younger person?

Sean Stewart: Absolutely. Yes. However, on average, likely. But everyone from, you know, a 20 year old up into an 80 year old, they kind of all have the same types of issues if they're going down that medical route. Okay. Right. Sleep, pain, anxiety.

Trevor: So Ajay, no, I'm just going to jump. Add in whatever you want, but let's say, so I have visited Sean, I'm a 50-something year old accountant, but I happen to slip to Sean that, but also, you know, I've got prostate cancer, but it's well controlled and some diabetes, and you know red lights go off in Sean's eyes. He says, yeah, I think you should talk to Ajay. So if I have now talked, how would I get a hold of you, what happens next?

Ajay Chahal: Yeah, so there's two different ways. We wanted to make it as accessible as possible. So we have our toll-free phone number, which you can call direct and get information about our services. And then we can book an intake where we go through your full medical history initially to make sure that we have all that information. And then, we do a consultation. So where myself or Anusha are reviewing the intakes in terms of... You know, the medications you're on, your medical conditions, your social history, things like is there a close family history of say like addiction, psychosis, anything that would be important for us to make recommendations. And then when we book a consultation, that's when we go through the actual information and go through process of different products and what makes sense. This is all done virtually. So it's done on clinic software. So we either do it via video call or by phone, whatever is preferred by our patients. Or you can, if you don't wanna give us a call to book an appointment, you can book online. So at www.apothecare.ca, you book direct online and schedule a consultation where we'll do the intake and then the consultation afterwards.

Kirk: Ajay, are you using standardized tools? Like, are using tools other practitioners might use? Or are these questionnaires that you guys have come up with?

Ajay Chahal: So we, if let's say there's a flag of something where we've created the intake personalized for ourselves, but let's if someone has like an addiction background, then we will use a standardized tool to assess that in greater detail so that we can have a more educated, precise look. Because we're not doing diagnosing, we're gonna do like the certain scales when it comes to like depression, things like that. We're doing more of a history and then it's more of, think of it like a very in-depth OTC consultation, like an over-the-counter consultation.

Trevor: And without going too far, no, no it's okay, that was actually on my list, and without going too far down the pharmacy weeds, I'll try not to bore everybody, but drug interactions, that's a big thing, a part of what both of us do just in our day-to-day, but not so easy necessarily with cannabis, it's a little harder to sort of plug that into a standard drug interaction algorithm that, you know, I've got in my pocket right now. So I'm on 15 meds, how are you figuring out what might be a problem and what might not?

Ajay Chahal: Going right down to the first principle, so we're looking at how each medication is metabolized, looking at therapeutic windows. So for example, like if someone's on atorvastad in 10 milligrams, which is a cholesterol medication, large dose range, and you're at 10 milligrams which is the beginning dose, CBD can interact through an enzyme metabolism, CYP3A4, I don't want to get too complicated, which could increase the amount of that medication in your system. But given the dose range, those from 10 to 80 milligrams, we're not as concerned. But if someone's on, say, warfarin, which is a blood thinner with a very narrow therapeutic index, so if your amount of that changes in your blood, that could have significant bleed risks. So we have to go through each individual medication, assess kind of what is the therapeutic window, we'll say, in terms of its safety, and make a clinical judgment on each and every single medication. Fortunately, there's no clinical tool that we can just plug it in and it'll tell you, oh, this is exactly what you should dose at. It has to be a very careful clinical thought process in terms of looking at dosing, what's safe and appropriate, and then monitoring too. Okay. And so.

Trevor: You've decided, you know, my fictitious accountant with sore knees and some prostate cancer and diabetes, you've decided it's all, you nothing seems, the interactions are seem fine. And the two of us have decided together that, yes, I'll make something up. Some CBD oil might be an appropriate thing for me. How? How do we complete the loop? How do you send me back to Supercraft? Or what happens next?

Ajay Chahal: Yeah, so a couple of things. I write up my note formally, give access to the patient, get consent for them to allow me to also send that note to their family doctor to keep everyone in the loop. I then will call Sean at Supercraft, say, just talk to, after getting consent from the patient. But I call Sean Supercraft say, talk to the patient, this is the product that I recommended. This is his name and phone number. You can give him a call, let him know that you have the product ready. I've also told the patient that who was referred out by Sean, that the product will be available at Supercraft. They'll give you a call so that to confirm that they have it in stock and that it's prepped and ready for you for pickup.

Trevor: And then I guess you must be in pretty close contact with Sean because something I've run into so ideal slightly a little bit ideal with actual cannabis patients are even older they're in care homes and we're getting sort of stuff mailed into them and something we've been running into is you know we had a one particular 20 to 1 THC CBD thing that was working well for a lot of people then suddenly wasn't available, which, you know, now we've got to drop a whole bunch of new dosing regimes for the nurses. That's... I didn't want... The point is, it took a little while to get, you know, to talk to the nurse, to the place it was getting mailed from, and it was a little annoying for everybody involved because there had to be so many people involved. Do you sort of have a... A catalog or something of Sean's so you know what he's got or do you give him a call ahead of time or how does that get coordinated?

Ajay Chahal: Yeah, so the retailers that we work with, every time that we do a consultation, because we know that products will change formulae or what's in stock with different retailers will change over time, depending on availability, new products coming out. So prior to each consultation, I go check the website, see what's available so that I'm not recommending a product that might not exist or might not be available, making sure that there's a good product for that particular condition prior. To doing the consultation. So I take a look at the intake, I get a sense of, okay, which different type of products might be beneficial. And then after I've done the consultation, then we solidify on one, and then I make sure that it's available. If it's not, then I look at alternatives, talk with Sean, see what selection he has. If there's any gaps, we'll talk about, okay, what product might need to be brought in, and then go from there. Make sure that our patient is supported.

Trevor: Sean, just to finish the loop on our little fictitious person, how's this been going? Have customers been liking this, using this, as we've been working?

Sean Stewart: Okay. Yeah, I think it's been going great so far. As with anything like the adoption is, is, you know, over time, it takes a bit, a bit to for, you know staff to get comfortable having those conversations. But what I will say, and just going back to Ajay's point, in terms of, from our perspective, and getting, getting involved in a program like this, I I think we have, we've always kind of prioritized it, but I think any, any retailer that is getting involved with Apothecare is now prioritizing, ensuring that we have specific types of products in our store. And so that's, when it goes back to the question of, you know, things changing, things change, it is frustrating from a retailer's perspective, but it is, I mean, at the end of the day, it's just business for certain things, so. Um, you know, we do our best to try to cover all of the basis in terms of what's out there and available with, you now, minor cannabinoids, CBD, THC, uh, non-THC, uh,

Trevor: And last, before I let Kirk lose, because I know he's always has a million questions. So Sean, you obviously, sorry, you're a business person, you obviously make money when people buy the product. Ajay, how do you get paid in all of this? Who pays you and how does that work?

Ajay Chahal: Yeah, so the patient, unfortunately, it's a non-OHIP or I guess, I'm not sure what, it's non-provincially covered service. Yeah. So it's $75 charge for the full comprehensive consultation on Apothecare's end to do the assessment.

Sean Stewart: I'll jump in there too, because I think in some cases, I mean, for the example I said yesterday, you know, a lot of the times we're, as the store, we're just willing to chip in that 75 bucks because we've built a relationship with that customer and for us, it's just a little something extra that we feel like we can do for the community.

Trevor: No, that's very nice. Now, put my pharmacist hat back on. Yeah, pharmacists are terrible getting paid for our services in general. So I like what Ajay, whoever ends up paying, I kind of like that Ajay is telling people, look, the pharmacist services is worth 75 bucks. Now, whether it gets paid for by the store, by the insurance, by the patient, just, you know. Pharmacists now I'll try not to get off my soapbox pharmacists were terrible about getting paid for our the extra services We do but I'm gonna stop this. No one else cares about that, but me. Ajay? Legalities. You are based out of Ontario you and Anusha you are doing this across Canada What do you know about? So in as far as you know, are you A virtual consult is, you know, like someone from Manitoba, virtually ending up in your, in your consult office in Ontario. So you're that works or, or do you have to do different things for different provinces or what do you know about that?

Ajay Chahal: So because our service, our location, everything is based out of Ontario and business address, everything that we do. So it's looked like as if someone calling from Vancouver to a pharmacy, if I was working in the pharmacy that day asking questions about products, pharmacist is able to practice just like they were in Ontario talking to a patient in Vancouver. So that's how it's treated and we do everything with through our EMR system. So everything's documented, documented, HIPAA compliant to ensure that we're meeting those requirements.

Trevor: I'm sure you got questions before I keep going.

Kirk: Yeah, no, I really appreciate the service you guys are providing, but I do have some medical legal issues I want to discuss. And one of the things I want to say is the services, the Public Health Agency of Health Promotions, Chronic Disease Prevention in Canada just put out a study about the perceptions of cannabis among adults 60 years and older. And you guys are definitely meeting the needs and the results of this study. But what I'm finding interesting is you are an online store, right? AAA Cannabis is an online store under under Supercraft, right,.

Sean Stewart: Correct? Yep.

Kirk: So are you your rec store, but you can buy online. So are you also a medicinal cannabis store? Because.

Sean Stewart: Yeah, go ahead, sorry.

Kirk: No, I guess what I'm asking here is that Canada has two systems, right? It has the medical system, which is online purchase. You get your prescription from a doc or a prescriber and you go online and you get your medical cannabis. We also have the rec cannabis, which is the brick and mortar. Now we all know that everyone are using brick and mortar now because it's easier, it's more convenient. We kind of, you guys have sort of found a loophole around the medical cannabis system because you're offering people cannabis for medicine, because they're coming to you for help, right? I mean, and I'm being careful with my language, because we all, I believe everyone that uses cannabis uses it ultimately as a medicine. And Sean, you mentioned that with your discovery individually. And I led you into that because you discovered cannabis, and you found that it helped you cope as an adolescent. And now you're helping people. But have we not circumvented the medical system here? In a good way?

Sean Stewart: Yes, I will say that, and I don't know if it's necessarily circumventing, maybe it's more of an evolution. We've seen this happen over and over again in the U.S. In terms of the starting with medical and then turning into recreational and then more or less the abolishment of the medical side of things. I think that's just a natural progression. I feel like there are a number of reasons why people don't necessarily go through medical. One is obviously convenience. The medical system in Canada is, well, there's a few different avenues, but in terms of buying finished products like oil, it's only mail order. So, you know, versus driving 15 minutes down the street and grabbing what you need right away, That's one strike against it, I feel. And, you know, in my mom's experience, quite honestly, like she's found that the medical and this is, we could go really deep into why this is a thing. Um, but the medical products are actually more expensive than the recreational products, apples to apples.

Kirk: Yeah, it's the whole tax issue. We've done episodes on that. Understood.

Sean Stewart: Yeah, right. So so those two things alone is like convenience and price are, you know, those are two of the biggest drivers for consumers. So that's why I would say it's definitely it's definitely shifted or is shifting.

Ajay Chahal: And I have some comments to add too and to reiterate the price comment is when I was doing a presentation at a cancer center just doing talking about some of the myths around cannabis some general information one of the patients there went through the medical access system and she was telling me you know she's not working right now she's going through chemo money's tight and she's stuck having to pay I think close to a $100 to get her CBD oil because that's the only way to get the shipping for free. And she told me about the product and I'm like, oh, the cannabis retailer down the street has the same product and you don't have to spend $100 at a time. And she was mind blown by the fact that she could access the same product for significantly cheaper, not having to bulk buy when finances are tight. So there's limitations within the medical access route. You need to find a physician that will prescribe it for you. So how many Canadians have doctors? There's a whole access issue there. And then Canada Post is on strike every few months, and I believe they're shipping it. So there's access, even if you have everything. And then we've had some scenarios and different cannabis clinics that are prescribing medicinally. Some are fantastic. We've gotten great feedback from other patients. And then others, patients find that they are kind of on their own to sort out and choose. And figure out the product selection themselves, which they find incredibly intimidating and they'll have their consult medically and then they come to us after and then we'll do a full consultation with them and then help them select a specific product so they get the support that they need. Because when you're 70, 80, trying to figure that out by yourself, it's incredibly daunting.

Kirk: So what do you find the product you're dispensing? I'm going to use the word dispensing here. What product do you spend some more? Flower, oils, where do you seem to be putting an emphasis?

Ajay Chahal: It's 99% of our patients are like not, are like more like first time users or they, because they're 60 year old plus would be the majority of our patients. They might have used cannabis like 30, 40 years ago in their youth, and now they're thinking about using again, they're like, this is completely new. So where it's oils, capsules, it's not flower. We've had some patients who are already using flower and then we'll discuss that but it's really more so people are new to cannabis they don't know kind of what to do what to look at and it's all it's typically the oils and capsules.

Kirk: And are you giving them a prescription in the sense start low, go slow for three days this much until you're getting the result? Are you actually giving them a recipe to follow?

Ajay Chahal: Yeah, absolutely. So we give them like clear guidelines. So I had a patient like that just earlier today, I did a consult said, initiate the dose, because he was doing and I can't get too in to the details because of privacy, but he was combining he was at a retail store and combining a couple different oils together, massive CBD dose, like almost no THC needs some and no CBN for sleep. So optimize that, took them off those, chose a product that made more sense. Said first day, first couple of days, start at this dose, then increase to this after a few days while monitoring your sleep because we're trying to find an effective dose before getting into the recreational doses. And then I'll be doing a follow-up in a week to see how he's doing.

Kirk: Well, this service is neat. I was just sitting down with a friend of mine at a meeting and she was asking me about cannabis stuff. So I sat down, what are you doing? Well, my daughter gave me CBD capsules that I'd take three times a day. How much? 300 milligrams. You're taking 300 milligrams three times day. Yeah. Thinking you're taking way too much. But so my point being is that there are, and this lady is also in her 60s. And the first thing I told her and say, find a prescriber. Right? Talk to somebody. So you're providing that service. When people walk into a rec store, they got that service, I think it's fantastic.  its an interesting model.

Trevor: And Sean, I just want to circle back to you, because again, for those not from Manitoba, you're St. Anne's, small town, traditionally French, older, generally conservative. So that might not be the group that your average Canadian thinks is looking for info on cannabis, but the stigma is kind of coming down, isn't it? Like there are older, more conservative. Catholic French people coming in there and asking you for questions about cannabis aren't there?

Sean Stewart: And what I would say, and we kind of joke about it is, you know, it's, I feel like what was not, well, what was surprising in the beginning was the support from the community. And I feel, like the French community was always very open to it. What's surprising is, and I'll just like, quote unquote, Bible belt area, which is Steinbeck. That part is surprising because what we see more of are seen like conservative seniors coming into the shop and you know looking for these types of solutions. So yeah I mean if you don't know the dynamics between the two places Saint Anne and Steinbach, Steinbach has not allowed cannabis stores and for the foreseeable future, maybe the next call it two to four years.

Trevor: And to give people context, when I was a young person, we'd have hockey tournaments in Steinbach, and my parents would get hotel rooms outside of the city limits of Steinbach because Steinbach at that point didn't allow alcohol. Like Steinbach only allowed alcohol in the last 20 years. So yeah, it's been a very Mennonite, very conservative place for a very long time. So sorry, keep going. Totally, no.

Sean Stewart: Yeah. And that's the, I mean, that just totally emphasized the point that I was trying to make was, um, in terms of the stigma changing, if a place like Steinbeck, as conservative as it is, have, you know, its elders come as they did to buy liquor outside of, you know, in St Anne and to ask questions about this, then yeah, absolutely it is.

Trevor: That's very cool. I'm loving everything about this story. Sorry, Ajay, we've been any other, we're getting close to the end of time so we'll all and jump in with either of you on anything but we'll go with my usual. Is there anything I forgot to ask or anything you wish we'd asked about Apothecare and older people and Manitoba or anything along those lines that that we should have talked about?

Ajay Chahal: I think we covered everything, just really the importance of anyone who's medically complex on several medications. It's really important to make sure you're getting a healthcare professional that can really assess those interactions with cannabis because even something like CBD, which on the surface many people think is completely benign, can interact significantly with medications. So it is really important for someone to scrutinize that and just make sure it's safe and appropriate.

Kirk: I guess one question I have is, Ajay, where did you get your cannabis knowledge from? Like does the College of Pharmacists in Ontario provide it for you? How did you your knowledge?

Ajay Chahal: Hundreds and hundreds of hours of reading through literature. So what actually sparked it, I became very, so I graduated in 2018 from the PharmD program at U of T, but in 2017 I was doing clinical rotations for the year as part of the regular pharmacy program, and one of the rotations was at a continuing education company called MD Briefcase, and they were one of pioneers to do comprehensive cannabis education modules and back then before cannabis was legalized, I was very curious because I heard about the therapeutic benefits and so I had done a lot of work with them during my rotation and was allowed to do their education modules, which was quite comprehensive. They charged like a thousand bucks for it. It was like 10-11 modules. You had to write a written exam and then you got certified in cannabis therapeutics. And so I was very interested in cannabis, just because I was part of, you know, helping them out and learning about the program. So when I was able to actually do it, I was probably one of the, at that time, maybe the most knowledgeable pharmacy student in the country in cannabis wrote the exam, got certified before I was even a licensed pharmacist, and just saw the potential and the massive gap in care. And that was maybe the first little step, and then there was so much more information needed. Massive amount of information within the retail market with the bud tenders, with real world use, that's just not captured. So discussing with that community was huge in terms of taking your academic clinical knowledge and pairing it with real-world knowledge and trying to do a holistic approach of just combining everything and being very transparent with patients. So I will tell them, you know, CBG does not have a lot of clinical evidence around it. But we've seen what we're seeing anecdotally, that it's been beneficial for for pain, or mood that some patients have been finding in combination with their like a CBD or some THC. So, but it's always got to be that transparency when talking with patients, you can't say, Yeah, this is great. This will work. It's about this this is the clinical evidence, let's try it. Everyone's unique and we'll find something right for you.

Kirk: In the college in Ontario of pharmacists, are they encouraging this behavior? Are you seen as a maverick or are you being told that it's a substance of misuse? How is your college behaving with cannabis?

Ajay Chahal: College has essentially said like practice within your scope and then they don't say Yeah, I do like there as long as you're practicing with your clinical knowledge set with it and what what is deemed appropriate That's that's what they've said

Kirk: So did you get some prescriber information when you took these cannabis courses? Because you are in some ways prescribing as well as helping them dispense. So did in your certification courses, or did you your prescribers, I did that?

Ajay Chahal: Yeah, well that course was geared towards physicians. So yeah, it was, it was through, yeah, so although pharmacist is able to take it, it was like MD briefcase. So it was that particular course was geared towards positions. So I got to learn really in depth how the medical access program worked in 2017. It's still the same. And I saw the gaps. And in reality, once I started practicing in 2018, patients were coming into the pharmacy asking me about cannabis. And I was able to answer those questions, but I know, and you colleagues couldn't, and I just saw this massive gap of, okay, people are going to go straight into retail stores. Is there accessible? They're not going through the medical access route. There needs to be healthcare professionals to address this gap in care. And that's where Apothecare was founded to really try to highlight education and...

Kirk: You're building new pathways in a profession, it's fun to see.

Ajay Chahal: It's hard

Trevor: And Sean, unfortunately we've got to start wrapping this up, but we'll give the last word to you. Anything else we should have mentioned, forgot to mention, that you think the audience needs to know?

Sean Stewart: I don't think so. Just seconding what AJ was saying about, you know, just like really get a medical opinion for those more complicated cases. No, thanks very much for having me on. Pleasure. It's a pleasure working with Apothecare and, you know, I'm hoping that we can roll it out to our other location.

Trevor: So Kirk, just like when we talked to Anusha in the last Apothecare episode, both Anushah and Ajay are pharmacists. So they are virtually seeing patients in their clinic on Ontario. So the way they see it and their understanding is it's like the patient virtually ended up in their clinic and saw them there. And... So that works well for them and I think it gives owners, store owners, rec store owners retail store owners like Sean a nice other option when people start asking them medical questions and they go yeah this sounds too too medically complex or too much like a medical issue for a a bud tender to deal with so I think it's a great combination but I know that leads you into some bigger problems you have with the medical system and cannabis in general.

Kirk: Oh yeah Trevor, I'm all over this. First of all, I congratulate these guys for doing this but. Essentially what's happening is we got a pharmacist and I respect you guys' skill, I've said this often that when I was in clinical practice up north, I'd often phone pharmacists, you being one of them because you're readily available to me to explain medication contradictions and stuff. So pharmacists are definitely important people within the healthcare system. But where in your practice have you been taught to prescribe cannabis? And I'm not asking this cynically, I'm asking this factually. So where, and I also know the curriculum of pharmacy has changed that now a lot of pharmacists are coming out with doctorates. So give me some background on pharmacists and your training on prescribing.

Trevor: Uh... with prescribing cannabis? We haven't that uh... We still there still doesn't seem it seems to be minimal at best well.

Kirk: But prescribing any medication though,.

Trevor: We don't prescribe and uh... The far and very

Kirk: Because there is you.

Trevor: Yeah, Pharm D.

Kirk: But you're allowed to recommend, are you not?

Trevor: Kind of. So first just you said pharmacists coming out with doctorates not to split hairs but there are different things. You can have a PhD in pharmacy but that's kind of a research degree and now most people who come out of pharmacy schools come out with something called a PharmD. A doctor of pharmacy. In my humble opinion it's not really anything other than extra year of training and money grab for the universities. I'm not sure. Back in my day, a PharmD was someone who sort of went back to school or stayed in school and specialized in something. Like PharmD looked after dialysis programs, PharmD's looked after cancer programs, and PharmD is looked after a cardiology ward. But now it's what's called an entry-level PharmD meaning everybody who goes into pharmacy school and ends up working at Walmart has a PharmD. so in my humble opinion, that's kind of diluted down or watered down the whole point of having a PharmD. What can pharmacists do quote unquote prescribing wise? We never really prescribe, but depending on the province, like some of my colleagues can give you an antibiotic if you're female and have a simple UTI. I can do an assessment on someone and give them medication that's normally prescription only for quitting smoking. So we have some limited quote unquote prescribing abilities differing in different provinces like Alberta seems to be almost unlimited like they seem to be doing just shy of running a walking clinic. But yeah, we don't traditionally have a lot of... Training in like physical assessment or diagnosis or that kind of thing.

Kirk: So, from an ethical perspective then, and again, I don't want to besmirch these guys because they're providing a service and I've been, I've quoted myself in the sense that The cannabis industry is creating... Is filling holes in spaces health care is not filling. And I've said this often, for example, the whole concept of cannabis coaches. You know, we have a non-regulated health profession developing, budding, growing, with the help of EduCanNation, the help other experts out there, because we healthcare providers, are not filling that gap. So we need cannabis coaches out there. Here we have a group of pharmacists that have seen a gap and they're filling it. But there's some ethical issues here about pharmacists essentially prescribing cannabis, and they are. I mean, I ask them that in the interview. You're helping people, but you're prescribing a medication. Doesn't that piss you off that the prescribers out there, the nurse practitioners and the doctors, are ignoring cannabis as medicine. That pisses me off. And Ethan Russo, I just had a conversation with our friend Shelly Turner, Dr. Shelly Turner yesterday, two days ago yesterday, we were just talking about this. Ethan Russo has put out a statement, a consensus statement in JAMA Network Open about developing medical competencies in America and around the world. And essentially, they got together doing a Delphi, and we talked about Delphi research before. And basically, they have put out that it's about stinking time the health industry come up with core competency knowledge, and they've put out a statement. So. The cannabis industry is upset with the health industry for not recognizing cannabis as medicine and now we've got pharmacists in Ontario dipping into Manitoba so they're crossing borders here providing a service because we don't have the service. This is great but it pisses me off. Does that make sense to you?

Trevor: No, fair enough. I would like more doctors to be involved. I think what Ajay and Anusha would say is it's still in their zone of competence, zone of expertise because the patient was going to buy and use this medication at the rec store anyway and they're doing a comprehensive assessment basically to make sure the medication they were going to use anyway, doesn't cause problems with A their current medications or B the conditions they already have. So that's kind of what pharmacists are good at you know you know doctor nurse whoever a prescriber gives a patient a medication and the pharmacist helps assess is that safe and effective with the other medications you're on and with the others conditions you have. That's what I would think that Anusha and and Ajay would say, sorry. Anusha or Ajay if you disagree let us know we'll put it in the comments but that that's my interpretation and but to would I like more doctors to be involved absolutely oh and but to just again give Apothecare a another plug they do produce a a document every time they do this and send it to the primary care physician when they've done sort of one of these assessments on a patient. So they're doing their best to sort of loop in the patients.

Kirk: You know what, and I that that is a good comment to make Trevor, I miss that. There is a collaborative nature of practice. I mean, in the recent years, most of the academic literature out there right now is talking about the importance of collaborative practices. It seems like everybody's practicing but but but an old school doctor who believes that they control everything which is which which is really... Difficult to understand when you consider the education of many of the para Paramedical professionals, you know Pharm D's now have this knowledge. There are nurse practitioners out there. There. Are There are you know, physiotherapists now, I think entry-level physiotherapies masters driven So there are there are people out there with as much medical education in their narrow focus of practice as a MD has in the global practice. The assumption that's happening here, and again I'm not besmirching Apothecare, I'm not calling them out, I am just saying that there's a window of problem here and that is, is there true collaborative practice happening? I appreciate that pharmacists do medication reviews because you have the time, you have the expertise, you have to focus, you should be doing that. A family, a family doc does not have that time to focus on everybody's med review. So they get a med review from a pharmacist. Fantastic. Now it's up to the doctor to then look at the lab results, the physical assessment, the objective information, the subjective information they gather from the client and put all that together and say, oh we have a problem with this med. Now you as the pharmacist might point out and say you know this this might be a Consideration to consider with this med but it's up to the doctor to go back and look at the big picture and see if he Wants to make an adjustment to the med that you're talking about and perfect example is blood thinners, right? Dr. Shelley Turner was telling me about how many of her clients are using cannabis with blood thinners and she is having a real tough time trying to get her colleagues in the medical field to respect the fact that not only does she have the knowledge about cannabis but they need to make an adjustment of meds because of the cannabis. So I think Apothecare has filled a gap. I respect that, I honor that, and I support them. But I'm calling out other professions that are ignoring cannabis as medicine, and calling out Health Canada, and not recognizing the importance of looking at cannabis as a medicine as more and more Aging people my age for crying out, you know, I'm a retired I'm retired I'm at retirement age working as a private practice nurse in cannabis. But essentially my peers group are now going to rec shops to get medicine, to get cannabis and use it as medicine and we're ignoring that as a health profession. That bothers me. And we've, I mean, over the last what, year and a half, many of our episodes focus on this, how I've written about it in our blog, how people are using rec stores to get medicine. So, so Apothecare has recognized that and filled the gap. Congratulations. But it doesn't, it doesn't address the ethical question why prescribers, and you say doctors, I say nurse practitioners, I'm saying prescribers, why prescribers aren't paying more attention to this? I just, it pisses me off, Trevor.

Trevor: No, fair enough. But just sort of bring it back to Ajay and Sean. I think, you know, Supercraft and Apothecare are filling a need, helping people out. People are doing better with them than without them. So I think it's a great service that two companies do and a great collaboration. Anything else we need to do to talk about for for these guys?

Kirk: I think that sums it up. I completely agree with you.

Trevor: So if that's it, I think we will wrap this one up. I'll say I'm Trevor Schufelt. I'm the pharmacist. He is Kirk Nyquist. He's the registered nurse. And where should they get more information, Kirk?

Kirk: Yeah, they should go to reefermed.ca. We have a library of cannabis knowledge available to you. And I just dropped my earphone. And I ask you to go to our webpage because there you can determine the episode, the topic you want to listen to. You can watch us on the video. You can hear us on audio by going to our web page. Now you can also hear us iTunes and Spotify and all the other platforms that when you're on the move, you can listen to us, but by going to our web page, you can decide better which episode to focus on because we have a library of information. And if you go into a library, you don't read every book every day, you go to a topic you're interested in. So that's what our webpage does for you that gives you a topic. So yeah, go to our webpage, reefermed.ca, tell your friends, you know, I've often said, Meta doesn't like us. We don't get pushed on social media. We depend on our listeners to share us. And to be honest with you, we are getting more and more listeners every month and I think it's by word of mouth. So please, tell somebody about us and help us get more listeners so we can... Get our editorials out there about cannabis as medicine.

Trevor: All right, it's been another good one. We'll talk to everybody later.