S3E1 - Team Wellness

Did you know some nurses could write prescriptions?  Kirk talks to Nurse Practitioner Erin O'Shaughnessy about her practice.  Erin works for Nalanda Health and prescribes cannabis for clients in need of help.  Trevor talks to Carl Byrne a pharmacist at Nalanda Health who acts as a cannabis educator for Erin's clients.  What does a medical cannabis clinic look like post legalization?  How do these health care professional work together? Why shouldn't you just go to a recreational cannabis store and try some cannabis for your medical condition on your own.  Listen and hear what Trevor and Kirk find out!

Plus a new My Cannabis Story from Jaqui Childs! - find her on @jacquichilds on Instagram.


Friday, 15 February 2019 07:50

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Episode Transcript

Kirk:  I'm off my script man. Now, I've got to start all over.  Trevor, a new season.

Trevor: Kirk, We're back. We're back for season three.

Kirk: That's what advisers are telling us.

Trevor: Good.

Kirk: Season Three, Episode One. Have we come up with a name. The nurse practitioner?  Wellness?

Trevor: Wellness.

Kirk: I don't know.

Trevor: Kirk's Wellness Journey.

Kirk: Kirk's Wellness Journey, that's a long chapter. We haven't seen each other again for weeks. How have you been?

Trevor: Good. No, it's been I would complain about the cold, but you've been farther north and more cold. So it, you know, I don't I think I'm preaching at the choir.

Kirk: I was attached to some nursing stations that actually had the residents attached to the station. So, I went days without being outside.

Trevor: Well,.

Kirk: I did take my Vitamin B tablets to make sure that I had enough nutrition.

Trevor: Yeah. So it's February and stop, stop being coldish and it's starting to snow more. I guess it's still winter.

Kirk: I yeah. You know, again, reading, doing lots of reading. On Instagram I did a bunch of stuff on breastfeeding and I don't know why, I just seem to do the paper I was reading.  I never got a chance to talk to Erin about breastfeeding moms. I guess I should have.

Trevor: But she really liked it. She tagged you on Instagram. She really liked your your thoughts about breastfeeding and cannabis.

Kirk: And check Instagram. We're going with the basically the breast-feeding guidelines. Now, the other thing, Trevor, is lots of stats and not very good ones. The RCMP, 2018 holiday checks stop stats. Week four and final results. This was published January 3rd. Winnipeg, Manitoba. The final week of the RCMP holiday check stop program.

Trevor: OK, between drum roll please.

Kirk: Between December 24th and January 1st. 2019. Forty-seven check stops conducted across Manitoba with approximately fourteen hundred and thirty three vehicles checked. Twenty-four people charged with impaired driving. Out of those twenty-four. How many with drugs.

Trevor: I honestly haven't read this so I'm going to say half. I'm going to say twelve.

Kirk: One.

Trevor: Really.

Kirk: One.

Trevor: Wow.

Kirk: And they don't even say what drugs. They just say one by drug. Twenty-three by alcohol. My reference point, this is coming from the Royal Canadian Mounted Police stats.  Five people charged with refusing the breathalyzer demand. Yeah. Like and again, the Free Press, the Free Press came out and Stat is the same stat. This is January 5th. And what have they got here? My paper rattling paper here.

Trevor: The one guy with a physical paper.

Kirk: The one guy with physical paper. Yeah. Rene's giving me the eye... RCMP Manitoba have laid thirteen criminal charges under Federal Cannabis Act and that issued thirty-seven tickets for violation, punishable by fines under provincial laws, usually for minors caught consuming cannabis or for drivers who failed to store their cannabis in the cargo area of their vehicle. Now there is a stat on the Web page says that they actually got a couple of people, three people who were stored their cannabis in the wrong place. So you know what? I guess what I'm trying to say here is that all the stats suggest that people who are using cannabis recreationally or medically are doing it responsibly, are doing it responsibly. And that's what we thought would happen to.

Trevor: The sky, did not fall.

Kirk: Not yet.

Trevor: It could be coming.

Kirk: Chicken Little is still running around. Let's talk about this this episode.

Trevor: Kirk. So, we finally got somebody who likes talking about nursing maybe more than you. Yes and no. Erin O'Shaughnessy. We've we've talked to her a couple of times. I think we both sort of met her through Shecan the the Facebook group that we mentioned all the time go see Shecan. But she obviously on this Facebook self-help group had a lot of knowledge. So, after chatting with her a little while online, we got finally got you to talk to her in person.

Kirk: Well, in person on person using that, using telephone lines. But once again, it's that whole wellness versus sickness model. And I wish I had more time because we nurses, nurses work on a wellness model and doctors work on a sickness model. And the difference is that as a nurse, our job is to keep you well in your sickness. And we've talked about this, and doctors, they search out what's ailing you and fix you by providing medicine. And that's where pharmacists.

Trevor: And that's where pharmacists come in. Yes, I'll say a couple of good things. But doctors, it's not quite as I'll say. I've met many doctors who really are interested in keeping their patients well. So, branding them all is just going after sickness is probably a little bit stereotypical.

Kirk: Yeah, it's the models of care, right? I mean, in all due respect to physicians, they do practice a sickness model. Now, I have met wellness doctors and they're fabulous. And most of them are actually salary-based doctors, not fee for service doctors.

Trevor: Which a real bugaboo for you.

Kirk: It is it is a bugaboo for me. But this is not a podcast about doctors, it's a guess about cannabis. We found a nurse practitioner who practices cannabis.

Trevor: Yes, a cannabis-based clinic. Now she's got as will go into the interview. She's got a ton of experience and a bunch of other areas. But this is where she's landed now because.

Kirk: Lets meet her.

Trevor: she thinks it's a great place.

Kirk: Let's meet her.

Erin: My name is Erin O'Shaughnessy, and she said I'm a nurse practitioner. I work for a company medical cannabis company called Nalanda. They're based out of Winnipeg. I live near Ottawa, and so do all of the work remotely. My background is pretty extensive. I've been a nurse for 35, 36 years and a bit a little bit of everything between hospital and critical care, community and just a little bit of a little bit of everything. But my first love was really oncology, cancer care. And I started working with children suffering from cancer a number of years ago. And that was when I first got exposed to using medical cannabis because we started using it in the kids going through chemotherapy, if you can believe it. This is back in 2002, 2003. And it was kind of at that point that I started looking. I've always been interested in complementary and alternative approaches to health care and health care issues and wellness and always believed more in a wellness format than an illness format. And you'll understand what that means Kirk. But cannabis really kind of really fit quite nicely. And I marched away from primary care into Cannabis full time about six months ago as things started to get a little bit busier. And I started to see the benefits in things. ya I think I want to do this.

Kirk: We are of the same generation. I've been nursing thirty-seven years and I also have a wide variety. But you know what I like that. I want to slip in a little bit and let's introduce our listeners to a nurse practitioner. My understanding is, my understanding is the way I look at as a nurse, I'm about the wellness model. And physicians, when you look at a doctor, a doctor is about the sickness model. Do you agree with us as nurses, we're sort of looking at the wellness of our patients.

Erin: I would agree with that 100 percent. I think the difference between physicians and nurses and this is something that is very philosophical in nature, right. Is what we call a paradigm. So, the way we're taught to look at people, we're taught to look from a wellness perspective as nurses in terms of how can you help people manage the challenges that they're having with their health so that they feel empowered and in control and that they're making well-informed choices and they're choosing to do what they want to do for their health. It's a little different going in to see a physician. A lot of the time still, not all, cannabis-based physicians are very much in the same camp as we are in terms of this wellness, you know, a Patient Centered Model. But a lot of traditional physicians are trained really to focus on what's wrong with the patient as opposed to what's right with the patient and looking for how we can treat the illness as opposed to what strength the patient brings to the table that they can then come forward. So, in terms of what the nurse practitioner, a lot of people don't know we Registered Nurse first, as you know. I was a Registered Nurse for a long time. We then go back to school, you have to get a master's degree, which I did have a master's degree from York University. Which again, is very socially focused university, very focused on you know, human experience and lived experience and qualitative research and that kind of stuff. I did that and then went back and did a what was a three-year term for me, because I did part time, which taught me assessment, diagnosis, prescribing, managing a chronic disease, those kinds of things. And then primarily we're trained to work in primary care, so in doctor’s offices and family health teams and things like that. But there's quite as you know, with nursing, there's a pretty broad range of things that we can get our hands into. If we are interested in cannabis just happens to be one of the things that came to the forefront for nurse practitioners. In Ontario about two years ago. We became allowed to do this. So a lot of us have moved into this area and it's really fascinating.

Kirk: So. So, you are in Ontario. You're a registered nurse practitioner in Ontario. You're also a registered nurse practitioner in Manitoba.

Erin: So, the way it works is and that's an excellent question. Nurse practitioners, we write a national exam just like RNs do, right. So, you moved from Manitoba to Ontario. You could apply for an RN license here and you wouldn't have to rewrite any exams or anything it just goes back and forth. But in the context of telemedicine, what is important is where is, where am I sitting? vis-a-vis the patients. So as long as I am assessing the patient and my butt is physically sitting in Ontario, which is where I am right now, I am legally allowed to assess and authorized for patients across the country. There's a big difference between cannabis medicine and primary care.  Primary care, when you prescribe, you really need to have a provincial license. So most, I mean, Trevor would be one to answer this. But most of the time, if you want to say prescribe something for a patient like an antibiotic, you have to be in the same province is that patients have that prescription go through. You need to have licensed in that province. Telemedicine is different. The college nurses have said you can be anywhere as long as you are in the province where you are licensed to practice. Your patient can be anywhere you like them to be anywhere across Canada.

Kirk: Now, is that because the licensed producers are national chains? For example, if you're writing a prescription for Manitoba patient, are you writing that prescription to a national Licensed Producer or to a Manitoba Licensed Producer of cannabis?

Erin: All of all of the Licensed Producers are licensed under Health Canada. This is not a provincially run program. Medical cannabis is federally regulated as opposed to provincially regulated. And that's where the difference come in.  Is that I fill in a prescription or an authorization to whomever, pick one; Spectrum. It doesn't matter. It's a federal form.

Kirk: Okay.

Erin: They simply ask you what provinces licensing, what your number, and as long as you're legally allowed to authorize cannabis based on your scope of practice in the province where your license, you find.

Kirk: That goes for all prescription writers. Now, like our audience may not realize this, but obviously your family doctor, your surgeon and your specialist, your internist, they can write prescriptions, but also as a nurse practitioner, you are writing prescriptions. So in the cannabis industry, in the cannabis industry, therefore, all cannabis prescription writers are writing a national prescription.

Erin: That's correct.

Kirk: Cool.

Erin: OK, so national based system.

Kirk: So congratulations on completing your nurse practitioners papers. It was one of my goals as an early nurse to get my nurse practitioners. It didn't happen to me, but that's fine. I'm still working in an advanced practice model in the northern communities I do.  So. So congratulations. Now let's talk about nurse practitioners. So, I guess one of the one of the things about going to your doctors is that usually we have a 15 minute appointment, like four other people when I see my doctor. So, I'm pretty secure I'm going to get five minutes from my doctor. When I see a nurse practitioner and that's fee-for-service Doc obviously. When I see a nurse practitioner, are you fee for service? How much time do you give a patient and tell me about what a nurse practitioner assessment might be?

Erin: So that's a really good question. So, it really depends in terms of how much time do I have to assess the patient? It really depends on where you work. So, in the case of the medical cannabis company, where I work right now, I have a half an hour to assess each patient. Any new patient that comes through to me immediately has a half hour appointment. Depending on what they're doing. So, the acute episodic situation with a sore throat or an ear ache or cold or whatever, I'm probably going to have a 15 or 20-minute appointment with you. If you come in for a physical or what we call a routine health assessment, we're kind of getting away from the term physical. Now, again, I'm going to have half an hour and maybe if it's a child, I might have 40 minutes. So, I think I function very, very, very similarly to a family doctor. If I was in the family doctor's office, the difference would be that I'm not fee for service. By scope of practice by provincial, and again, all LP are provincial but in terms of regulation. But the provincial standard for Ontario absolutely forbids me billing the provincial health care system. We do not bill. I have a provincial health care number, but for me, when I'm ordering labs so that the patient doesn't get charged lab. It’s got nothing to do with me. I get paid a base salary. So, places like a family health team or a community health center who have NP's on staff and many of them are doing exactly the same work as their physicians, they would be receiving a certain pocket of money from the province to fund their Nurse Practitioner position. It's not fee for service. It's quite different. And for that reason, we don't get paid anywhere near family doctor salaries at all? Not anywhere close because it’s all a salary model. It's actually primary care actually is less lucrative than, say, working as an NP in hospital. I left my advanced practice position as an RN, my salary went down as an NP, but it's not about the money for me. It's about how can I make a difference? And this is something I wanted to do. OK, yes, I know that my salary is going to go down whatever it just is what it is. This is one of the big challenges not being able to bill.

Kirk: This is killing me because I'd love to go down that rabbit hole with you about wellness models verses sickness models, but unfortunately our time is focused on the cannabis. So rather than changing the health care system in this one podcast, let's talk about cannabis.

Erin: OK.

Kirk: So because really the wellness model, the government, the government's all about funding, you know, a new MRI in anyway, I'm not going to go down that rabbit hole.

Erin: We won't solve it today.

Kirk: Let's talk about cannabis and nursing. When Trevor and I started this project, I went to my college nurses in Manitoba. I went to the you know, to the legality guy. I phoned a lawyer in Toronto about, you know, nurses and cannabis. And there's so much gray area as a registered nurse working within the acute care, you know, facility, I have to make sure that there's proper organizational policies and all that. So as a Nurse Practitioner, what limitations do you have? What advanced practice protocols do you follow? How did you get involved with cannabis; it is such a controversial subject?

Erin: It's a complicated question, but I got involved with cannabis mainly because a friend of mine was approached by a medical cannabis clinic. Now, this is one of these kind of, you know, prescription-mill type places. And they were looking for yet another NP. And so, they asked me if I would come on board. I did for a brief period of time. I wasn't crazy about their model, but I was, you know, gave me the opportunity to learn about cannabis, to learn about how it might help people. And I kind of took it from there. I then moved into working for a company where I work full time. I'm involved in a lot of the policies and procedures. And there's a lot of things when you're working within an institution, for sure. When we're working with patients in their own home, it's a lot easier. But I have run into a number of roadblocks similar to what you're talking about. Well we have a patient in long term care or a patient who is in their own home but is requiring assistance because of medical issues. They were struggling to get, you know, the staff involved to to assist him to give the cannabis. But for me, in terms of why did I leave, my primary care and emerge completely and cannabis was that I've as I said at the beginning, and you will totally get this, when you've been in nursing as long as we have. And it worked in a number of environments that we have and I spent some time up north as well. You get to a point where you get frustrated with the traditional approaches to various medical sickness issues, illnesses, and you realize that we don't really do that great a job. A lot of medications that we prescribe either don't work or that kind of work, but they've got ridiculous side effects. People can't afford them. That's another story. But they they end up stopping this because they just don't tolerate them. So, merging into cannabis was like, oh, my goodness. So, all of these really difficult to treat illnesses, anxiety, depression, chronic pain, all of these things that we really don't do that great a job of that will really impact not only the patient's quality of life, but their ability to be productive members of society. And then cannabis enters the picture and you turn their life completely around. And to get off the stuff that's bothering them. They get back to work. In one case. I have a Parkinson's patients that was like literally who thought he had won the lottery. He'd been able to shovel his driveway for the first time in ten years because of CBD oil. So, when you see things like that, it really encourages you towards going towards something that is completely outside the box, because the stuff that's in the box is the working.

Kirk: Now, one of the things that came our way was, you know, Kirk, if you're going to start this podcast, how are you going to do it? When how are you going to promote cannabis? And that's the word they use. You're going to promote cannabis in your podcast when there's no studies that say that cannabis is working. As a Nurse Practitioner, what studies are you using when you go and prescribe cannabis for somebody? Or I guess.

Erin: That's the million-dollar question.

Kirk: It is a million-dollar question and maybe it's the wrong question to ask. I guess in your assessment and your treatment protocols, how do you choose cannabis? That's a better question.

Erin: Well, most of the time, patients come to us wanting to try cannabis. So, one of the requirements or the guidelines, if you like, that we have we don't have a lot. But certainly, there's some documents that have come through Health Canada, National Academy of Engineering and Science and a few other Canadian family practice. There's there's some issues with all of them. But the reality is that we are talking to patients that have generally run the gamut of everything else that medical science knows how to do. So, they've tried opioids or they've tried anti-depressants or sleeping pills or you name it, they've tried it. Someone with chronic pain has likely been to see physiotherapy, occupational therapy, maybe massage, Chiro, and they are at their wits end. They're sitting at home not being able to work because nobody's been able to manage their pain. So, someone from some opioids and then they get into that whole cycle. So, you have to step back and go, OK, we've tried everything we know how to do and it's not working. It's time to move outside of what we know to something that just might work. And there's a heck of a lot of value to anecdotal experience. And I know that even evidence-based-practice, which is where you and I were taught. You do things based on evidence. Sometimes the type of evidence that you're looking for isn't there yet. Why? Because this has been an illegal product. It has been on a Schedule One. We haven't been able to research it. It would be like asking a research ethics board. The people have approved clinical trials for testing on humans to approve a study involving heroin or something like that. Until recently, they sat on the same list. We are now in a position to be able to start to get some good quality research the way you what I were taught and need for making decisions.

Kirk: So, again, I'm following the logic here. So, you are working within a clinic that is cannabis based clinics, so your patients are coming to you with that understanding. So they meet you.

Erin: Specifically.

Kirk: They meet you. You obviously need access to their medical records. So, they sign over confidentiality form allowing you to access their records.

Erin: Yes and no. Like, what happens is that prior to legalization, we required patients to come with medical documentation proving that they had X, Y, Z. We kind of backed off on that to some extent because with legalization, we really, it's legal. So, we don't need to prove their medical story by documentation. I get a story from patients. I ask them, what have they tried? There's an excellent template that I follow that is through the Consortium for the Investigation of Cannabis. They have a really nice template. And I was able to look at it. I looked at the guidelines under Health Canada and looked at the Canadian Nurses Protective Society, which is a liability insurer for nurses and nurse practitioners. They have a bit of a statement around medical cannabis. And I took all of those things and put them together and said, what do I need from my patient to ensure that this is, you know, on a level that nobody's going to question the decision-making process here? One of the things we do is we document in very clear detail, what a have patients tried up to now. What has been the outcome of whatever it is that they've done. What brings them for cannabis? One of the first questions that I'll ask is, what are we treating, what brings you for cannabis? What was your thought about coming and asking about that? What else do you try? Most of the time they've been through quite a long list of things that they are at their wits end. And this is kind of a last step in trying to manage what's going on with their health. My oncology background really helped me with this because 99.9% of what we do in pediatric oncology is by the seat of our pants because we don't know a lot and a lot of cancer is treated that way. We do. We have some guidelines. A lot of the kinds of traditional approaches don't work. Then we have to start thinking outside the box. And this is a very common scenario in oncology. So I wasn't that uncomfortable with the idea of not having, you know, traditional evidence base. There's some evidence, but there's a heck of a lot of valuable stuff that is not available and published because it's in the hands of people that don't publish. So our colleagues that Shecann and Strainprint, for example, have a bucket load of data that they're just collating and that data is going to be massive. But they're not medical type people. So you can't find a space with the data that they have. Right. So you know where to look. Stuff is out there.

Kirk: Do you have access then to the Strainprint clinic database where they have a lot of that are correlated?

Erin: Not as much as I wish. I have like the Green and Silver report and I have the things that have been put more out into the public domain. They they're keeping your stuff fairly close to their chest, which I totally understand. I'm hoping and I've been encouraging them what I've been talking with them. Please think about publishing this, because there's people out there that we you've got data that those of us in health care need.

Kirk: Right? Right.

Erin: Sure it's lay data, but it's still very valuable data. And this is the biggest challenge that we're having is there's lots of data, which is not where we can find it.

Kirk: So here's the next question. When your patients come to you and you assess them, are you now as a as a health care provider keeping stats. Are you doing your own research in-house? Are your patients open to being researched like five years from now, you're going to be able to sit down with your database of patients and the pros and cons of what hit what missed.

Erin: That's I wish I could say yes to that question because it's a fantastic idea. We aren't set up for that right now in terms of how to collect the data. But because we have an electronic medical record, as you know, any time you have an electronic medical record, you can go back and pull certain pieces of data from the record as long as you're coding things properly when you're entering it.

Kirk: Right.

: So what I've been trying to code diagnoses and things and I've been making sure that I'm documenting and I put them in medical cannabis as a medication. All with the idea that down the road I'm going to be able to start pulling some of this stuff. But the problem is that, as you know, the electronic medical record is going to say is a diagnosis. And what my authorization was in terms of grams per day, I then would have to go back to the patient, find out what product they chose, that's where Strainprint comes in because they're tracking that.

Kirk: I just find it incredulous. I mean, I've been I've been aware of cannabis for decades, and it's only been the last two years at Trevor and I sort of intensely started studying it. And for a country that's had legal cannabis for 14 to 16 years, depending on which act. We don't have any data on it. It just kills me. We should be, I mean, if I had a medical clinic, I think one of the first things I would say to my clients is that by participating in this clinic, please sign the following because we are researching you. I mean, that's I don't understand why we haven't done that. I mean, we as in collective health care providers.

Erin: And I think it's an excellent point. And certainly, you're certainly giving me things to think about in terms of as we move forward between myself and as you know, I'm a pharmacist that was with me as an educator. So that's a really nice blend to be able to put some of this stuff together. But part of the challenge, I think, has been that there's still been this massive stigma. So, and we don't really know enough about the endocannabinoid system. There's lots of research going on. There's ethical issues around blind studies. There's quality control. So, in terms of trying to do studies. It is grossly difficult. So, for example, you've got one patient that is taking CBD oil. Well, you know as well as I do, there's one hundred and forty-six, I think LP on the Health Canada page as of this morning. Not all of them have CBD oil. But if you pulled everybody CBD oil into the lab, you probably wouldn't find two that are the same. So then try to research stack is very difficult because if you think removing variables like we're supposed to in science, it's really tough to do in the medical cannabis world. You have to take a group and give them all one License Producer CBD oil.

Kirk: Yeah.

Erin: Ya know, to be able to do that. And that's the hiccup we keep running into. How do you standardize it.

Kirk: And that's the plant medicine side of things, right. How do you standardize plant medicine and naturopathic way of doing business. Well, its plant medicine. Cannabis is throwing a real red herring into the medical field. Erin and I got so much I want to talk to you about and I'm looking at our clock. But you know what, let's you are an exclusive cannabis Nurse Practitioner or you obviously have other prescriptions you can give people. Are you exclusive cannabis.

Erin: I'm, I work exclusively full time in medical cannabis now. As of last fall.

Kirk: And you work for one clinic.

Erin: I do OK, because I work full time.

Kirk: OK, fantastic. Thank you for taking some time out. So your fee for service, how does your clinic then charge your client for their expertize? If I walk into a show, my Manitoba Health Card and my private insurance company card, how does how does one pay for the service?

Erin: It doesn't cost you anything. So, as you may or may not be aware, most clinics and we are not unique in this by any stretch of the imagination. But most medical cannabis clinics have agreements with licensed producers. So, some clinics will have a handful of Licensed Producers in their stable. Many have a lot. And what happens is when patients place orders, there is a kickback for lack of a better way of putting it, back to the clinic. And that's how the clinic gets paid. I get paid out of the clinic's coffers. Patients are not out any money. And that's a key, key thing. And that may sound a little sideways, but in fact, it's standard across the board. Pretty much all the clinics are doing that now to avoid having to charge patients, because back when this all first started, patients were getting charged a couple hundred bucks for assessment that was happening.

Kirk: So, some real quick questions. And I guess I'm asking for real quick answers because we're running out of time. But I noticed on your Webpage now you work you work out of an out of out of Ontario and you do Telehealth assessments. And I noticed you do a Telehealth assessment in Alberta, in Manitoba and Ontario. So, my Alberta, if I'm in Alberta, my Alberta health care pays for that clinic visit. Now, if I need if I need specialist referrals, like you can refer people to allergy testing, sleep testing, pediatrics. So as a Nurse Practitioner, if you find that your patient needs other referrals, you can do that as well.

Erin: Actually, no, because we are not a primary care clinic. We are a medical cannabis clinic. So, if I would talk with the patient, I felt something was going on. And I've done this on more than one occasion. If I felt something was going on that they maybe hadn't addressed with their primary care provider, whether it's a doctor or another Nurse Practitioner, I would suggest to them I really think it would be a good idea if you went back and talked to your primary care provider about whatever this issue is like, maybe they need additional counseling support or there's something just missing in what what's going on now? So, I send them back to their primary care provider.

Kirk: You have electronic medical records. So, when someone comes and visits you, do you then e-port or e-mail what you've done to their family care provider if they give you permission to then share what you've done?

Erin: Yes, we will. Only with permission from the patient, because, as you know, there are a number of providers out there that are not in favor of medical cannabis and quite a number of patients are concerned about disclosing. So, I will ask. Some of them will say I'll talk to my own provider. OK, that's fine. But if they give me permission, I have a standard letter that I sent to send to the doctor or the NP, and it includes things like how to monitor or drug interactions that may happen.

Kirk: Good.

Erin: Just because they might start them on something before the patients back to see me again. So I just give them a little bit of. And it's also a way of educating the primary care providers in the community-based providers about potential of cannabis.

Kirk: Exactly. And I think I think if you listen to our podcast, both Trevor and I are advocating that people talk to their primary care provider about their cannabis use. So, my assumption is, as a Nurse Practitioner, you will say to them, here's the care I'm advising you now, I'm advising you to let me talk to your doctor or whoever else is your primary care provider is because.

Erin: That's correct. They don't always agree. And obviously, ultimately, it's the patient's decision whether or not we connect with them. A lot of patients will say, I'll talk to them myself. OK.

Kirk: OK.

Erin: That's fine. But yeah, it's definitely it's actually a built-in question on my template to make sure I don't forget to mention it.

Kirk: Well, I know the clinic. I know the clinic that you work out of a telehealth from. I go by it almost every month. Sum it up. What haven't I asked you? What was some key points you wanted to make that I haven't given the opportunity to do yet?

Erin: I think probably the most important one is that if you are considering medical cannabis. Someone told you that it might help you, please if you have medical conditions you're trying to manage, please access a medical cannabis professional for your assessment and to get some guidance. There's been a few, you know, incidents of people going into recreational stores and unfortunately landing with products that potentially would do more harm than good. So, if you are a medical, if you have medical issues, you have cardiac issues, pulmonary issues, anything going on with your health that you are on medication for, you are followed by specialists, please reach out to a medical professional, whether it's your pharmacist or whoever it is, to get a proper assessment done. To make sure, because we do need to make sure people are safe with this product. And there are some things that, you know, shouldn't be mixed. Certain meds. That kind of thing. So reach out. Don't rely on someone in a recreational store to advise you if you're using medical. This for safety.

Kirk: Thank you very much for that. That's something we are also advocating. So we allowed that to go full bore, right.

Trevor: That was that was great. You guys had a great talk. I think it could have gone on for hours.

Kirk: It would have. So, what I really found fascinating from that discussion is that I can go to her cannabis clinic and not pay extra dollars.

Trevor: You end up paying for cannabis from the Licensed Producer. And basically a Licensed Producer retroactively pays for your visit.

Kirk: But that's the pharmacist speaking. I'm talking about the nurse. I go see the nurse. And there's no fee for me to seeing her.

Trevor: No, but the money that pays Erin came from the Licensed Producer.

Kirk: All right. So, so but it's not coming out of my pocket. Not the visit.

Trevor: Not the visit. Eventually, when you buy the cannabis. Yes. It's part of that gets goes back to the clinic to pay for everything.

Kirk: And the government taxes that medicine, which is another issue.

Trevor: A whole other issue. And they should stop doing that. But that might have to be an episode.

Kirk: So now you also spoke to somebody from the same clinic, a pharmacist.

Trevor: Yeah, I talked to Carl. But you know what? Before we'd get to Carl. Oh, you have a really good, My Cannabis Story.

Kirk: I do. This is a this is a lady that I have been following on Instagram. She's huge in social media, and she has given us a My Cannabis Story. And Jacqui Childs, thank you. I mean, this is a wonderful story.

Trevor: She has a great story.

Kirk: Let's listen to Jacqui Childs My Cannabis Story

Jacqui: Hey, guys. Jacqui Childs, My Cannabis Journey.  My Cannabis Experience is, I don't know, pretty normal is what I'm hearing. I had been prescribed a lot of pharmaceuticals for anxiety, depression, PTSD, etc. and I have Crohn's and I was getting ready to have a hysterectomy. I was going into menopause and one pill led into two, led into three, led into nine. And it was overwhelming and too much for me. And I decided to quit it all. Cold turkey. With the help of CBD.  I had read a lot about CBD oils, tinctures, and I wanted to go to plants and not pills. So I started the CBD and it helped a lot with my withdrawal and my anxiety and depression. During the time it took about three months to be completely weaned off my meds. It was an uncomfortable three months. I'm now about sixteen months in phrama-free, but during that my sort of health and wellness journey of to cannabis and researching everything, I noticed that I was drinking more. So, I had got rid of the pharmaceuticals and started to drink a little bit more than I had wanted to. And this experience was supposed to be a journey to health and wellness. So, I introduced THC and not through smoking. I was using edibles at bedtime, occasionally a tiny like a five milligram, eight milligram. If I was going out or if I was having people over and I lost the booze, I was saying it was time to lose the booze and THC smoking a joint or I don't know, I haven't hit a bong yet. But anything I was doing in the cannabis space as far as to get quote unquote, high or elevated was a positive experience. No hangovers. My anxiety and depression had pretty much lifted. I mean, yes, I'm still a nervous Nellie, and by no means am I cured. But cannabis has definitely helped my experience, my health and wellness journey. And I'm happy to say I'm sixteen months big-pharma-clean. I am transitioned into menopausal old woman. Just kidding. No, really I am. But with the help of CBD and THC. So and how do I take my CBD, I, take in oils, tinctures, capsules. I'm researching a patch and yes I use you CBD three times a day. Every day. Never missing. I do have a CBD vape-pen and my THC favorite way to consume is still edibles. I enjoy hosting high teas at my home. Where we have some infused foods and some teas with a little bit of oil in them, and I also I juice cannabis leaves regularly and the raw leaves, I put them in cubes, ice cube trays, and in the morning I have it with my smoothie as well as a little oil. And yeah, I bath in THC and CBD bath bombs. I use THC, CBD, skincare lines and hair products, etc. So just over a year I am completely transitioned to plant-based living and plant based medicine. And my experience is extremely positive other than the stigma around it. I have lost some contracts and work that I do in the influencer space. I have been a social influencer for almost three years. I have over two million followers on Facebook on a verified Facebook page. I think I'm one hundred and thirty-two thousand, hundred thirty one thousand on Instagram and twenty seven, twenty eight thousand on Twitter and social media is how I earn my living full time and the cannabis space, although very exciting, interesting, so much to learn and lots of amazing opportunities. Because of the stigma, there's still a lot of negativity and I'm in early, I guess. So, there's still a lot for other people to learn. Yeah, that's it. I'm Jacqui Childs and I am living pharma-free thanks to cannabis and thank you for allowing me to share my story and my journey. You can find me: (NOTE: these links are cut/pasted into transcript)

www.jacquichilds.com, www.facebook.com/jacquichildsmodel, www.twitter.com/jacquichilds,www.instagram.com/jacquichilds,

Google me. No, don't. Thanks for having me, guys. And if there's any way I can help anyone in their cannabis journey, let me know. Take care. Bye bye.

Kirk: I like that story.

Trevor: I really like that story. So if you want to submit, you're My Cannabis Story record on your voice memo app on your phone and email it to us at This email address is being protected from spambots. You need JavaScript enabled to view it.. Can't remember that. Go to the website www.reefermed.ca All the instructions are there. Just click on My Cannabis Story.

Kirk: So.

Trevor: We have Carl the pharmacist.

Kirk: Carl the pharmacist.

Trevor: So Carl and I sort of get into a little bit more of the practical what happens when you walk into a clinic and how do you physically get the stuff in your hands? Let's listen to Carl.

Carl: Thanks Trevor.  Thanks for having me. Well first and foremost I'm a pharmacist for I guess about a 20-odd-years give or take. But now I'm doing something a little bit different. I'm working at a company called Nalanda Health. And what we do is we help people get the medical marijuana.  So, my role basically is to walk the patient through all the steps from prescription to in hand basically. So, I guess it can be almost like a facilitator or something like that.

Trevor:  No that's fantastic and interesting. I've got lots of questions but before we do that let's just walk everyone through it. So, let's pretend I'm a patient. So, do I physically walk into Nalanda health and say I'd like some medicinal cannabis or I call or how do I first sort of get introduced to you guys.

Carl:  There's actually a number of ways you can do it. First and foremost, you can walk in. Book an appointment to see our nurse practitioner. The we would do it right now is via telehealth so you would sit in a small patient room and the doctor over the computer. And she would evaluate you know she has certain set of questions that she'll ask you and evaluate how you talk and look and all that sort of thing and then you know if you qualify she will write a prescription which will be on the program that we all have access to. You can also register on Nalanda.ca and you can do all that stuff at home as well so as long as you have a computer that has a webcam. You can get your appointment at home the same sort of thing she'll walk through on the questions. And then again, the prescription will be on the program that we all have access to. So, you know there's a number of different ways we can do. And you know worst case scenario we could always do just a straight phone call from home for the first one that's not ideal. But it is definitely available if there's connection issues.

Trevor:  OK. No that's good. So I've booked an appointment. I've talked to the nurse practitioner. Let's say I physically came into your building and had the telehealth conference. OK. So, she has decided that medicinal cannabis is appropriate for me written the prescription. Now what. What. I assume that's probably when you when you jump in.

Carl:  That's right. Yes. At that point. You know I will have a quick chat with the NP and she'll normally tell me just a quick patient profile.  You know why she will be prescribing the cannabis. And what and where she is prescribing. Then she'll log off and I will talk to the patient and I will get them registered on the appropriate sites. You know we have a number of different LPs or licensed producers.

Trevor:  So, Carl I'm going to jump in. No not just because. So, if it's as a regular pharmacy you know and a nurse practitioner wrote a prescription that they'd hand it to me and I'd physically go to the back of the store get it counted and hand it to them. So, there is there is no medicinal cannabis in Nalanda health.

Carl:  That's correct yeah. We have nothing on site everything that you order comes in the mail from directly from one of these LPs.

Trevor:  Ok so I interrupted you so. You've talked to the patient a little bit and now you've you're going to get the license now who's picking the licensed producer. You or the nurse practitioner or does the patient say you know I like licensed practitioner x y z or how do you pick?

Carl:  Generally speaking the NP will pick it.  Now there's a couple of qualifications there. Sometimes products are short. You know just like in the pharmacy these regular shortages. So they need pick one and then I'll have to contact the nurse and get them switch to another one. In rare cases the patients may be more educated than the average patient and may have a particular LP that he or she likes as long as we're associated with that LP then we wouldn't have a problem sending it there. But generally speaking nine times out of 10 the NP will pick the LP.

Trevor:  OK so you've signed them up on the LP's website. Filled out the paperwork got the prescription from the nurse practitioner to the LP. How does the patient get the cannabis in their hands.

Carl:  OK so once the patient is registered. And the prescription is in CannaTrust or. So that's one of the options will send the product the information to Health Canada and they get registered with Health Canada as a medicinal user. At that point they gonna transmit an e-mail to the client and once they get that email and each takes a day or two day or two business days. The patient can order.  So, there's no sort of initial ordering right off the bat you have to wait a couple of days get an e-mail with an ordering code of some sort and then they will go online they will find the product that has been recommended to them order it to pay for it online and it is shipped directly to their door.

Trevor:  OK. Now do you ever see the patient again and sort of follow up with them and say Hey how's it going. Is that sort of part of the process?

Carl:  Oh absolutely.  Yes. What we like to do and what we're really trying to do more now is follow up with the patient a week to 10 days after the initial visit. This way we can or I can find out if they've had problems ordering if they haven't received their that e-mail that allows them to order the product If there are shortages. You know if they have any questions any problems any anything at all. I try to follow up and see if I can help them solve it most often. Not a big deal. People will be very happy. You know they'll have a part in hand or have already ordered and you know they have no concerns.  But something always pops up so that we are definitely sorry we also require follow up at three months at six months and one year.

Trevor:  Oh no that that's that sounds like very reasonable patient care. So how about sort of regular pharmacy things especially after you've got the prescription from the nurse practitioner. Are you going through sort of the medications they're on and seeing if any of those will be problems with the potential cannabis prescription?

Carl:  Yeah. Again, the Nurse Practitioner she has all that information on the file and a lot of times she will ask me because I'm a pharmacist. What I think if you know if I think there'll be any potential problems. You know medicinal cannabis really doesn't have a lot of interactions. There are some you know if we try to make sure that you keep your THC or CBD in line with whatever is required essentially. So, we always ensure that we have all the information that we need. You know no one ever goes in there and is prescribed you know just blindly something just like in pharmacy you know we try to check as much as we can that what we're doing is appropriate.

Trevor:  A question we get in general is so why especially now that recreational cannabis is legal. Why should somebody bother to you know see the nurse practitioner get it through the medical system. Talk to the pharmacist. Why not just go down to you know the local recreational store and buy something, try it out and see if it works.

Carl:  That's actually a great question. You know for maybe the experienced user that may or may not be appropriate for them. Maybe they've been smoking for 30 years. And they know exactly what works and they know how to you know hide it.  Maybe that is a poor term but they know how to sort of disguise it. So, people aren't aware that you're using it for someone who is just being introduced to this product going into one of these street level stores blindly. I think it's overwhelming. You know we have all these strange names like Kush you know Magic and all that can do nothing that will tell you what it's all about. There's no indication what it's for. No indication how it works. What is going to do to you so. from that end of things. I think.  Seeing the nurse practitioner and or myself really gives us sort of like a buffer. We're able to find the product that is appropriate at the appropriate strength. There is no guesswork here as to what happened this week that we have a goal of what we can use for that goal in addition of course the whole the legality issue is when you go to the medicinal route you do get the official prescription status for this product. So then it's covered by things like the Health Protection Act and you know in terms of day to day activities you're entitled to your privacy. You also have something to back it up. You're not using this. because you want to get high you're using this for a very specific reason. That has been assessed by a professional and has gone through Health Canada and everything is on the up and up.  Does that make sense?

Trevor:  Oh absolutely. Two things that pop up in regular pharmacy world that I'm not sure if they are in medicinal pharmacy world yet. One is insurance I've been reading a little bit about some insurers considering paying for medicinal cannabis. And the second would be taxes. Like if I got a Ramipril prescription for my blood pressure even if I paid for it 100 percent I could still deduct it towards my income tax.

Carl:  Right.

Trevor:  Any of those either insurance or taxes. Coming up in the medicinal cannabis world.

Carl:  Not directly.  I've had a lot of clients try to get reimbursed through the health spending account a lot of insurance plans will have almost like a slush fund for chiropractors and massage therapists and stuff like that.  So, they're trying to get to reimbursed that way and that's been I guess moderately successful. You do get the official prescription receipt. So, it is something that in my opinion should be acceptable.

Trevor:  No thank you. That's fantastic. So, you and I are both pharmacists in Manitoba. So we've both seen stuff coming out from our licensing body the College.  College of Pharmacists who've officially said you know as pharmacists Thou shalt not have anything to do with cannabis or advertising anything to do with cannabis or talk about cannabis or so. You're a pharmacist. How are you not running afoul of the College and their decree against cannabis.

Carl:  Sure. Well what I do is actually 100 percent separate from the pharmacy. We do have in-house pharmacy that it runs for your basic prescriptions the pharmaceutical stuff like the Ramiprils and you know pain-killers and such antibiotics.  But what I do is in a completely separate part of the building and not run to the pharmacy here at all even though and the pharmacist my title is not pharmacists here. I'm more of the educator. So, what we're doing is completely outside the purview of the college with the exception that I am a pharmacist and that's sort of the only link to the college. So, it really is not something that should be concerned about because it has nothing to do with them.

Trevor:  That works for me. So, when we're talking off air you had some really good anecdotes about some patients that you've seen helped a lot by medicinal cannabis. Do you want to share any of those with the listeners about some success stories?

Carl:  Yeah but the first to tell you that there is a lady come in probably mid 70s had arthritis in both knees and shoes essentially housebound.  Her knees were bad enough that she couldn't walk very well. They were all swollen and she was in pain. So, her quality of life wasn't as great as it could have been. And you know she was starting to feel that.  Feeling little depressed. A little cooped up.  So, she came in talk with one of our NP, her name is Erin, she is incredibly knowledgeable NP, as all of ours are. But Erin talked to her, she assessed her. She put her on really what is the standard dosing we have been using as of late.  With CBD during the day and in CBD TCH combo at night for sleep and I would say within you know I don't have exact time frame; about three or four months. It was relatively quick. She had cancelled the activities that had been planned she had started bowling again which you know, that's incredible. And she's just so much happier. I think her quality of life was improved immensely. Her moods improved and the pain was still there. You know don't get me wrong, it was not gone 100 percent but the inflammation was down and the pain was at that point where it became manageable and didn't rule her life.  She's now had a life because of the CBD THC that she was given. So, you know that's kind of one of my great success stories that I've seen.

Trevor:  No that's really good. I'll get to the second one. I just got to ask about first one for sorry I'm jumping in but you and I both have seen people who will take opioids for an example they know the opioids really help their pain. They thought that was great but you know they couldn't manage the side effects. You know I love this opioid I can do my stuff again but I'm so constipated. I love this opioids but I'm so foggy I can't do anything anymore. How about your bowling lady? How our side effects of the cannabis for her.

Carl:  You know one of the great things about this product is practically no side effects. We go with what we call a micro dosing routine. So, it's a very small amount of liquid oil, if in a capsule, it is a small amount of oil inside the capsule. So, side effects are for all intents and purposes for the average person practically nil. And in fact, this lady did not have any side effects, she never complained of being foggy, tired, there's no consultation there was nothing dizziness and nothing bad at all. You know she was it was almost like you know in her words almost like a miracle and she tried everything that you would find in the normal pharmacy, you know ranging from the anti-inflammatories all the way up to the opioids. I mean she tried some of the biologic so she had gone through sort of everything that she could. And then along came product that seemed miraculous because it didn't cause her any issues yet that solved her pain problem. So yeah, nothing really to report. You know worst case scenario and make you a little bit drowsy during the day but CBD strictly speaking does not really cause that so side effects are practically none. Especially compared to opiates.

Trevor:  So OK jump jumped in. You had a really good anecdote number two.

Carl:  Yes. No worries. So, this one's not really so much a success story as it is an interesting story. You know, you're aware and probably even most of your listeners, as a whole the medical community is a very sort of resistant against change especially when it comes to a whole different field of treatment.  And so, for years obviously, cannabis has always been sort of blacklisted shall we say, it’s a illegal drugs, only used by potheads and you know, stoners and slackers and that sort of thing.  So, I had a lady come in, probably the end of December, she was preparing for orthopedic surgery, I think it was on her ankle, I can’t remember now.  Anyways, the surgeon, whose name I didn't get unfortunately, not only did he not write for the traditional painkillers like the Percocet or Tylenol 3s.  You know what you see after every surgery and a stool softener every time.   What he did is he had her come see us. To get some of the CBD oil and start on it before she started before she went into surgery. So that was the painkiller of choice for that surgeon. And that's incredible that a surgeon of all people would recommend CBD over any type of pain killers.

Trevor:  Yeah no I've never heard of that.

Carl:  Yeah, I know I was shocked, surprised, I was happily surprised. It was an amazing thing to hear. So, you know the change is coming. Coming very slowly but it is coming.

Trevor:  So, a couple of quick things before I got to let you go. Carl, a little bit from our conversation beforehand but it sounds like your practice has sort of changed, your practice and your thoughts about cannabis have changed a lot over the last year or so. How about just quickly walk listeners through you know, Carl two years ago what he thought about cannabis and what sort of changed along the way.

Carl:  You know I'll tell you first of, my opinion is changed in three months.  It's been so rapid but if you ask me six months, a year ago what I thought of cannabis as a painkiller or as an antidepressant or something along that line. I would say like, most pharmacists, I would say well you know I guess maybe you could try that, but this is more effective and this has a study behind it and this is going to work this way and this is going to do it for you. So, you know, I was always very much the chemical, I guess, route.  Do it the pharmacy way because nothing else has ever really worked for anybody.  Within the last 12 weeks or so, I would tell you I've had more success stories from people than I had in 20 odd years in pharmacy.  In just three months, as you know as a pharmacist, people come in and most often you will hear, well you know that the product worked but, you know as you mentioned before, you know the constipation or the fogginess, there's always a but or just straight out, you know my stomach hurts is there not something else we can do.  With this product, people come in and they're happy and they're amazed, they are shouting, you know, at the top of their lungs, they’re telling friends. Just the sheer amount of relief I've seen with this product has me turned around 180 degrees.  I'm fortunate in that I don't have a lot of pain so I don't need a product like this at the moment. But if that changes and you know change will occur of course. This is the route I'm going.  I am not going down NSIAD or anything else. It is CBD or nothing.

Trevor:  You're 100 percent convert.  It was this nice to see or hear someone who stands behind his convictions so as we wrap up Carl if somebody is interested in getting hold of your services or how would they get in touch with you or the clinic. How will they going to get in touch with you guys?

Carl:  Sure. So, our phone number is 1.855.625.2632 or it's 1.85Nalanda or go on a Web site www.nalanda.ca or finally you could just walk in our Winnipeg 1880 Ellis Avenue. 9 to 5 Monday to Friday you can walk in and book an appointment that way. Any which way you want. You can book everything on line too and have your appointment done at home as well. (NOTE: As off March 2021, This clinic is now closed)

Trevor:  Carl this has been really interesting and I really appreciate that.  Anything I've forgotten, anything that you really thought I was going to ask or you really want to mention cannabis before we let you go.

Carl:  Nothing major and I just think people need to have an open mind. I will admit that my mind was closed before I started doing this but my eyes have been opened and my mind is open and I don't even use it.  So I think people who are struggling pain are struggling with depression anxiety and don't like the prescription part that they are on, and there's a lot of people like that, consider this it's safe it's effective. It's not it's not a stereotype anymore. No you're not going to be looked at as a pothead or a junkie or something like that. This is a legitimate product for legitimate purpose and it's definitely worth at least getting from talking if nothing else.

Kirk: All right.

Consider this. It's safe. It's effective. It's not it's not a stereotype anymore. You know, you're not going to be looked at, as, you know, like I said, a pothead or a junkie or something, that this is a legitimate product for a legitimate purpose. And it's definitely worth at least given some thought, if nothing else.

Kirk: All right. My Cannabis Story and Carl, it's been a great, great episode.

Trevor: It's been a really good one. So Kirk Nyquist, the nurse.

Kirk: And Trevor Shewfelt the pharmacist, how are you?

Trevor: It's been good. What are we working on next?

Kirk: Oh, gosh, man. We've got you into the interview with a guy from drivable.

Trevor: Drivable. That was a fascinating one about impairment, but it kind of let me down a different road than I thought it was going to.

Kirk: I listened to that interview. That is that interview did not go where I thought it was going,.

Trevor: But they still really good.

Kirk: Oh, yeah.

Trevor: You know, you should listen when it comes out.

Kirk: You know, all the interviews are good. The other thing that I'm off to Vancouver Island next week and I'm going to be doing some Cannabis stories out in Vancouver Island. I still don't know if there's any if there's any available recreational cannabis out there.

Trevor: I can imagine there is.

Kirk: Traveling across Canada with your own stash. You can do it now. We're are still working on our 100 mile diet.

Trevor: So, Kirk who do you have for us this week.

Kirk: Carly Dow. She's out of Onanol, which is just about 62 kilometers south of Dauphin. She has a song, Not a Songbird, off of her album Ingrain.

Trevor: Let's listen to Carly. Thanks for listening. Everyone has been another good one.

Kirk: Reefer Medness.

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