Episode Transcript

Kirk: Trevor. We're back. I beat you to it.

Trevor: You did, So, we had somebody Nurse on Board. Susan Hager.

Kirk: Yes.

Trevor: Nurse for 36 years and she was talking about something called a vibrational mismatch. Like what she was saying she did all the hospital stuff, everything from critical care to research and. But she was getting to she didn't really like being anymore there anymore because they weren't talking about wellness. They weren't talking about the patient anymore.

Kirk: Where have you heard, where have you heard that rant before?

Trevor: It's come up with once in a while with this guy with this red beard.

Kirk: White now. But you know what Trevor, I found, I found a like mind. I found a soul sister. This is I got to tell the story right. This is this is a story how we stumbled into this episode. You and I did the Executive Links seminar and for our first time and I guess we were the first ones first time Executive Links had two speakers.  And we each got our got some contact from it.  I got some contacts with people, nurses that are looking at cannabis and nurses that are self-employed. And one of the individuals that took our class, turned me on to Susan.  And for many reasons.  We started talking offline and just discovered I discovered somebody that has so many of the same thoughts I did. Working as a nurse for more than 30 years. I think I'm coming up on 40 that I've been in the health care profession. Scares me, scares me that time passes so quickly, but how disappointed nurses can be with the sickness model. You know, and the vibrational disconnect that she's talking about, I think has to do with the fact that nursing is all about wellness. I mean, our job is to help people in their sickness to be well. Right. My job as a nurse is to is to get you well within your boundaries in which we work. So when we go into a hospital situation, it's all about sickness. It's all about sickness. Nurses are pushing the medications that the doctors prescribing that that you make your livelihood on.

Trevor: god damn pharmacists.

Kirk: Sometimes as a nurse, you don't get an opportunity to spend time with your patient, with your client. Susan found that opportunity by becoming an independent, self-employed nurse. So and that's a different story, because in the process of meeting these nurses, I've discovered I'm also a self-employed nurse and need to treat myself that way, too, with the podcast. So, through that she came up with her business called Nurse on Board. Nurse on Board, they don't want to call it, they'll hear it in the story, she doesn't want to call herself an advocate, because when you call yourself an advocate, although she is a Board Certified Patient Advocate, she sees herself as someone that navigates and helps people. Navigate through their sickness model going to the doctor. This is so cool because I'm in a situation where I have relatives. Elders. Older relatives and I'm very fortunate to have a nurse in my family, not just me, but in my extended family. There are health care providers who have guided relatives through the system. And as she was telling her story, I was thinking, gee that could very well be my family she's talking about. And so, what it is, is that these are these are nurses that help clients go through the health care system. They help clients go to doctor’s meetings. So they're with their doctor. And as you know, many clinics are very busy. You could be you can sometimes be in the waiting room longer than you can be with your actual doctor. So you take you take a Nurse on Board with you and the nurse helps you and the doctor communicate what's going on, what needs to be happening. So when the client leaves, the Nurse on Board can help with the care. I think it's a brilliant model. I just think it's a great model. Right. Well, they also have a cannabis program. So, OK, here's the story.  Susan gets into Susan gets into telling us how she discovered it. And let's listen to her story.

Trevor: Let's listen to Susan and then we'll chat a little bit more at the end.

Kirk: Yeah. Yeah Okay.

Susan: OK, my name is Susan Hagar and I am a registered nurse and have been for thirty-six years and most of my career until 2009 was in a hospital environment. In all sorts of roles, including critical care and clinical research. And somewhere along the way it felt like a what I call a vibrational mismatch. Where I didn't feel invested in what was being spoken about in that environment. I didn't enjoy that the focus wasn't on wellness and a holistic view. So, I made my way out of the hospital into independent practice and I was involved in a holistic center and getting that off the ground. And in 2015 I launched Nurse on Board and we do private health care navigation and advocacy and care management. And so we are in eight regions of Ontario at this time. And in that role, in our holistic view, I see cannabis as a very important medicine for our patient population. And so we do everything we can to advocate for that, to get it in their hands, to get a good result for symptom management and more, and for people to feel empowered that they have that right, that choice, that option. And that's our role.

Kirk: So so, the Nurse on Board that is a private nursing home, home visits, home service. What is Nurse on Board?

Susan: Yes. So our website speaks to that quite well www.nurseonboard.ca. And we do everything from people that are involved in difficult hospital medical situations, to community care issues, everything in between. So we may be attending medical appointments. We may be advocating for proper support by government paid services. Whatever it is, often helping adult-children-of-seniors to navigate the health care system. People want to stay living in their home.

Kirk: So it's an advocacy group. It's an advocate, more than a home care provider. You're an advocacy provider.

Susan: Well in a way yes because, although we do skilled nursing, the nurses with Nurse on Board typically have 30 and 40 plus years of experience. And this is how we do keep people out of the hospital and out of harm's way. So it is on the shoulders of these highly experienced nurse clinicians to spot problems before they become serious ones. So we are dealing with the health medical issues, but there is a lot of advocacy required in order to get people the results they deserve to have and to help people understand their health care consumers. They have a right to second opinions. They have a right to ask questions. They have a right to understand and be understood.

Kirk: Well, we were just discussing that when you go and see your doctor, you're in the waiting room longer than you are seeing your doctor.

Susan: Exactly. And then when you get in there, the study shows that people are cut off between 12 and 15 seconds in their narrative and the doctor takes over. And so that's not long enough for people to really describe their symptoms, their circumstances. And then on top of that, even though every study has shown that we need to give people written information, the truth is that they go to these appointments. They remember half of what they're told and then half of that is wrong. So, now you're down to twenty-five percent or one out of four things. So, having a health professional, a nurse, with you at these appointments obviously impacts outcomes. Means that the right questions are being asked and that people are getting the care they deserve.

Kirk: You know, it's interesting. I think I have a different experience. My personal physician is as a strong acquaintance of mine. So, when I see him once every four years, whenever it is because I have to maintain licensure because of my age as well, I have a professional driver's license. So, I think I have to go in every two years for a medical or whatever it is now. But when I go with him, I have a list. You know, I've done my blood work already. I've gone in and I got I go for things I need to discuss with him. So, you know, sitting around and talking to colleagues or friends and they go, how do you do that? I go and I've got I've got three minutes. And he only looks at one issue. I said, well, I'm not sure how that is, but I don't allow that to happen. So, I wonder if patients realize how much power they actually have to take control of their health care.

Susan: Well, I'm sure that's exactly how it is, because when I do talk to the community and teach people about having a better experience in navigating health, you have to help your doctor to help you. So, you do need to be prepared. You do need to have your questions. You do need to think ahead about what kind of information do I need to share, what kind of numbers. So, and everything. So, I think you're wise because you have the nursing background. You know how to get the best out of your appointments and not everybody does.

Kirk: So the Nurse on Board help people with that?

Susan: Absolutely.

Kirk: So so in your practice and with your team, where does cannabis fall into this?

Susan: Well, certainly the team members, these nurses understand the effectiveness of cannabis. They understand the opioid crisis and all the down side of opioids for pain management. So the nurses are educated in cannabis. They take the Cannabis Competent Nurse Certificate Course so that they have filled in the gaps in their knowledge to the best they can. And then there's additional webinars, of course, in the community as research comes forward and things we're learning. So, we're very knowledgeable and we lean on each other. Certainly, they lean on me because I would be the leader for this team in terms of cannabis knowledge and direction and experience with patients, but we sure have amazing results. I had a lady, 60-year-old, who had six compression fractures in her back and extreme anxiety. She was on painkillers and she was on Ativan six milligrams a day for 20 years. She now strictly takes CBD. She takes no other pain medicine and she takes no Ativan. So got her off her benzo, got her off her painkillers. CBD is all that she needs. So we have so many success stories like that that why wouldn't people be using cannabis?

Kirk: I love case. I love case studies like that. So let's stay on that for a while. So again, we're talking about your business Nurse on Board. We're going to segue to cannabis in a minute. But in this case study, you have an elderly, elderly, 60... My age, have a young old person who's got some serious pain like actually documented real pain. And they see, they follow the regular track and they get some heavy analgesics. How did how did you help them? How did your organization help the health care system help this patient? What's the process?

Susan: Right. Thank you. So, I'll start out by saying that with somebody with her long history of anxiety, that one of the key pieces was developing a trusting relationship with her. These transactional relationships in health care don't support people who are anxious to look at different options. So, in hiring Nurse on Board, she had an opportunity to have a nurse and feel supported and understood and really hear what she was going through. So that was a key piece because like most people, she the stigma of cannabis, she was afraid, but she was also very afraid of opioids and how that experience was. And actually, they weren't even helping that much. So, she was disturbed that as only being 60, what was the rest of her life going to look like? She actually asked me if she could be a candidate for medical assistance in dying.

Kirk: At 60.

Susan: I can't. Yeah, she said I can't plan to live my life in pain like this. It just can't be true. And I want out if this is what it looks like. So, as we work through medical appointments, it was clear that her physician was not that supportive. But that's because it was a couple of years ago and people weren't as awake. Certainly, the physicians weren't to this possibility. So basically, I just had to advocate for her that it was her option that we were going to go down that road. He wanted us to use a bricks and mortar cannabis prescriber. And I said, no, I'm not seeing the results from them because people aren't getting the good follow up, not being seen often enough given very low prescriptions, really, so that they couldn't titrate up. So, we went with O'Cannabis Clinic for her and that's a virtual online cannabis prescribing by Nurse Practitioners. And so, then we and went from there. And so, the interesting part was actually as a backup, her family doctor wasn't willing to prescribe, as you know, but we had support from an allergist that she deals with and others. So, she felt supported. I think she needed to know that there was a physician that said this was OK, one of her physicians, because people are afraid to upset their doctor. They're afraid to go against doctor advice. And so, she did have somebody in her circle of care that was supportive and has been very supportive. So, we were fortunate in that way. And then I just coached her. I coached her how to move up to get to the right dose and also to how to move down off her benzo to get off that Ativan. And she was really it was and she was in this difficult position because of it. Again, the medical model let her down because of steroid abuse. She had such a history of allergies. When I met her, she was taking eighty milligrams of prednisone a day.

Kirk: That's a lot.

Susan: Ridiculous. Yes, of course. Osteoporosis as a result of that and other things and her adrenals, we didn't know what kind of shape they were in either because of this. So just to say that getting her off her Ativan and getting her to not use steroids anymore. So there is a lot of work to do to support her. But gradually we changed all of that around. And so CBD is her life saver.

Kirk: How did the primary physician, the primary care physician work the family doc? How did they work with you on that? Or were they just were you just informing them of what you were doing?

Susan: We were just informing them at the follow up visits how it was going. And honestly, once again, he wasn't asking about dosing or anything because he wouldn't know all the right questions to ask. So, it was just like, OK, so she's taking CBD.

Kirk: So, he wasn't tracking her benzo use, he wasn't tracking anything, he just he had his five minutes with her. He probably did a quick read of what he did last time and said, how's it going? There was no tracking.

Susan: Correct.

Kirk: It just frustrates me.

Susan: Yeah, well, I mean, he the only involvement I had with him and I thought it was important was the reduction of the Ativan. You know.

Kirk: He was asking about that.

Susan: Yes. He wanted us to follow a plan that would likely more likely meet with success. So, you know, we somebody with 20 years of use of Ativan, you don't want to abruptly stop. So we were very measured in how we came down on that six milligrams. And he wanted to be part of that conversation, which was fine.

Kirk: Well, as he should have been as he should have been.

Susan: Yeah, but, you know, when I say part of it, you know, I was involved in the day-to-day conversations about moving up and moving down and that kind of thing. And he was comfortable with that I think, because he knew at this point he had a relationship with me. So he was also trusting me that I wasn't going to do anything that wouldn't be in her best interest.

Kirk: And that's a key point, isn't it? You have to have trust between the health providers. I mean, in my practice, I've been I've been doing Northern Nursing for about 12 years now. And there is a handful of doctors that I know intimately because we've worked we've worked together face-to-face at different stations. But when I get to you know, I get on the phone with a new doctor. They don't know me. I don't know them. And you're trying to feel each other out and who knows what you need to have that trust. So, if you walk in as a patient advocate and the doctor knows that we've done this before and they trust you, that would certainly help.

Susan: As you say that, Kirk, it reminds me to say that in the early days, 2015 when I started this business. I referred to us as patient advocates and I quickly changed that. And our business cards say nurse care managers. And the reason is that a lawyer actually pointed this out to me, that by calling ourselves patient advocates, it would be like raising the red flag, that there was a problem. And so that she said as soon as somebody bringing a patient advocate, it's like saying to people, OK, you're in trouble what you do wrong. And, you know, we're here to build bridges, not burn them. And I don't honestly think anybody in health care signed up to be nasty or to not do right by people, but for a variety of circumstances that's what we witness. In any case, in our care management role, that's an easier for people to swallow. And they don't necessarily think we're coming in guns blazing because of course not.

Kirk: Right now, I recognize cannabis is just is part of what you do in the sense of helping people understand it. Using the term alternative health care. Is cannabis alternative health care, or should it actually be first line health care? I mean, when I study cannabis, it's like third on the level of pain management. It's always it's always low on the level. And they talk about they talk about not enough studies for it to be a primary medication. But yet doctors often use medications off label such as gabapentin without the science. So it's you know, in my early days studying cannabis, I've been doing this now for three years, actively studying cannabis. I find it so frustrating that people such as, your example -- couldn't CBD has been her first her first drug five years ago. I mean, of course, we didn't have what we know now, but why aren't doctors thinking, you know, rather than put you on this really high, strong opiate, let's try cannabis. You know, let's just try cannabis. Where are the docs with this?

Susan: Right. You know, so first of all, I would call that complementary therapy. I don't see that it has to be an alternative because I also think patients are afraid where they think that they have to choose one or the other. Like its an alternative. It is an alternative, but it can complement what they're doing. So, nobody has to turn away from the medical system model; every pharmaceutical agent they take. But they need to know that cannabis may replace some of them. If they're on medicines for anxiety and pain and so on, then cannabis can be a great solution. And I believe that the reason the doctors haven't been suggesting it is because they don't feel they know enough and they aren't well supported by their colleges also in terms of cannabis education. So, you know, people tend to in life shy away from things where they don't have the knowledge or the education. They don't want to talk about it. They don't want to even show reveal the gaps that they have in knowledge. So, they just prefer not to speak about it. And honestly, I don't buy it, though, because I, as a nurse, know plenty about cannabis and I've made it my business to know it, and I think it's important to know it, and I think it's true for physicians as well. If you think it's important, then go out there and get the education you need to support your patients. They deserve it. And so that's my stance with it. I think they could support it much better. And I think it will come.

Kirk: Two avenues. I'd like to segue into the course, but I just want to talk one thing about recreational use of cannabis. What I find interesting in my practice, my practice is a lot of recreational cannabis is not medicinal in reserves. Ironically, a lot of reserves, you know, they're dry reserves. So, they restrict alcohol and drugs and cannabis, though all of the things are actively happening on reserves, unfortunately. But I often have people come in, often come in. And, you know, I ask them now as part of my history gathering, do you use cannabis? And they do. And then I look at the antipsychotic meds they're getting and I'm thinking, ah man. So, I brought this up to one of my physician acquaintances, friends in the north, and he is not an advocate of cannabis. I don't think he'd mind me saying that he believes any doctor that prescribes cannabis is a drug dealer. So we were together for two solid weeks because of covid. He was isolated and worked with us at the nursing station. Was wonderful to have him. We had some fantastic discussions about cannabis and became friends over our discussions because we were so on opposite sides of it. But he actually turned me on to an idea I didn't know about. And that was in Manitoba. The College of Physicians have a policy statement that only the primary caregiver can prescribe cannabis. So, you know, let's use myself for the scenario. I go to see my doctor. I fall off my bicycle on the local trails. I fracture a rib. I'm in some pain. I'm taken Ibuprofen. I'm taking some Tylenol, but I want to get to cannabis, the CBD and do it. Do it, you know, get some medical while my primary doctor wouldn't prescribe it for me because you felt this was only a, you know, an acute situation. The pain will go away. And his argument was a good argument. No problem. But now I can phone. I can dial up HelloMD. Or I can call Dr. Shelley Turner out of Gimli and say, you know, Shelley, I've got I've got some pain. I'd like to use a medical cannabis to get through the pain. No problem. So, here's a question. I'm not sure if you're qualified to answer it. I know that the college doctors haven't addressed my question to them. What happens in Ontario? Do the College of Physicians allow other doctors or just the primary caregiver. The law is so fuzzy with prescribing cannabis? I do have any knowledge on that.

Susan: Yes, certainly the any physician can order here in Ontario. So I have patients where it was not their family doctor because their family doctor was unwilling. And so somebody else did the prescribing. They just have to have a physician, a college registration number. So, yeah, that's not been an issue.

Kirk: Well, it's not an issue here either. But when you look at when you look at the literature, when you look at the guidelines of physicians, they're directed by their college that only the primary doctor can prescribe it. So, it's a nuance of the wording. And this is this is the debate I got in with the doc in the north. Was it these doctors are operating outside the college and saying, well, why aren't the college doing anything about it or why aren't they updating?

Susan: I mean, I can understand that perhaps the intention behind it was they want the person who's the quarterback, who knows the most about this patient to be managing this. And they don't think a specialist sees you often enough to be managing this or monitoring pain, anxiety and those matters. So, I can understand there was a rationale behind it. The downside, though, certainly in these early days, is that if your GP is not prepared to do it, then where are you at? So, you know, it takes away your right, your option and so on. And, you know, to the point you were making earlier about recreational use of cannabis, as far as I'm concerned, we would probably have a lot of people in our society on SSRI and other medicines for their mood if they weren't using recreational cannabis.

Kirk: Agreed.

Susan: I totally support the recreational use of cannabis. I see no reason why not to. This is the one of the oldest medicines on the planet. Nobody's died from it that I know of. And sure, you can have pretty miserable overdose symptoms. I witnessed it. And the reality is, though, that if we look at the options out there, cannabis is far superior than the pharmaceutical agents that I've seen anyhow in many cases.

Kirk: Yeah, this is a wonderful segue. Let's talk about the Cannabis Competency Course. I'm just swiping to the webpage. Cannabis Competency professional courses. I will we will put the Web link in our webpage. But let's talk about this. What? What is this course Canadian edition? Cannabis competency consultants. If I take this online course, I become a consultant. How does that work? Who certifies me as a consultant?

Susan: Right. So, to be clear, it is a certificate program as opposed to as opposed to a like a certification. So, we don't have a governing body to give out the certification. But what we know is that this level of education is sort of entry level to have a cannabis role, which you may have in a clinic. So this is sort of the base information. It's not the advanced information that a nurse practitioner or a physician would need for prescribing purposes, but it certainly gives the solid foundation to support the safe use of cannabis by our patients. And that's what I think the average nurse in Canada needs this. And in fact, we have a lot of other countries reaching out to us for this education, for their nurses. And so, we will are in the midst of translating this program to meet the needs of these other countries because, of course, they see Canada as world leaders given our legalization. And so, they, too, want to have their nurses knowledgeable about cannabis.

Kirk: So, who created this course? I noticed this is one, two, three, four, five, six, seven, seven modules. And I mean, it's called the professional courses. Who are the originators of this course?

Susan: Right. So, the originator is Morgan Tomb's, who did cannabis education for nursing students at Ryerson University in Toronto. And then Morgan and I, well, you may have seen us, I don't know, in November of 2018, we were on CTV National News and the article was nurses, Cannabis Savvy Nurses Leading the Way. And so back in those days, Morgan and I were collaborating on how do we fill these gaps in knowledge for nurses. So what Morgan did is she basically translated this course she gave Ryerson into this online course. And I was offering input in regards to what the gaps are for nurses in the community, which I know well because of the Nurse on Board team.

Kirk: OK, is this a pass fail or is it a participatory.

Susan: Yes. So, you need 80 percent to pass. But you basically, as you go through the modules, you do the tests and it just sends you back into the module if you don't pass and then once you pass, you move on to the next module. So, we are wishing to first deal with all the myths around cannabis and get rid of those. We deal with all of the eligibility and exclusion criteria for the use of cannabis. Then we take the dive into the endocannabinoid system so people can understand the pharmacology, pharmacokinetics and pharmacodynamics. And then we get into looking at how we support our patients and we give some tools as part of the kit so that nurses can actually print out if they need to, or save all sorts of sort of algorithms and other things that they can use so they can support their patients in a way that they feel confident, because this is new information for a lot of nurses. And so, we've given them the tools to help them. And we do case studies as part of this program. And you also get a one-year membership to the education platform where there is a webinar once a month and we can give out new information about cannabis research, have a guest speaker, an expert. So that's ramping up this fall as our members within Cannabis Competent Nurse grow. And so, you do get a Cannabis Competent Nurse certificate mailed to you when you're finished. I have one right here in my office. And for people who want to work in the cannabis industry, which a lot of nurses do, and there's lots of physicians out there now, this is a perfect way to get started.

Kirk: OK? And it's recognized in Ontario. People are recognizing the certificate.

Susan: Yes, I would say so. There's certain things that you have to do to have people get reimbursed for courses like this. But this varies from province to province, what these requirements are. But certainly, it's being recognized by people that are hiring nurses in these positions. Yes.

Kirk: Nursing is an interesting profession. I mean, I'm talking to a self-employed, self-directed nurse, but most of us are working in acute care centers. Most of us operate under organizational policies. We were talking about earlier off camera about how does someone consume medical cannabis in a health care facility. There's very few health care facilities that recognize medicinal cannabis, although it's been around for almost nineteen, eighteen, nineteen years now as a medicine in Canada. What advice, how would you consult, how would you help a nurse who is working in an acute care environment where they are mandated by policy that cannabis is a stigma, a cannabis is a problem. People that use cannabis have drug problems. How do you help somebody in that environment? What advice would you give?

Susan: Right. Thank you, Kirk. You know, it's certainly different from one province to the next about the use of cannabis, medical cannabis within an institution. So, for example here in Ottawa, you can, nurses will dispense people's medical cannabis if they are not capable of dispensing it themselves. That's the rule of the hospital. Otherwise, they bring in their own and they dispense their own. And truth be told that their pharmacy is actually stocked with some cannabis because they know that there are times they're going to need it. Even because you otherwise would have to wait to get it from a Licensed Producer. So this varies from hospital to hospital and province to province where the rules are. I think the key piece though, is that helping nurses to understand and this isn't just about cannabis, but our focus needs to be on the patient experience. And so, the patient experience means that if they're using cannabis just because they've been institutionalized or they're in hospital or wherever they are, does not mean that they don't have the right or that they shouldn't be supported to continue the use of their medicinal cannabis for their own benefit and preference. Whatever it is, it is their body. It's their business. So, I think it's reminding nurses, educating them about the fact that patients are health care consumers and that they have the right to choose their medicine, choose what they think is good for their body. And so often these reminders go a long way. And education, what we've come upon, we've actually had a situation a few years ago where a nurse essentially overdosed our patient. And then when the nurse care manager from Nurse on Board came in to see the patient, he was so out of it. She's like, what is going on here? Now, this man has Parkinson's Disease. So, you know, it was she didn't know exactly what had happened. But when she interviewed the nurse, she realized that the nurse gave the wrong dose. And it's because she didn't know the product she looked at, took the wrong bottle and gave the dose. So, she gave the dose that should have been perceived. She gave up a THC based product. So, the patient, of course, was basically zoned out and very high and not unhappy about it. But it was education. You know, the nurse admitted she didn't really know what she was doing. And so, this is part of the pushback is people's fear around this. So why are they feel supported? Makes all the difference in the world.

Kirk: It's interesting. So obviously, it was an ingested product. It was. It was. Yeah, it was ingested. I used to be a nurse manager, it was the worst job I ever had. But if I was dealing with that as a manager, I guess I would ask her, what would you do if it was another type of medication? How would you have if you if you weren't familiar with the Lasix, would you not have gone and searched it? So, what was different about cannabis that allowed you to think you didn't have to research before you gave it? And I'm not sure if I'm thinking too deep, but because cannabis isn't considered a medicine by nurses, maybe they just say, well, this is this is the medicine, I'll give it to her. You know, I can remember back as a student, I made a mistake with heparin. I had given heparin instead of hep lock back in the day when you gave hep-lok. Well, I had given heparin instead of the Hep-lok That was a student error. But since that time, I've learned to read labels differently. So so, again, knowing being a cannabis savvy guy, I don't think as a manager I'd get too upset with the nurse. But I think I would ask the question, what was different about the cannabis medicine than any other medicine? Why did you treated differently? Where were your three checks? Where were you five checks?

Susan: It's you know, it's really true. And I think that what happens with cannabis is much like, well, it's not really my responsibility. I'm just kind of, you know, so and that's not the way, of course, to go about it. But it just shows the knowledge deficit, people not understanding the harm of getting it wrong. This is it's still a medicine. It's not something that you can just hand out like candy. But, you know, appreciating that the medical model is a culture of shame and blame, where people are afraid to report an error because of what the consequences could be rather than it being an educational opportunity. So, you know.

Kirk: Well, our colleges, our colleges actually encourage it. I mean, what is the college there for? To protect the public from nurses? That's their that's their mandate. So, I mean, in the nursing profession, we're continuously being bombarded with make sure that your colleagues have competent practice.  So, we're not there to encourage each other as nurses to work where we're there to observe that you're incompetent. So, I must tell on you.  I've seen so many young nurses get beat up by older nurses because they don't have a competency. Well, but they're young nurses. Why don't we guide them and help them? Why are we all of a sudden writing them up? Right. It's so I think in cannabis, that's one of the reasons why Trevor and I did this, was we're so frustrated with the ignorance and the stigma of cannabis.  And how do we educate people. So, this course, this course Canadian edition, what makes it the Canadian edition? Because, of course we are recreational legal?

Susan: Well, it makes it the Canadian edition because cannabis is legal in Canada. And so, and also what we speak to is the Canadian model around Licensed Producers. So, in the early part of the course, we address that because right now nurses in Canada don't understand how people even get the cannabis. And are they going down to an approved dispensary or how are they getting in and what makes what makes that the right way to do it? So that piece of the course addresses that Licensed Producer model, which would not apply to the states and other countries.

Kirk: Yeah, OK, here's a question. Currently, medical cannabis is only came in the mail, right? Do you have actual brick and mortar medical cannabis dispensaries in Ontario?

Susan: No. So, you're correct. It all comes through the mail and then the legal dispensaries are not for the medicinal use. I mean, of course, you could go in there and buy the product and use it. I mean, in a way, I consider a lot of cannabis medicinal use because people are using it for reasons probably beyond what they even realize. But in any case, the thing about it is if you go in these bricks and mortar places, you're not going to get any guidance around your health issue and what might be a best product. You know, that's not the kind of guidance they're giving. But it's certainly legal to go buy it.

Kirk: They're yeah, they're actually limited. I mean, and one of the episodes and one of the episodes we did, I talked about I walked into a dispensary and said, "I want to cut the grass today." What would be a good recreational cannabis for me to cut the grass? The bud tender, he was able to talk to me about the cannabis strain that would work for cutting the grass. But I can't go in there and say, you know, I've got a Parkinson's tremor. What would be a good cannabis for that? And quite frankly, I don't want to budtender talk to me about that, you know, so you could take this course. I'm looking at it. So, you're offering this to all health professionals, naturopath, chiropractors, physiotherapists.

Susan: Yes. You know, mainly because the language isn't highly medical, but it is you know, it does have that feel to it. And so, the language that we use, I think, for any allied health professional would be a good fit. But, you know, we have a lot of people that want this information, everything from personal trainers and other sort of different roles in the community where they're helping people with their health and wellness. And so, they want to be knowledgeable about it. So, we are making other versions of the course available so that it is appealing and meets the needs of people in their various roles in the community.

Kirk: Yeah, I well, I tell you, I'm planning on taking the course for two reasons. One is just pure interest and the other is I want that certificate.

Susan: Thank you.

Kirk: So, Susan Hager, thank you very much for your time. Is there anything you'd like to sum up our conversation? Is there a question I didn't ask you?

Susan: Thank you. Well, I just think that what I would like to share is that I believe nurses are the solution to the problems that Canadians are facing with health care. And I certainly think that veteran nurses that we are this is a big loss where nurses are fed up with their hospital life and shift work and then they retire. This is huge wisdom, knowledge, experience, skills that we as Canadians could benefit from. And so, I think that our roles with Nurse on Board and other senior nurses in the community, I think we're here to solve the problems that others haven't. And I hope that we can collaborate with you and certainly in the cannabis world and otherwise to help people.

Trevor: So, Kirk, so many things I liked about Susan, let's start with something you alluded to earlier, how advocate, at least from the lawyer she's talking to, and you know what, this rang true. Advocate. If you present yourself to a doctor as an advocate, the doctor immediately gets defensive because that means maybe someone's.

Kirk: Upset.

Trevor: Maybe you're saying I did something wrong.

Kirk: Yeah, someone's upset.

Trevor: So, you know what? So, she's not an advocate. She tries to present herself as someone who's obviously advocating for the patient. But she also sounds like she is working hard not to piss off the doctor, you know, because she recognizes the doctor is not, as much as she may not agree with how they're treating him. The doctor really does want the patient to feel better.

Kirk: They're doing what they call health care management. Right. So, they're allowing a nurse to come in and be your care manager. So, this is their offering that service. The Web page nurseonboard.ca kind of explains their services. What I really like about this story Trever and again, all of our episodes to me are stories. What I like about this story is that here again, we find health care professionals in this story, who are out there offering assistance, in a marketplace that needs it. I mean, Canadian health care system is a sacred, sacred entity to Canadians. I mean, conservative, liberal doesn't matter what spectrum you're on in Canada, unlike our neighbors down south. Everyone agrees Canadian health care is a sacred one. We don't touch it. Right. We don't touch it. You don't go near it. If you talk about private health care, everyone goes crazy over it. But in a sense, this is just a private health care helping people in the Canadian system. Because the Canadian system lacks one thing. We seem to forget that patients are clients and customers and are there for assistance. And I think this group of nurses help the health care providers that they're networking with to remind them that we're providing a service here. Right. And.

Trevor: Yeah. And just to make it more cannabis specific, no, no, I like your overview, but one of the patients she's talked about just kind of blew my mind. You know, obviously, we picked the most exciting case study. But just so we had a lady in her early 60s on six milligrams of Lorazepam, not just for the maybe non-doctors, non-pharmacists, non-nurses out there.  Six milligrams of Lorazepam a day is huge. And then on top of that, she was on 80 milligrams of Prednisone a day, which is a big freaking huge like it's... Yes. And you can make fun of the pharmacy profession all you want. And that's on this case, maybe rightfully so, because probably at least half of her problems were directly from the medication.

Kirk: You think?

Trevor: You know, it's one of these she had some issues, but we went way too far on the medication end. And, you know, maybe there should have been a pharmacist involved earlier on to scale that back. But that's another story. But she was way over medicated and the medication was now… probably more than half her issues and just, you know, on to cannabis and off of some of these medications made a world of difference.  Now but she's also right that it you can't just both the prednisone and the Lorazepam, you literally can't just stop. We'll take the benzodiazepine to begin with. If you just stop someone on that big of a dose, they could actually have a seizure. So, you know this, she's doing some really good and frankly relatively complicated work at getting people off of some of these medications while getting them on to cannabis.

Kirk: Well, once again, we hear a story that cannabis is an exit drug. You know, this is this is.

Trevor: I would have never guessed a prednisone exit drug. That just never crossed my mind.

Kirk: But I mean, how many how many episodes have we had were health practitioners, prescribers have told us that cannabis helps, you know? So, this is another story. This is why I like this story. I think in some ways this is her cannabis story that she's given us. How an unhappy health care provider, this being a nurse, wanted to change the system. So how do you do it? You become self-employed and you go out and you provide a service. And in that they discovered cannabis. Which leads me to the next story that we didn't touch on in the intro. I told you a couple of episodes ago that I'm a cannabis competent nurse.

Trevor: Yeah. And you guys talked on that a little bit. So what does that mean? What's that involved?

Kirk: Well, it involves taking a webinar that that was designed by Cannabis Competency Professional group. They it's again, we have we have a website here that will put on our website. And essentially, it's cannabis competency training for health professionals. Now, I've been networking with this group of people and I hope I have another story on this. But what it entails is, I basically spent oh, I think I spent about eight hours on it, maybe two days. I've been doing a lot of training since I've been home, actually. So I spent about I think I spent two days on it. It's a webinar and it basically taught me Trevor, how to dispense cannabis and actually how cannabis is prescribed in the medical documents. So it really taught me the medical program as a practitioner. And they're telling me now that this program, this certificate is is being recognized now by other health professions in Ontario. Its an Ontario course. So I'm going to I'm going to leave it there because I do want to do an episode on this and we'll link the two episodes. But just again, for health practitioners out there that listen to our podcast, Reefer Medness - The Podcast, me being the.

Trevor: I am Trevor Shewfelt I am the pharmacist. You are.

Kirk: I'm Kirk the nurses, We seem to forget to introduce ourselves.

Trevor: Say who we are.

Kirk: who we are until the end of the show. But what I hope to do is I want to encourage other health care professionals to look for training. This one's a good one, I really enjoyed it, it challenged me, I had to go through a series of multiple-choice questions and all that sort of stuff.

Trevor: Yeah, no, I think that's a great point. And, you know, we keep hearing from other health care professionals, both through the podcasts and elsewhere, that I don't know anything about cannabis. Finding training on cannabis is not that hard. Like my national body, the Canadian Pharmacist's Association has a they called a six-credit-hour, not six, two-and-a-half-credit-hour cannabis course, which was really good. And two-and-a-half-credit hours means they're literally going to spending two to three hours on a Web thing, answering questions, yada, yada. But it was really good. I'm going to one next week put on by Spectrum Cannabis like, yes, they are Licensed Producer and see what you will about it. Just like in the pharmacy world. Yes. Sometimes the maker of antibiotics, you know, blood pressure medication X puts on of course. Yes, that happens. But, you know, it's happened forever. It's not that means it can be done badly.

Kirk: You sound so defensive. Why are you sounding so defensive?

Trevor: Well, because we hear that a lot. Why you can't go to that? Because it's put on by the drug company. It doesn't mean they're doing it wrong.

Kirk: Its a taxable benefit.

Trevor: Sure. So, yeah. So I'm going to one Zoom call next week, put a buy Spectrum Cannabis. Sorry. I think they call it a Spectrum Therapeutics there in the Canopy Group. So the education is out there. You might have to look a little bit, but you don't want to look that hard. It's out there.

Kirk: And hey, Reefer Medness - The Podcast is also education and.

Trevor: Absolutely.

Kirk:  and I think I think the people that are listening to us should be giving us some feedback by giving us an evaluation on either iTunes or whatever podcast platform you use. Send us, let your friends know.

Trevor: Give us a review.

Kirk: Give us a review,.

Trevor: Preferably a good one. But, you know, any review will do.

Kirk: I'm in the health care profession. I'm very used to getting improvement.

Trevor: Required.

Kirk: Yeah. You know, Kirk showed a lot of enthusiasm, but there's room for improvement. So, I'm okay with getting any sort of feedback. And unlike some podcasts, we will we will let people know, anything you send us we were advertised and let people know that people are actually listening to us. Do us a favor. Also tell two friends about us. And let's get let's get this community Reefer Medness community activated Trevor.

Trevor: That sounds fantastic. All right, Kirk, another good one. Enjoyed it. And looking forward to all the episodes that are coming up next.

Rene: Well, that was great, guys. I really enjoyed that. And now I guess it's time for me to pitch in here. I'm Rene, the producer. Of course, for those of you out there wondering how suddenly there's another voice here. Susan Hagar was asked to choose a song to end her episode with what she chose was Get Ready My Soul by Daniel Nahmod. And so that's what we're going to play. So thanks for listening, everybody, and keep listening. And thanks for your continued support.