hello my name is lisa aereo i am the director of belmont health collaborative welcome back to another decision of focus on health today i'll be speaking with dr don about who i will lisa this is a billion honor and i'm really excited about this topic i have been very fortunate to be involved with uplifting at the moment since august of two thousand and fourteen when we started this clinic in munich mass and we are now located at washington state approximately four years ago and i've seen over four thousand patients here and in massachusetts i've seen over five hundred patients my population is over the age of eighteen and i really love what i do and i'm very passionate about this and i cut into this about learning about cannabis about six years ago i had never learned about this as a medicine as a plant medicine and then i did not know that there was a system of why this medicine works so well it is known as the endo can benoit's system and this system is a mere six hundred million years old wow and people say what you want to forget forgetting is equally as important as remembering and we see this with our patients that have p t s d post traumatic stress disorders where they've had an incident that happened we think of p t s related to vets but we see it with other patients of all different issues and events that occurred forgetting if a woman had to remember childbirth do you think we would have babies being born now absolutely i can attest to the fact that there would be a lot of one children families yes men would not be happy women years were caught them to be pregnant so forgetting is equally as important as remembering that at the same time these five words to mean balance homeostasis so too much or too little of any of these words could be detrimental so if somebody forgot too much as an ou to mention that is equally as important as not forgetting the same goes to relaxing eating sleeping protecting and forgetting in my practice i made th statement two years ago cannabis is not an entrance drug it's an exit drug from pharmaceuticals and narcotics and for many years people have always associated cannabis as a gateway drug right and i was also misled and also educated that way as far as cannabis being this evil drug and we always think of reefer madness in the one nine hundred thirty s and when i started to research about this was because my mom was dying fibrosis i p f fancy term for we don't know what caused your lung disease my mom who i never smoked and she my parents had been living have the time in india and half the time here they had come to visit me in washington where i was working as a occupational environmental medicine physician and family physician and i'm also an m r o a medical review officer doing compute my whole life i had told patients not to smoke and in my second life i was telling patients to protect themselves if they needed to be exposed to minimise their exposures to wear respirators we did surveillance exams i monitored them so telling patients to smoke was just not on my agenda and that's where majoring in began when i started to learn about it at this  time do not have a prescription in my office and i'm proud to say i do not contribution to the op you are that but then me ok let's pause there because i'm sure our audience has some questions as do i let's back up to january of two thousand and twelve massachusetts passed a law allowing for medical cannabis to be prescribed to patients it has taken a while before massachusetts has set up dispensaries can you talk a little bit  about the law and what it allows doctors to do and a little bit about how the prescriptions get from doctors to the dispensers ok to patients very good question lisa and a lot of patients the first thing i always clarify for people to understand is that doctors do not write a prescription for this medicine good points i think there's some confusion out there that perhaps perhaps if someone is in pain or feeling ill that they can go to their primary care physician and walk out with a script to then go to a dispensary but you're saying that's not how it works not at all doctors cannot write a prescription for cannabis because it isn't schedule one tell us about there's there are five scheduled drugs absolutely and the schedules were created in one thousand and seventy by the controlled substance done in cannabis is in schedule one since then along with heroin alist an ecstasy which is criminal right of him highly addictive dangerous drugs absolutely so schedule one means that the medicine has no medical use that there's no medical research in the united states and the potential for abuse ok so let's clarify about abuse everything has a potential for abuse addiction is a different illness of its own and even with that we know cannabis addiction is approximately nine percent v whole and tobacco is near thirty percent so i want that to be understood doctors don't write a prescription we write a recommendation so when a patient comes into my office i evaluate them we consult with them we go over their medical conditions and symptoms we require them to bring in medical records at some point it is not required for that initial visit we will still see them and we will require them at some point to bring that in but once they are seen i will make a recommendation that say you are seen in for example you come in with a condition for chronic pain and it has been to a trauma or something were in tear rheumatoid arthritis injuries whatever it may be if that is your condition i qualify you under that condition you then would be i would do a registration because i am a physician registered with the ph to be a doctor that can write these recommendations and once you're very just then you will get email and this is a process even at that point you don't walk out with something that you can go to the dispensary it takes about three weeks for you to get  email process and some of our patients struggle with this and we help them to be registered as well is also a paper process which is a little longer but approximately three weeks from the time that they are registered with the ph that they get their actual card once they get their card then they can go and be seen at the dispensaries at the present time i'm proud to say that we have six dispensary we have one in salem we're acting north hampton areas brookline and lol and hopefully there will be more opening and this is of great concern because patients were told that they can go get this medicine they've got their piece of paper and again safe access so what i started with our patients in november of two thousand and fourteen was a patient care giver support group and we run these monthly and these are for patients and we say caregivers and this could be caregivers could mean the family members patients friends whoever and also caregivers that actually get the medicine for patients so what are spilt in support for people who are in parking on this as a therapeutic absolutely option now will you if i were to show up at your clinic with severe pain from rheumatoid arthritis would you then after doing a full evaluation and reviewing my medical records would you confer with my primary care physician my thing is i am believing the patient the patients coming in to see me so this is just like any other visit i have no reason to mistrust the patient so  we do a complete history in france a call we get a history and then we require eventually to get medical records what i do in my practice is that i see the patient back in three months for follow up and usually within the first three months there is able to get their card and they know that they've been registered and were able to see where they are and they're able to get their medical records and usually they're able to get records faxed her office but i just want to say you know a lot of patien tends to tell to doctors about wanting to use cannabis because i have three sets of patients exposures they'll either go to their primary care doctor and their doctor alienate them and says to the point of even having them kicked out of their practice or says i know nothing about this the second group of patients may go to their doctor the doctor says i'm not going to write the recommendation for you my hospital that i work does not support this so i'm not going to do this for you but go find somebody else where the third patient may have the exposure to their doctor that says go ahead it works for you but i don't write the recommendation so they that's how they end up at my door so one theory stablish with me i like to see them back at six months and then the certification process what i do is i give them durations of six months certifications after their follow up after the six months and then give them a one year certificate but i like to see my patients every six months and so many patients like to see me more often which is fine too ok tell us a little bit about why you believe in this as a therapeutic option or simply stated what are the benefits that medical cannabis offers that another reintroduced maybe by their children even as an option or they travel to colorado or went somewhere and recently tried it and are like you know i tried this this worked for me what i see with my patients is that they are really wanting to improve their quality just that i mention for prescription never mind what they get over the counter tylenol the nguni in each of these meds have a side effect every medicine either metabolize to the liver the kidney so there's toxic effects of this and with cannabis i always say it's not for everybody but it should be a first line option and not the last resort it should not be after you've killed your liver in your kidneys and you have nothing i want to see this offer to all patients i want health care providers to be educated about the endocannabinoid system i'm not saying all doctors go out there and write recommendations where they need to be educated we were physicians don't know and most patients don't know cannabis was legal in this country doctor wrote prescriptions for cannabis until nineteen forty two it was in the form of copier it's because of political reasons not evidence based medicine that this medicine was placed in schedule one what we want to know is that this medicine has been around for is we have cancer patients we have patients that are recovering from different procedures people that have failed surgeries people that are private i have lupus patients i have m patients i have my seniors parkinson's patients and the list goes on in our in our very long list and know what you don't shame why this works so in the beginning i mentioned this beautiful world word called in other parts of the body and this goes into why different delivery systems can be used so once the person gets a recommendation they look at different options uses to eat it to wayne to i put it on my skin do i put a patch on my body do i use a subpar the tory do i put it in my mouth how do i consume it so and it gets overwhelming it's not like in the old days quickest and most rapid delivery system what i mean by that is when you're in here you can either smoke or reprisal smoking a lot of misconception and i want to clear those smoking  not is not related to lung cancer dr donald her skin u c l a professor paul monologist did a research study where they looked at four groups of patients that had lung cancer and they went back and said how many of them smoked how many of them smoked tobacco how many of them smoke cannabis and how many of them smoke tobacco and cannabis and guess what the people that smoke cannabis had less lung cancer than the people that smoked nothing and when they compared to people that smoke tobacco and people that smoke tobacco in cannabis people had smoked about on campus had less lung cancer than people that smoke tobacco what i'm saying maybe this protective and we're finding out about this so the plant cannabis can or this  stock or fiber and best means a plant with two sexes male or female it's the male plant that has no psychoactive properties and it's the female plant that has the psychoactive properties we've heard about in the news about c b d which is the nine psychoactive component in t h c which is the cycle active component so these are the two spectrums but we need the whole point and i what people to understand one is not important unless we have the whole plan so they work together absolutely it's also known as the entourage effect where you need both specs ok are there risks associated with using medical cannabis absolutely and we don't live in a perfect world and cannabis has the side effects that we know the dry mouth the drive through the panic the paranoia heart racing and the worst symptoms that i've seen is even somebody puking their brains out with the ingestion of cannabis again spectrums of how people can we're so for my patients i always say you've got to go to hydrate before you medicate ok and basic principles of low and slow for some of my patients i say very low and slow so you can tell you this and this is something that always is of a concern because coming from a western mentality of medicine what's the dose people simple what about dosing well you don't have to worry about doesn't this is not going to kill you and so i always say do it with somebody in a safe environment and make sure that you are in a controlled environment where you know that you don't have the paranoia you don't have the fear factors and that you're with people that know how to use and a lot of my time that spent in our office is with my staff that spends time with the patients because by law i can even tell the patients how to use the medicine but my staff is not just my staff but they're also patients so they're able to sit with the patients one on one and that's part of the support that yasser so let's go back to the scenario of me i'm in chronic pain and i talk to my doctor my doctor recommends an office such as yours i have the work up with you i fill out the paperwork i get completely registered now i go to a dispensary one of the ones you mention i'd probably say for belmont resident brookline might be the closest so now i appear in brookline what do i expect what what form will the cannabis be given to me when i get to that point will it be an edible will it be something you mentioned vaporization you mentioned inhalation i have there's oil as i've heard that so what form would i expect and what kind of education would i get let's pretend i have no clue about dosage in this is where you know i have not had a chance to visit the dispense trees to see the problem one before it was opened but i'm planning to go visit all the dispensaries what my experience from a patient has been then it depends and again we're trying to use limited sometimes they say flour i e weed or the bud is available some places have concentrates that are available that can be pricey some of them have vaporization tools where they come in liquid forms but again limited supply in different places and we're hoping that they will expand more  also talking with the ph to find out about in a standardization what patients can expect what kind of education then again we are trying to make this is best as possible for the patient i've been told that different dispensary it's not across the board the same as far as products what they're getting even the education what they're getting even the treatment of how the patients are being explored scored it in and what the step by step  does vary from various even within massachusetts absolutes discounts are interesting yes two are owned by ned up but there's different ones that are owned by different owners so they're all individually owned and some of them are owned by more than one ok now would if i i get my dosage i get the medical cannabis would i expect relief almost immediately or do i need to take this over the course of many many days to expect really very good question again this depends again what the delivery system is and what you're trying to treat so some patients again initially might not have any relief some people might feel extreme against this is where the ti begins of journaling and all my patients part of their counseling i tell them to journal so what works for lisa is not the same for works for john or mary or whoever it may be again concepts of low  always make it simple as s for sunshine so it's more of a head high warmer t h c based indicus i think of insomnia or some of my patients say in the couch so couch lock but it's more for a nighttime use but again  different things and again it depends on what you have to do what your requirements are i might have a mother that might have children so she's got different means than somebody that's working maybe with machinery or they do only what is your their day safety and risks that you mention again we want people always to be cautious i don't like the word recreational i think of it as adult use is the better word to use precautions again we need to be safe we always tell being safe with again you don't have to worry about overdose but again don't leave your medicine open if you've got children and animals and pets be cautious treat this just like any other medicine and again we're here to help and i'm only one one question before we have a few minutes left one question that comes up out there i've heard in our community is will this medical  treat my disease will it help eliminate some cancer cells or will it help with what's going on with my auto immune system with lupus or is it just simply alleviating the symptoms of the disease really depends again and it's very good question vic and these are all excellent questions because there are certain data that shows it cures cancer and that's a big word that is huge yes and we are seeing this with depending on the cancer depending on when the treatment is done my biggest thing with this medicine is that it improves quality of life and it is able to help patients get off their medicines and i stand by the statement it is an exit from pharmaceuticals and you i think that the information that you've given to our audience is very valuable and if people have further questions of people are out there suffering if they feel that this might be a viable option for them they can contact the your office we provided be contact information and would that be a good or absolutely one that they go to their primary care physician first or contact your office either way some people like i said are sometimes reluctant to go to their primary care because they fear factors but either way and our phone number is five zero eight four four four two three two four and my lovely assistant lisa jordan is always very helpful and the name of our clinic is uplifting health and wellness and i will come everybody to come tomorrow to our patient caregiver support group meeting which will be at the v f w in natick and we will provide this information for you to put your listeners as well ok well thank you doctor and thank you lisa this it was my pleasure in a very informative conversation i think