Becoming a Patient

Medical Cannabis, IBS & Intractable Pain: Vicki's Story

20181203_141827.jpg

LeafLine Labs patient, Vicki, was born and raised in Hibbing, Minnesota where she currently lives. She is a mother, a grandmother to four grandchildren, and has been with her significant other for over 14 years.

Vicki is a caregiver for her mother, who lives down the street, and she is passionate about helping people; she gets joy from inspiring smiles and laughter in others. She considers herself spiritual and meditates regularly. When she can, she incorporates yoga or pilates into her daily routine.

For the majority of her life, Vicki has lived with the pain, anxiety, and other symptoms that come with Irritable Bowel Syndrome (IBS), Fibromyalgia, Arthritis, GERD, Celiac disease, and numerous other food allergies.

To treat her various conditions, she has tried a seemingly countless list of medications and physical therapy, but the relief was always minimal and the side effects many.

Vicki describes herself as a happy, outgoing person but for the past few years she did not quite feel like herself. Her health, both emotionally and physically, went into decline. She experienced more pain and anxiety and began to eat and sleep less. She remembers days where she would force herself to get up and out of her pajamas just of so that her significant other, Kevin, wouldn’t know she hadn’t gotten out of bed all day.

When Vicki first learned about the medical cannabis program in Minnesota, she assumed that the requirements to become a patient were more restrictive than they actually were; she thought that one had to have been diagnosed with cancer or another terminal illness.

When a friend recommended she get certified and she realized she could qualify with her conditions, Vicki decided she needed to make a drastic change and would do anything to get there.

Vicki had experimented with cannabis in the past as a way to self-medicate but didn’t quite feel as though she was getting the relief she had heard so much about; she was eager to see what differences she would experience after enrolling in the state’s program.

In October 2018, she had her conditions certified, enrolled in the program and scheduled an initial consultation at the LeafLine Labs patient care center in Hibbing.

Since her first appointment, Vicki’s life has taken a drastic turn for the best. “The medical cannabis has taken the inflammation out of my body; it has taken the pain away,” she shares.

Now, she is doing things once again that she hadn’t in over two years. She feels an undeniable difference and everyone around her has noticed the improvement in her mood and the way she moves about her life.

Amazingly, Vicki has not had to take a single prescription or over-the-counter painkiller since she began using medical cannabis. She still takes medication to help her sleep at night, but has been able to cut her dosing in half.

Since she was young, Vicki has lived with thyroid problems. Just the other day, her test results came back and she was told she needs to decrease her dosing of Synthroid, a drug that replaces or provides more thyroid hormones. Since 1994, Vicki has never tapered her use of thyroid medication, only increased; Vicki is ecstatic about this change and believes wholeheartedly that cannabis has helped her get to this milestone.

Feeling better and more optimistic than she has in quite some time, Vicki is eager to see what other firsts and progress come as she continues to use medical cannabis. “It has given me my life back,” she shares.

She is grateful to have the energy and desire once again to spend time with her loved ones, pursue her passions and to move about her day with newfound effort and ease.

Vicki with her son and daughter.

Vicki with her son and daughter.

How May Cannabis Help Patients With PTSD?

_E4I1049.jpg

Post-traumatic stress disorder (PTSD) became a qualifying condition for the medical cannabis program in Minnesota on August 1, 2017.

PTSD is a mental health disorder that manifests after a traumatic event. Symptoms of PTSD are varied but often include: disturbed sleep, anxiety (specifically when in a situation similar or reminiscent of the traumatic event(s), flashbacks, and more.

In severe cases of PTSD, these symptoms can greatly impact daily life. There is no cure for PTSD, but its symptoms can be managed with medication and therapy.

Medical cannabis can help patients with PTSD by decreasing anxiety, improving sleep, decreasing nightmares, and helping to reduce avoidant behaviors.

LeafLine Labs pharmacists are experienced in treating patients with PTSD, and many of our patients who are currently being treated for the disorder have achieved great symptom relief. Our goal with medical cannabis therapy is to help manage the symptoms of PTSD and help improve patients’ quality of life as much as possible.

How May Medical Cannabis Help Patients With Arthritis?

LLL Product (48 of 72).jpg

Arthritis itself is not a qualifying condition for the medical cannabis program in Minnesota, however, LeafLine Labs treats many patients with arthritis who have qualified for the medical cannabis program under Intractable Pain.

Medical cannabis’ ability to reduce pain and inflammation is well established, and many patients currently being treated for arthritis symptoms at our care centers have reported greatly improved symptoms.

Every arthritis patient has unique needs, and a consultation with a LeafLine Labs pharmacist is the best way to determine what medications are most likely to work for their symptom profiles.

For example, one patient may be seeking greater pain relief and help sleeping through the night, and another patient may be trying to be more active with less pain during the day. These two patients would likely have different treatment plans. We can create virtually any custom ratio of CBD to THC and use what the patient feels works best for them.

Our goal with medical cannabis therapy is to help manage the symptoms of arthritis, such as reducing pain and inflammation, and to help improve patient’s quality of life as much as possible.

How May Medical Cannabis Help Patients With IBD and Crohn's?

Product Family (1 of 1).jpg

For patients with Inflammatory Bowel Disease and Crohn’s Disease, pharmacists typically recommend products, or combinations of products, that provide ample CBD levels with a smaller amount of THC.

Cannabis has anti-secretory effects and decreases intestinal motility, therefore reducing the frequency of loose stools or diarrhea.

CBD is highly effective as an anti-inflammatory agent; studies have reported CBD is anywhere from 4 to 20 times more potent than aspirin as an anti-inflammatory. CBD also mitigates certain effects of THC; by using higher amounts of CBD than THC, patients experience the benefits of THC with a smaller chance of undesired effects such as sedation or dizziness, allowing them to be more active during the day.

THC can reduce intestinal contractions and therefore help with cramping. THC also helps reduce pain sensation. Unlike most opioid pain relievers, cannabis does not cause constipation. THC also reduces anxiety, decreases nausea and increases appetite.

IBD & Crohn’s disease patients make up a small but growing number of our patients. We have seen patients experience symptom improvement, less diarrhea and nausea, and better pain control. Our goal with medical cannabis therapy is to help patients manage their disease and lead a more function, productive life doing the things they want to do. (And not having to worry about bathroom breaks!)




 

How May Medical Cannabis Help Cancer Patients?

LLL Product (70 of 72).jpg

Tangerine, our high-THC and low-CBD formulation, is our most commonly used medication for cancer patients.

THC often gets a bad rap, but provides a lengthy list of therapeutic benefits such as: decreasing pain, improving appetite, increasing weight gain, and improving sleep. THC is also known for its anti-nausea, anti-emetic (vomiting) and anti-anxiety properties.

The small amount of CBD that is in this product has anti-inflammatory properties. CBD helps to improve the anti-nausea, anti-emetic and anti-anxiety properties of THC, which are helpful in progressive diseases as well as during and after chemotherapy.

THC and CBD have also shown to have anti-cancer properties, similar to chemotherapy but without the systemic damage. This has not been clinically proven, as it is all based on patient reports, but is promising nonetheless.

At LeafLine Labs, we see a variety of patients with cancer, ranging from pediatric to elderly, with a wide variety of diagnoses. We have seen many cancer patients who have experienced decreased nausea, healthy weight gain, pain management, improved sleep, decreased anxiety levels and who have been able to decrease their use of narcotics, sleep aids, or anti-nausea medications.

Read how medical cannabis from LeafLine Labs has helped Char after her stage 4 metastatic breast cancer diagnosis on the blog.

Pharmacists' Role in the Minnesota Medical Cannabis Program

DSC05038.jpg

Unlike most other states, Minnesota’s Medical Cannabis Program is overseen by the Department of Health and mandates that MN licensed Pharmacists meet with patients to develop a plan of care.  Product selection and dosing are determined by the Pharmacist in consultation with the patient.

Whether you are a prospective patient or you are simply curious about the patient experience at LeafLine Labs, we have consulted with our Pharmacy Team to provide insight on the role of pharmacists in the Minnesota medical cannabis program.

When you first come to a LeafLine Labs Care Center, you will meet with a Patient Care Coordinator to fill out initial paperwork. A Pharmacist then conducts an Initial Consult, which can last 30-45 minutes. As part of the Initial Consult, Pharmacists gather information from you (or a caregiver/guardian). We discuss past medical history, all current medications including other cannabis use, current and past diagnoses, any treatments for your qualifying condition, as well as other conditions or symptoms presently of concern. We screen for elements in past or current history that may warrant special consideration in LeafLine Labs medication therapy initiation, such as drug interactions or other medical conditions. Information you provide to the Minnesota Department of Health on a Self-Evaluation Survey is incorporated into our internal LeafLine Electronic Health Record, and reviewed with you.

After a thorough consultation, you and the pharmacist agree on an initial plan of therapy designed to meet your goals for symptom relief.  We educate you on all aspects of how to use your new medicine, as well as what to expect for effects and side effects. You will purchase your medicine at the end of the consult, right from the dispensary in the Care Center.

Generally, we like to see you for a Return Consultation after about 2 weeks of using Medical Cannabis, so we can “fine tune” the medication plan to best help you.  From there, you and the Pharmacist have an ongoing relationship for follow-up consultations and dosing adjustments as needed.

Minnesota Medical Cannabis Program Annual Recertification and Enrollment

As a participant of the Minnesota Medical Cannabis Program, each year you must have your qualifying condition recertified by a Minnesota licensed physician, physician assistant (PA), or an advanced practice registered nurse (APRN) and pay the enrollment fee if you wish to continue to participate in the program.

Here’s what you need to know:

  • As a patient or caregiver, you must resubmit a copy of the certification from your health care practitioner on a yearly basis. Your recertification must be dated within 90 days of submission.
  • Recertification requires an in-person office visit with a health care practitioner who is registered in the Minnesota Medical Cannabis Program. You may recertify your condition up to 90 calendar days prior to your enrollment expiration date.
  • Your enrollment expiration date is based on a rolling year calendar that starts on the day you receive your acceptance e-mail into the program.    
  • You will receive a recertification reminder email at both 60 and 30 days prior to your enrollment expiration date.
  • If you complete the condition recertification and enrollment process prior to your annual enrollment expiration date, you will be automatically reenrolled on your yearly enrollment anniversary date. You will receive an approval e-mail confirmation once your reenrollment application has been reviewed by the Minnesota Department of Health.
  • If you are an approved caregiver in the Minnesota Medical Cannabis Registry, you do not need to complete any type of recertification or reenrollment. Your caregiver’s status is active, as long as the patient in your care is classified in the APPROVED status in the Registry.
  • If you do not complete the recertification process along with your payment before your annual expiration date, you will not be able to visit a Patient Care Center (PCC) or purchase medical cannabis. If you are listed as expired, you must complete the recertification and enrollment process and receive an approval e-mail from the Minnesota Department of Health before you can visit a PCC or purchase medical cannabis.

Questions about the annual recertification and enrollment process? Please comment below, call one of our patient care centers, or send an email to info@leaflinelabs.com.

How to Talk to Your Doctor About Medical Cannabis

Minnesota Medical Cannabis Program Background

In Minnesota, we have established the most rigorous and “medical” law to date. There is no smoking in the program, and we do not classify our medicine by cheeky strain names. We also do not keep plants in jars. All medicine is created using a pharmaceutical process and is independently tested following state mandates. Licensed pharmacists who are trained experts at cannabinoid dosing are responsible for determining the best combination of medical cannabis types and forms, as well as dose amount. Pharmacists can coordinate with doctors to keep everyone on the same page.

A prominent problem patients face is that most doctors are not even aware of the state program’s details (or even that it exists at all). Many doctors do not see cannabis as truly medical, and they still believe that “medical” is just a code word for legalization.  Few know that cannabinoid preparations were the second most prescribed pharmaceutical in the late 1800s, or that the American Medical Association (AMA) advocated for keeping cannabis a medicine just 80 years ago.

5 tips of Advice from Gary Starr

As knowledge is power, we consulted our Chief Medical Officer, Gary Starr MD, to compile a list of advice and resources to educate and empower you in preparing to have this crucial conversation with your doctor.

  1. “Your doctor is likely not aware of the benefits of medical cannabis. Medical school and residency have not included medical cannabis in the curriculum.  Your doctor’s viewpoint is more likely influenced by decades of political rhetoric. Once you find a doctor you trust, ask him or her to objectively and compassionately learn about how medical cannabis is an option for you and may improve your quality of life. You’ll need to guide them towards the educational resources they may be unaware of (see the list provided below).
  2. Be scientific. Know your data, your disease process and the way that medical cannabis has been used to treat it, and the research studies that support your point (don’t be afraid to bring them with you.)  Patients with the most success in managing their complex diseases and symptoms tend to be scientific about their disorders, even if they use alternative medical therapies too.
  3. Most doctors speak in terms of data. There are many doctors who do not believe there is any data to support the use of medical cannabis.  That is because, as explained above, they often don’t know that this data exists.  They learned to say “there’s no data” from someone who learned the same words the same way before them.  It’s likely going to be up to you to introduce your doctor to the data (see #4).
  4. Gently educate; raise the medical cannabis topic after you have developed a good flow to your conversation. Be kind and personable.  Doctors often do not react well to patients “telling them” how to practice medicine.  This may seem unfair when they do not know anything about medical cannabis, but it is your health and wellbeing, so it is up to you to use good communication strategies that work.  Many doctors will be willing to listen to your data and take an interest in learning more if you present it to them in the right way.
    1. Stick to your point. No matter how kind you are, your doctor is still only able to give you 10-15 minutes of time before their next patient.
    2. Tell a story.  Do not just list all of your symptoms. Talk about your illness and how you’ve attempted to treat it.  Discuss how this has made you feel. Remember, you are a patient who needs care, not a customer expecting to get the item you came to buy.  
    3. Discuss your goals. Consider using other local patient success stories to illustrate your points, but be clear and prepared to discuss how and why you feel medical cannabis is appropriate for you specifically. In Minnesota, the state’s registry data has recently been published, showing a majority of patients realizing benefit with medical cannabis treatment. Bring this data and other supporting studies and summaries with you to give to your doctor.
    4. REFRAIN from using recreational cannabis terms to argue your point. AVOID using data from sources on the web that focus on plant strains or different ways of experimenting with cannabis dosing.  Unless your doctor is already supportive of this, it is very likely that this will decrease your credibility.  Most doctors are not impressed with uncontrolled, federally persecuted, smoked plant matter as a medicine.  Do not try to get them to speak that language.
    5. If you can, highlight how one of your goals with medical cannabis is to decrease the use of other medications which cause worse side effects and are not working well for you, such as opiates for treating chronic pain. One thing many doctors are afraid of is “drug seeking”.  If you discuss your desire to decrease opiate or other controlled medication use, it greatly diminishes the fear of “drug seeking”. This will get their attention.
    6. Know the law in your state backwards and forwards. Bring printed material to walk your doctor through the process (see below). Many doctors are afraid of the topic and do not realize they are not writing any prescriptions. They may be unaware–in Minnesota specifically–that another licensed medical professional (pharmacist) is educated in dosing cannabinoid based medicines along with your other medications.
    7. Bring a friend or family member to your appointment. He or she can be your advocate. Whoever you bring should have the same knowledge (see above) as you so he or she can help you keep the discussion focused and on track.
    8. Know the facts about medical cannabis safety, addiction risks, and limitations. Acknowledging these points in your discussion may increase your credibility on the topic.  Doctors are often suspicious of anything that has “no bad side”, so being honest and knowledgeable about a treatment’s negative aspects will help them hear you and at the same time probably teach them something.
  5. If your doctor continues to object to the discussion, or is against certifying you for medical cannabis use, you may be prepared for some “say-it-like-it-is” arguments.  Try to avoid using these unless it seems like a little extra nudge is needed. For example:
    1. “If I was dying…” Your doctor is your best advocate for helping you heal with compassion.  If they would certify you if you were “dying”, why are they holding back as you try to live?  Where is the line?  How close to dying is “ok”?  Many doctors will not have thought through this and it will make them begin to consider it.
    2. “Would you refer me to…”.  There are a lot of things some doctors do not believe in personally, but they would not prevent you from trying. If your doctor had to refer you to an acupuncture therapist before you could see them, would they refuse? …even if they didn’t understand how acupuncture therapy works? In general, most doctors would not refuse this even they did not know anything about acupuncture. Why actively refuse to certify you as eligible to use medical cannabis, then? Any response to this question either highlights their moral objection (which is not sound medical practice), their lack of knowledge (back to the top), or their fear of legal risk (lack of knowledge).

I encourage you to use some of the following resources to prepare yourself.

Be well,

Gary Starr, MD & Chief Medical Officer at LeafLine Labs

Resources

State Law Resources

http://www.health.state.mn.us/topics/cannabis/rulemaking/index.html

Patient Checklist

https://static1.squarespace.com/static/5923984ce3df28823044715d/t/59494e5336e5d3af64ba27b2/1497976404530/HCP_Checklist+.pdf

Minnesota Office of Medical Cannabis Data

http://www.health.state.mn.us/topics/cannabis/about/stats.html