Chino: Welcome, good evening. We are here again at Ohana Care, we’re showcasing right now Wayfare Nursing. We’re gonna talk about medical cannabis and some of the frequently asked questions. Some topics that might be up there that needs to be answered. Because really, we’re bringing an expert on that field so we’ll dive right to it. My name is Chino Gapido, you know me from the past episodes and this is MP, my co-host.
MP: Also working with Ohana Care. It’s good to be back as a host. I don’t feel that I’m in the hot seat anymore. And we are joined today by Cindy Owen. Cindy is the Vice President and Co-founder of Wayfare Nursing. Which specializes in guidance for medical cannabis for the general population, right, yes.
Chino: Yeah. So we’ll pull it back a little bit and then ask really with Cindy Owen. I know we started way back when I was just a foot care nurse. Even before Ohana Care, I knew her. And she was a general manager at one of the locations that we had. So, but yeah, Cindy.
Cindy: So, thanks for having me. Yes, like you said, Chino actually, I’ve met both of you in a previous workplace that I worked in, in Seniors Housing. So, my name is Cindy Owen, I’m a registered nurse. I’ve been a registered nurse for over 28 years, I’m embarrassed to admit. And I have co-founded and I’m the VP of Nursing Services for a company called Wayfare Nursing, which we provide mobile in-home support by professional nurses for patients undergoing treatment with medical cannabis. So, we actually go into the home and support the patient with the education, with the dosing and titration scheduling and ongoing support around questions that they may have with medical cannabis therapy.
Chino: Okay. Yeah. So, we have a list of questions that were emailed to us, the people called in and ask us. But I think it’s nice if we brought back questions out there because the people that are watching tonight might have the same questions.
Chino: First one was…oh, actually, what is medical cannabis and how it’s different than the recreation one because that always gets confused.
Cindy: And that’s a very common question. So, cannabis has actually been used for health ailments for hundreds of years. There’s a lot of history of that being used for multiple ailments, pain and stomach issues back through the decades. But the medical cannabis is very different dosing and strains than what we would see in the recreational market. So, the cannabis plant has actually over 100 what’s called cannabinoids in it. But the two most well known and researched cannabinoids are THC and CBD.
So, the recreational market and the history of cannabis where people talk about, you know, the getting high, the euphoria, that comes from the THC cannabinoid of the plant. And while THC does have some really great medical benefits for chemo, induced nausea and vomiting, some pain relief, muscle spasticity, so it’s used for multiple sclerosis or Parkinson’s disease. The doses of THC that you would see in a medical product are much lower than what the recreational product or the recreational client is looking for.
And then alternatively, the CBD cannabinoid is not intoxicating. So, there is no euphoria, no psychoactive effect to CBD. And it’s having some really great positive effects again on many conditions. So, pain is a big one but it’s more the inflammatory pain. CBD is a very potent anti-inflammatory, anxiety, sleep. It’s used for migraines and some really great effects in some of those conditions. So, there is a difference between the two THC as what people know from the ’60s and ’70s. The high that came with that component, very different. While we do use THC, it’s in much much lower doses in the medical products than what you would see in the recreational market.
Chino: Wow. So, THC is actually what makes you high?
Cindy: Correct. So, many of our medical patients are on a predominantly CBD strain. There’s always a trace amount of THC in a cannabis product because we use the whole flower. So, there’s always a trace amount in there, but many of our medical patients are strictly on CBD. So, they’re not experiencing any of those side effects or that euphoria. And while we do have patients as well who do have THC, we watch how much THC we suggest they use and really titrate it slowly to make sure…the goal is to get them, you know, as comfortable or symptom-free as we can without the side effects.
So, we’re not looking for a population of, you know, particularly our seniors walking around on a high. We’re wanting to find that sweet spot where their symptoms and their condition is markedly improving without the side effects.
Chino: Exactly. Because for example for our clientele, you know, all seniors they…what’s the word? They don’t wanna just walk into the store and just order.
Cindy: Correct. And so, I get that question a lot. Like why would we go through a physician to get a medical cannabis prescription when we can just go into a retail store? And they can. The differences or drawbacks to doing that is, one, in a retail store they’re not able to give any medical advice. So, if you walk in and you’re looking for something for an ailment or you’ve, you know, got some medical condition, they’re not able to give support and guidance in that.
Again, the products that they choose to bring into these retail locations, they’re feeding a recreational market. Those are the products that are largely on their shelves. I mean, if you think of it, you don’t go to a liquor store to buy non-alcoholic beer. Same type of thing. Most of the recreational clientele is looking for the higher THC products. So, the medical patient may not find the products that would be most suited for them. And then there’s the whole…every one of us has what’s called an endocannabinoid system in our body, and everybody’s is unique to them.
And so it is a process of dialing in the right product at the right dose. The right timing to take the dose. If you’re just going into a store and purchasing something without that knowledge, it’s really hard to figure out what exactly will work for you. And to really get it dialed into the right product and dose. Also the recreational market, the retail outlets cost is higher than our medical patients will pay through our service and connecting them with the licensed producer. As well as if it is for medical purposes, they also are able to write it off as a medical expense at tax time. So, there’s definitely benefits for the medical patient to pursue it in a medical way.
MP: So it’s very similar then to a pharmacy, right? Because you have the over the counter where you’re kind of, you know, aimlessly going through the aisles trying to find the best product but if a pharmacist is not there, then you may be struggling in finding them.
Cindy: And trying to sort of wing it on your own. Exactly.
MP: Exactly. So, you know, medical cannabis is now the legalization, it’s so new, not every doctor feels very comfortable prescribing medical cannabis. So, if a senior was to look into getting medical cannabis for themselves but their physician has reservations that they’re not really able to vocalize why the person is not a good candidate, what would be the few steps that they may wanna take?
Cindy: So, that’s a really great question and we get that question a lot. So, many physicians are currently not necessarily comfortable with prescribing medical cannabis. It’s not something they learn about in medical school. Being that it was criminalized for so many years, there isn’t a lot of research or data necessarily behind some of the benefits of cannabis.
What we do have is anecdotal, right? A lot of very positive patient testimonials that people that are really seeing great relief. So, there is some hesitation by some physicians. Our hope at Wayfare Nursing, our goal is to try to keep the family physician involved. We think it’s important that the family physician is overseeing all of the patient’s care and prescriptions. And so, if someone is speaking to their physician and they’re not entirely sure they’re comfortable with it, our hope is that we’re gonna bridge that gap. That knowing that we’re there to support them, provide the education for the patient, because we have the professional trained nurses who have that knowledge that they may be comfortable prescribing.
If the physician is supportive. Which we find they say, “Yeah, I support it, I just don’t feel comfortable prescribing it.” Then we do have a network of physicians that we’re happy to facilitate a referral to. Especially for the more complex cases. And they can go and see a physician and have that discussion about them prescribing. So, even if someone’s family physician isn’t comfortable, we do have a connection that we can make for them if they wish to pursue that as an option.
Chino: Wow, that’s very good information because a lot of questions out there is, do I need a prescription, do I just walk in?
Cindy: Yeah. And it is like any other medication, it does require a doctor’s prescription. Which for cannabis is actually called a medical document, but it’s the same as having a prescription. So, even with our service, you do have to see a physician. And have it actually signed off but we’ll be that link, we’ll support the physician. You know, we’ll send them articles and research.
If they’re not certain, we can connect them to a physician to have sort of a phone consultation. If that’s something they’re interested in. And then we provide, sort of fill that gap and really make sure that their patients are well supported. They understand, you know, their dosing and titration. They’re able to call us at any time if they have questions or concerns around what they’re feeling or what should they do with their dose. So, we’re always available to support the patient and the physician as needed.
Chino: Wow, that’s good to know because now I know. And I think it’s better too because, like you said, different body types, you respond to cannabis differently.
Cindy: Respond to it very differently, we’re all unique, right? We have unique genetics and unique endocannabinoid which is a receptor system and everybody’s is different. So, no two people would be on the same strain or dose and have the same effect, it’s very unique in that way.
MP: One thing that I’m curious about is, you know, in understanding that everyone is different, you know, those…most of your clients already have a diagnosis of something and they’re probably already on medication. So in your assessments, do you take into consideration their actual medical conditions and their actual medications?
Cindy: Great question.
MP: And how much in-depth would be the assessment then?
Cindy: Yeah, no great question, MP. So, we’re really, at Wayfare Nursing trying to put the medical in medical cannabis. And that’s been a big thing of importance to us is making sure that cannabis is not a cure all, and it is not for everybody. And there is an assessment required to really know that, and that’s not necessarily done in some of the other areas around cannabis.
So, we do…we have quite a robust intake assessment that walks through the patient’s medical history, as well as their medications. When we send the report back to the patient to take to their physician, we put any cautions or concerns or contraindications on that document for the physician. So that they’re fully aware of any concerns we have. Because like I say, it’s not for everybody. But it’s a valid option for many people. Particularly the most common conditions that we see are people with chronic pain, sleep and anxiety. Those are the three big requests for medical cannabis. Although there’s many other indications or conditions that people are seeking to try it for.
But yes, we do believe that that assessment piece is very important. You know, there are contraindications and people who should not be trialing medical cannabis. And so, we have clinical tools that we use, we do a brief pain inventory, opioid risk tool, a bunch of clinical tools to really assess the appropriateness for cannabis.
Chino: Another question, what about our clients that are snowbirds, that they fly down south, can they bring their cannabis there?
Cindy: Great question, Chino. So, absolutely not, cannabis is legal in Canada and so absolutely traveling within Canada is no concern. We always say make sure you’re bringing your actual packaging so that, you know, it can be seen that it is medical cannabis. Because there is limits on how much you can travel with within Canada.
However, you cannot cross the border with cannabis even if you’re going to, say you’re going to the States. Even if it’s legal in the state that you’re going to, cannot cross the border internationally. So, what we say to our clients and patients is that, you know, check where you’re going. If it’s legalized there, we can let them know, you know what exactly the product and the dose and strain is. They can take that on a piece of paper when they get there. They can go to a retail outlet if it’s legalized there and try to get a close, you know, match to that product. If it’s legal medically, and they’re a snowbird and they’re down there for six months, well then they can see a physician and get a prescription.
So, they still, in many situations can access the medical cannabis but you cannot transport with it, nor can you purchase it in, say, California and come back to Canada with what you purchased. It cannot cross an international border. So that’s a really good question.
Chino: Even though it’s legal on both [inaudible 00:14:20]
Cindy: Even though it’s legal. And my hope is that someday soon that changes because it is a medication for these patients. It’s a very valid treatment, it’s their pain medication or their sleep medication, no different than somebody needs their blood pressure pill. It’s a shame to have to not bring it with you but we’re just…we’re not there yet. So, hopefully, that’ll change in future but for now, yes, traveling Canada with it, no problem, do not cross an international border.
Chino: That’s great information.
MP: It is. Well, and it’s clearly stated at the airport as well, but…
Cindy: Absolutely. But you never know what people choose to do or forget to pay attention to.
MP: So, you know, as you mentioned, you’re a nurse and you are looking into medical cannabis. A lot of the seniors that we encounter have tried cannabis in their hippie years by smoking it. And as a nurse, you would agree that smoking is not the best method to get any sort of medication and for smoking in general. So, can you tell us a bit about the other options and the other forms that cannabis can come into so that people don’t think that you have to be smoking because we know…that’s not what we want at the end of the day.
Cindy: So, smoking is not something we recommend with anything but certainly medical cannabis as well. So, there are a variety of ways that a medical patient can take their cannabis. Most commonly we see oils and gel caps, soft gel caps. Most of the medical patients again, they’re seeing it as their treatment, their medication and those are the preferred forms that they take it in, as well as with the oil. It makes it very easy for us to dose it, especially slowly, we like to increase the dose very slowly and the oil is very easy for us to do that with.
They can also vaporize it, so vaporization is much safer than smoking it. It only heats it to a certain amount so it doesn’t combust in the same way that smoking it would, it’s nearly as harmful to the lungs. Again, not largely something we see in the medical patient, especially with our seniors, which is the largest growing demographic that is looking for medical cannabis, but it is an option. Vaporization will give them almost immediate response.
So, for some of our cancer oncology patients who are needing something really quickly for breakthrough pain, we may see vaporization, but for the most part, it’s in oil form, soft gels. There are sprays that they can spray, you know, under their tongue, those types of things. But yes, smoking is definitely not the preferred way. Again, that’s sort of from their hippie days and that recreational market sometimes will still smoke but not most of our medical patients. That’s not the way they’re looking to ingest it.
Chino: So, smoking and brownies.
Cindy: That’s right. That is right and that’s a big caution as well, is people ask about that. “Well, can I just put, you know, the oil in butter and make my own brownies?” Well, the issue is several-fold. Is one, you don’t know where that oil just settled in your pan of brownies, you don’t know how big of a brownie to eat. And when you ingest cannabis, just like any other medication, if it’s ingested and it’s going through the first pass of the liver and all of those things, it’s a slow response. So, sometimes it can take up to two hours for you to feel the effects.
The concern is that you’re gonna eat a brownie and a half an hour later say, “I don’t feel anything.” And then you have another brownie and another brownie and now you’re really feeling something. So, again, the edibles is not something that we recommend or really see in the medical market, that’s more the recreational clients looking for that.
MP: And another difference between medical and recreational, I guess would be, you know, as it is a medicine, it is intended for a specific user as well. So, would it be common to have couples living together but having different medical marijuana prescriptions?
Cindy: Absolutely. Good question. Yeah. So, it is specific to that individual and it’s not…a lot of people think, oh, it’s, you know, weight base. So you should be on a lesser dose than Chino because you’re tinier. It’s not like that, it’s about our unique systems. And so, you know, it’s not a matter of you would just take less than Chino. It could be a very different strain that may work for your condition or ailment, could be a completely different product. You may have to take it four times a day and Chino might just have to take it at bedtime, it’s very unique. So, we do recommend that people not share their cannabis.
Particularly in seniors housing there’s a lot of, you know, “Hey, this worked for me, do you wanna try that?” One because, you know, you don’t know whether it’s even a contraindication for you but two, if you’re not on the right dose, and you don’t give it time to titrate up in your system, we find there’s a large percentage of people that will abandon treatment because they think it’s not working.
Well, it may not have been the right thing for you. And if you’ve done it properly with the support and titrate it up and people overseeing and looking to see your response to it. Very likely, we could have got you to a place where you had some relief from your symptoms or your conditions. But if you tried two nights, you know your neighbor’s CBD oil and it doesn’t work. Then it, you know, becomes, “Oh, I tried it, it didn’t work.” So, it’s really important to understand there’s a dialing in process. We say, “Cannabis is a journey” and it is. You know, sometimes it takes us a month or even more to really, you know, dial in what dose and what strain works for someone. And that’s what we’re there to support and do for our patients.
Chino: On that note, I’m really curious now because I’ve been reading about medical cannabis. Like, what are some success stories from your patients?
Cindy: We’ve had some really great success stories. So, one that sticks with me is I have a lady who’s in her middle 80s, was having some definite pain and was wanting to try it. So, we started her on CBD oil, now CBD can be cumulative in the body. And so, sometimes it takes awhile before you feel the effect and it can be quite gradual.
And she actually was going on a trip so she wasn’t able to take her cannabis. So she took herself off it a few days before. And she said, she phoned and said, you know, “I was wondering if it actually did anything. I wasn’t sure it was actually helping,” ’til she went off it. She was off it for five days and she said, “Wow, do I notice the difference, huge difference.” So, she can’t wait ’til she’s back from her trip to go back on it. Because she was going to the UK so she actually wasn’t able to purchase it over there, they were just going for a short trip.
I have another gentleman who undergoes cancer treatment. So, he gets a lot of the chemo-induced nausea and vomiting with his chemotherapy treatments. And so we started him on a strain for his cancer pain, but then at the start of his chemo, he would put him on a different product to try to counteract that nausea. And he said typically with his chemo, three to five days where he is on the couch and so nauseated he can’t move. So, his first round of chemo on the cannabis, he had two hours of nausea and that was it.
Chino: That’s it?
Cindy: Yeah. We haven’t even necessarily titrated it to where, you know, and he was just blown away. He kept waiting for it to come, waiting for it to come. And he said, “Actually, I think I might have even overdone it and that’s why I was nauseated. I’m not even sure I would have had nausea.” So I mean, those are the stories that, you know, you wish everybody could hear. Again it’s not for everybody and I can’t guarantee, you know, it doesn’t cure. But it certainly can combat many conditions and symptoms for people and it’s a viable treatment option for many people.
Chino: And that’s really good to know because there’s options out there that are…I don’t know if I’m correct, but easier on your liver.
Cindy: Well, it has a very low side effect profile compared to many of the medications. Again, especially our senior population. Some of the medications they’re on, you know, for pain, they’re on opioids and they’re on so many different things that are not well tolerated. And have a lot of side effects and then they end up on another medication for the side effect. And cannabis has quite a low side effect profile. The most common side effects typically are red eyes, dry mouth, sometimes a bit of nausea while they’re adjusting to the product. The side effects that you may hear about, the more concerning ones. Psychosis and panic attacks, those are in very high THC products again.
So, typically not something we would see in our medical patient but we, you know, we monitor them closely for those types of things. But compared to many of the medications that are out there, cannabis is a really quite safe option, it also has a very low addiction rate.
They quoted about 9%. Which is very low and again it’s again, largely the higher THC products that would align with that addiction. So, it’s quite a safe option. And more and more people are, you know, taking their health into their own hands. And they’re asking for it and they’re asking the questions. So even though some of the research isn’t necessarily caught up to what the big pharmaceutical companies would be able to show about a medication, they’re willing to try it. And they’re wanting to have that discussion with their physician. So, you know, we’re happy to support that. And we’re happy to give them tips on how to talk to their doctor. If they want to start the dialogue because it is something that people are very curious and interested in.
Chino: Wow, certainly learned a lot tonight.
Chino: It’s just a lot of…what’s the word now? Confusion between recreational and…because I knew that medical cannabis has been legal for a long time.
Chino: And then they confuse it with recreational.
Cindy: Yes, and in a lot of the data or, you know, information that you do read, they just talk about cannabis as a whole and they talk about, you know, some of the side effects and concerns. But that’s again more related to the recreational market and the higher THC products. It’s not necessarily, you know, the medical dosing that we would be using. So, it is confusing for patients out there trying to find the right information and where do they start. So, we’re happy to start them down the right path and support them as they go.
MP: Well, in saying that, you know, we’re looking at when we’re starting. To what extent is Wayfare going to be accompanying there? Because you mentioned it’s a journey, right? And you said maybe up to a month before we figure out the right dose. So, how frequently would you be visiting your clients then, if they want you to hold their hand through the process?
Cindy: So, we’re happy to do that. I mean, we do do, with the package, they are getting an in-home visit by their nurse to go over the education, the titration and those types of things, help them order the product, get set up with their licensed producer. We are happy to go back and see them in the home again, if they are needing that.
There is, of course, a cost for that if you send a nurse into the home. But the ongoing support, they can call us, video chat us, text us at any time, there’s no end date to that. So, you know, it’s not like a month and then we, you know, say you’re good. Months, year, ongoingly. We are happy to support them, we give them prescription reminders when their prescription is running out. We get lots of just general questions about travel or about things that, you know, we’ve educated them when we started. But they’ve forgotten and they just wanna be clear. So, we’re always there to support them, they’re our patients. So, we’ll do what needs to be done to support them on their journey.
Chino: That’s great to know. So, I guess I’ve learned a lot, you’ve probably learned a lot.
Chino: So, maybe we’ll bring her again in the future.
Cindy: That would be great.
MP: And if you have any questions regarding medical cannabis, we would be more than happy if you can drop a line in the Facebook Live, and then we can gather the interest. And when Cindy comes back, it’s gonna be your specific questions instead of…
Chino: Comment down below on what questions you may have and we’ll give you the information.
MP: And if you have a specific situation that you would like to discuss, we strongly encourage you to reach out to Cindy at Wayfare Nursing.
Cindy: Can I just give my phone number?
Cindy: So, Wayfare Nursing, you can reach us at 1-833-537-6665, or our website is wayfarenursing.com. Wayfare is W-A-Y-F-A-R-E. Not to be confused with the online furniture company. But yeah, you can reach out to us at any time. And we’re happy to answer questions or support you if you’re ready to consider cannabis as a treatment option.
Chino: Great. Well, Ms. Cindy, thank you for sharing all your knowledge and insights on medical cannabis. And also if you do have questions, you can call Cindy or you can call Ohana Care. We’re working together closely with Wayfare Nursing and we’re always ready to answer your questions.
Cindy: Absolutely. Thanks for having me.
Chino: Okay, all right.
MP: Thank you. We’ll see you soon.
Chino: We’ll see you on the next episode. Have a good night.