When a patient arrives at Philadelphia’s BEYOND / HELLO cannabis dispensary, they’ll find pharmacist Michael Ruggiero, the in-house cannabis “pharmacy specialist,” behind the counter.
“Typically the patients come to me when they come to the dispensary and they don’t know what they want. And here I am in my long white coat being like, ‘hey, I have some information for you if you want,’ and a lot of times I’m met with a lot of resistance because they’re all — it’s just cannabis,” Ruggiero said.
But while the average cannabis patient might think “it’s just weed, what’s the big deal?” — a pharmacist like Ruggiero can find potentially adverse drug interactions which may otherwise go overlooked by the average well-intentioned budtender.
For instance, he mentioned a patient who came into the dispensary who had received a liver transplant and was using an anti-inflammatory drug called Tacrolimus which can adversely react to CBD.
It’s safe, but there are some risks
“[Cannabis] is safer than alcohol but there are some risks you gotta watch out for,” Ruggiero said, adding that he believes a pharmacist’s role should be to take a holistic approach, examine if the patient is using their medication appropriately1, and if there are any issues with dosing, timing, and administration.
Before he began working in cannabis, Ruggiero, “like a lot of other people in healthcare, wasn’t really sure about the medicinal benefits of it.”
As Ruggiero describes it, in his six years of study to become a pharmacist, the only time he recalls cannabis being discussed was during a single meeting of his medicinal chemistry class where they spoke some about metabolic conversion and THC.
Ruggiero spoke last month at the Clinical Cannabinoid Pharmacy conference, put on by the International Society of Cannabis Pharmacists, where he gave a talk about palliative care and cannabis.
Why a pharmacist?
With a doctor providing certification and budtenders giving product recommendations, where does a pharmacist fit in the medical cannabis patient’s journey from certification to treatment? It largely has to do with filling in where doctors are unable to provide guidance, Ruggiero said.
“A lot of times a doctor doesn’t really have time to provide a full consult, or to really go into depth or maybe they don’t even have the full educational background (about cannabis) and that’s just a reality of the field.”
But the consultation doesn’t stop at drug interactions, and at its core is also guidance on the right methods for using cannabis — something that can be highly individual.
“If you’re having panic attacks randomly in the day, I tend to lean towards more of an inhaled method because the kinetics allow for it to kick in faster. If they need treatment that lasts throughout the day, I tend to prefer oral formulations because they last longer. If you can’t stay asleep I’ll go for a tincture and if the issue is falling asleep i’ll go for a vape. And also, if the person plans on smoking flowers, I’ll always give them a heads up about smoking and heart risk.”
Not just for medical marijuana
As Ruggiero put it, this sort of advice shouldn’t get limited just to medical cannabis users.
“I think a pharmacist should kind of be on staff at all times, even at recreational based markets, just in case something does come up. It’s good to have a resource that kind of understands both traditional Western medicine and also what cannabis brings to the table, and understands the interplay between the two.”
Ultimately though, the cannabis industry would be greatly benefited by reaching some sort of standardization like with other medications, he said.
“Patients don’t really understand what they’re taking and people don’t know how to dose, so restandardization of dosing and labeling something — the cannabis industry should definitely learn a lot from in terms of the pharmaceutical world.”
In the meantime, patients at dispensaries like BEYOND / HELLO are in better hands with pharmacists on site to give expert advice that can not only improve their treatment but also prevent potentially adverse side effects
Next year’s Clinical Cannabinoid Pharmacy conference will be held on August 12-14.
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