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Jul 16, 2020 18 min read

The cannabis nurse is in

author
by The Cannabis Enigma Podcast
Cannabis nurse

Katherine Golden voted against cannabis legalization when it was on the ballot in her home state of Colorado. A lot has changed since then.

Today she runs a free telephone hotline staffed by fellow nurses trained in cannabis medicine, available to answer anyone’s questions about medical cannabis, what CBD does, and anything in between. And there are a lot of questions.

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“It’s all those beginning questions that someone rightfully so doesn’t want to pay $100, $200, $300 for a clinician to ask him some of these questions and just be told, ‘Oh yeah, you’re right, it’s not right for you — or yes, you can use it,” Golden says.

Cost and accessibility are behind most of Leaf411’s activities, from the free hotline to financial support for pediatric patients to trying to connect low-income patients with reduced-cost programs in their area.

Katherine Golden, RN, of Leaf411
Katherine Golden, RN. (Courtesy)

“If it was just a prescription that they had to pay a copay or $15 for their tincture bottle or whatever it is,” says Golden, a registered nurse with over 20 years experience, “their tablets and a tincture bottle, gosh, it would be so much easier. That is our struggle — affordability.”

While cost is a huge barrier to more people using cannabinoid medicine, and despite a sea change of public attitudes over the past decade, anti-marijuana stigmas are still significant and widespread.

One way that people overcome those stigmas is when they get word-of-mouth recommendations or endorsements from people they know and trust. The other is smoking.

“If we can get everyone to understand that smoking or inhalation doesn’t have to be a part of the equation, we’d have a lot more people calling us right out of the gate,” she says.

“That’s the stigma we still have to squash with people — thinking about the old ways of using cannabis and just smoking it — and now [we need to communicate] how it’s changed to tablets and patches and gels and all kinds of different Western looking medicine that they can be comfortable with.”

Leaf411’s hotline is 1-844-LEAF-411

Edited and produced by Michael Schaeffer Omer-Man. Music by Desca. 

Full transcript:

Michael Schaeffer Omer-Man: Welcome Katherine. 

Katherine Golden, RN: Thank you. Thank you for having me. 

Michael: So one of the things that Leaf411 does, as far as I understand it is you run a free hotline for people to call and talk to a nurse about medical cannabis. I’d like to start by hearing what that looks like on a day-to-day basis. What do people typically call to ask about what are some of the more common questions that you guys get?

Katherine: Sure. Yeah. So, you know, our hotline is actually our first program. So as a nonprofit, as an organization, what you do is you constantly create programs to fill needs. And our first one was the one need that we saw and identified the most, which was large community scale outreach. That was the first one. So that hotline program with our first development.

So we saw the need that so many people across the country and we even get, you know, um, contact from outside of the country have just some basic questions. And that’s where we saw this kind of hole. So we knew when we hit it out of the park with that, because we had so many callers say, “Oh my gosh, I actually, you know, didn’t even know where to start,” or “I don’t even know why is this CBD craze out there,” you know, questions like that, you know, “What’s the big deal about CBD” or, you know, “I’ve been hearing that it could be potentially beneficial for X, Y, and Z, but, you know, do I have to get high? You know, I don’t want to get high” or “I get drug tested and I can’t. So that means I can’t use marijuana right, for medicine.” 

And so it’s all those beginning questions that someone, you know, rightfully so doesn’t want to pay $100, $200, $300 for a clinician to ask him some of these questions and just be told, “Oh yeah, you’re right. You know, it’s not right for you or yes, you can use it now, you know, now we need to go into our conversation and then there’s another cost. 

So we wanted to kind of fit in that missing link. We want it to be that piece of puzzle that was missing with that first step. So those are all the questions that we, we get — people go down the kind of that black hole of Googling some kind of a condition or a question, and then don’t know how to get that answered specifically for them.

So that was a need as well as like, wow, there’s all this wonderful education out there, but what about my question? What about what I have, you know, that’s great that I can hear about, you know, Tom and Sally asking questions about them, but my situation’s just a hair different, how do I get my question answered, and then know if I need to pay for a physician.

So those are some of those beginning questions that we got. 

Michael: And do you find that it’s mostly people at the beginning of the road or is it also people stuck in their treatment or they tried something and it’s not working or they had a bad reaction or something like that. 

Katherine: Yeah.  So it’s all over the board. In the beginning, I would say that we were astounded how many people we had — I would say about, gosh, high about 80% of our callers in the very beginning had never used CBD hemp nor what we consider marijuana — being above that 0.3% that you need to purchase in a dispensary.

So we had people constantly telling us that they hadn’t tried either. So that was our first shock, was wow, you know, we’re getting these questions from people that are just starting their journey, just starting right to open up and see, could this potentially be for me now, I would say that has reduced to, well, at least 50% or less because now the callers that we get have maybe tried CBD hemp, probably due to its popularity over the years. Whether it’s a topical that they just bought in a vitamin store, or a friend said here, try this and gave them something that they had purchased. A lot of topicals have been used, a lot of CBD hemp oils. So we are seeing more people that have experimented with something like that, even much so that we actually changed some of our non identifying demographic questions to gather this data. We changed it to: in less five years have you used marijuana or CBD hemp? Because I was getting a lot of people saying, Oh yeah, I’ve used marijuana. And then later on in the conversation finding out, oh, but it was in my youth, you know, which all we all know is very different now.

Now I would say about half are new users open to thinking about consuming, and the other half were experienced. 

Michael: How do people relate to that? I don’t know if you can call it a dissonance between the status of marijuana or cannabis just 10 years ago in most of the country to where it is today that, you know, most or many, many people accept and see, and are reading the evidence that’s out there that we know today about its medicinal properties and what it can do. Do people have a hard time connecting the two? 

Katherine: Good question. Yeah. You know, it’s funny because word of mouth and family and friends holds the most water — holds the most weight. So when people come to us asking questions, not just even thinking about this journey, somebody has told them and somebody who they value their opinion, told them about cannabis and what it has done for their family or friend or loved one.

So that always is something that’s you know the story within the story, like, you know, we asked them, you know, how did you hear about us? Oh, well it’s when I came here and visited this dispensary and saw your information or saw you online, but then when you dig a little deeper, you find out that, oh, well, I did have a family or friend that has been using CBD hemp or marijuana that has told me, hey, it worked for me.

And even if it’s just one person that you know, they know that has said something’s worked, that’s there, that’s the door that flies open and they run through to say, Oh, could it work for me? So they don’t even need a lot of research or, you know, a lot of reading new articles or studies or any of that and they could have the preconceived judgment and initial reactions to marijuana from the past, it just takes that one person. It just takes that one person that they trust or know to believe to say, Oh, something worked for you. Okay. I’m going to look into that for me, because I am so sick of where I’m at right now with either pharmaceuticals working but having side effects or not working at all, or just wanting to, you know, really change their lifestyle.

Michael: And do you hear from people who have just — even simpler than that, a mindset switch within themselves of, I’m thinking of people who maybe never understood that they were drawn to smoking marijuana because it reduced their anxiety — but now we know that it’s actually something that’s recommended by physicians at times for that and then it’s legitimate. Or somebody who smoked some marijuana before bed and now it’s actually something that people are using legitimately as a sleep aid. 

Katherine: Yeah, I think we can. I think what’s the holdup here in our stigma is smoking. I think inhalation. I think if you were to take inhalation out of the equation, every would have, there was a lot of mindsets that would have been changed immediately, but because the connotation with  euphoria and drug use and smoking is there, I think that that’s the hard part because when people start realizing thatI don’t need to smoke it to get the medicinal benefit or the relaxation or the euphoria that I want to experience. 

Then there’s —  it changes for people. So even though we do talk about inhalation as being very significant use in how we talk about vaping versus combustion and the benefits and the caution tends to all of that, I that’s the one part that puts up that wall. If we can get everyone to understand our public, to understand that smoking or inhalation doesn’t have to be a part of the equation, we’d have a lot more people calling us right out of the gate. 

So there’s that hesitation with that, that inhalation or smoking is more recreational and it can’t medicinal benefit me because I know smoking is bad, you know? So, so we’re trying to, that’s the stigma we still have to squash with people, thinking about the old ways of using cannabis, you know, and just smoking it. And now how it’s changed to tablets and patches and gels and you know, all kinds of different western looking, you know, a medicine that they can be comfortable with. 

Michael: Right. So we talked about people’s changing perceptions. I wanted to ask you about your own journey. How did you end up doing this? Were you always interested in cannabis and its medicinal uses or was there a moment that brought you to it?

Katherine: That’s always something that I think about because I have never — I was never an advocate of cannabis. I used it in my youth experimentally and it never worked with my body. I didn’t know why I just thought, Oh, I was always paranoid and why my friends enjoyed it. I never enjoyed it. It made me feel ill.

So that was in my youth. And then from then on, I kind of, I definitely believed the propaganda and had the stigma. I knew friends that I felt like, you know, had maybe an abuse  potential with it than something that was beneficial. So even when it came to Colorado, I voted against it. You know, I thought, Oh, this is just, you know, uh, I don’t know why people just want to use this just to get high and not be motivated in life because that’s the way I saw it — whether it was just a couple of friends that I saw never really put my interest into it until a family member was suddenly diagnosed with stage four, lung cancer. Never smoked in his life at all ,two kids in high school, ready to graduate, and given two to five years to live. Devastated our family as you can imagine, and as they were going around to different specialists in the pulmonary field, cancer lung cancer researchers, and cannabis came up a couple of times with those researchers saying, well, you know, we, we’ve got all these other therapies then you get into chemotherapy and radiation. Then after that, if everything fails, we will look at cannabis, but we know nothing about it. So there’s that. So, because it came up a couple of times in conversation, I told my family, well, since I’m the medical person in my family, in our family, I will at least take that off your plate to look into.

Um, cause now you, I got all these other Western modalities that you’ve seen or heard of that you’ve got to look into fast gene therapy, immunotherapy, you know, you’ve got to look into what those are all look into this and at least see if there’s any validity to this marijuana stuff that we keep hearing about.

And then that’s when I completely changed because I went to our, you know, as a clinician — 20, 23 years an RN — now going to the resources we look at for what we call white papers, or just kind of those studies, you know, let’s see what’s out there. And when I started looking into that saying, well, wait a minute, there is so much research out here. Yes, it’s in vivo and in vitro, which means animal and lab models, and not those large scale human models because it’s been federally illegal, but there’s still so much research that gives us hope. Why haven’t we been told that this exists for years now, or at least screamed at the mountaintops that, hey, there could be something here.

So it also kind of made me angry that, wow, I’ve got the public’s, you know, best held — I’m supposed to be guiding them as a clinician, and yet I have not known that this existed. So, that started my journey back then. Yeah, no, we were still self-educating ourselves. There wasn’t a lot of really solid, uh, platforms that you could go to train medical professionals, nurses and doctors, you know, where do you go? So I found my journey along that way, you know, I started doing the deep dive into self-educating. 

Michael: What’s your relationship with other healthcare professionals today? Do you think that, beyond those doctors and nurses and other clinicians who are more directly engaged in cannabinoid medicine, do you think that there’s a greater sort of openness and understanding and willingness to look at, look at it as you were saying back then it was a treatment of last resort, but as a first-line treatment these days for many conditions. 

Katherine: Yeah. I think the more that people are using cannabis, the more positive. A symptom or relief or even a disease treatment that is being said out there and being open about, I think that it is changing a lot of minds, you know.

Just last week I heard a caller tell me about a really well-known hospital here in Colorado that he knows the founder of and said, I know for a fact in every meeting now they’re actually finally talking about marijuana as, “Hey, we have patients that are using this, maybe we need to be a little bit more open and invite them.” Which was shocking to me.

Even last year or this year, I think pre-pandemic, we were invited to come speak in front of graduating residents at a big medical center here in Colorado to have this discussion about marijuana and saying, “Hey, you are now going out into the workforce. You are going to have patients from all ages that are using either CBD hemp or marijuana, and you, you know, let’s help you find that education and learn at least some of the basics.”

So you know, just seeing that we’re being invited to different groups and community groups that never wanted to talk about marijuana, that never opened their arms to it are now wanting to talk about it and saying we can’t ignore this. Now we know our community members are using it when you can just buy it at, you know, a shoe store or Amazon, you can buy CBD hemp. You know, we want to be able to educate everyone to safe and effective use.  

Michael: I think about this a lot — how adult use legalization has impacted medical marijuana programs. I’m originally from California and in Colorado you’re in a similar situation. Do people explore it on their own, self-medicating looking for relief or for treatment before looking to the medical establishment for guidance. And is that a problem or is that, you know, actually just lowering the entry barrier?

Katherine: Yeah, I think what you’re saying, lowering the entry barrier. I think, you know, people have always looked to alternative therapies and that’s why our nutritional supplements industry is huge because people are always looking at what can I do that I have full control over that I don’t have to pay a copay or an out of pocket expense just to ask a physician, Hey, prescribe me something, or what do you suggest? You know, you’ve got that nutritional supplement industry that you can — you know, look up tumeric and you can look up fish oil and you can say, okay, how can this benefit me? So we’ve had that all along and people love that autonomy, love that empowerment that they have and this kind of fits right along with it.

It’s great that we have recreational states that they can get it on their own at a minimal cost. It all does come down to cost. It really does because it’s what someone sees a value in and what they can afford and what they’ll, you know, pick and choose what they’re going to put that, that funding into.

Michael: I want to ask you exactly about that. Leaf411 is a nonprofit. You talked in the beginning about one of the ideas behind it and being that there’s a need for people to get free or cheap access to medical care. And I know that one of your, I believe at one of your other programs focuses specifically on accessibility. We know obviously the cost of healthcare in the United States is a huge issue. So I think people might not think about that as applying to medical cannabis. How does it? 

Katherine: Yeah, and that’s right, exactly. It’s like right now, the way our Western world works and in healthcare you can access the quality of medicine of medical care that you can afford. And that’s where we’re hurting because our communities and our public out there deserve quality medical care, but don’t have either the access to it or can’t afford it. So that was our main point of the free hotline and creating this organization to be a nonprofit. It is, we said, well, we needed to be an affordable, free and accessible hotline because most people can at least access a phone in some way.

So that’s really important because we get calls all the time with people saying, you know, I can’t afford to spend a lot of money or especially right now, since the pandemic I’m out of a job, you know, or I’m struggling financially, but I want to still see if I can treat my X, Y, and Z problem, you know?

So they’re at least trying to. They have an access to us now that’s that quality of care that they, anyone can afford. And that’s what we try to scream about is that, you know, we want to make sure that, you know, this is quality healthcare, you know, for free, we’re all registered nurses. We’re all trained in cannabis with the highest training that you can get on I think one of the most comprehensive platforms for medical cannabis practitioners that we were all trained on multiple different platforms. So, so there you go. So now you have something that you have that everyone has: equal opportunity to access, which is quality healthcare in cannabis. There is that. Anyone can afford this cause it’s free. And then we’re building programs for accessibility. So even if someone can’t afford the medicine, what did they do? You know? So we built an affordability program that is going to address those concerns as well. 

Michael: Another thing I wanted to ask you about is, um, pediatric patients. Obviously we’re talking about their parents primarily. We know that one of the only FDA approved use of a cannabinoid is treating children with certain types of epilepsy with CBD. Do you get parents coming to you sort of wondering, or even desperate for answers?

Katherine: Yeah, I say. Both. I said, I’m both wondering and both desperate for help. Um, so we are very transparent, honest, open, and that’s why I think we have had such success because as a profession, nurses have been voted, number one trusted profession for 18 years in a row now, because, you know, we will tell them honestly, and we, we convey that on the phone as well.

When a parent calls and says, look, you know, I’m interested in treating my child with cannabis, scared, nervous. I’ve heard success stories but I don’t know where to start. We are always guiding them to get that cannabis clinician on your team — that’s always your number one. And then if they’re maybe going in the wrong direction in trying to treat on their own, I know I’ve had calls like that, “oh well, I haven’t really told my pediatrician because I think I kind of know or think that they’re going to be against it, but I’m using it and it’s been successful.” 

Talking to them about ways that they can use now, the language that’s out there to talk to their primary and to get them on board, or at least get them on board with looking at the available information that’s out there.

Just last week, I talked to a mom that’s been using cannabis for her child and said it’s very successful, and has already reduced the pharmaceuticals, but she’s kind of at a loss of the next dosing. And she hasn’t told any of her clinical team and this child is pretty severely ill. And I said, you know, I can’t give you dosing. That’s outside of the nursing scope and practice. That’s a physician’s role and here is why that’s important and really doing what we have done all of our years. As nurses in hospitals, in a clinic setting, is being that support, being the go-between that physician and that family to explain why these things, if they’re asking why this is necessary at a level that they can understand. 

And that’s what we do day in and day out. You know, that’s who we are when we’re in a hospital setting, you know, you’ve got your, your loved one, having a team of clinicians for every different kind of area. And we have to navigate that and explain, well, this physician wants this information or is, is prescribing this for these reasons and this clinician is prescribing this for these reasons, you know? So it’s that, that. That’s what we do is we help them understand the language and why things are necessary. So when a parent calls us, we hear them out and we guide them in, especially number one is going to be, you really want to get a cannabis physician on your team so they can give you exact dosing frequency, route, suggest the right cannabinoids for you when it’s a child.

Plus, you know, here’s why you need a medical marijuana card: you need that level of protection and legally, even though it’s a rec state and you can buy it, you really got to protect yourself and your child that you’re doing it in their best interest. And you’ve got that medical marijuana card that a physician has signed off on so that you can legally administer it.

Michael: How far away do you think we are from there being certified specialties in cannabis or cannabinoid medicine? 

Katherine: Oh for certified specialty, I don’t think we’re very far off at all. I think we’ve got, you know, there’s already a master’s degrees and other degrees and certificates coming. It seems like all the time, colleges are saying, announcing that they’re having programs for learning about the plants, whether it’s just the botany, whether it’s just learning about the endocannabinoid system. So there, I hear all the time of legitimate schools that are building programs. I know there’s one of them being built here in Colorado through the university of Denver. I think there’s some courses that are being thought of to start, um, building and putting together.

So I think on that front we’re going fast and there’s legit legitimacy now with these licenses, certificates, degrees that are going to start coming up, recognized as a significant and real specialty. We’re still working towards that. I know the American cannabis nurses association, the ACNA is working towards getting it recognized as an actual specialty. So that way people can actually put that behind their name. Now they’re certified in cannabinoid medicine, you know, so we’re working towards that and we’re getting there fast. 

Michael: My last question, I want to come back to one of the first things you said, which is that your job as a nonprofit in this field is to identify needs and then find ways to fill them. What do you think is the biggest need that’s not being filled right now in the world of cannabis medicine?

Katherine: I think the biggest need right now is access to affordable medicine. Honestly, I think because it is federally illegal, it’s out of pocket for everything from a quick physician visit to your medical marijuana card to the product itself, you know, a tincture bottle can be anywhere from $75 to a $100, to $150, I’ve heard for either a CBD hemp bottle or something that has more THC that they don’t even know how to use it correctly and then if it’s going to work and then they, okay. If it’s a parent, then they have to get here. Um, they have to get to pediatric, a physician to physician, sorry, for a pediatric patient to sign off.

So that’s two doctor’s visits they have to pay for. Then they have to pay for the card, which is around a hundred dollars. Those doctor visits, each can be anything from $150 to $300. Then you add on a hundred dollar card. Then you add on the first round of. Let’s see if this tincture bottle works and that’s a hundred dollars.

So yeah, it’s all that cost that adds up. I think that is our barrier there, you know, so, Leaf411 is here is to say, okay, well, at least your questions can be answered for free and at least start you on that journey of where to look for your next answers and the resources. Because that’s what people need to — resources that I can trust. The hemp manufacturers and retailers and marijuana, dispensaries, and retailers, we have, you know, we vetted as a nurse organization and said, okay, well, we can’t guide any of our public to anything, unless we’ve checked them out, significantly, checked them out.

And they checked all of our boxes to know we’re handing off, you know, at least safe information. We’ve built a library on our website to give them resources. So it’s all about resources. We have a resource called Aunt Bertha that we’ve added and partnered with that if we do hear language of them talking about financial struggles, then anywhere in the country, they can put their zip code in a search box and and it pulls up free and reduced programs for that individual around them, you know, so we’re trying to think of all different ways, but like I said, at the beginning all comes down to money, you know, what can I afford? Where am I at? You know? And, um, if we could, if it was just a $10 copay, it’d be much easier.

You know, if it was just a prescription that they had to pay a copay or $15 for their tincture bottle or whatever it is, their tablets and a tincture bottle, gosh, it would be so much easier. That is our struggle — affordability. 

Michael: How can people find you? 

Katherine: Uh, they can find us on our website leaf411.org. That’s leaf411,org. Our toll free number is on our website, 1-844-LEAF-411. 

Michael: Thank you so much for speaking with us

Katherine: All right. Thank you. Thanks for having me. I really enjoyed this.

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