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Jun 10, 2020 6 min read

‘Every cannabis patient has a different goal of care’

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by Michael Schaeffer Omer-Man
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For many patients — and if we’re being honest, for many doctors as well — getting a medical marijuana recommendation is a one-time affair. It’s a box to check and then you’re on your own. But it shouldn’t be that way — and doesn’t have to be.

“People need more than just some guidance of ‘try some medical marijuana,’” says Dr. Steven Salzman, medical director for adult medicine at Leafwell, a network of online medical cannabis clinics.

“Leafwell was built on the premise that people come first,” explains Dr. George Gavrilos, the company’s chief pharmacy officer. “So we built a platform where patients could easily speak with a like minded, open, empathetic compassionate provider — not only to be certified, but to continue cannabis care through the course of their treatment.”

Medical marijuana pipe
‘The truth is that our patients are teaching us as much as I’m teaching them.’ (Sonya Yruel/Drug Policy Alliance)

That is something patients are looking for. Upwards of 80% of patients who get a medical cannabis recommendation from Leafwell come back for follow-up visits, Dr. Salzman said on the latest episode of The Cannabis Enigma podcast.

Getting that first appointment is easy, of course. For patients in 18 US states, the time it takes from logging onto the Leafwell website to actually speaking with a doctor specializing in cannabis is usually no more than 5-10 minutes. In some cases, a valid medical marijuana recommendation can be given within an hour.

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Figuring out what the patient wants — and needs

But that’s not why people come back. It’s also not how Leafwell’s doctors and clinics have become trusted by thousands of patients and doctors who refer them.

One of the ways to do that is by clearly establishing a patient’s goals for care and, in several stages, using medical cannabis to reverse engineer healthier version of oneself. That usually starts with getting a good night’s sleep.


“Everybody who came in, it didn’t matter what was wrong with them: back pain, neck pain, cancer, ALS, rheumatoid arthritis, PTSD, it didn’t matter — every single patient had some form or another of insomnia, anxiety, depression,” Dr. Salzman explains.

Tackling those secondary symptoms often makes it easier to address the primary symptoms like pain, anxiety, or tremors. Only once those two stages are complete can you move to the third stage: lifestyle changes like diet, exercise, and addressing inflammation, which not only helps people feel better but also provide tools to deal with flare-ups and stress., which not only helps people feel better but also provide tools to deal with flare-ups and stress.

“One of the things we discovered earlier on is that part of the cannabis conversation should be what are your goals of care,” Gavrilos adds. “And so for every patient, that’s different.”

A couple smoking medical cannabis
Every patient has different goals of care. (Shutterstock)

Combining research and personal care to find the treatment that works

The second way Leafwell approaches cannabis medicine differently is through experience and research.

“I see so many thousands of people and it’s not the growing science — the truth is that our patients are teaching us as much as I’m teaching them,” Dr. Salzman says. That experience, and the data patients have allowed him to collect, has allowed him to create medical cannabis treatment protocols for specific conditions.

That involves a lot of trial and error and refining treatments on an individual patient level. Because cannabis science is still so young, follow-up and ongoing care is critical “to see what’s happening, to be able to make changes, to grow our protocols, and to narrow spectrums down so that in several more years it’s not trial and error,” says Dr. Salzman.

woman rolling a joint
‘Follow-up care — that’s when things get fine-tuned.’ (Joshua Resnick/123RF)

There are many questions that doctors still can’t answer about cannabis medicine, but there is a lot of information and knowledge that can go into creating the right individual treatment.

“We know that individual products have varying degrees of onset of action, duration of action, and we know that for some conditions, the combination or ratio of CBD to THC or cannabinoids or terpenes works better than in [other] conditions,” Gavrilos, the clinical pharmacist explains.

“The qualifying condition of the patient, the patient’s goals of care, their comfortability with different consumption methods when they’re afflicted the most,” he continues, “all of that information helps us initially give them some guidance right now. Follow-up care — that’s when things get fine-tuned.”

‘Change usually comes on the back of tragedy’

Cannabis medicine has changed dramatically and rapidly in recent years, and one of the places Salzman and Gavrilos see that change taking place is among their peers in the medical community.

Obviously some of that change has come with regulatory, scientific, and cultural advancements — primarily, that medical cannabis is legal, accepted, and we know more and more about how it works.

Patients are also often a catalyst for that change, speaking to their doctors about their experiences with medical cannabis, which has led to a greater openness. Today, Gavrilos says, Leafwell’s largest source of patient referrals is from other doctors — particularly pain specialists.

Of course, the other phenomenon that has led many in the medical community to become more open to cannabis-based medicine is the opioid crisis.

“It’s very sad to say this but change doesn’t come easy,” Dr. Salzman adds, “and usually it comes on the back of tragedy like many other things that happen in this world.”

“So I think now that lots of people are dying of opiates and with the acceptance of cannabis and the familiarity with it and the usage of it,” he continues. “All of this sort of conspired nicely together to make people more aware and more accepting.”

Patients are more relaxed talking to a doctor from home

Of course, there is another tragedy taking place which is changing the way cannabis medicine is being practiced and viewed — the coronavirus pandemic. One of those changes has been in the designation of cannabis and cannabis medicine as essential in every state where it is legal. The other, is a more wide-spread adoption of telemedicine.

For many medical cannabis patients, telemedicine has become a necessity. “We have a patient population that is sick, that has the highest comorbid conditions like hypertension, like diabetes and they’re immunocompromised,” so allowing them to get treatment without having to leave their homes and risk exposure to the virus has been very important, Dr. Salzman says.

Curbside pickup cannabis dispensary COVID-19
Many states have started allowing curbside pickup at a cannabis dispensary to comply with COVID-19 social distancing rules. (The Cannigma/Anthony Travagliante)

It has also led to other, unexpected benefits. Speaking to your doctor from the comfort of your own home reduces external stress factors that one might encounter in a doctor’s office or by having to travel to a doctor’s office.

“We’ve seen patients relax because now they’re in their own home and they can ask the questions that they may not have asked in the office, which has lent — this experience has led us to getting a real deep dive into patient’s lives. You get to see what their home life is like, they’re relaxed, they don’t have that wall, and they provide so much more information,” Gavrilos adds. “It’s made for consultations to be even stronger than they were before.”

“If I’m being honest,” Dr. Salzman adds, “although this is an absolute tragedy, it’s shown us that telehealth is here to stay. In our practice, it’s essentially equally as effective, perhaps even more.”

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