Today we’d like to introduce you to Susan Marks.
So, before we jump into specific questions about the business, why don’t you give us some details about you and your story.
I’m a registered nurse and a member of the American Cannabis Nurses Association. I am actually quite surprised to be writing about my new career and reinvention as a cannabis nurse, as I was never a cannabis user in my life. My cannabis journey began over two years ago. I am fifty-eight years old and I have a progressive neurological movement disorder called “essential tremor”. Essential tremor most often affects the hands, though it may also affect the head, voice, arms, or legs.
With essential tremor shaking occurs with simple tasks such as tying shoelaces, writing, opening a jewelry clasp, or shaving. Symptoms may be aggravated by stress, fatigue, caffeine, and temperature extremes. This is a progressive disease and my condition had evolved to where I was embarrassed to have a cup of coffee or eat soup in public as my tremor had become so bad. I knew I would get to this point eventually as six of my seven siblings have it.
With much reluctance, I succumbed to the traditional treatment which is anti-seizure medication. Just as dosing is a key aspect of using medical cannabis effectively, it’s the same with many pharmaceuticals. Over a period of months, as my medication increased and the tremor did subside, the side effect grew more severe. My symptoms included nausea, headaches, poor sleep and constant fatigue. While I was miserable with my tremor, I knew what to expect and it was somewhat predictable. The anti-seizure medication side effects were a whole new story and I was miserable on a whole new level.
As time goes on you have to increase the dosage to the point where the medication becomes toxic, and they switch to a new anti-seizure medication, and the process begins again until they run out of medications. My older brother with essential tremor had exhausted all of the medications available and was signed up for brain surgery which is called deep brain stimulation. They implant electrodes deep in the brain to circumvent the abnormal brain activity that causes the tremor. I won’t go into this other than to say it freaked me out!
This is when I began researching alternatives and learned that cannabis was a successful treatment for essential tremor, epilepsy and Parkinson’s…. all variations of neurological disorders. I began experimenting with cannabis. I quickly learned that other than the wealth of information available on the internet regarding cannabis research there aren’t many doctors or “live“ resources for people with medical conditions.
Within three months I had weaned myself off the pharmaceuticals and my tremor was 80% controlled! I use daily doses of high CBD (Charlotte’s Web), raw cannabis (THCA) and low THC (4:1 sublingual spray). Being a traditionally educated nurse I was somewhat familiar with alternative medicines, but these results were incredible to me! I continued my research and started working with clients. In April 2017 I attended the CannMed conference held at Harvard Medical School. I met and had a chance to learn from the top medical researchers and practitioners from around the world. I was already passionate about pursuing cannabis as medicine and this conference gave me even more knowledge, motivation and confidence to make this my career.
I’m very fortunate and grateful to have found not only a cure for my own disease but a new path and passion as a nurse and educator where I’m part of opening up the new world of using cannabis as medicine to help others. Every day and every client is an opportunity to learn more about how cannabis treats different diseases. In this regard cannabis is like any other medication – working with each client is unique, What works for one person doesn’t necessarily work the same way for the next person and like any treatment approach, it isn’t for everyone.
I’m excited to be on this path and meet other patients and professionals who are working to normalize the use of cannabis.
Has it been a smooth road?
In the big picture, the biggest issue has been the stigma and politics around cannabis.
Even though cannabis is now “legal” in California there is still a labyrinth of state and municipal regulations for all aspects of this new industry. That doesn’t even include the complications related to cannabis still being illegal federally. The issues with that are no access to banking services, doctors avoiding cannabis because their DEA licensure is federally regulated and true medical patients having no access to any type of insurance support.
Most people still associate cannabis with “smoking pot”, getting high and all of the negative stereotypes from decades of government prohibition and the War on Drugs (when cannabis was classified as a Schedule 1 drug with no medicinal value). I’m not going to give a history lesson here, but in fact, cannabis and hemp were major agricultural crops in the U.S. until the 1930’s when financial developments with other commodities made it convenient to discredit hemp.
One of the fascinating things about cannabis is that this one plant has proven effective for so many diseases. The technology and research on cannabis have been happening in Europe and in particular Israel for over fifty years. Most people are familiar with the THC (psychoactive) and CBD (non-psychoactive) components of cannabis. There are in fact at last count 113 cannabinoids (compounds such as THC and CBD found in cannabis).
Terpenes are another component of the cannabis plant that gives it it’s unique aroma (think skunk or diesel).
Terpenes are the essential oils in the plant and provide their own unique therapeutic effects. Terpenes are important because research has suggested that when a terpene interacts with cannabinoid receptors they can assist or hinder the effects of cannabinoids. I didn’t mean to go off on a tangent, but the point is there is so much new information and technology related to cannabis for medical purposes that research related to the lesser known cannabinoids and terpenes is constantly yielding new applications and opportunities.
On a personal level, my initial challenges were feeling comfortable sharing my private health concerns with others and publically disclosing my medicinal use of cannabis.
There is still a negative stigma attached to cannabis and not everyone is on board with this option for health management. It did not take long to get over both of these because my clients were getting such excellent results that I wanted everyone to know about the benefits of cannabis. I have had the honor and privilege to help relieve suffering and improve quality of life, so my personal disclosures now seem inconsequential.
So let’s switch gears a bit and go into the Dear Nurse Susan story. Tell us more about the business.
I work with medical patients who want to include cannabis therapeutics in their health management program. Almost all of the clients I see have been using traditional medicine and pharmaceuticals to treat their condition with varying degrees of success.
Many, like myself, initially get positive results in treating the issue or symptom, and then, unfortunately, experience the unwanted side effects related to that regimen. Others do not get relief with traditional medications and therapeutics and are desperately looking for an alternative.
I work with patients with the following medical conditions:
-Chronic pain including nerve pain (shingles, sciatica, trigeminal neuralgia etc)
-Auto-immune diseases (Lupus, Chron’s, MS)
-Neurodegenerative disorders (Parkinson’s, Alzheimer’s, ALS)
-Wasting and, many others…
As with any treatment plan, discovering the right approach, products and dosing that works for you is a process. My initial meeting with clients is about education and assessment. My clients complete an intake form just as you do with any doctor. I learn about their medical history, current symptoms and medication and what their goal is for treatment.
Depending on the client’s previous experience with and knowledge of cannabis I educate and consults with clients on:
– The endocannabinoid system and how cannabis works in their body and is specific to their disease or issue
– How to select safe and reliable products
– The dosing process
– The risks and benefits of cannabis
– Identifying drug interactions and avoiding unwanted side effects
– Understanding that cannabis is a treatment within a continuum of care which involves interacting components and being able to integrate cannabis with the client’s current treatment choices and lifestyle. With this knowledge, clients can make informed decisions about their cannabis regimen.
As I mentioned earlier, its amazing that the cannabis plant is effective with so many diseases. This is where an understanding of the various cannabinoids, terpenes, and products come into play. As with traditional medicine coming up with an approach that works for a condition is a process of identifying the variables at play and working with the various products, dosing, etc. until the client is getting relief. It’s a lot like putting together a puzzle: using the right cannabinoids and terpenes to effect each symptom; using the best method of ingestion based on time to onset, duration of action, and personal preference; finding the lowest effective dose for the individual; and, selecting product(s) that match the above variables.
I virtually never recommend smoking cannabis flower. It is very hard to dose and inhaling carcinogenic material is counter to improving one’s health. I use sprays, tinctures, edibles, suppositories, topicals and when needed vaporizers. Every method has different timing regarding how quickly it takes effect and how long it lasts.
Being a medical professional who has successfully found a solution to managing my own debilitating disease is something that sets me apart from others. I bring an understanding of disease processes, physiology, pharmacology, and standards of practice, and combine it with the medical research findings and therapeutic properties of cannabis and cannabis products. I know what it is like to face a bleak future of increasing disability and embarrassment and feeling desperate to find a solution. And because I know what that is like, I do everything I can to help my clients find their unique solution.
One of the biggest issues for true medical patients who want to try cannabis if finding someone who can really help them. Physicians are reluctant to discuss cannabis with their patients because of the federal prohibition and Schedule 1 listing. Also, this isn’t a slam on dispensaries, but very few dispensaries have staff that is qualified to deal with medical patients. I’ve heard so many stories of people with a serious condition, particularly seniors, leaving a dispensary with a bag of pre-rolled joints and edibles and they have a terrible experience because smoking a joint and eating too many cannabis gummy bears was not the answer!
Another aspect of my work is educating the public, dispensary staff, and other healthcare providers (MDs, RNs, PT’s, psychotherapist, etc) who want to learn about medical cannabis. I am a frequent speaker at local government meetings and educational events.
Some cities like Santa Monica may actually require budtenders to be certified to ensure they understand the numerous aspects of cannabis and health. Soon I will be releasing an online budtender certification course and an app for patients and cannabis personnel to help them put all the pieces of the puzzle together. I have worked with dispensaries that have an interest in educating their staff as well as their patients.
“I am very grateful for this plant, and I’m committed to working with other patients who can benefit from cannabis therapy.”
Susan is a native Californian and received her Bachelors of Science in Nursing (BSN) from Mount Saint Mary’s College. She has clinical experience in Adult Medical/Surgical; Pediatric Oncology/Hematology; Home Care; Case Management; Disease Management; Quality Improvement; and Risk Management.
She has received certification in the following subspecialties:
-Certified Professional in Healthcare Quality (CPHQ)
-Public Health Nurse (PHN)
-Legal Nurse Consultant (LNCC)
-Catastrophic Case Management and Life Care Planning
-Susan was inducted into Sigma Theta Tau, International Nursing Honor Society.
How do you think the industry will change over the next decade?
This is an exciting time for many aspects of the cannabis industry, including the medical.providers. Everyone hears about the explosive growth that is expected for cannabis as legalization continues and it becomes a more mature and regulated industry.
While there are people in the industry with a real medical focus and interest, the time money and attention on recreational use far exceed the interest in meeting the needs of medical users. One of the shifts I anticipate is a growing recognition of the medical value of cannabis. At whatever point cannabis becomes federally legal in the U.S. it will open up U.S. private and possibly federally funded research. This will go a long way toward influencing and legitimizing medical cannabis use. Just as other alternative options have grown and become mainstream over time (e.g. supplements, acupuncture, chiropractic), I expect cannabis to move in this direction.
Maybe this is just wishful thinking, but soon medical users could outpace recreational users. Many see the biggest potential growth among the “canna-curious”. As long as cannabis is federally illegal some people will likely avoid it.
Once its legal and big pharma and tobacco get involved the stigma will surely go away and more and more people will try it… particularly for medical purposes. Because of the decades of negative propaganda, many will never accept cannabis as a positive alternative. However, once we get the federal OK, doctors, corporations and institutional investors will all have the green light to get involved and make some money. Ironically, the opioid crisis, that was designed by pharmaceutical companies, is paving the way for greater acceptance of the medical benefits of cannabis.
Aside from the growing mistrust of the pharmaceutical industry, more and more people are looking for alternatives to prescription drugs. Until there is an accessible solution to chronic pain management (cannabis in some states), the opioid crisis will just get worse.
Pain is a real issue. The majority of opioid addicts start out using opioids prescribed by their doctor for a real medical need. In fact, 80% of heroin addicts started with an addiction to prescribed opioid pain relievers. Opioid addiction can develop in as little as 3 days of use. The nature of opioids creates addiction among a significant number of people that would never become drug users.
While there are clearly instances where cannabis is not a substitute for stronger medication (post-operatively), more and more research and statistics from legal states are showing that cannabis or a combination of cannabis and opioids does reduce opioid addiction. Last year alone, 64,000 Americans died of an opioid overdose; no one in the history of the world has died of a cannabis overdose. In Colorado, there was a 25% reduction in opioid deaths during the first year of legalized adult-us, as reported by the American Medical Association (AMA).
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