Cannabis: a word loaded with different meanings for different people. Cannabis is the botanical term for a large family of plants. The term marijuana often refers to cannabis used for recreational purposes, while hemp generally refers to cannabis grown as a fiber crop for clothing, insulation and biodegradable plastics. Another important use of cannabis is for the treatment of a wide range of medical conditions. Although scientific research in the field is relatively new but evolving quickly, cannabis is shown to treat cancer, HIV/AIDS, ALS, Parkinson’s disease, Multiple Sclerosis, spinal cord nerve injury, epilepsy, inflammatory bowel disease, neuropathy, Post-traumatic stress disorders (PTSD), substance abuse disorder, chronic pain, nausea from chemotherapy, anxiety, and many other problems. Opioids will always have a place in pain relief, but are easily abused. Cannabis can replace opioids to some extent for pain and can help those addicted to opioids.
New York State legalized the medical use of cannabis in 2014 and is one of thirty-three states and the District of Columbia that allow medical cannabis. In New York there are currently ten different companies offering dispensaries and manufacturing facilities. Each company is limited to four dispensaries and the state selects the locations. In the North Country, the only dispensary, located in Plattsburgh’s West End, is owned by Curaleaf, Inc., a publicly traded company based in Wakefield, Massachusetts. Curaleaf, which operates in eleven other states, is a vertically integrated company, in that it starts with seeds, grows the plants, harvests and processes, makes up the tinctures and oils, packages the products, counsels patients, and sells the products.
The Plattsburgh dispensary is spacious and well lit. There are no tell- tale aromas in the air; its atmosphere is calm and quiet. Visitors are greeted by a friendly security guard who verifies identity and checks medical certification and state issued cards. New patients meet with Kirsten Bezio, Pharm D (doctor of pharmacy) who is the dispensary’s manager. She interviews each patient in depth to gain an understanding of their problems and needs. On occasion she consults with the referring medical professionals, but often they rely on her knowledge to develop a treatment plan. Bezio, a graduate of the Albany College of Pharmacy, grew up on a dairy farm in the Mohawk Valley and came to Plattsburgh with her husband, a North Country native, to raise a family. “I was a traditional retail pharmacist,” she explained. “It took a lot of second guessing to make this career choice. It was life changing for me; it’s been the most rewarding job I’ve ever had. The best part is talking to patients and changing their lives.’
Medical grade cannabis has two main components: THC and CBD. THC offers the euphoric sense recreational users look for but it is also used to treat severe pain, nausea, vomiting and as a sleep aid. CBD does not provide euphoria but addresses neuropathic pain, inflammation, anxiety and epilepsy. The dispensary offers several delivery systems, including a vaporizer pen, tincture and capsules. THC and CBD are used together because studies show the combination provides greater medicinal effect than when THC or CBD are used alone. The medicine can be had with equal amounts of both, as well as high CBD and low THC and low CBD and high THC. Curaleaf prides itself on the purity and quality of its products.
The vaporizer pen, which gives the fastest relief, heats the oil to 338 degrees, well below the combustion temperature, thus preserving delicate but useful compounds that would be destroyed by higher temperatures. Tinctures are the next fastest acting, and are given in drop form under the tongue. The slowest acting but longest lasting are capsules. New York law forbids selling plant material for smoking, nor are edibles like brownies allowed.
Curaleaf grows and processes over twenty varieties of marijuana at its grow center and laboratory in Albany County. THC and CBD are extracted and packaged under strict conditions and heavy security. A former police chief oversees security and handles transportation of the product. It is not shipped by armored car but by an elaborate and secretive system designed to elude potential thieves.
Who are Curaleaf’s patients? “Everyone from age 9 to 99,” said Bezio. Children most often are treated for epilepsy and cancer, while a number of veterans are treated for PTSD. Cancer patients use the products to relieve pain and nausea. The next closest dispensaries are in Syracuse and Saratoga, so Curaleaf in Plattsburgh draws patients from St. Lawrence, Franklin, Essex, Clinton and Warren Counties. Approximately 1,800 patients use Curaleaf’s Plattsburgh outlet.
While patients are required to appear at the clinic in person to make purchases, a caregiver, such as a family member, may also be approved to make purchases on behalf of a patient. Plans are in the works for home delivery for patients and caregivers. Prices for the various products must be approved by the state.
Medical cannabis patients must have a certified need provided by a medical practitioner. Certify is the same as prescribe but because marijuana is still illegal under federal law, the term certify is used. Medical doctors and nurse practitioners who have undergone training and are registered with the state may recommend medical cannabis to patients. Physician assistants working under a certified doctor are also eligible to recommend cannabis. The State Department of Health website lists registered practitioners by county, although not all registered practitioners are named on the website. In the North Country, there are seven certified practitioners listed in St. Lawrence County, three in Essex, three in Franklin and seven in Clinton.
Curaleaf would like to see more medical professionals become certified, and, to that end, offers education and works closely with the medical community. The company recently conducted a training day for law enforcement officials to familiarize them with the products and required certifications.
Although federal law still classifies cannabis as illegal, research continues into this useful plant. Call it marijuana or call it cannabis, as more people learn about its wide-ranging beneficial uses, the more accepting and understanding they become.