South Dakota Focus: Medical Marijuana

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Stephanie:

Hello and welcome to South Dakota Focus, I'm Stephanie Rissler. Tonight we're going to take a closer look at marijuana. We'll examine the benefits of medical cannabis and the likelihood of it becoming legal in South Dakota. As we move through the hour your thoughts and comments will help guide tonight's discussion. 

Now let's meet our guests. First up, Betty Smith, a retired associate professor of political science from the University of South Dakota. Betty's husband Larry has been battling Parkinson's for over 20 years and part of his journey is showcased in the documentary Ride With Larry. We'll learn more about their story as we move through the hour.

Next we have Melissa Mentele, the director of New Approach South Dakota, and organization working to legalize marijuana in our state. We'll learn more about their efforts and the specifics behind the movement.

Last, welcome Dr. Tom Wullstein, a pharmacist and owner of Brandon Pharmacy. Tom's wife has suffered with chronic pain for many years, but with Tom's pharmaceutical background he worried about the impact certain medications could have on his wife and her future. He'll also share their story with us tonight.

Welcome to all of you. Thank you for being with us. We've got a lot to cover, some video clips we're going to see from the documentary.

Melissa, I'm going to start with you and we'll work our way around the table. When we talk about medical marijuana, medical cannabis which is what I'll call it tonight, what is the difference between recreational and medical?

Melissa:

I think everybody has their own opinion on what is the difference of it. We tell a lot of our patients that in a legal state where you're able to go to a dispensary the price is what the difference is. In a state that's illegal obviously there's a lot of differences between recreational and medical. But in a legal state you are able to go into a dispensary and choose the same medications on either spectrum of it. However, a medical patient will save significant amounts of money.

Stephanie:

Okay. I want to talk about New Approach. We're going to start to hear more about this in South Dakota as you guys kind of ramp up your efforts. Talk to us about what the organization is and its mission.

Melissa:

Okay. We are a volunteer-run, donor-funded advocacy organization of patients and families who are advocating for safe access in South Dakota. Many of us have personal reasons for doing this, and we have banded together to make a change in our state. A very much needed change.

Stephanie:

Okay. And so you're going to work to legalize recreational and medical, both? What's the mission?

Melissa:

We say medical and recreational as kind of a side part of it, because we do realize our state needs tax revenue, and with the medical program there is no revenue. So we wanted to be able to offer something back to our state. So we chose to do the recreational alongside of the medical. We will do both of them.

Stephanie:

Okay. As we move through the hour we can talk more about the specifics. When we might start to see legislation pop up, which sounds like it could be the next legislative session?

Melissa:

It is. We have petitions going right now on that too.

Stephanie:

All right. Very good. Tom, we're going to come to you. A pharmacist in the Brandon area. Now you became involved, and I kind of mentioned this in the intro, because your wife was dealing with some chronic pain. Briefly talk to us about what's going on with your world.

Tom:

Yes. Well thank you very much for having me on. Unfortunately for a lot of people or a lot of issues, people don't get involved until it affects them personally. And that happened with me and my wife. We were battling this pain that she's had for quite a while. I had her medications maximized as best as I could with my knowledge. And the only thing left is to keep increasing those opioids, and taking a little bit more, a little bit more, and goes from two a day to three a day to four a day. And I've seen that enough in pharmacy where it's just not a path that you want to go down if you don't have to.

So I looked at some other options, and I had not a lot of knowledge about medical cannabis. And I started looking into it and it was just amazing the misinformation that was out there. And I started looking at it, and I'm like, "Why is this not an option for South Dakotans, for everybody?" And so I was like, "I have to get involved and maybe change a few people's minds at least." Because this is definitely something that could certainly help a lot of people out.

Stephanie:

With your background, a trained pharmacist, are people ever surprised with your outreach on the topic?

Tom:

Well, yeah. You don't see too many pharmacists speaking about it. But that's just I have a certain situation, you know, most pharmacists works for another company and they're not going to speak out too much on that for fear of what the company might say. But since I own my own pharmacy I don't have to worry about that.

And then also I have, like I said, the situation where it involves me. I think to certain patients that I have too, who I know they have certain situations that maybe could benefit from it, I've just kind of talked to them about it. "What do you think about this?" And they've all been very receptive, and they ask me for updates now. Like, "How is that going? Do you think that's going to happen in our state?" And that sort of thing. So you know, people are I think appreciative of seeing a medical professional who is willing to help them come up with another alternative.

Stephanie:

Okay. Very good. Betty, thanks for being with us tonight. We're going to see some clips of you and Larry as we move through the hour. But before we move to that, talk to our viewers about how you got involved with this really outreach as medical cannabis and why you feel people need to be better informed about it, and your own journey.

Betty:

Sure. So Larry was diagnosed with Parkinson's disease when he was 42 years old. He was a young police captain, we had children at home. And we took a very proactive approach. We did everything. We did exercise, we tried many different kinds of medication, plenty of sleep, nutrition, and so on. His progression was slow, but at some point he needed to take so much of the basic Parkinson's medication that it caused this side effect called dyskinesia.

And when you see people with Parkinson's there's two things going on. One is tremor. Larry doesn't have tremor. But the second is dyskinesia, and that is actually a side effect of the drug. And so it's actually it's kind of a cosmetic problem because he moves around a lot and it's a lot of uncontrolled excess motion. His neurologist estimated he was probably using about 1000 calories a day just in the excess motion. He was losing weight, you know, it was harder for him to talk to people, to interact socially because people are a little taken aback.

And nothing seemed to calm down the dyskinesia, until another Parkinson's patient said to Larry, "Well have you tried high CBD, low THC marijuana?" THC is the part of marijuana that makes you high. CBD does not. And so he, and you see it on the film, he introduces Larry to it. And it works. It absolutely works. Now Larry's never smoked. He was a police officer for 26 years. So he's a little iffy, right? But it had a pretty dramatic effect.

We spend part of the year with out family in California every year. He was able to get a prescription from a physician. And you know, there was a nearby neighborhood dispensary that actually compounded this specially for people with Parkinson's. And so he came in and as soon as he said he had Parkinson's, the guys said, "Okay, I know exactly what to make."

Stephanie:

He knew?

Betty:

He knew. And so it has really helped Larry. And of course, we can't have that in South Dakota. Because street marijuana that people take for recreational purposes in South Dakota is very different from what you can get in a dispensary in a state like California where people are trained and they understand exactly what they're giving you, and it's a measured dose.

Stephanie:

We're going to take a look at the clip here in just a few seconds, but I kind of want to, not really set it up, but the people that produced it, they too have their own struggles with Parkinson's. Talk to me about those that produced it and why.

Betty:

Yeah, so Larry had the initial idea that he wanted to, before it was too late, right, do something really big. And so his initial idea was we were going to ride out bicycles across the United States. And I said no. No, I wasn't going to do that. So he said, "Okay. South Dakota."

And my niece heard and she said, "Well would you mind if some of my friends came and filmed it?" And pretty soon we had an executive producer from Hollywood who had a close relative with Parkinson's disease. Everybody who gave their time to this video knew somebody, somebody close to them had Parkinson's disease. And so in the end it was a labor of love.

Stephanie:

Melissa, talk to me about what you've seen in terms of public opinion when it comes to medical cannabis. And how that compares, South Dakota, our public opinion on this to the rest of the United States.

Melissa:

I will say public opinion in South Dakota, it's really a mixed bag. There are people that are very supportive of it, and people that are sit on the fence, and then we have those people that are really in strong opposition to it. And those who have the strong opposition to it have never taken the time, and I always tell people, "If you are on the fence, or you are scared, or there's something about cannabis that bothers you, sit down at Google. Sit down at your computer and spend 10 minutes. Put in something that affects you, with cannabis." As in Larry's part it would be Parkinson's and cannabis. Or cancer and cannabis. And just start reading. That's all it takes. It just takes a little bit of knowledge to turn those people that are a complete no into a maybe. And then a personal experience turns those maybes into a yes.

The public opinion, as more and more stories like Larry's come out, people are saying, "Oh my goodness, it works. We need to look more into this." So the tides are changing. They're changing a lot in South Dakota. We've noticed just in the last three years that our base demographic of signers with petitions is 50 and above and we don't get a lot of that young crowd that people think are the ones pushing this. It's older people, it's our Baby Boomers. They're really interested in natural healing. And those tides are really changing and so is that public opinion. Which is really nice.

And like the gentleman said you go into a dispensary and you feel like you're doing something wrong. The first time I ever went into one in Colorado I actually walked back out because it was scary. You know, you stand there and you wait for the cops to come because it's so taboo in our state and it's so normal in another state. That education that you can get in the dispensary, we're doing the same thing here without being able to prescribe the medicine or recommend a medicine. These stories are wonderful to see because that's what changes public opinion.

Stephanie:

So Betty, you've had the opportunity, you go to California, but you call South Dakota home. Have you found a difference in public opinion from the West Coast of our country versus Great Plains, Midwestern?

Betty:

Yeah, you know, preparing for this made me look back at numbers from 2006 and 2010 when we had ballot measures. In 2006 it was relatively close, 48-52. But it was overwhelmingly against in 2010. And I think some of that is that law enforcement, usually in the last two weeks of the campaign, comes out very, very strongly against it. And I think that there is a myth that equates marijuana with hard drugs. And I think that just isn't accurate.

When our kids were growing up and they did all the D.A.R.E. programs and they told them that marijuana was a gateway drug, we actually always told them the truth. And the reason was because we thought if they equated marijuana with heroin and methamphetamine, and then somebody smoked marijuana and didn't have a terrible experience, then maybe they would think heroin was okay and methamphetamine was okay. So we always felt it was very, very important to tell our children the truth.

Stephanie:

Okay. That is one of the questions, because some of the re- well, the information ... As I was looking, it's often called the gateway drug. And I wanted to get your opinions. How do you respond, Tom, when you hear things like that?

Tom:

Well, first I just want to add on that in high school I was a D.A.R.E. role model. I was the official person that went and talked to the kids, so ... But marijuana being a gateway drug. So if you think about, if we're talking about gateway to say heroin. Someone who does heroin is going to do a lot of things to get there. That doesn't necessarily mean that A plus B plus C is going to cause heroin. I guess the big thing right now is the opioid epidemic, which is why I'm talking about heroin. I wrote down a number, 78 people die from an opioid overdose everyday. Now South Dakota does not nearly have those numbers. But four out of five heroin users start by misusing prescription drugs, prescription opioids. So I guess if there is a gateway drug, I would have to think that people like me are the one that are dispensing it.

Stephanie:

Okay. I want to go back, because we're talking about public opinion, but what our law does is a whole 'nother element of this. The FDA has not approved medical marijuana, but they have approved two man-made cannabinoid medicines. They treat nausea and vomiting for chemotherapy. Tom, do you ever think we'll see approval from the FDA with this?

Tom:

Oh, absolutely. I mean, eventually it will happen, I guess it just depends on when. But it'll absolutely happen. If you were talking about will it happen in South Dakota, again, it's going to happen. It's just are we the sixth to last state or the last state that does it? It'll definitely happen, the trend is just more and more public approval and they're just going to have to start listening to the public eventually.

Stephanie:

Melissa,  What have you seen in terms of families that are struggling financially because maybe they have prescription drugs for an illness that they're suffering versus if they moved to medical cannabis that helps them?

Melissa:

We're seeing with our families with children with catastrophic seizure disorders are spending anywhere from five to eight thousand dollars a month out of pocket on prescription meds for their children. We've also seen those families of similar medications go to Colorado and end up on a medicine that's costing them 150 dollars every month to two months.

It's amazing to see how you can swap out these pharmaceuticals for a safer option. You know, we look at the kids that are on Sabril or Keppra or Onfi and these medicines have to be titrated down because if you take your child off of them just cold turkey they're going to end up in status which they could die from. With cannabis you don't have to titrate down, you don't have to titrate up, you can start with the dose and you see where you're going. And it's not going to cost you three, four, five, six, seven, eight thousand dollars a month to find seizure control for your child. And I think it's really important that people know that. Is that cannabis is not only safer but it's also a much cheaper option.

Stephanie:

Yeah. Tom.

Tom:

It's a great point about the dosing, because for pain the standard dose for any pain medicine is one to two tablets every four to six hours as need for pain. Well that's a lot of leeway in there, and it takes half hour to an hour for a pill to kick in. So one of those things where, do you need one pill or do you need two pills? Well, if you're in chronic pain you hate that and so you maybe take more than you need. One of the good things about dosing with a medical cannabis is that it kicks in much quicker. So you'll within five minutes, so you won't have to worry about taking too much. You'll just, you're good until you have an effect, which is very quick.

Stephanie:

Okay. And we're starting to get some comments that are coming in. One particular individual wrote in that by them taking medical cannabis lotion, it keeps them narcotic free, it keeps their inflammation down, and gives them more mobility. "I shouldn't have to be a medical refugee in another state." So we may be getting a lot of comments like this, and we welcome those, send those in. Betty, I'm guessing you can relate to what this individual is saying.

Tom:

Yeah. It's very hard for us. I mean, our home is here in South Dakota, our friendship network is here, this is where we would like to live. But I have to say that life's a lot easier when we're in California.

Stephanie:

Yeah, yeah, for sure. In just a few minutes we're going to take a look at an interview I did with a scientist out of California who's going to share some of his insight with us. Before I do, I want to come to you Tom. And I want to talk about the research on this. There's not a lot of money to be made in the pharmaceutical world, these companies. Therefore from what I could read and the research that I did, is they're not doing a lot of research in terms of medical cannabis. Is that true?

Tom:

Well, the drug companies aren't. And when you say there's not a lot of money to be made, if a drug company's involved they're going to make their money back. We've had a bit of a, with one of the drug companies trying to get a monopoly on CBD oil. And it's unfortunate because them coming to the table, what good is it? Are they making it safer? I don't believe so. I mean, that's probably their argument. But what they're doing is they're charging South Dakotans insurance companies and South Dakota Medicaid thousands and thousands of dollars that can be fixed with a 100 dollar bottle if it was legal here. But yeah, there's a lot of research, there's just not the really good research that the pharmacists especially and doctors and things like to see. The double-blind placebo controlled fancy studies. But there's lots of research, they're just not those particular ones that they want to see.

Stephanie:

Yeah, Melissa, you were going to add onto that.

Melissa:

I was. There's not a lot of research being done because patients have done their research for them. There's 25 years of anecdotal evidence from patients. Patients like Larry who share their stories, or families with children with seizure disorders who share their stories. We're doing the research for these pharmaceutical companies.

And like GW Pharmaceuticals has flown into the cannabis market with a product that is essentially the same thing that is already being made and manufactured in the United States. And this is an overseas company trying to come to the U.S. and create a monopoly in the States for a CBD product that, like Tom said, it's 100 dollars a bottle and they're charge three to fifteen thousand dollars for it. But they don't have to do the research. I mean, yes they can do the double-blind placebos, but they know it works. They're just wanting to see where they can pull a niche and take a spot from somebody that's already done 20 years of research and patients that have been there, and profit off of it.

And cannabis has never been a for-profit industry. Yes, it makes a lot of money, but it's an industry that is built on helping people live a good life. And that's why pharmaceutical companies, they're not interested. But now that they're seeing a million dollars a day or a hundred million a month, they want in on it. They want a piece of that pie.

And I don't, I personally don't think it's fair. I mean, I see the patients that this industry is being built on, and the suffering that they have gone through to get where they're at. I don't think a pharmaceutical company should be allowed to swoop in and take over an industry that's already very regulated, there's lots of checks and balances, and lots of research being done. We just need to reschedule federally to have more United States research before we hand it over to an overseas company.

Stephanie:

Okay. Dr. Daniele Piomelli with the University of California at Irvine is a leading scientist when it comes to researching marijuana-like compounds in the body and their effect on health. He is trained in neuroscience and pharmacology and works effortlessly on outreach regarding the issue of researching medical cannabis. Dr. Piomelli took some time to answer some of my questions earlier this week, here's part of our interview.

Stephanie:

Dr. Piomelli, thank you for taking the time to call in and visit with us. As our viewers are watching, I want you to if you can, explain to them what your work and research has been in terms of medical marijuana.

Dr. Piomelli:

My work has been mainly about the brain's own cannabis system which is the system of receptors and neurotransmitters that are really responsible for the effects of cannabis. And I've also studied the impact that cannabis has on this endogenous cannabinoid system, as it is called. So basically, we have in our brains and throughout our body a series of molecules that, neurotransmitter molecules, that work, produce a series of interesting, important physiological effects including the control of pain, the regulation of mood, the response to stress by combining with the same receptor proteins that are recognized by the active principle, in the active component of cannabis, which is delta-9-tetrahydrocannabinol, THC.

We have in other words, in our own brains, sort of a cannabis-like family of molecules and these molecules are called the endocannabinoids.

Stephanie:

Now your name came across my desk because you are one of the leading experts in terms of the research in this area. I also came across some video of you at the Senate Judiciary Subcommittee on Crime and Terrorism. And if I'm correct in this, the main focus was on the use of marijuana compounds in the treatment of diseases. What can you tell us about your mission to speak to that subcommittee? And were they hoping to get specific information from you during that time, or was your role just to educate them on what you've learned so far?

Dr. Piomelli:

They tasked me with giving an overview on what we know about the risks and the benefits of cannabis use. And what I told them is what I think we all, scientists all agree on, that there are certain medical conditions such as for example chronic pain, in which there is pretty good evidence that cannabis can be helpful. And there are also many other medical conditions in which no such evidence is available, and a lot more work is needed.

Also I mentioned that we do know now for sure about certain risks associated with cannabis, which are not necessarily those that people necessarily expect. For example, a lot of folks are concerned about impact on the lungs, but turns out this to be a very minor impact. On the other hand, people do not realize that cannabis is actually an addictive substance. Not as addictive as other substances, but still fairly addictive and should be considered with caution because of this.

Stephanie:

Okay. One of the questions I have is, what are the risks, and you just laid those out, and if they outweigh the benefits? I suppose that would be up for the individual user to determine for themselves. What have you heard in terms of people that you've worked with on this issue? Do the risks outweigh the benefits for them?

Dr. Piomelli:

It will depend of course on the medical situation that we are dealing with. The benefits, in my opinion, the opinion I think of the scientific community at large, outweigh the risks. Especially if the use is controlled and is followed by a physician. But also because the alternative to cannabis can be although effective, it can be also very dangerous. And the opioids, the opiate drugs such as Vicodin for example are the most frequent drugs given for chronic pain. But they do cause addiction, they are very, very addictive. They are more addictive than cannabis is. And they also have a substantial number of side effects including potential lethality because unlike cannabis, opiates can cause overdosing. They can kill by overdose, something that cannabis can not do.

Stephanie:

Okay. When I was watching the video from you testifying at the subcommittee or presenting at the subcommittee, you shared with lawmakers during that time that cannabis has actually been used with human for thousands and thousands of years. And it actually was legal at one time in the United States up until around 1937. Is that correct?

Dr. Piomelli:

Yes indeed. In fact there is archeological and ethnological evidence that indicates that cannabis has been used for 11,000 years. And it was used for a variety of reasons. It was used for pain, it was used for cough, it was used for a variety of symptoms. And then [inaudible 00:31:51] for about 50 years and then, a little bit over that, and then in 1937 the Marijuana Tax Act was passed which all but outlawed cannabis use. And it started the criminalization that we are still in the middle of.

Stephanie:

Quickly, what have you come across as the biggest misconception with this issue?

Dr. Piomelli:

We really need to fix this federal versus state law conundrum we are all living in. As you know, cannabis is a Schedule 1 drug according to federal law which makes it fully illegal. Whereas many states in the union, including the state of California where I live, of course accept it for medical use plus also some states, including California, accept it also for recreational use. So this dichotomy, this schizophrenic discrepancy between state and federal government has created a situation where the only thing that really suffering is research.

A misconception we need to fix is researchers need to do their work. We need the freedom to do the work. We are happy to be controlled, but in a way that doesn't stop us from doing the kind of work that the public wants us to do.

Stephanie:

Very interesting. Dr. Piomelli, I thank you so much for taking the time to be with us and share in the information that you have. Thank you.

Dr. Piomelli:

Very much my pleasure.

Stephanie:

And I want to thank Dr. Piomelli for taking the time to do that. Melissa, I'm going to come to you. He really talked about the frustration he has with not being able to do the research. Now here back at home you have been working on trying to get this passed legally. Let's move to that. Talk to me about what voters can expect to see when this issue comes up.

Melissa:

What they can see now is petitions. You're going to see petitioners out there circulating. And that is one of the biggest things I want to tell people is we're not going to be able to see anything on the ballot unless you sign a petition, or get involved and help collect signatures. We do need about 13,871 to get on the ballot. So people will see us out this summer, and you know, we're ready to have a conversation with you if you're interested in cannabis. That's what we're here for. We're here to make you understand why this is so important in South Dakota. So that's, right now that's what you're going to see, you're going to see petitions.

Stephanie:

So this makes it to the ballot. Voters go in. If I vote yes and this passes, what will this do?

Melissa:

This will open an industry in South Dakota to provide compassionate access for our patients in our state. It will also open a secondary recreational market that will bring tax revenue and jobs, skilled jobs, into our state. A lot of bringing back of ag programs, hemp programs. We'll see a lot of that. We'll see a lot of influx of new jobs and a new industry and training. So it's a really exciting time for South Dakota, and we want our state to be part of that.

Stephanie:

So Betty, when you look at this issue, and we know that it's been up before for voters, what is the biggest hurdle with this passing?

Betty:

Boy, you know I think first it's misinformation. I think in general what happens is two weeks before the ballot measure is up for a vote the law enforcement community comes in and says, "No, no, no, this is a gateway drug. We can't do this. It will lead to crime and violence." I don't believe that. And I think if you look at the 29 states that have legalized marijuana to date, you just don't see that happen. It's an organized market. It's a business. I don't think any state has had an increase in crime and violence as a result.

Stephanie:

Tom, what do you think as you look at this? It's not new for our state, we've voted on it before. What's the hurdle? Why can we not get past this?

Tom:

Well, I think we are going to get past it. And misinformation is such a great, that's all it is, is misinformation. I was misinformed and once I started looking into it and found out some things, I changed my mind.

And the one thing that we haven't mentioned yet, and I think it was one of the things that made me change my mind the most, was that you can not lethally overdose on marijuana. I think that's important to keep saying that over and over. Because if we're comparing it, in recreational we're comparing it to basically with alcohol, and with medicinal we're comparing it to many different prescription drugs that all can be lethally overdosed on. And this can not be. So with that as the baseline, it should absolutely be an option for us.

Stephanie:

So Melissa, I want to talk about the other states that have moved forward. We're one of the few that have done nothing, correct?

Melissa:

Absolutely. We are one of six. There are only six states left that don't have some kind of access. Whether it be a CBD law, a full medical program, a limited medical program, or recreational. We are one of six.

Stephanie:

And I think we have a map, and we're going to throw that up. So the way it looks, if I look at the map, and I have it here with us so we can kind of take a look at it. In the middle us, Nebraska, and Kansas, and Idaho. And then we've got over here on the East Coast. Even some of our neighboring Republican states, Wyoming, Colorado, we know where they're at, but North Dakota. They've all moved in that direction.

Melissa:

They have.

Stephanie:

Do you feel confident that we're going to follow suit with the rest of these?

Melissa:

I do. I feel that it is South Dakota's time. We have spent so much time over the last three years having this conversation and keeping it relevant. Making sure that the voters in South Dakota see that this issue is still coming. We didn't sit down after 2016, we stood back up and we're still having the conversation. And I do believe this is our time. I believe there are so many people that have seen the stories and have seen the evidence, and they're ready. They're ready for safer options.

Stephanie:

I remember seeing that (Riding with Larry) for the first time Betty, probably this past winter. And it changed me. And I connected with you, and here we are. So one of the questions that when I would share this with people they would ask me, how long did the effect last?

Betty:

Yeah, so that one drop, it works pretty quickly and it lasts a few hours. And as it wears off, it wears off gradually. And you know, in general, the dyskinesia happens, nobody really knows why, but it's like a gearing up problem. And once it's kind of calmed down it doesn't always come back as severely as it was originally. And so often he could just have a few drops and he would relax, he would enjoy life for a few hours. And then maybe later in the day he would have another drop. But it took very, very little of this extract, it's a very concentrated form of high CBD, low THC.

Stephanie:

Okay. Melissa, do we know about side effects when individuals say take the drops?

Melissa:

So far all we're seeing for side effects is a lot of sleepiness. Some people, because there's not a lot of research done, we don't hear about side effects. We hear a lot of people, "Well, I think I may have had a little too much, I was very groggy and sleepy." And you know, that's what we're hearing. We don't hear those side effects where you know, "I took too much and I was vomiting all night," or, "I took too much and I had to go to the ER," or, "I took too much and I thought I was going to die." There's nothing like that.

A lot of the side effects are really managed by taking a nap, having a meal. You know, don't use the cannabis drops on an empty stomach, you can get a little nauseous from that. But as far as true, real side effects? No, we don't see those. We see mild ones, but you know, a mild side effect with cannabis is something you wouldn't even see, that's just a normal effect of say an opiate medicine or an anti-seizure medicine. Those are just effects you live with.

With cannabis, you can titrate, I won't say titrate, you can adjust the dosage to work for you. So if you're too tired, you cut back on say your THC because the THC can make you very sleepy, and you add a little more CBD into it. You change the strain that you use. There's all sorts of ways to work what mild side effects there are out.

Stephanie:

We're going to take some questions here. And if one of you think you have the answer just kind of give me a nod or a handshake. Is the oil, THC-free medical oil, as effective as the plant or flower? Melissa?

Melissa:

It is. It depends on where the oil is made. If it's made from whole plant cannabis plants, or if it's something like you would buy in a vape shop. I would never suggest some of the vaping meds that they sell in South Dakota or in other states that are just in like a smoke shop. Those are not effective. If you're buying a true medicine, there are several really good providers in Colorado, California, that make a good oil. But it will depend on your product, is my answer.

Stephanie:

Tom, do you know, can it affect people if they smoke it versus the liquids versus eating it? Does it affect them differently?

Tom:

Sure. Probably the biggest thing is how quickly the onset is. And one of the things I'd like to, you know, smoking it is probably not my preferred method if I were to suggest it to people. There haven't had any problems with it necessarily, but you can still have those same quick onset with say vaping it, which is where you can make the plant material warm enough so that the medicine vaporizes, but it doesn't burn the plant. So that kind of gets around a lot of the problems with the smoking burn material. 

But for all the other ones, the liquids ... I mean, there's so many different ways you can do it. There's patches and creams and things. The biggest thing is going to be how quickly the onset is, and perhaps how long it lasts in your system. And edibles are one of things I'd be more nervous about, not because you can die on them or anything, but you certainly, when people have really bad experiences it's because they haven't been told thoroughly enough about how to properly do edibles. But otherwise, yes, the main difference is just how quickly onset it is.

Stephanie:

Okay. Another question that came in. "How well does medical THC-free help with the crooked hands, the feet, that are ..." How does she say this? "Feet helping stop the destruction of the joints?" Do we know, it sounds like this person may be, I'm not quite sure what illness they're struggling with. Does it help relax the joints, so they're a little bit more fluid with their movement?

Melissa:

It's not so much that it's a THC or a CBD, it's a strain. There are certain strains that have muscle relaxing properties. Where if you get the joints that are contracted up it's a shortening of the muscle. So you're going to look for something that will release that muscle and cause the muscle spasms to stop. I think that's one of the biggest misconceptions we see, is people think that THC is going to do this and CBD is going to do that. And a lot of the times you need that entourage effect of both of them. Even Larry does a low THC, high CBD. Our kids with seizures, they do the high CBD, low THC. It's not so much one or the other, it's finding that right balance of both to get what you need.

Stephanie:

Tom, I'm going to throw this one at you. And if you don't know the answer then that's fine. But this individual wrote, "I'm taking 30 to 40 milligrams of oxycodone quick release per day for non-curable cancer bone pain. Chronic pain and feet and hand neuropathy. I'm building a tolerance for oxycodone now after taking it for about a year. If medical cannabis was legal in South Dakota, would it be safer, more effective, long term alterative than oxycodone for me? Please share some pros and cons."

Tom:

Well that's exactly why I would want to see it legalized. And then have a medical professional explain how to implement it properly. Because one of its biggest side effects is it can make you drowsy. And you combine that with opioid medications already, pain medicines, and then you really might be in, not in trouble, but you could really have that bad side effect.

So you'd want to have a professional explain, "You been taking six of these tablets a day. Let's start off by trying the medicinal cannabis at night, let's say, and then don't take your pain meds for that period and see how you react." And then if that works, then explain how you can increase the medical cannabis and decrease the prescription medicines at the same time.

And since they work in different systems, that's another great thing about it. If you're starting to get tolerant on the opioids this works a different way. So it's a great add-on therapy.

Stephanie:

Okay. Another question that came in, and I don't know if we'll know the answer. "What are the numbers on what has happened in states that have legalized marijuana in terms of alcohol use or DUIs, those numbers coming down?" Do we know? Melissa have you seen any?

Melissa:

There is lots of data out there but none of it is exact. We work with an organization out of Colorado, the Cannabis Patients' Alliance. And we have been told that in traffic stops in Colorado, even if cannabis is mentioned in it, it becomes part of the police report. So when we're looking at DUIs versus somebody driving with cannabis or intoxicated on cannabis ... I use that term really loosely because people drive on narcotics all the time, and they absolutely should not be on the road. But somebody that is consuming cannabis should not for safety reasons, but there's no true data. We don't see if those alcohol numbers are going up or going down. A lot of it is they're still in that really new stage of trying to see how do we do a statistic on this if there's cannabis in a traffic along with alcohol, is what's the intoxicant here? Is it the cannabis, is it the alcohol? So the statistics are really not there yet.

Stephanie:

I'm going to bring up, and it's not really a question that came in, it's a comment. But it'll be the last one that I share. And it goes back to when we were talking about the FDA and federal approval. And this individual wanted us to know that, "DEA, federal government owns all the patent rights to marijuana, and will not allow research. They have to give consent. The National Institutes of Health and other agencies have petitioned to do the research but have been denied." Their source comes from 60 Minutes. This is something that you're all familiar with, you know this?

Betty:

Yeah. So you know, cannabis is a Schedule 1 drug and research is very, very tightly controlled. Apparently there's one place that the federal government ... Is it University of Missouri?

Tom:

One of the southern states.

Betty:

Yeah. So there's one place where they grow a particular type of marijuana for research. And of course what I see in places like California is that they're growing many different types and they're hybridizing specifically for people who have specific ailments. And so this is not a one size fits all. And unfortunately having only one source for research marijuana is a big problem.

And the level of control at this point is so extreme. I think over a period of 25 years there were 60 peer reviewed article. That's not very many. On all diseases, and actually the largest number were for MS. But of those, two thirds of them showed positive results. So it's ... Yeah, I mean the control issue is really a problem. But unfortunately it's a federal problem, South Dakota can't solve that.

Stephanie:

Yeah, go ahead Tom.

Tom:

The schedule class that it's in is a C1. Cocaine is a C2 drug, so it's less controlled. And also methamphetamine is a C2 drug that is less controlled. That it's a C1 drug is insane.

Stephanie:

Okay. We've got about two minutes left in the show. The emails continue to come in. If we did not get to your question, I'm going to share these with our guests once we go off the air, and they may reach out to you personally if they can.

I want each of you, there's misconceptions with this, what's the one thing you want to leave viewers with tonight that you want them to be corrected on when it comes to this issue?

Melissa:

Oh, there's so many it's hard to choose one. Educate yourself. There's so much evidence out there. Sit down at your computer, and like I said at the beginning of the show, put it into a Google search. And sit there, spend an hour, spend 10 minutes. Educate yourself. Because the lies that have been told for 30 years, it's time to take our blinders off and really look at cannabis as a medicine. It's time to stop believing that it is the devil's lettuce, like they had said in that movie.

Betty:

Reefer madness?

Melissa:

Reefer madness. I was drawing a blank there. But in that movie they made it out like it was really just something terrible. It's not. So educate yourself. People need to, we need to stop the misconceptions and educate.

Stephanie:

Tom, same question. You have about 30 seconds.

Tom:

The biggest one I'd have is that people, the person they think this is for, they have an image in their mind. And they're probably thinking of the stereotypical stoner type of person sitting in a basement. I was them to change that to the soccer mom, the softball coach, the Sunday school teacher, the PTA president. Because that's, I just described my wife, so I want them to think of that.

Stephanie:

Thank you. Betty, same question.

Betty:

Sure. I guess I would encourage people to watch the film. If you don't know anybody who's used medical marijuana, watch the Ride With Larry film. I think medical marijuana clearly has specific, even dramatic, benefits for many people. Not only with Parkinson's, but with epilepsy, with MS, recovering from cancer, going through chemo. And it should be made available to them by prescription as a matter of compassion.

Stephanie:

Well, we thank Larry for making it available to all of us.

That will conclude this edition of South Dakota Focus. I'd like to thank our guests for being with us. Thank you to Betty Smith, retired USD political science associate professor. Thank you to Dr. Tom Wullstein with Brandon Pharmacy. And thank you to Melissa Mentele with New Approach South Dakota.

Thanks to everyone who connected with us tonight to ask their own questions and comments. Be sure to join us for our next South Dakota Focus as we zero in on today's aging workforce. With advances in health care, seniors are working and living longer than ever. We'll introduce you to some new programs designed to provide seniors with the tools they need to stay connected, active, and in the workforce. That's Thursday, May 18th at 8:00pm Central, 7:00 Mountain.

Until then, on behalf of all of us with South Dakota Public Broadcasting, we thank you for watching, good night.

 

 

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