In the latest episode of Civilized's new podcast 'Cannabis & Main,' host Ricardo Baca spoke with Constance Finley - Founder and CEO of Constance Therapeutics, a medical-marijuana that helps patients find the perfect products and delivery systems to treat various conditions with cannabis. Ricardo and Constance discussed problems with cannabis research, the importance of knowing how your medicine is grown and why patient consultation needs to go beyond a quick chat with a local budtender.
Transcript: 'Cannabis & Main' Episode 105, “Cannabis & Patient Education”
Ricardo Baca: Hello and welcome to 'Cannabis & Main,' a Civilized podcast where we extract one sliver - one tiny little slice from today's cannabis scape and go deep. I'm your host Ricardo Baca - Founder of Grasslands and The Cannabist. It's great to be with you today. Of course you can learn more about this show alongside the marijuana news and cannabis lifestyle coverage you crave from Civilized, found on the world wide web at civilized.life.
This week we're going to shine a light on cannabis and patient education with a guest who almost died from the pharmaceuticals prescribed to help alleviate pain and inflammation caused by a rare autoimmune disease. And who was dumbfounded when medicinal cannabis provided the relief she needed. Now she specializes in educating the many critically ill patients and their physicians who come her way for whole plant extracts.
Dr. Sanjay Gupta (excerpt from April 2018 CNN interview): When I looked at the macro view of medicinal marijuana in this country and I started looking at all the scientific literature, which is where I start, 94 percent - we calculated 94 percent of the studies were designed to find harm. What is the risk of addiction? What is the risk of cancer? What are side effects? Only about six percent were designed to find any benefit. If you're looking at that from a macro level, you'd say, "There's nothing here. This is mainly problematic." I realized that was a problem upstream.
Studies designed to find benefit were not getting funded. Researchers could not conduct those studies. It was preordained as a substance that has no medicinal value. That's when it started to change.
Ricardo Baca: I am truly, truly passionate about the subject of patient education when it comes to medical marijuana in 2018 and 2019 because I think our current system - a relic forced upon us because of federal illegality - is well meaning but incomplete. This is no slam against budtenders, who do great work from California to Massachusetts. But untrained budtenders should not be educating patients suffering from PTSD or chronic pain or even cancer. Especially in a public space such as a dispensary.
Think about it: if you're suffering from cancer and working through chemo and radiation, are you going to want to discuss the intricacies of your side effects in an open room, where you might feel rushed by the customers waiting in line behind you? The more cannabis becomes commercialized, the more we get away from one-on-one patient education. And that's where this important conversation comes in.
My guest today is Constance Finley - CEO and Founder of Constance Therapeutics. That's a Prop 215 compliant company that has patented cannabis products that they prescribe to patients. Although, is prescription the right word there, Constance?
Constance Finley: Actually in California you can't even use it as a doctor when you're talking about cannabis. We say “recommendation.” It's to keep the doctors from losing their ability to prescribe to federal Schedule I substances.
Ricardo Baca: It makes sense and I was well familiar with that. But, you know what's interesting in Texas’s nascent CBD market - that's state regulated - there's three businesses out there. Those physicians use the term "prescribe" and that's the language that's written into the state code - The "Compassionate Use Act - out there.
Constance Finley: That's pretty interesting. I will have to check that out and understand their rationale for why they think they can do it.
Ricardo Baca: You and I have a shared passion for knowledge - for legitimate education and getting it out to the people. Putting it in their hands and allowing them to use that as they will. For me, I really appreciate the ability to have this microphone, to be able to put pen to paper and spread quality information - primarily because I recognize that for most of my life, I've been exposed to misinformation when it comes to this plant. Where is your passion born from when it comes to educating patients and consumers?
Constance Finley: It really came from the fact that I was kind of prejudiced against cannabis. I wasn't a Republican. I lived in San Francisco. I thought it was a person's right to use plants for what they wished, but I felt that - wink-wink, nudge-nudge - medical marijuana was silly. I was wrong. I was absolutely wrong. But it took me a while to figure that out.
When I almost died from allopathic drugs prescribed by my doctor, who fully intended to help me, but they had very bad, unintended consequences. Friends of mine really encouraged me to consider [cannabis]. It was legal in California since 1996, and what I'm talking about is around 2007 [or] 2008.
Finally in desperation, when my doctor said, "Absolutely no more drugs for you and the likely outcome of this is a very early heart attack from intense inflammation." I said, "Okay. I'll give it a whirl." That's how it started. And what I found was that it was so powerfully efficacious - after I learned to make extracts - that I was on fire to share for the other patients that were out of options.
In fact this could really be a no-harm medicine that could require some adaptation in your life, but you weren't going to trade five years of health for an early death. For the first time, I looked at something that was profoundly helpful and there wasn't a trade-off. I got on fire about what can we do with this plant.
We felt at times like we did live in [Orwell's] '1984.' The reverse is what's said not a subtle misstatement but, actually, the reverse of the truth: “This plant leads to psychosis.” Well, it turns out that CBD and THC may even help people recover from psychosis. It's those kind of disparate messages that were so untrue that when I found out, I was on fire to tell people about the truth.
Ricardo Baca: My favorite one of those messages - gosh it did so much damage in its day - but marijuana is a gateway drug, don't you know Constance? Here we are in 2018 with multiple academic studies showing us that of course it's not a gateway drug. We understand that now from federal health data. But more importantly, it's potentially an 'exit drug' for those addicted to far more addictive, far more deadly and dangerous substances like opioids. And, of course, we all know people who have used it in that capacity, but aren't you so pleased to see this narrative overturned?
Constance Finley: I am. For about five years we've been talking about that, the white knuckling is not the right approach for addiction recovery. Just like the war on drugs, the war on addiction doesn't work. For those who can, great, I applaud anyone who can do AA and make it work. But I think that it's time. We are faced with an avalanche of doctor-induced addiction to opioids. These are not people who had a mental problem and they became suddenly an addict because of their own behavior. They were actually given a prescription. We're dealing with a different population. We need to deal with as much compassion as we showed towards their chronic pain and helping them deal with their addiction. And cannabis truly can be an answer.
Ricardo Baca: There you go. And since we're here to talk about patient education, I'm curious, how were you educated? Whether it was a friend who was guiding you, or a staff at the dispensary, who was there to really educate you, if anybody?
Constance Finley: The bad news is it wasn't anyone.
Ricardo Baca: Let's talk about patient education now. What's the key?
Constance Finley: Making a mutual exploration into this plant-based medicine that has the potential to save their life, to change my life and to change the world.
Ricardo Baca: You're also operating in an extremely unknown environment of legality, and you are ultimately recommending and distributing a medicine without that license. That must have been terrifying, daily.
Constance Finley: It was. And to say, "We're not doctors. We're not scientists. What we can do for you is give you very in-depth cannabis knowledge that's founded on what we know. And what we don't know, we don't say." That attitude led a lot of very serious physicians to trust us with their patients.
Ricardo Baca: Just acknowledging what you're not. But if you're not a doctor and you're not a scientist and yet you're recommending and dosing out this medicine, what are you?
Constance Finley: I've seen a lot of people in cannabis want to be heroes and it's kind of like you get to be a doctor without going to medical school. It's so tempting. That is a dangerous slope. So when people used to rush up to me and say, "You're an angel." No, I'm not an angel. Cannabis is an incredibly powerful plant and I'm paying attention to what it has to give.
Ricardo Baca: A complaint that a lot of people have about the modern industry and how it operates is this system of dispensing. - and you know where I'm going with this – inevitably, whether we're buying on the medical market or as medical patients on the adult-use market, we are going to them and saying, "I have this ache and pain in my lower back, I'm having a hard time sleeping." And they are making these recommendations of certain strains or extracts or edibles or topicals for us to try. We're talking about patient education, the frontlines of patient education are budtenders. Do you think that's where cannabis needs to be in 2018?
Constance Finley: I don't. I don't think it's where cannabis needed to be in 2008. We have never sold our products through dispensaries. We've taken the very, very high cost route of having individual meetings with trained coaches that work with our products that meet the patient in person. We deliver anywhere in California, historically, and the world has come to us in California.
We feel it's really important when you're working with that potency of medicine that you are dealing with someone who's had more experience than you and has learned to take themselves out of the equations. We have symptoms packs. We have sample packs, so people can come and buy small amounts of, say, five different things and two or three vape pens and then we'll coach you. We'll have a conversation with you after a couple of days. How's it going? What do you find this reasonable for?
When I did this, it was rad. Even doctors were like, "Oh my god, I wish we had that!" But now our industry is adopting that a lot. But what I want to challenge our industry to do is to adopt it not just in messaging format but to really actually be educated. But an $18-22 an hour budtender cannot have the same expectations. We cannot put on them that they can do what somebody as serious as our organization that doesn't have a single recreational user, that has spent 10 years doing nothing but this. If there is a stratification that occurs, I think we should take the serious medicine away from the cannabis dispensaries or they just become an outlet for it. But we don't have misrepresentations and mis-expectations about what those people can do.
Ricardo Baca: When you say "serious medicine," are you referring to this high potency product? These oils and formulations that as you mentioned earlier have a lot of kick to them - a lot of cannabinoids in them.
Constance Finley: Or also maybe just a condition that could be microdosed. If the person working had understood and seen lots of other people and spent their time reading Dustin Sulak's work in Maine and actually got intrigued and began to do some of that work themselves. It's a different attitude. It's not just like 'What will work?' or 'Is cannabis good or bad?' Those are the questions that should be left behind. What is cannabis good for? In what method? In what delivery mechanism? From what extraction methodology?
Ricardo Baca: You have your own methodology, but given that we've all inherited this construct of the dispensary system [and] the budtender relationship, what advice would you have for - whether it's license holders listening to us right now, or budtenders listening to us right now - what advice would you have to them to be responsible patient educators?
Constance Finley: First of all I'd say to remember as broadly helpful as this plant is, the more we responsibly communicate about it from an evidence based mechanism and manner of talking, the more we're going to be taken seriously. If you throw out a chart that says, "Oh my god look! CBD's good for over 200 things!" And you start tracing it down, it's like, "Well there was a study that said in vitro one time that CBD might have had an interplay in this connection." It doesn't belong on a chart on the internet as researched. It belongs as a very early indication of potential benefits.
It's okay to say to patients, there's one study. If you have a rare disease that shows that that might help you, and we know CBD isn't harmful. Awesome. Let's do a customized blend for you. And let's see if that helps. And let's pay careful attention. And let’s take good records so that you actually know whether or not it helps. Not whether or not you had a better day.
Cannabis is so broadly helpful that we can kind of make it seem like snake oil. And the positive is that it truly is that broadly helpful. And we know now because it's the ECS. We are working with the endocannabinoid system, so we're working at the basic level of regulatory systems. But let's really try to stick to evidence. Let's not put out bad science because we're anxious to prove how good our plant is.
Ricardo Baca: I love it. And thank you for the advice to industry. Now I'm going to ask you for advice to consumers and patients.
Constance Finley: The most important thing you can do is identify how your cannabis is grown. You can grow it well indoors, outdoors, all kinds of ways. But does your grower pay attention to whether or not there are toxins? We've had the amazing experience of having people who have used cannabis before. They heard about us, they wanted to understand what was going on and they just raved because they had no hangover the next day. I'm like, "Hangover? From cannabis?" All kinds of people said it. I finally realized it's the toxins from the growing and it's the toxins from the process. And when you don't have those, cannabis is a super clean experience and you actually feel better the next day.
Know where its grown and if you can, know your grower. If you live in a state where access is possible and you're only smoking bud, I'd say give it a go [at] growing a couple of plants. Give yourself access because you're going to learn so much more about that plant. In fact, it's gonna become a pet. You're going to come racing home from work and want to see what's happening with it and that'll make you learn a lot.
Then the next thing is, how is it extracted if you're using an extract? Is it butane? If you're a sick person I wouldn't, I just wouldn't. If it is CO2 and you have cancer or you have my disease, I also wouldn't. There's very few CO2 machines that have answered all the questions we need for huge ingestion. It's different if you're doing a vape for recreational. I'm not nearly as concerned as I am putting a gram in my mouth every single night from a process. That process better be clean.
Ethanol is our bias. We take it from the herbalist. We think that it's the gift of herbalist to cannabis. Mammals have been working with ethanol for thousands of years. We know that even if a baby got a glass of wine accidentally, he's not gonna die. I would suggest that you go to ethanol process when you can find it.
The other thing I do is I really pay attention to CBD, but I wouldn't stop there. I would say that CBD is super helpful for cushioning the effect of THC and amplifying in synergistic ways those effects. I would start with CBD and then I try a mild THC. I'd see where my body wanted to be. Some people are actually almost allergic to THC. It just disorganizes them. It makes them feel dreadful. It's not a good experience and they don't get over it. Those people are in the tiny minority but if you're one of them, you don't want to go to THC but most people can attenuate and learn the benefits from some synergistic combination of the two.
Ricardo Baca: I like too that you recommended that they ask how it's grown. Who grew it? One easy question that new consumers can utilize. Don't be afraid to ask, maybe even call around a couple local shops and ask them if they're vertically integrated. And if they are, that means that they are growing it and they're selling it and that means they have more knowledge about how it was grown because it wasn't these pounds that came in on the wholesale market. They grew that, they transferred it over to their retail inventory and now they're selling it to you. If they are vertically integrated then they can answer those questions a lot more easily.
Constance Finley: We've always thought it was really important that if you are actually trying to meet needs, how can you do that from bulk product picked up on the street? Honest to god? The first five years, I grew everything and then after we outgrew my ability to grow, we moved to contracted farmers who we give our genetics to, who really care about the medicinal needs of the patients. They take less money from us than they do from dispensaries and it gives them their cause back. They know it's going into actually helping people's lives.
Ricardo Baca: I love it. You have a very graceful of sharing your story and I'm thankful that you shared it with us here at 'Cannabis In Maine.'
Constance Finley: Thank you so much for having me. That's delightful. We do, you know, do interviews for digital magazines. We have a very well developed website. I have a personal site as well where we try to keep things up that aren't only just about cannabis. We like to say that the legacy I want to leave is that we help mammals turn back to plant based medicine.
Ricardo Baca: I love it. What are those websites just so we can get them in here?
Constance Finley: We're at constancetherapeutics.com and constancefinley.com.
Ricardo Baca: Check 'em out. Everybody, Constance Finley, CEO and founder of "Constance Therapeutics" out of California joining us here on 'Cannabis & Main.' Constance, thank you again.
Constance Finley: Thank you so much Ricardo.
Ricardo Baca: 'Cannabis & Main' is a Civilized podcast. Our executive producers are Ricardo Baca and Derek Riedle. We are produced by Katie Labrie and Vince Chandler, along with Civilized, F420 Films and Grasslands. We are hosted by Ricardo Baca and directed by Vince Chandler. Interact with Vince on twitter @vinniechat, Ricardo @bruvs and Civilized @civilizedlife.