Growing Pains

AACP Article

When a patient was suffering from the effects of cancer, one pharmacist and UMES faculty member sought relief through medicinal cannabis. Now, she hopes to combat the social stigma of this medication and discuss the role pharmacy schools play in this important area of practice.

By Kyle R. Bagin

A bond between a pharmacist and a patient can be special. Over time, a dialogue about pain, suffering and solutions for relief grows between the two people. And oftentimes, other caregivers become involved. As a result, the pharmacist plays many roles: medication expert, counselor, listener. Dr. Mary Pat Hoffman, clinic it. Twelve years ago there was a lot less information out there than there is now. I understood his concerns, and thought if my mother was 83, how would I want the end of her days to be? Would I be worried about smoking, or would I be worried about quality of life?

I said “I can’t promise that this is going to make a difference in her wellbeing, but I also can’t find any good reason to say no. If she’s comfortable with the physical act of smoking, give it a shot.”

She came in two weeks later, looked at me and said, “Honey, you changed my life!” She was sleeping, eating and her mood had been lifted. She said she smoked a couple joints a day, and had never felt better.

It eased her nausea, increased her appetite, improved her mood, lifted her energy levels and she was able to get some sleep. I thought, “Wow, there’s gotta be something to this.” So I spent the next 12 years researching and learning what I could about medical marijuana.

Q: How did this experience lay the groundwork for a course at the University of Maryland Eastern Shore?

A: In fall 2015, I applied for a medical dispensary permit with three partners, situated on the Eastern Shore of Maryland, which is a great area for cannabis and hemp cultivation. And with a great university nearby in the University of Maryland Eastern Shore, which has a pharmacy school, a physical therapy school and a physician assistant program, we sought their support in our endeavors to open this dispensary. After meeting with the school’s administration and explaining the approach we were taking, which was a medical-based model of care that I have a lot of experience in—they gave us their support.

Then in April 2016, Dr. James L. Bresette, associate dean of development and external relations and associate professor of pharmacy practice, called me and asked what I thought of co-teaching a medicinal cannabis class. I didn’t even have to think about it—it’s pretty groundbreaking.

Q: What topics did the course address?

A: Dr. Bresette and I wrote the curriculum: it was a one-credit elective class, with 10 students, and covered all the important topics, such as the history of the plant, the variety of the plant, the pharmacology, the pharmacokinetics, the endocannabinoid system and associated medical conditions. We had an analyst from Steep Hill Laboratories weigh in, along with a private sector attorney, a public sector attorney and an addiction specialist. It was an all-inclusive and very complete introductory class.

When these students graduate next year, cannabis will be legal to use as medicine in our state. And we have many pharmacists and physicians who don’t know anything about it. I think bringing it into the pharmacy school curriculum is an important first step.

Q: How important do you think it is for pharmacy schools to provide this type of education and training for students?

A: I think it should be mandatory. Cannabis therapy is legal as medicine in more than half of our states now. As pharmacists, we are positioning ourselves as experts on the way medication works in the body, but we’re leaving one drug out and it’s one that has been around for almost 5,000 years. Cannabis has been used as a medicine a lot longer than it has not been used as a medicine.

It was important for me to teach this specialty area of pharmacy because I believe erasing the stigma is a huge part of the success of cannabis therapy. Patients have to be open and honest, and if they’re afraid to tell their pharmacists or physicians that they’re using cannabis, they’re not going to get the best outcome. Cannabis can interact with some medications and can decrease the need for others. If you’re a pain patient, and you’re prescribed opiates, but you’re also using cannabis to control your pain, how is your prescriber going to know to cut your dose, or help you step down your dose, and let the cannabis step in and supplement that? We need to have an open dialogue with our patients.

Q: Do you think it’s up to schools to lead a change in practice? Or do you think change starts from practice and works toward schools?

A: Starting in the schools is important, because there is so much of a social stigma, and if you’re learning about this in a professional program, it’s going to help to break that stigma.

If you’re a medical professional, turning to traditional professional journals, the information isn’t there. This is a grassroots effort and I think that we start hearing more personal accounts from people using it, that’s when people are going to see the benefits and realize that this is an incredibly useful plant.

Q: What’s next for the UMES course?

A: This was a great first step. It’s the first time we’ve offered the course and so we definitely have some changes to make. If we can start while students are still in school, by the time they graduate and are out as practicing pharmacists, it’s just going to be another medicine to them. It’ll be part of the science and part of drug therapy.

The majority of people that are using it are very serious about using it as a proper medicine. We still have a lot of work to do, but we’ve come a long way, and I think it’s important to keep moving forward.

Kyle R. Bagin is digital media manager at AACP and
editorial assistant for Academic Pharmacy Now.