The 411 on Medical Cannabis from a Medical Cannabis Counselor
Recently I attended the Michigan Medical Cannabis Summit. I learned a lot about the benefits of medical marijuana for a variety of health conditions including chronic pain. I also learned about the complexities of using medical marijuana even in Michigan where it’s legal. I was happy to meet Julie Barron (pictured right) who works for Blue Sage Health Consulting in Ann Arbor. She is a medical marijuana counselor. I was fascinated by her role in the medical cannabis industry and sat down with her to learn more.
Can you tell me about your background and how you started working in the medical cannabis industry?
After getting my Bachelors Degree in psychology at the University of Michigan I went to Boulder, Colorado, for my Masters Degree in counseling and music therapy. While I lived in Colorado I had the opportunity to work in medical cannabis part-time. When I returned to Michigan I was able to combine my two passions at Blue Sage Health Consulting. I feel very fortunate to now do cannabis counseling.
Can you explain what cannabis counseling is and how that works at Blue Sage?
At Blue Sage, my job has two parts. One of those we are doing now - education. A good part of my job is reaching out to community groups, doctors, and wellness centers and teaching and giving resources for cannabis.
The other part of my job is meeting with clients one on one. My clients have health conditions and they are looking for symptom relief. They are either new to cannabis or just need some direction. What I do is sit down with them and we go through some basic cannabis education. I also check any interactions and contraindications with medications they are taking. Then I will help them build a protocol with dosing and match them with specific products. I will even walk them over to the dispensary center near my office and help with product matching.
How does one get involved with cannabis counseling?
Different states have certification programs but Michigan does not. I became involved by attending every conference I could and doing in-depth research. I call myself a counselor because I am a counselor that happens to work and counsel on medical cannabis.
So there is not a certification people should look for when seeking a cannabis counselor?
No, there is nothing official in Michigan.
How did Blue Sage Health Consulting come about?
Bloom City Club is a provisioning center in Ann Arbor, AKA a dispensary. But we are no longer able to use that word in Michigan. The new term for dispensary is provisioning center. Bloom City Club would notice that people would come in very green - no pun intended. Clients did not know anything about medical cannabis. Their doctor would sign their application and give them little or no information at all about the product they should use. For example, the doctor might say get something with no THC in it. They would show up and they would look to the bud tender (the sales person behind the counter) and they would say these are my health problems and medications, please make a recommendation. Remember, you are talking to a sales person. Many bud tenders are very knowledgable, especially at Bloom City, but I don't know it’s true of all centers. The problem is, clients are asking a very wrong person at a very wrong time a very serious question. Bloom City Club was noticing there was a huge gap here. They felt something needed to happen between the doctor writing a recommendation for cannabis and somebody showing up at the dispensary and buying product. There needs to be in between service offering guidance on how to help clients get from A to Z. This is what I do. Blue Sage Health developed the partnership with Bloom City Club to fill this gap. So Blue Sage Health developed out of this need.
Can you walk me through what a typical interaction would be with a patient from start to finish?
Patients find out about us through medical providers, friends or walking into Bloom City. You can make appointments online at bluesagehealth.com or call 734-585-7063. There are some forms to fill out before your appointment. We meet at Bloom City Club and then we go next door to my office. I start with cannabis education. If I am going to make recommendations, I really want clients to know why I am making the recommendations. I start with the basic cannabinoid education: what are the cannabinoids; what do they do; what are the benefits and side effects; how do they work together; and then we discuss the human body’s endocannabinoid system. We discuss why we use plant cannabinoids to supplement the body’s endocannabinoid system and how that works. We talk about what the endocannabinoid system does and why it’s important to keep it healthy and what other things you can do in addition to cannabis to keep the endocannabinoid system healthy. We will discuss their health conditions, the problems and symptoms they are having, and their treatment goals. Next we will review the medications they are taking. I will make sure to the best of my ability that there will be no contraindications. Then we will get into why they are here — to see how cannabis can help. We will talk about the best methods of delivery for them, how to safely use the product and very specific protocols to follow. If clients want, we will go next door to Bloom City Club and I will walk them through the dispensary process. I will help match them with the product and how to dose the product they are buying as dosing can be a challenge. This is the end to the initial consultation. However, this is not an exact science. This is personalized medicine. Everyone reacts differently. I like to follow up with clients and see how it’s going and if there are any side effects. From there we can fine tune the dosing and product choices. We also can schedule follow up consultations.
What is pharmaceutical CBD vs non-pharmaceutical CBD (i.e. over the counter in stores)?
There is no difference between the two. However until recently you could buy CBD products over the counter without a medical marijuana card. Michigan’s new policy requires all purchasers to have a medical marijuana card. There is no more over the counter CBD in Michigan.
Something else that is related is that in order to be a provisioning center in Michigan the product you are selling has to be from the state of Michigan. You are not allowed to buy online or have it shipped from another state. While I can’t say you won’t be able to buy it online, I do know it’s not legal for it to be shipped to you.
How is CBD made?
CBD is made two ways. It is made as both an isolate and a whole plant extract. They both start from the cannabis plant. There are different processes to extracting the CBD. One of the processes is to extract the CBD only and this is called CBD isolate. You can go into provisioning centers and online and buy isolate cheaply.
The second way of extracting is to extract all of the cannabinoids from the plant. This includes everything the plant has to offer as medicine. A little history, there are different varieties of the cannabis plant. They all have different levels of cannabinoids. Some have very high levels of THC, some have low levels of THC and some are CBD rich and some are not. Following the federal law, products sold over the counter could not have more than .3% THC. If you found a variety of the cannabis plant that had less than .3% THC then you could extract everything from that plant and it could be made available over the counter. But this law just changed in Michigan. Now you can’t sell anything over the counter. Whole plant extract includes all of the terpenes which gives the cannabis it’s smell and taste. The terpenes are very healing too.
From my experience the whole plant product is superior. To give you an example, I had a young girl who had very severe seizures every morning. She had between six to ten seizures a morning. The whole plant extract worked beautifully. She was not having seizures anymore. It is an expensive product. When her product ran out her Mom said she had gotten a bottle of isolate she wanted to try. It did not work. It was the same dosage and it did not work. I see these results all the time for pain and inflammation too.
I am not a scientist but from what I have learned, a whole plant extract has a much wider therapeutic window. It’s easier to find the right dose on a whole plant extract versus an isolate. It’s harder to fine tune the dosing of an isolate and it takes more time. Isolates have more side effects and more interactions with medications than whole plant extracts. If you take an isolate, it will work on the one pathway of the body it was designed to work on. If you take a whole plant extract it will work on twenty or more different pathways. I think of whole plant medicine as being a balanced medicine. The cannabinoids work together with great synergy. When you take one extract out of the plant it loses some balance, and I think that is how it can lose some balance in the body as well.
What is our endocannabinoid system and what does it do for us?
Our body has an endocannabinoid system. Every animal with a spine has one. We learn about all of our other systems in school - digestion, nervous, etc - but we do not learn about the endocannabinoid system. It is a shame. It is vital to human health. It’s role is to provide homeostasis or balance to the other body systems. Because we have an endocannabinoid system, we produce cannabinoids in our bodies. Any system can get out of balance. If it happens to the endocannabinoid system, it is happening to other systems in the body as its role is to balance the body. We have receptors all over our body that can bind to cannabinoids. The receptors are in our brain, gut, organs, skin, immune cells and more. We can supplement our system with phytocannabinoids or plant cannabinoids.
It is important to note that endocannabinoid receptors are not in the brain stem. The brain stem is where our vital living functions occur. Pharmaceuticals like opioids have their receptors in the brain stem. This is why you can overdose on opioids. You can stop breathing or your heart can stop. This is not true with cannabinoids. While you can overdose on cannabis, it’s different. You can become paranoid, have anxiety, fast heart rate, or even throw up. However there has never been any lethal overdoses on cannabis. Researchers believe this is true because there are no endocannabinoid receptors in the brain stem.
How do you approach your doctor about whether cannabis is right for you?
I would tell your doctor, “I have been hearing a lot and doing my own research that CBD may be helpful for me.” I would then share brochures and research studies with him or her. Blue Sage Health Consulting also offers a service where we will go to the doctor with you or we can schedule a time to talk to your doctor.
If you have a doctor who is not receptive or you just don't feel you can bring it up, you can go to a certification center. As long as you have a qualifying condition and your medical records to prove it, a doctor at a certification center can sign your state application for a medical marijuana card.
What do you need to know before trying cannabis?
You need to become educated on CBD. Blue Sage offers different classes that can help with this. It’s important to know how to use it and how to minimize intoxicating effects if you don’t want those effects. Becoming educated is the first step to deciding if it’s right for you.
Do you work with chronic pain patients?
I work with a lot of chronic pain patients and fibromyalgia patients. It’s exciting because there is a lot of potential relief in a very safe way with cannabis.
Deciding to try medical cannabis is a big decision. There are things that should be considered. For example, if you travel, you will not be able to travel with your medicine. As patients we need to be advocating for rescheduling cannabis from a schedule 1 drug so that research into cannabis can become easier and we can learn more quickly about this plant.
The bold text is writer Sharon Waldrop and the regular text is Julie Barron.