MedicateOH first interviewed Dr. Steve Davis, an emergency room doctor who heads up Canton’s Advocare Clinic, to learn more about the process of getting a medical marijuana card in Ohio. Recently, we caught up with Dr. Davis again to talk about his recent work fighting COVID-19 in Canton as well as using medical marijuana as one of many methods that have shown to significantly help patients caught in the opioid crisis.
MedicateOH: Have patients been getting better? While I’m sure there are stories of patients you couldn’t save, are there also some stories of healing that you’ve seen?
Dr. Davis: Yes, the majority of patients experience COVID-19 similar to the common cold and get better. As an emergency physician, I have cared for a few patients that were very sick and one that I am aware of died from the illness. In the emergency department, we see them and then get them to the appropriate clinical setting for their symptom severity. The majority of the patients I have admitted have gone on to recover. Most patients we see that are COVID-19 positive get symptomatic treatment and a self-quarantine at home. They follow up in an out-patient setting. So, yes, I have seen a lot of cases where the patients do just fine. It has only been a few unfortunate patients that have had a fatal outcome.
MedicateOH: How has your medical team been handling the emotional issues that come along with fighting this pandemic? What have you done to support one another through the crisis of losing patients?
The stress with the pandemic comes from a lot of things. There is the stress of worrying possibly taking COVID-19 home to family or friends. There is the stress of possibly being taken off the schedule for a fourteen-day quarantine if you have an exposure to an asymptomatic patient who turns out to be COVID-19 positive. Wearing PPE (personal protective equipment) for an entire shift is stressful, as well. The team has done a fantastic job of supporting each other through it. Teamhealth and Aultman Alliance Hospital have gone above and beyond to make sure that providers have everything they need to care for patients safely. That has helped tremendously with dealing with the stress. Our medical team is a cohesive group that has each other’s and the community’s back.
We always feel bad when a patient does not survive despite our best efforts. We look at those cases to see if anything could have been done differently. Fortunately, we are usually able to get patients stabilized and transferred to a higher level of care. This is what our primary role is during this pandemic. We are the ones who see and assess patients and get them to the most appropriate care setting.
MedicateOH: Why is continued social distancing, wearing masks, and other restrictions put forth by Ohio legislators so important for people to follow into the late spring and summer months?
The goal is to limit contact which means limiting the spread of the virus. Important points to focus on are frequent hand washing and decreasing close-quarters contact. When wearing a mask, every time you touch it to adjust it, etc. you need to wash your hands. Also, masks are not meant to be used over and over. Cloth masks, if used, should be laundered after each day of use.
Bottom Line: Decrease contact = Decrease spread
MedicateOH: Where do you see COVID-19 a year from now?
There is a lot we still do not know about how the virus behaves. We do not know how long the antibodies last when a person has had the illness. So, we do not know if they can get it again. If they can get it again, that is a huge gamechanger. I anticipate another large wave this fall as school resumes. I think there will be another wave in late winter or early spring. Unfortunately, I do not see an easy resolution in the next 12 months.
MedicateOH: In the early stages of developing quarantine measures, marijuana was deemed an essential service by the state of Ohio (among many other states, including recreational ones) to the delight of cannabis advocates everywhere. Why do you think marijuana is viewed as essential, especially for medical patients?
Medical marijuana patients are as legitimate as any other medical patient. In fact, the majority of medical marijuana patients have tried all other avenues of conventional medicine before turning to cannabis as a last resort for relief. Marijuana is essential because it is the only medicine available to these patients who rely on it for relief. Every medical marijuana patient has to have a bonafide, patient-physician relationship in order to participate in Ohio’s Medical Marijuana Program. At AdvoCare Clinic, we see our patients three times in their first 12 months. That is more than almost any other physician’s office.
MedicateOH: For those who want to try marijuana but have had COVID-19 or have other respiratory issues, and worry about doing something that involves inhaling and coughing, what advice would you give them?
There are multiple oral and topical forms available. Oral forms include gummies, chocolates, lozenges, cookies, granola, caramels, capsules, oil concentrates, and tinctures.
MedicateOH: What non-inhalation methods of marijuana would you recommend? How do these affect a patient differently and what warnings or advice would you give to someone trying an edible for the first time?
It would depend on the symptoms the patient is trying to address. Tinctures are nice for being able to control dosing. They allow for fairly tight titration (dose adjustment) to the desired effect. The onset of action for a tincture is about 30 minutes and the effects last about 4 hours. Edibles; gummies, chocolates, caramels, etc. are another option but they are a little trickier to dose. The onset of action is about 90 minutes and the effects last 6-8 hours. So, if the patient overshoots with an edible, they have a longer period to wait for it to wear off. However, taking a measured approach to initiating edibles by starting low and going slow usually yields very good results. So, the advice is to start low and go slow with edibles. Be patient and allow about a week to find the optimal dose.
Edibles and to a lesser extent tinctures affect patients differently than vaporized flower or Vape cartridges. Vaporized THC goes directly into the bloodstream from the lungs and avoids first pass metabolism (digestion). Vaporized THC reaches maximum effect at 10-15 minutes. Vaporization tends to give more of a head effect. Edibles get digested and this causes a chemical conversion of some of the compounds. Oral dosing tends to have more of a body effect.
The other advice is that with cannabis, less is more. Finding the lowest effective dose is key to optimal results and sustainability.
MedicateOH: Many patients utilize marijuana to supplement or replace traditional mental health treatments and PTSD is even one of 21 approved conditions that the state of Ohio recognizes in order to qualify for a medical card. What advice would you give to a patient who chooses to utilize marijuana right now to deal with the emotions of quarantine, job loss, or fear of dying from COVID-19? Is there a thing as “overdosing” on marijuana and what would be the effect of an overdose?
The first thing is to define the results the patient is wanting to achieve with using marijuana. There are multiple factors; strain, potency, CBD/THC ratio, a delivery method that determine the effect the marijuana will have on the patient. Also, no patient should stop any medications without discussing it with their medical provider. Supplementation with cannabis for symptoms of PTSD, like anxiety, is usually very effective. Over time, some medications can be reduced or discontinued but not without medical oversight.
Cannabis is a medicine that can be helpful in stressful situations but it is not a panacea. Taking cannabis is not going to replace dealing with your feelings or getting help from a mental health professional when needed. At AdvoCare Clinic, we stress a holistic approach to these situations; mind, body, and spirit. That means sleep, exercise and nutrition are just as integral to handling mental and emotional stress as using cannabis. Cannabis can certainly help a lot when used in the right way.
Yes, you can overdose on marijuana. You can overdose on pretty much anything. The thing about a marijuana overdose is that it does not cause respiratory depression. Therefore, it is not lethal. It can be very uncomfortable causing psychosis, paranoia, feeling of impending doom, palpitations, nausea, and vomiting. These effects can last for a long time in a severe THC excess. The important thing to do if this happens is to find a calm place, hydrate and chew some peppercorn or eat some lemon zest. Taking some CBD, preferably in a vaporized form, will also help calm a THC excess. CBD mellows the effects of THC like adding water to whiskey.
MedicateOH: One concession made to the stay at home order issued by Governer Dewine in addition to calling both marijuana and alcohol “essential”, was to allow alcohol via carryout by restaurants statewide in order to increase liquor and bar sales. Jokes about such flooded Facebook, as many Ohioans clearly resonante that alcohol is an appropriate elixir for the mind. For patients who use and abuse alcohol regularly to numb emotional pain, how could medical marijuana help them approach their mental health differently?
In some studies, regular consumption of small quantities of alcohol, the equivalent of six ounces of red wine a day, can have some health benefits. The problem is that most people who drink alcohol consume much more than that. Alcohol is a toxin that is dose-dependent. Regular consumption of large quantities of alcohol has negative effects on the liver (cirrhosis), vascular system (peripheral vascular disease), brain (alcohol-induced dementia), and heart (cardiotoxic and raises blood pressure). Alcohol is also a central nervous system depressant. Marijuana is an excellent alternative to alcohol for easing emotional stress which is why it is approved for PTSD. While marijuana is not approved specifically for anxiety as a sole diagnosis in Ohio, decreased anxiety and improved mood is by far one of the biggest side benefits patients report when using cannabis for one of the other qualifying conditions. We have had several patients with alcohol issues stop their alcohol consumption completely through using cannabis.
To the point about how marijuana could help patients manage their mental health differently, the are several things that make it different than alcohol. By adjusting strains, terpenes, delivery methods, potency, and CBD/THC ratios different moods and emotional effects can be achieved. Alcohol has only one dynamic and that is dose or quantity consumed. Alcohol works by the central nervous system, CNS, depression. Cannabis works through our endocannabinoid system, ECS, to cause its effects. Our ECS is our system that maintains wellness, balance, and repair of systems. Marijuana is by far a superior medication physiologically over alcohol.
MedicateOH: What other benefits could result in opting to utilize marijuana over alcohol?
Better overall health. Alcohol dehydrates and adversely affects body systems as described above. Marijuana does not do that when using it in a medicinal manner.
A question I like to ask people is, “Would you rather be sober in a room with 10 people who have had a little too much to drink or in a room with 10 people who have consumed a little too much cannabis?” Most people pick the cannabis room without even hesitating.
MedicateOH: Where do you see medical marijuana in Ohio in one year?
I am hopeful that there will be more growers and dispensaries operational. We really need the cost of the medication to decrease.
Legalization at the Federal level may come into play depending on the results of the November elections. I do not think Ohio will be recreational in a year. I think it will be in 3 years.
MedicateOH: How has telemedicine changed the way Ohio medical marijuana doctors can reach patients?
Telemedicine has made it much easier for patients to have access to this medicine. Many patients have chronic pain conditions or weakness that makes it difficult for them to come in for an office visit. Telemedicine requires a streamlined process to make sure all the documentation requirements are being met.
To view our first interview with Dr. Davis where we learned about the process of getting a marijuana card, click here.
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