In Service of the Patient w/ Dr Erick Kaufman

People have been using cannabis as medicine for thousands of years. With the lifting of prohibition and advancements in technology, we now have the opportunity to explore its full potential. The Edge of Cannabis Medicine podcast features interviews with innovators in the medical cannabis industry, including doctors, researchers, cultivators, and entrepreneurs. Dr. Eric Kaufman, the founder of Doctors of Cannabis, discusses his transition from traditional medicine to cannabis medicine and the importance of education and understanding in this field. Traditional medicine has not provided much information on cannabis, so Dr. Kaufman had to rely on basic science, research articles, and the experiences of clinicians in other states with medical marijuana programs. Personal experiences and interactions with patients and industry professionals have also contributed to his knowledge. The process of finding the right dosage and type of medicine can be complex, but it is important to listen to pa For over 5,000 years of documented history, people have been using the cannabis plant as medicine. From ancient Chinese medical journals to the modern-day dispensary, cannabis and its many medical uses have found their way to every company on earth. Today, as the prohibition against this plant is slowly being lifted around the world and our technological capacity grows exponentially, we finally have the opportunity to discover what this plant is truly capable of. Please join me, Matthew Myra, as I speak to the remarkable innovators working at the cutting edge of these discoveries. This is The Edge of Cannabis Medicine. Hello, beautiful people. Thank you so much for joining me for this episode of The Edge of Cannabis Medicine podcast. You are here because you know that this show is the place to be if you want the very latest and the very best information out there about the medical cannabis industry. I speak to doctors, and researchers, and cultivators, and entrepreneurs, and anybody that is doing incredible innovative stuff in this space. I am having a conversation with them, and I'm bringing their wisdom to you. If you're enjoying this content, if you're getting a lot out of listening to these episodes, please go over to wherever it is that you like to listen to these and leave a review. Let me know how you feel I am doing. Let me know what you think of this show. I love to hear about it, and I love to hear from you. So reach out, Matthew, at edgeofcannabismedicine.com. That's how you can get to me directly, and I'll get back to you every single time, because that's how I love to treat my listeners like you. So today I am very honored to be able to share with you this conversation I had with Dr. Eric Kaufman. He is truly an innovator in this space. He has created a group called Doctors of Cannabis, where you can go online through video conferencing and speak to one of 1,200 doctors that he has around the country in about 23 different states. So you can go speak to a professional that is vetted personally by Dr. Kaufman. He puts a lot of effort and a lot of passion into this vetting process. He has a lot of experience in traditional medicine, and for the last five years or so, he has taken a deep dive into medical cannabis to learn as much as he can about the plant, about how it interacts with the body, and how it can be most beneficial to you, the patient or potential patient. And he wanted to make sure that you have the best experience possible as you go through your healing journey. He is a gem. He has a ton of wisdom, and I'm really happy to say that he's become a friend over these last couple months. So please enjoy this conversation with Dr. Eric Kaufman. Hi, I'm Matthew Miro, and this is the Edge of Cannabis Medicine podcast, and today's guest is Dr. Eric Kaufman. Eric was born and raised in Oklahoma City. He graduated with honors from the University of Oklahoma School of Medicine in 1992 and went on to train as an ophthalmologist. Dr. Kaufman then completed an internal medicine residency and board certification in Portland, Oregon. He enjoyed over a decade of private practice in a large multi-specialty group. In 2010, Dr. Kaufman returned to Oklahoma City to join the University of Oklahoma College of Medicine as assistant professor and also served as medical director for the Internal Medicine Residency Clinic, where he led and taught outpatient medicine to the next generation of students and residents. Along with an accredited group of investors, he led the creation of Doctors of Cannabis Medical Practice, where he is currently the medical director. The primary focus and mission of Doctors of Cannabis is to be an authoritative source of clinical care for patients who wish to explore cannabis for medical use. Eric, it is a pleasure to have you on the show. I'm so grateful that you wanted to be here today. Hi, Matthew. Thank you very much. I really appreciate the opportunity to be here. Great. Absolutely. We've had some conversations in the past, and you've been able to come at this industry from very interesting angles, and there's a lot of different places that I want to touch on. But first, I'd love to hear about your transition from traditional medicine to cannabis medicine, and what really sparked that interest for you in 2018? Sure. That's a great question. I didn't see it coming. I'd really enjoyed my time in medicine, both serving patients and serving their families, and teaching and doing research. I'd really decided that it was my mission to help teach young doctors how to not hurt patients with overprescribing. We've seen that become a big deal. That was part of my mission of being a teacher, and I really enjoyed that. When it was time for me to leave medicine and work on other things with my family, the law passed in Oklahoma in 2018. Some folks that I knew asked me what I thought about medical marijuana, and I had to admit that I really didn't know anything about it at all. Then I realized that patients are going to need medical professionals that can understand where they're coming from, and their desire to take more control over their healthcare and be less dependent on the paternalistic medical environment, sometimes get off of dangerous medications like opiate pain pills for something that's safer. That really fit with my mission. Along with a small group of like-minded individuals that each had their own skillset, we put together Doctors of Cannabis in order to be able to give validity and understanding and knowledge to those that wanted to explore cannabis as a medical alternative. We've done that. It's been very, very enjoyable. I've seen thousands of patients myself. In the beginning, I was the only medical doctor. Of course, we've been able to grow and get other medical doctors that are likewise qualified. Of course, I had to learn what medical marijuana was and how it worked, because it's not traditionally taught in medical school or training. As a matter of fact, the thing that we mostly know is that we don't have to worry about it much, because we don't see patients coming in with toxicity or dying or having organ failure from cannabis. Now, there are toxicities, but they don't tend to be deadly. As an internal medicine doctor, we didn't get too concerned about cannabis use. Of course, I've learned since that there are significant potential side effects, adverse drug reactions and other things, where a medical professional that actually knows a little bit about cannabis and medicine can be useful. That's the intersection we've found. That's been a big motivator for me, and I've really enjoyed the ride. Yeah, that's great. What was your process of self-education like? Who were you reaching out to? What kind of sources were you utilizing? Right. That's a bit of a problem, because traditional medicine doesn't really talk about or educate about cannabis, primarily because there's no good research studies showing in a scientific way how it compares to other medicines. Most of the studies have been designed to look for harm. They've been observational studies and other things that don't really meet the highest level of scientific scrutiny that most physicians want, and I'm one of them. What I've had to learn is from the basic scientists about how the neurobiology works, what the endocannabinoid system of receptors that mammalians like human beings have, and how the different cannabis compounds interact with those receptors to produce the positive as well as the adverse effects. It was a lot of traditional science. It was a lot of reading original articles, but there are some clinicians that have been in the practice in other states and have already synthesized that knowledge into courses and books, and so I availed myself of all of those things. I joined medical societies of like-minded clinicians who've been working in other states that have a long history of medical marijuana programs like California, Colorado, Oregon, and so I just tried to find the attractive leaders in the space and learn from them what their experience has been like on a clinical basis. Then, of course, they call it the practice of medicine for good reason, and that is that sometimes you just have to do it, and you have to listen to patients and their families and hear what their experiences are like and learn from the practice of medicine, so I've done all of those things. That's great. It's actually not too dissimilar from my own educational process to be able to speak to lots of physicians with a lot of years of experience treating patients and working step-by-step through the process of trying to find the right dosage, the right type of medicine, the right means of registration. It's pretty complicated what we have to deal with. It really is, and I had family members that could have benefited from medical cannabis, and one of them was my wife, and so through her courage and desire to learn and want to figure out how cannabis could be part of her therapy, she got a license, and I've gone with her to dispensaries and met with producers and growers and salespeople. I've seen her try to find the right medicine for her, and so I've also seen some family members go through that and, of course, patients too, and so by being able to have our boots on the ground, so to speak, and go to dispensaries and go to processors and go to growers and talk to them and learn from them about what it is that they're trying to do, I've been able to add a lot to my own personal knowledge. Yeah, that's great. I was a cultivator for 15 years. I'm not sure if you knew that about my history, but one thing that's extra complicated about that prospect is that you can take a branch, a flower, from a lower branch on the plant and test it compared to one of the top colas, and you'll get different test results in terms of the phytocannabinoids just in the same plant, so trying to get that same kind of consistency over time is incredibly difficult. I'm of the opinion that more regulation is probably what's needed in order to be able to understand the different combinations and formulations of the phytocannabinoids in conjunction with all the different terpenes and now we're getting to the flavonoids, and it's such a complicated plant, almost a pharmacy in itself. I agree 100%, and I really do understand that there are folks that can recreationally use a variety of different compounds and really not suffer a lot of adverse events from those, and that includes things like tobacco in its various forms. They get away with it. Alcohol, traditional prescription medications, and nothing bad ever happens to them. They use it as directed or as they figure that they need to use it, and cannabis is one of those things, and they're just either not sick enough or they don't have a lot of complicating medical problems or other medications, and they can figure out how to use it themselves, but there are other people that really struggle to try to figure out how to maximize the benefits and minimize the downside, and that's where I get concerned because a lot of the people in the dispensaries are enthusiasts. They are able to use various forms and tolerate the side effects, and in fact, some of them may be primarily going just for the THC effect to be able to explore different levels of consciousness and so on, whereas a lot of medical patients that need it really can't tolerate those THC effects or the unopposed THC effects because it can lead to increase in anxiety or paranoia or heart rate, depressed blood pressure, psychosis, other things, and they don't have the reserve, the mental reserve, the physical reserve to be able to tolerate that, and I've been concerned that people want to quit before the miracle. They get curious and want to try it and then have a bad time and say, that's not for me, and really what they needed was just somebody that they could turn to that was knowledgeable about health, wellness, medicine, and medical conditions in cannabis, and so it's been a great intersection for me to be able to get involved in that because it's like starting a whole new practice of medicine. Ophthalmology is a certain set of skills. Internal medicine is a broad set of skills. Cannabis is a smaller set of skills, but it really integrates with the comprehensive medical approach that I've enjoyed and still enjoy. Okay, so I have a couple of questions from that last statement. So you said unopposed THC content. Now, correct me if I'm wrong, but for me that meant that many cultivators have bred the CBD out of the plant, and so the THC levels keep rising and rising, and the levels of paranoia and potential psychosis comes from the lack of CBD, where the anxiolytic qualities of it would counterbalance some of these more paranoia and anxious effects. Is that what you were speaking to? That's exactly right, and yeah, it turns out that biologically speaking, our endocannabinoids system, which is really a hormonal system, but not like sex hormones, like hormones that affect things like serotonin and dopamine and things like that, that there's about a hundred different cannabinoid ingredients that can activate a hundred or so of those receptors in mammals like human beings, and so THC is one of them. But as a matter of fact, I'll just tell some of you readers that may or may not know this, but there is an isolated THC that's available as a pharmaceutical, and I saw a patient one time in the hospital who was elderly and at the end of their life and suffering with metastatic cancer. They had pain, restlessness, anxiety, air hunger, trouble sleeping, all of that, and of course they were on all the standard pharmaceuticals and still suffering. And so as a young doctor, I decided to write a prescription for the pharmacist to deliver and the nurse to administer some pure THC to this patient. Well, listen, that was one of the roughest nights for all of us. I got calls all the time from the nurse, from the patient's family. The patient was increasingly agitated, increasingly paranoid, hallucinating. The THC was absolutely the wrong medicine for that patient that night. Luckily, it wore off, and I learned, and the nurse learned, and the pharmacist learned, and the patient and the family learned that there's more to it than THC. And so that's my concern, it's exactly what you said, which is that a lot of cultivators and extractors and other people involved in the industry have really focused on increasing the levels of THC, even, as you said, by reducing the ratio of THC to the other cannabinoids, the other 100 or so, CBD being one of them, and an important one. And so it's really about balance. As you probably know, it's called the entourage effect, and that means that there are compounds that sort of open the door for the other compounds to be able to work in balance, in concert, to be able to maximize the benefits but minimize the side effects. And my concern is that depending on the dispensary a person goes to, they may only find relative high THC options, which increases the probability that they could have an adverse event. So we try to educate people about that. It's hard to do in one visit. A lot of people, you know, just want to try to figure it out, and they work with dispensaries who want to be able to help them. Of course, the dispensaries know that they're not in the practice of medicine, so they have to be careful about how they couch things. So there's just a lot of uncertainty for the patients and their families out there. And I don't like that. And I think more regulation, more educational requirement for physicians that participate in this, maybe involvement of pharmacists in dispensaries to be able to answer those medical questions. But of course, then we get into the federal legality of THC compounds and how that creates a sense of fear in the people who work in the industry as medical professionals because they don't want to be accused of prescribing, which they don't, but, you know, running afoul of federal legislation, which is still making THC illegal. So that's a long statement. I'm sorry if I got off track a little bit. No, that's what I wanted to support you, and that's exactly what I meant, is that unopposed THC or high levels of THC, especially if taken without understanding the potency of the object that they're getting, for example, in an edible, can really lead to regret and uncomfortable and even near visits for patients. Yeah, it certainly can. I've known a number of folks that that's happened to. Or their dogs, which is also unfortunate. Yes, that's right. Yeah. And so something that I've been working through with a number of the doctors that my organization is working with is even trying to, so the idea of the entourage effect is great. It's wonderful that it starts to really bring the other phytocannabinoids into our universe to help shine a light on how important they are. But it also, you know, an entourage is usually, though, there's one person that's the focal point, and then there's the group of them that hangs around with them. So even calling it the entourage effect is still really highlighting the THC as the main player here. And so we've come to start calling it the ensemble effect, just showing how it really is an orchestra. And there's no one component that is more important than the others, but they all work together in this way that we're slowly, slowly, slowly, because of federal regularization, trying to understand how they actually do play with one another. And then play with our own endocannabinoid system. So as a professor of medicine for a long time, how often were you able to teach your students about our endocannabinoid system, and what are you seeing in terms of reform within the medical community so that we actually get to have professionals that know more about it? Yeah, this is a great question. And, you know, when I was in traditional medicine, I retired from that in 2017, and then I got involved in the cannabis, medical cannabis in 2018. So there really was no overlap, but I kept in touch with my traditional medical colleagues. And as a matter of fact, a year or so into our work in cannabis and my growing knowledge, I had lunch with a chairman at the university, an old chairman of mine. And he said, well, it's very interesting what you're doing. And, you know, how's it going? And I had some of the same topics that you and I have talked about. And, you know, told him my concerns, you know, about it being kind of the wild, wild west, particularly in Oklahoma, which we can come back to. And, you know, leaving, you know, patients kind of out there, you know, and the quality of the physician care that they're going to get can influence their outcomes, you know, and there's some education that can be had. And there are even some absolute contraindications where I've advised people that it's not advisable for them to use it because it could worsen their medical condition. So my personal view as a physician is having physicians available for those that need it. And I think probably a lot more could benefit from that than currently do. I think it's a good thing. Anyway, my colleague said, well, how is it that you can prescribe medical marijuana when you have no evidence about its benefits? And I had to correct him first and say, well, we don't actually prescribe it. We recommend it and or not based on the individual, the individual's, you know, risk and so on and the gains they're looking for. But more important, I asked him, well, how is it that you can continue to prescribe medications for which there's clear evidence of harm, even organ damage or death? And he said, well, gosh, I hadn't thought of that. So I think the traditional medical practitioners have a valid concern, which I have too, as a traditional medical practitioner and scientist. And that is that there's a whole lot that we don't know. But people are doing it and they're going to do it. And the states are making it legal for them to do it. So why not participate in the solution instead of just sticking your head in the sand and saying, well, you know, there's no evidence, so I'm not going to participate in helping people to figure out how to use this safely. I think that's, you know, if you're, if you're busy in your traditional medical practices, an internist or ophthalmologist or orthopedic surgeon, sure, you've got no reason to get involved. And as a matter of fact, I wouldn't encourage you to because there's a big learning curve and you're busy enough doing your traditional medicine. But there are other folks like me who've now got the time to be able to help folks in this very kind of specialized and relatively uninformed, from a scientific standpoint, clinical care. So, yeah, that's it. And it's categorically false that there's no evidence. There are three cannabinoid-based, pharmaceutical, FDA-approved drugs on the market currently. How can that exist if there's no evidence? That's absolutely right. And the one that I'm sure you're thinking of that is available in Europe is actually a combination of CBD and THC. Some of the prime acid, Tevix, I think. Tevix, yeah. I mean, we don't have access to it here in the U.S., right? But there are European studies, well-done studies. And, of course, the compounds that they use are not just extractions made in somebody's garage or in an extractor that's not being regulated. They're actually done through the scientific regulatory factors in those respective countries. They're very standardized doses. It sort of helps to standardize the scientific studies. They can actually do this gold standard, prospective, randomized trials where they have placebo controls and they can use a large number of statistics and actually monitor all those things, the benefits and the side effects. Those drugs are approved in many, many countries, just not in the U.S. So, you're right. And they do have evidence that those compounds are helpful together. All right. So, let's change gears a little bit. I'd love to hear more about doctors of cannabis. So, I have found this organization to be incredible in so many different ways. My company, we speak to a lot of different physician groups around the country. And most of them are very local or even just state-based. And what you have done to expand the borders across state, which not many people are willing to do because of the state's laws individually and the transportation things, but medicine and the practice of medicine can travel across state lines, just not the cannabis. So, how did you grow from just being in Oklahoma to the idea of moving beyond the borders of Oklahoma? And, yeah. So, we'll start with that question. Sure. So many questions. It's a great question. You know, when we started, you know, we were really ambitious in wanting to help Oklahomans. And there were not lots of new Oklahomans coming online. And we were only able to help a small percentage of them, of course. And other doctors were able to participate and help patients, too. But our primary goal was to use the tools of traditional medicine and research and build a medical practice that met very high standards. And we weren't looking for retired doctors who had been out of the practice of medicine and didn't understand or kept up with traditional medicine. And so, that left people who already are in a practice of a sort or another. And they'd be looking to sort of add on in their after hours or weekends or days off or something like that. And a lot of those people became very, very good because they were able to see enough and educate themselves enough. And so, for us, we actually brought people into offices. At one time, we had seven different physical locations that were staffed. And that was difficult. And then, of course, COVID came. And it just really wasn't the safest option to bring patients into the office where we could, you know, take a picture of them and copy their ID and get their signatures and all of that stuff. And so, we were able to pivot to having an online practice where the patients could see us from home. And, of course, people learned how to use Zoom and things for their kids and so on. So, it was kind of a perfect intersection. Most people have a smartphone. Some people still have laptops or tablets with cameras. And so, it created some problems for some patients, particularly older and people who aren't so savvy with technology. We had the staff and the desire to be able to help people to solve those problems, like create an email account if they needed one and so on. So, just by putting patients first and having a culture that really focused on excellence and realizing we weren't for everybody, but we were going to be the best we could for each single person that came to us, we were able to make that pivot. And then, that allowed us to get rid of some of those superfluous office spaces, consolidate our staff, and then reach out to doctors that we hadn't personally met. They hadn't come to our office, but they would contact us and we would have Zoom calls and do vetting and see if they were a good fit. And, you know, some came and stayed and some came and moved on to other things. But because we were able to solve the technology problem, and then we found some solutions to recruit high-quality doctors that we could invite to participate as affiliates with us, and if they weren't a good fit, they either just left or we asked them, you know, to try to improve. And if they couldn't, then, you know, they didn't get to stay with us. That allowed us to take the next stage and take this to 22 additional states where we had access to doctors in the laws, favor, telemedicine, and so on. It's been an ambitious project. We've had lots of help from marketing and software agencies, our individual employees, and so on. So it's been a challenge. And we've recently only launched in those additional 22 other states. And so we're still growing. We've got a lot of room to grow. And we really want to offer something that isn't just that the – it's not just transactional. In other words, it's not trading dollars for a signature on a piece of paper. We're actually looking for people who are looking for what we do, which is to help people be successful and answer the questions and be available on an ongoing basis to have an ongoing doctor-patient relationship to the degree that they desire it. Of course, most states, they really only need to see the physicians once a year, but we're available if people need to see us more than that. So yeah, it's been difficult to get all those pieces of scheduling and software and doctors and patients and then bring them together in a way that we can really still have control over the quality of the experience. Sure. And what is the bar that you set for the participating physicians? What is it that you actually expect them to meet in order to be a part of your organization? Yeah, that's a really good question. And what we've found is some of our patients have been to our competitors and then they end up bumping into us and they tell us their experiences with other online providers. And of course, we probably don't hear from all their satisfied customers. We just hear from the ones that things didn't go well. But we would hear things like, well, the doctor just spent 30 seconds with me and I could hear a baby crying in the background and it seemed distracting and I'm not sure why this doctor is doing this. The doctor really couldn't answer my questions. He said I should talk to my doctor about that. I don't want to talk to my doctor about that. That's why I came here. That's why I called you. Or I did talk to my doctor and he said don't talk to me about that. That's a very real possibility, sure. Yeah. And so, you know, we kind of learned what not to do by making our own mistakes too. You know, with technology and other things, we sort of, well, here's what we do. We ask every single patient, we give every single patient a microphone. And that is that we ask every single person, after they see us, to review us. And then we give them the tools. And they can post it on Google or Facebook or Instagram. You know, so we hold ourselves to the bar that our patients want to hold us to. And so if they say, you know, gosh, you know, you said you'd get this done by tomorrow and I haven't heard from anybody. Well, then there's a system error in our system somewhere where the follow-up fell down. And that's not acceptable. And so we learned how to build, you know, checks and balances and be able to just do things as well as possible and find the pain points that people have. And one of them is they don't want to do business with somebody online that they can't trust. And so trust is really important. And so the best way to let people trust you is to be trustworthy. And so that's what we work on in all of our communications with people, whether it's emails or phone calls or text messages. And we – I think we've nailed it pretty well just by – well, I have to say one other thing. And that is that there are physicians that have been willing – no, I should even back up. Before I got started, I went to the medical board and I asked them, I said, what do you guys think of this? And they said, well, we don't really know much about it. It's coming. We know that. But outside of that, what we hope is that there are not going to be doctors sitting around in vans, in parking lots, at dispensaries, trading cash for signed pieces of paper. That's what we hope. And I said, well, I hope so too. You know, people deserve a lot more respect than that. You know, they deserve to have their medical records preserved and available should they need them for an employer or a court-ordered drug screen or whatever. And this practice of medicine should be practiced at the same level as every practice of medicine should be. And, of course, I came from the quality and safety department in the Department of Medicine. That was another one of my roles. And so, you know, setting standards and developing processes to live up to those standards was something I was trained in. This has just been another application of that. And sometimes we do get doctors who are really just more interested in collecting a little money for the least amount of work. Most people don't last because generally the conversation goes, you know, your patients expect a lot more out of you than that. And so do all of us. And, you know, sometimes nobody's had that conversation with them. And then they go, oh, yeah, I see that. Yeah, I remember walking down Venice Beach, I don't know, 15 years ago or so, and there's a guy in a lab coat with a sign with a big pot leaf on it and an arrow pointing this way. And you go in there and you get your recommendation right next to the dispensary. Boom, boom, boom. Nobody cared. It took five minutes. And that's the problem. That's the problem. That's part of what de-legitimizes. It does. And I understand there have always been a lot of recreational marijuana users and they don't want to deal with unsavory, illegal drug dealers. They'd much rather be out in the daylight and be able to be legal and all of those things. And frankly, they don't need our services. I mean, if they did, they'd be coming to us. They've been going to their drug dealers for decades and they're quite happy with that. The problem with that is twofold. One is not everybody's in that position. Some people really need a medical doctor that understands where they're coming from and can help them meet their goals safely. Number two, a lot of the stuff that's being sold in medical marijuana dispensaries is just way stronger in the THC category than they may be used to. And, of course, the other thing that that can do is it can lead to the development of tolerance in those users who use high THC, which means that they have to now use higher and higher potency THC products to achieve the same goals that they were getting at much lower doses. So, in other words, they lose their tolerance, which becomes expensive and increases the risk of complications like psychosis. And I've seen that. I've seen people using these really high THC distillates that come in solid form often and are really potent forms of hashish in a way. And they get habituated to the point where they end up with an addiction. Of course, it's called cannabis use disorder now, but there are a lot of people who have that. And part of that is because they never talked to a professional. They were sold a bill of goods that the higher THC, the better. And then they got habituated to the point where they had to take increasing and increasing doses. And all of those things are complications that I think legitimate dispensaries and legitimate medical marijuana patient holders could avoid if only the clinicians would take more responsibility for protecting the public's health. In your experience, have you seen any kind of, I guess we'll call it an efficacy cutoff point, where the levels of THC no longer do anything extra beneficial, say for pain, but you're seeing a place where maybe there's a sweet spot and go over it, and there's more possibilities for adverse reactions? Have you seen anything like that? Yes, to some degree, but I haven't been able to quantify it very well from a scientific standpoint. So it's really kind of anecdotal. And the anecdotal stuff is, I see people who are users, and they want to become legitimate medical users to avoid the social problems with the law and breaking the law and so on, and to have access to medicine that they can see and smell and touch instead of just buying whatever their drug dealer brings to their house. So I've seen them. And then what happens is I ask them, how's it working for you? And they say, oh, I just got to do this all the time. And they're just anxious and jittery, and they're paranoid. They're looking around. They may be vomiting. And the only thing that they say that makes them better is using cannabis, when in fact they probably have cannabis hyperemesis syndrome, which means that they've been going to doctors in emergency rooms and getting IVs and being treated for dehydration and maybe even having a gallbladder operation, when in fact they nor their clinicians had no idea that it was actually the high THC that was making them sick. And nobody told them. Or if somebody told them, they didn't really, like maybe an ER told them, but the patient was so high they went home and they don't even remember what happened with the ER. So I don't know. It's kind of a long tangential answer, but hopefully that touches on a couple of points for your listeners. Yeah, for sure. Sure. So Oklahoma was a pretty wild scene out there. It's not one of the most populated states in our nation, but it definitely has the most licenses given out for dispensaries. So what happened there? How did this explosion happen? And is it going to be reined in at all, or what do you see going on? It's a really good question. When the voters passed the ballot measure, the government then had a mandate that they had to get this done in a certain amount of time. So they formed the OMMA, which is part of the health department. It's an arm of the health department like most states do. They had to create new positions and new staffing. And a lot of the compliance part, the patient safety part, testing, feed to sale, all of that stuff was really delayed. And so in the beginning, when they said, okay, now dispensaries can take their license and open their doors, what happened is there was already product on the shelf. Of course, that wasn't grown in Oklahoma. It couldn't have been. It couldn't have been grown and processed. That takes a considerable period of time, a year, 18 months, something like that. And literally, illegal cannabis was showing up in just thousands of dispensaries, having been imported illegally in large quantities from other states that had surpluses, like Colorado and Oregon and so on. And there was no compliance arm that could deal with the volume of dispensaries, processors, growers, and patients. It became literally the wild, wild west. People who had been illegal drug dealers in the quiet of the night now could legitimately, for $2,500, open a dispensary and have a license and sell their stuff out in the open. Of course, it wasn't all legal, as I'm trying to imply. And of course, it wasn't tested for safety and quality. As you know, most states, and Oklahoma now has this, require the products that are being sold to have been grown in that state from a seed and tracked, and then to be tested for potency of THC, as well as, I'm not sure about the requirements for the other cannabinoids, but most testing includes all of those. And then it has to be tested for safety. Things like absence of pesticides, absence of heavy metals, absence of mold that could lead to lung infections if it were inhaled or smoked, etc. So none of that was being done in Oklahoma for years. And it was really scary, as a doctor, to be able to be honest with you. And so part of what we did is when, say, a patient would say something like, well, my son in California said that for my Parkinson's that I should try cannabis because I've tried all these other things and I'm still having a lot of symptoms, so I need my card. And then they thought somehow that the doctor had their card. Well, we don't. It's actually a license that you're issued from the state after seeing a qualified medical doctor who's there to help protect you and to have an ongoing relationship. Well, not a lot of people in the industry respected that. Not a lot of people that wanted to just sell their products as quickly as possible to any willing buyer really took the importance of that to heart and encouraged their patients to come to qualified doctors, ask those questions, and then to hold themselves up to the standard of saying, well, we do have testing, by the way, even though it's not required. And let me show you the potency of this product and how maybe the ratio of CBD to THC is in a ratio that will help limit your side effects. Not a lot of people in the industry and the dispensaries and even maybe some of the growers that were targeting certain cultivars, maybe they didn't understand that either. And so other states usually limit the number of dispensaries. In Oklahoma, it's unlimited. And there became, I don't know, over 6,000, maybe 8,000 licensed dispensaries. States like Missouri, I think, have maybe 30 or something like that. And they do that by selling fewer licenses at a higher price and forcing businesses, if they want to have multiple locations, to consolidate so that the compliance arm in that state can actually go visit and verify that they're doing what it is that they're supposed to be doing. And that didn't happen in Oklahoma. And it's still very, very hard. I think it's detrimental for the industry itself to have such a small pool of people that can actually go and purchase these products and have such a wide array of places to be able to go for it. There's no way that the cultivators can make a living at that point because prices have to keep coming down because of the competition. And it's just terrible for the industry. It really is. And, you know, I'm just going to expose a little bit of my bias, which I've probably been doing unintentionally this whole time. One of the things that I get concerned about, in particular for people who are naive to cannabis or their experiences in the 60s when the percentage of THC was 3%, now it could be 30. So for those people who are relatively naive to recent cultural changes and so on, I ask them, well, have you ever tried an edible? The reason I ask them this is because they're going to. And I want them to be a little bit educated because the difference between the respiratory tract and the gastrointestinal tract is that when you use the respiratory route, you can sort of auto adjust. Because if you inhale some, in a few minutes, it's going to become activated. You're going to be able to measure the effect. Even where you can take more, if you've had a little much, it'll wear off pretty quick. An animal is a commitment. You're going to take something an hour or two from now. It's going to have its effect. And it's going to have that effect for a long time. So if you're having a bad time, you're going to have a bad time for a long time. And so I want people to know that ahead of time. So here's my point. Here's my bias. People would say, or I would say, have you tried it? And I say, yeah, I went to Colorado, or I go every year, or I have a place in Colorado. And I get these little gummies, and I take half, and it just works great. I sleep through the night. The next day, I feel clear. Everything's great. I say, well, the likelihood of you walking into one of the 8,000 or so dispensers in Oklahoma and picking up an edible and going home and having that same experience is pretty low. And the reason is that all the bad ones in Colorado washed away. Because there weren't that many in the first place. And in Oklahoma, there's just too many to choose from. I mean, how could you possibly know what a quality product is? And if somebody carries a certain product, it may not even be there the next time you come in. And isn't it something with the metabolic procedure where, I'm not mistaken, 11-hydroxy-THC that it turns into because it's metabolized? Yeah, that's right. So when you, well, if you just eat the plant and it hasn't been activated, which can be done by temperature or your liver, okay? So if you just eat the plant, well, it will go through your liver and it will become activated and you can get the effects. The reason that it works through the respiratory system and people smoke it is because the heat changes the THC compound and some of the other compounds into active ingredients or more active ingredients. And so vaporizers can do that, for example. So I like to encourage people who like the respiratory route to use a handheld or even desktop vaporizer that doesn't reach ignition temperatures of 1200 degrees or something. It just heats like an oven. And the oils from the plant vaporize just like butter and vanilla vaporizes in your oven. You can smell it when you're cooking cookies. Well, it does that also with the cannabis oils. And then you can inhale them. So it just heats them like an oven, say 400 degrees or 350 or something like that. And so then the compounds become activated and they quickly get absorbed into the bloodstream and go to the receptors throughout the body. And they also get metabolized quicker. And so there's more of an up and down effect when the respiratory tract is used. A lot of people like that because they want it to come on when they want it to come on. They don't want to have to wait an hour or two. And they also can adjust their dose on the fly. The gastrointestinal tract is using your liver to metabolize those active ingredients. Well, to metabolize the THC, CBD, and those other compounds, CBG and others, to metabolize them into active form. And that process takes digestion, absorption, and running through the machinery of the liver in order to become activated, which is why there's this delay. And then, of course, for reasons I'm not sure I know, there's just a prolonged duration. So if you can be prepared ahead of time, for example, suppose you have multiple sclerosis or something like that. Nighttime leg cramps and you're constantly hurting. Well, you can take an edible an hour or two before bedtime and the intoxicating effects will come on while you're going to sleep. Which can help you sleep, reduce your muscle cramps, and have that sedative relaxing effect that you're looking for. And still be clear in the morning when you get up. So you don't have problems with your balance, worry about falling over and getting hurt because you're already impaired. Because you have multiple sclerosis, for example, but there are other conditions too. Being educated about how edibles work and how the respiratory tract works and what your alternative methods of administration are. And how to watch for balances between the proper amounts of THC and CBD, for example. Those being two of the most important and potent compounds. That all has to come from a trusted source or you're just going to have to figure it out on your own. And that's where you come into play. So you have started a line of CBD products as well. Is that through the doctors of cannabis? So it's not. So what we've always done is look for the best people that we can collaborate from. We can't do it all. And there is a physician in Maine who has been working in this space primarily, I think, for many, many years. I think Maine's had licensing for longer than, for sure, Oklahoma. I'm not sure how long because, again, I didn't get into this until 2018. But his name is Dr. Sulak, S-U-L-A-K. And he is also very interested in this patient-centered approach and the educational approach. And he understands that products without THC, so in other words, extracts of the cannabis plant that contain CBD, CBG, CBN and whole terpenes and a whole bunch of other active compounds but are low or, you know, legally low in THC so that they can be sold without a license as a CBD product, although they contain more than CBD, that he was able to find, produce, I'm not sure how he did it, his own label. And it's called the Healer Brand, H-E-A-L-E-R. One of the things that I like to recommend when people are getting a medical license to be able to buy THC compounds is that they have a high-quality CBD product available to them. Because that can be used as a rescue in case they get too much THC. And, of course, if they're finding something that has too much THC but they still want to use it, they can balance that out by taking a high-quality CBD compound with it. So, we have become affiliates with Dr. Sulak's Healer product. And that is how we're able to recommend his product. We don't like just recommending anybody's product, but we know that it's been thoroughly developed with the end idea in mind, which is medical patients that want to get the benefits of the cannabis plant and limit the downside. So, whether those patients want to use THC compounds in addition, they work in conjunction. So, you can use a CBD product with a THC-containing product. And let's be honest, a lot of the stuff that's out there being sold in vaporizer pens or other things is really just pure THC. So, depending on where you live and what your dispensary is, you may be limited in what you can get. Having a high-quality CBD compound that has a lot of these other categories we've been talking about along with it can be used in conjunction and provide a level of safety and balance and efficacy. Well, Dr. Kaufman, we've come up on an hour already. That was really fast. So, I'm going to go ahead and ask you the last question that I like to ask all my guests. And that is, if you can see one change within the medical cannabis industry happen right now, what is that one change? I think it's going to be very difficult to do, but I'm just going to reach for it anyway because it's not as easy as it sounds. But that would be to make THC compounds legal for the scientific community of clinicians in the United States to study it. Yeah, did you see the bill passed through Congress, the research bill? I did. It'll move to the Senate. We'll see what happens, but that'd make a huge difference. Exactly, exactly. And the Sativix, I think we mentioned, that's available in Europe is really a very highly purified, limited number of compounds. That's necessary to start science because if you have too many variables, you can't figure it out. Here in the U.S., medical marijuana is basically what anybody wants to grow and whatever they want to sell you. Related to that is to find some industry standardizations where people can develop certain models of compounds that they're looking for and then have a recommended level based on clinical studies and then have standardization in the industry so that whether clinicians actually get into the dispensaries or whether the medicine moves into the pharmacist or however that works, there's industry standardization, industry-recognized best practices, and so on. And I just don't think that's going to happen until we can move it into the traditional research-oriented spaces that depend upon dollars, state dollars, federal dollars, to actually fund the clinical research, not just the benchtop research. And industry dollars as well. Industry dollars as well, you bet, absolutely. I'm looking forward to the day when a lot of these large organizations that have spread across the country and are valued up in the billions, that they start putting some of those revenues toward the furthering of this industry by providing funds for research. I think it's going to be huge as we move forward. Agreed. Well, thank you so much for your time, Eric. Is there anything else that you'd like to share with the audience before we take off? No, I don't think so. Well, I guess just a shameless plug that we cover 23 states in the U.S. And by going to our website, docsofcannabis.com, you can learn more about us, you can learn more about our staff, and you can see the states that we serve. And if you think we're potentially a good fit, you can reach out to us. We can talk on the phone. We can communicate basically all the modern ways people communicate. Or you can just book an appointment and meet with one of our doctors and see if we're a good fit for you. That's great. And there will be links in the show notes so you can go directly to the Docs of Cannabis site. And I highly recommend going and checking all that out and seeing if you're a fit and seeing if there's someone in your state. It's important to know that you can find a physician through this site that you can trust. And clearly that's, Eric, what you've set out to do. And it's wonderful to see it happening. Well, thank you, Matthew. I'm so glad there are people like you that help get the word out and are really interested in improving the industry. And we've got nowhere to go but up. And things are definitely continuing to grow throughout the world in this field. And I think if everybody and by and large the people in the industry do have a servant's heart, they do want to help people to use this medicine and get the results they're looking for. But we do need to recognize that legitimate medical professionals can play a role, be pharmacists, nurse, professional educators that have a scientific understanding. So anybody in the field wants to pick my brain or wants to have a conversation with me or anybody in my group, feel free to reach out to us. We're happy to collaborate. We think we all do better together. Couldn't possibly agree more. That's a great place to leave it. Thank you very much, Eric. Be sure to make sure all the listeners go check out DOC and see what you've got going on there. Thank you, Matthew. Appreciate you having me. Thanks for sticking around for this entire episode. If you want to be a medical cannabis patient yourself, I highly recommend going to docsofcannabis.com. They'll know what stage you're in and they will connect you with a doctor, a confident, vetted and verified physician to help you along your path to healing with medical cannabis. It's really important to understand that there are some pitfalls. There are possibilities for adverse reactions. There are drug-to-drug indications that might be involved. There are other prescriptions, which is so important to keep the relationship going with your doctor. You can understand and they can understand what it is that you need most in the moment. We can't stress this enough. We all have in our history with cannabis and to have it be truly a medicine, we need to treat it like a medicine. So with that, I leave you to do everything that brings your heart joy and I look forward to being with you next time on this show. So now my friend, please, I hope that you can enjoy yourself. Copyright © 2020, New Thinking Allowed Foundation