Issue link: https://www.e-digitaleditions.com/i/1426211
24 nurse focus cannabis patient care | vol. 2 no. 3 cannapatientcare.com just the stigma; it's also the lack of good guidance." Offering patients guidance on medical cannabis is another role that Wohlschlagel plays in the cannabis industry, providing education and dedicated phone calls as a consultant. If these patients are not doing conventional treatments, Wohlschlagel makes sure they understand what the current treatment op- tions are. She said that some people turn away from convention- al treatments or never even give it a try because in the past they witnessed a loved one suffer through chemo right until death. "Oftentimes these patients are determined that they're not go- ing to do that, and they don't even understand that the doctor's offering a non-chemo treatment for them or a less chemo inten- sive treatment. So, I just try educating them about that, I make sure it's a priority. Then I discuss the pros and cons of immuno- suppression risk and high dosing, and the drug interaction risk, especially with CBD preparations," she said. Wohlschlagel gently explains how to use medical cannabis for symptom management, which she says can still take an hour of dis- cussion because it's all new to most of her patients. She added that it's very rare for someone to contact her for symptom management if they've been heavy cannabis users all their lives. "It's the can- nabis naive patients that need a lot of education, and they usual- ly need a caregiver, child, or sometimes a spouse or partner to also listen in. I'll do joint conference calls or they'll be on speaker phone, so everyone's making notes and learning," she said. "They want my opinion, which is hard as a nurse, but I share what my experience has been," said Wohlschlagel. "It's general- ly about an hour long phone call and then usually a follow up call within two weeks that is another 30 minutes. Those calls get re- done about every two months, if we're lucky. They'll chat with me and let me know what they're doing or what products they got." Wohlschlagel stressed that for patients that have success with cannabis and see their tumors shrink, they cannot just stop tak- ing it. "For example, patients with HER2 positive breast cancer who were unable to get conventional treatments because of a heart condition, but had metastatic HER2 positive breast cancer—in those situations where high doses of cannabis for them was suc- cessful, they understand that they can't just stop it after 90 days, like a Rick Simpson Oil protocol might imply," she said. "Rick Simp- son protocol doesn't actually tell them to stop. It tells them to go on with the maintenance dose, and they don't know what a main- tenance dose is. Nobody knows. But I can tell them that we meas- ured what they were using when they started getting tumor re- gression on scans, that's likely going to be in the 80 to 100 mg THC per night range. And if that's what they were using, then they probably need to use that indefinitely to suppress it until doctors and scientists can discuss what's next or a new treatment like a vaccine for their cancer comes around or something. So, there's a lot of potential for patients to use it if it works long term." She added that every year she gets several patients who may have worked with her in the past and were successful but then at some point they stopped. "These patients see the cancer come back and they just thought it was cured, even though I told them it wasn't. That 'cure' word is really dangerous, especially in the set- ting of cannabis," said Wohlschlagel. Medical Professional Support Wohlschlagel sees medical professionals both supportive of medical cannabis use and against it. Much like the patient side, education is greatly needed for medical professionals across the board, especially as cancer patients start using repurposed drugs. "More and more doctors are supportive. Now, my fear is that I'm repeatedly encountering patients who ask about using can- nabis or they are told it's fine, but those same patients are be- ing put on immunotherapy. So, they're actually being told by the doctor, it's fine. You don't have to worry about it. Even in clini- cal trials sometimes people are being told it's okay. I'm stressing that these patients need to be careful," said Wohlschlagel. "Now it's almost like some doctors are going the other way: They're trying to be so open minded and supportive, but they don't un- derstand the rest." Advocacy Efforts WOHL SCHL AGEL AL SO PL AYED a role in some advoca- cy efforts in Hawaii for patient rights and increased plant counts for home growers. She told us that the legislative committee shared that it was her testimony that changed their minds. "I'm proud of that," she said. A year after that legislative meeting, she was asked to present from a patient advocacy perspective to a group of more than 100 FBI agents in a resort town on the island of Hawaii. "There were FBI agents who were skeptical, but there were also a bunch of them who thanked me after for open- ing their mind to the fact that there may be real medical rea- sons that people use cannabis," she said. "Patients should not be so stigmatized, they should not be so suspicious. The FBI were literally going to require patients who went to a dis- pensary and got a cannabis product, that the only way they could legally drive with their cannabis products in the car was if they were in a sealed package from the dispensary. It couldn't have been broken. I pointed out what if they have a pain pill prescription in their purse that's been opened at home and used, but it's carried in their purse in case they're away from home and they need it. Are you going to tell them they can't use it without that little red tamper proof tape on it from the pharmacy? No. Well, then why are you treating cannabis patients this way? If they're impaired and they're driving under the influence just as if it were alcohol, that's a problem. But don't just discriminate against patients who might have a package of cannabis or cannabis products in their purse. That was my goal for that meeting."