Expert: Cannabis Dispensaries Need to ‘Become More Like a Pharmacy,’ Otherwise Pharmacies Should Be Access Points for Unbiased Cannabis Dispensing

To recognize National PTSD Awareness Month in June, Pharmacy Times interviewed Jordan Tishler, MD, president of the Association of Cannabis Specialists, faculty at Harvard Medical School, and a cannabis specialist at inhaleMD, on how medical cannabis can be used to treat post-traumatic stress disorder (PTSD) among veterans and the general public.

Alana Hippensteele: How might access to medical cannabis treatment be improved to support patients with PTSD?

Jordan Tishler: Well one of the things that I find is that the word access sometimes gets used in this particular field to mean simply being able to buy cannabis products, and I think that that kind of misses the boat a little bit.

To your point a moment ago about how some of the things I've been saying aren't widely understood in terms of the vaporizers and the application of cannabis, in this situation, giving people with a serious problem like PTSD access to the plant material is only a small piece of the larger equation, which really is giving people access to people who know what they're doing with that plant material and who don't have a vested interest in selling those products either.

So, typically, if people go into a dispensary in their state, they're going to encounter somebody we call a bud tender, or the salesperson, and that person is going to profess to have great knowledge about how cannabis affects people and then advise them to buy a lot of cannabis.

Unfortunately, the folks behind the counter rarely have any training, and they're certainly not physicians or pharmacists. In a couple of states, there are requirements for pharmacists to be involved, but it's generally not the norm. Even in the situation where the bud tender or a pharmacist is on hand, we have to remember that they work for the sales company, the dispensary, and so even with the best of intentions, there's some conflict of interest there.

So, I think that what we really need to improve now is not so much the access to the material but access to the knowledgeable providers, and that is part of the reason that I formed this association of cannabinoid specialists. We want to get all of the docs and other professionals to be reading from the same playbook, and that playbook should be very much driven by data, and in particular human data, not test tube or rat model data. Those things are interesting, but they don't necessarily tell us enough about what happens in humans.

Then the other thing that we need to do is reach out to all of those other providers, the people who aren't doing what we do but don't know enough to know Mrs. Jones is here today with her back pain or Mr. Smith with his PTSD. This is an area where cannabis could be helpful, so I'm going to refer them to Jordan. That's kind of the thought process that we need to get spread out throughout the land and the world so that that access that you're talking about really goes along with a proper medical referral and careful guidance and monitoring through the professionals, and then also feedback so that everybody else in that patient's care team—the primary care or neurologist or psychiatrist, or all of those folks—we're all on the same page, and we all know what's going on.

So, that's the way I run my practice, and I think it's a successful model, but it isn't the norm throughout our country at this point, and I think that needs to change.

Alana Hippensteele: Yeah, that makes sense. So, you're mentioning pharmacists and access to a certain level of knowledge. Do you see it being possible that in the future, pharmacies themselves might be able to sell cannabis for treatment purposes?

Jordan Tishler: I do think so. The question will be will they sell cannabis in its botanical and manufactured form sort of like we get through a dispensary or will they end up selling pharmaceuticals that are either derived from cannabis or from the knowledge we gain from investigating cannabis. I think the answer is that we're probably going to always have some of both, and where the pharmacies literally fall into that I don't know at this point.

What I do think is, and this is sort of back to your access question, is that one of the major keys that's missing at the moment is the prescription. If I write a prescription for dronabinol, which is a THC pharmaceutical, or lysine pro, or any other medicine, then when the patient goes into the pharmacy, the pharmacy dispenses that as written, and there's no attempt to sort of dissuade or upsell, there's no wink, wink would you like a side of Percocet with your lysine pro?

That doesn't mean that the pharmacist doesn't look at it and say, “Dr. Tishler, what are you thinking here?” That kind of collegial negotiation is wonderful. But what happens at the dispensary in the absence of a legal mandated prescription is that whatever I've told the patient—and believe me I write it down on a prescription pad for the patient—but at the dispensary they say things, and this is actually a quote that was fed back to me by a patient, “Oh, I don't know what your doctor's talking about, forget what he said. I'll tell you what to do.” You'd never hear that in a pharmacy.

So, we need the dispensaries to become more like a pharmacy and/or the pharmacies to be able to do some of the stuff that dispensaries are doing in terms of providing medicine.

Alana Hippensteele: Right. That's fascinating, and that's specifically interesting to our audience of pharmacists who would be I think a great audience to hear that. thank you so much for taking the time to speak with me today, Dr. Tishler.

Jordan Tishler: Oh, it's my pleasure. Let me take 2 seconds here just to remind everybody that if they're looking for resources about cannabis medicine, they should visit the association of cannabinoid specialist website which is cannabis-specialist.org. Thank you again.