Rescheduling could change how medical practitioners do business: Q&A with marijuana health pros

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Exterior image of U.S. Food and Drug Administration headquarters

(Photo by JHVEPhoto/stock.adobe.com)

Image of Rebecca Abraham
Rebecca Abraham (Courtesy photo)

Acute on Chronic is one of many cannabis ancillary businesses that stand to benefit if the U.S. Drug Enforcement Administration moves to reschedule marijuana.

The Chicago-based company has two physicians and several registered nurses who assist patients nationwide with product selection, dosage and obtaining medical marijuana cards.

“We’ve been preparing for this because we knew the problem already existed,” Rebecca Abraham, founder and CEO of Acute on Chronic, said about the prospect of marijuana being moved from Schedule 1 to Schedule 3 of the Controlled Substances Act.

“Patients need guidance; we need more science, more information.”

Days after the U.S. Department of Health and Human Services released an unredacted version of its recommendation that the DEA reschedule marijuana – including 252 pages of documentation supporting its reasoning – Abraham and two colleagues spoke with MJBizDaily about how the recommendation and potential rescheduling could affect the business and the cannabis industry as a whole.

Dr. Jessica Montalvo is the medical director at Acute on Chronic as well as an integral and functional-medicine physician at Origins of health.

Dr. Ryan Buck is research director at Acute on Chronic and an assistant professor at Chicago’s Northwestern Memorial Hospital.

Here’s what they had to say:

What was your reaction when the federal government released the unsealed rescheduling recommendation?

Rebecca Abraham: There’s more evidence (that cannabis has medicinal value) than we’ve ever had.

It’s silly that cannabis is Schedule 1 with no medical value when Marinol has been used – although it’s a synthetic – since the ’90s.

There’s clearly some medical use now, based on 30,000-plus global studies, and we didn’t have that in 2016 (when the DEA last rejected marijuana rescheduling).

Will having government documentation that cannabis has medical value change how you do business?

Image of Ryan Buck
Ryan Buck (Courtesy photo)

Ryan Buck: One of the barriers that we run up against certainly is stigma.

I think that people are reluctant to consider cannabis – or they think of using it for symptom control when they’re desperate as a last resort.

I am hopeful that people will consider using cannabis for medicinal reasons earlier in the process rather than only after opiates and everything else has failed.

Jessica Montalvo: If this can be Schedule 3, then it makes it a heck of a lot harder for insurance companies to not cover it.

One of the biggest moves as far as how we do business is that a lot of people feel intimidated by an out-of-pocket cost, and it becomes harder for (insurance to refuse payment) with rescheduling.

Abraham: There’s a punitive cost to us because of stigma – even though we’re health care and ancillary.

Just being able to have a payment processor that I don’t get charged three times the normal amount for will allow us to reduce prices for patients.

Many cannabis industry veterans worry rescheduling will usher in Big Pharma. Is that a valid concern?

Image of Jessica Montalvo
Jessica Montalvo (Courtesy photo)

Montalvo: I don’t know that Pharma would be kept out, quite frankly, by whatever the scheduling is.

I will say that, if insurance starts covering this, then I definitely think that may motivate Pharma to want to throw their hat in the ring so they might get a piece of that insurance pie.

Abraham: Since the whole Purdue Pharma opioid debacle, patients aren’t really clamoring to use pharmaceuticals when there’s another option available.

The drug companies are going to come in, but it’s going to be a really hard sell for them to say, “Try our formulated CBD-CBG-THC patent for $17,000 a bottle,” when you can just go to a retail operator or brand and get a very similar – probably better acting – medicine for $32.

I don’t think the recreational people have to worry; it’s a boon for them, too, because there’s still going to be people who are going to want recreational cannabis.

Even with medical patients, I think there’s still going to be crossover.

Of the studies that were included in the rescheduling recommendation documents, did any come as a surprise?

Buck: They’re being conservative, which I’m not at all surprised by. They want to feel above reproach in getting the DEA (to approve the rescheduling).

They used a lot of big review studies and found there was enough credible evidence to support the use for pain, for anorexia and nausea and vomiting.

For there to be at least some credible evidence for one condition – and the recommendation includes three – I think that’s great.

Then, let the scientific community take that and move forward.

Montalvo: They did look at the evidence for things like inflammatory bowel disease and seizures, etc., which are all things that clinicians who use cannabis are frequently using it for.

If people see cannabis can be used well and safely for something like pain, which is something we all struggle to treat, I think they may become more interested in using it for other things.

Buck: I would say probably at least 50% of the people that we see have pain in some capacity. They’re looking for relief.

Do you think the studies released with the recommendation might lead more people to medical marijuana or cannabis in general?

Abraham: Both. The health care industry – even with the proposal of (rescheduling) – they are going to have to start changing policies rapidly to meet the needs of even the current patients.

Once the gates open to rescheduling, technically, you can now use this in the hospital.

While hospitals may not want to have any formulary or products on hand, patients are going to say, “Wait a minute, I want to bring my own, why are you disrupting a regimen that works for me to give me narcotics?”

Buck: What the operators need to know – and this is part of our mission and what we do – is that in order for new cannabis users to have a good experience where they get relief and they come back and continue to be customers, is that they really need education and guidance on how to use it.

Especially an older person who may not have used cannabis since the ’60s or ’70s.

If they come in and get the wrong budtender and leave with the 100-milligram THC gummy, that’s it. They’re never coming back.

Having really robust education, maybe with some guidance from physicians, is going to be really important.

This interview has been edited for length and clarity.

Kate Lavin can be reached at kate.lavin@mjbizdaily.com.