By Jimmy Magahern
Patients over 50 are exploring medical cannabis to treat a range of ailments
As a naturopathic doctor, Sam Schikowitz says his main goal was always to treat chronic pain using natural medicine approaches.
But because N.D.’s (in 16 states, including Arizona) are also authorized to prescribe and refill many controlled substances the same as an M.D., Schikowitz found a big portion of his day was spent refilling pharmaceuticals, including opioids, for patients reluctant to give them up.
“It was an everyday thing,” he says. “But it was also the worst part of every day.”
Schikowitz describes the fairly toxic doctor-patient relationship that can develop when patients, dependent on opioids for pain relief, come to treat their doctor as a dealer.
“These patients would come back every month for their refills,” he says. “And these were just good people, with real pain and real problems. But you could see the opioids change them. Eventually they would be asking for more, asking for early refills, asking for increases in their doses.”
“It’s not their fault; it’s inevitable. It’s what happens with opioids. There isn’t a time when that doesn’t happen,” he adds with a sigh. “But the patients become sort of villains in the system.”
Growing resentful of patients putting him at risk for malpractice suits, license revocation and even criminal liability for over-prescribing painkillers, Schikowitz began moonlighting at a medical marijuana clinic, and he immediately noticed a healthy difference in patients who managed their pain using cannabis instead of opioids.
“It was like night and day. They didn’t exhibit the addict behavior I saw in opioid users, who always showed a kind of emptiness or neediness about them. You don’t see that in the marijuana patients. They’re typically people who are engaged in their own health management. They’re appreciative of the medicine, but they can do without it. I had some patients remark that when they were feeling good, they’d often forget to take their medicine for a week. That never happens with opiates or benzodiazepine. Never.”
Schikowitz decided to open his own certification centers, becoming one of the first 100 licensees following the 2010 passage of Proposition 203, which legalized the use of medical marijuana in Arizona. Today he serves as owner and chief medical officer of the Medical Marijuana Card Certification Centers of Arizona, which operates 10 locations around the Phoenix and Tucson areas.
He says he’s happy to no longer be contributing to the national epidemic of opioid addiction, which he contends pain management doctors need to take some responsibility for.
“The seed is sown the moment you prescribe that drug to them,” he says. “You set them on this path. You put something in their life that will make them forever tied to the medical system, tied to a substance and looking for it for the rest of their life. It’s heartbreaking when you think about it.”
Still, he says much of the medical community has been reluctant to acknowledge medical marijuana as a viable alternative to opioid painkillers.
“There’s been some progress, but there’s also still a lot of dyed-in-the-wool, head-in-the-sand doctors who are really dedicated to their position and refuse to look at the evidence,” he says. “Their job is really to manage people’s opiate regimens.
“But the users themselves are finally seeking other pathways,” he adds, optimistically. “And for a growing amount of them, that’s medical marijuana.”
Making the connection
The wall in the lobby of the newly opened 12,000-square-foot Mint Dispensary in Tempe is covered floor to ceiling with a giant photorealistic mural of a bank vault door opening up to reveal an endless garden of tall, leafy green cannabis plants. Raul Molina, marketing director for the company, which operates another store in Mesa, has seen plenty of Baby Boomers’ jaws drop in pure comic Cheech and Chong awe at the idyllic vision.
“We get a lot of these guys who were smoking in the ‘60s and ‘70s who can’t believe how things have changed,” says the serial entrepreneur (previous goldmines include the Tio Rico and El Gordo title loan stores), who was born in Ciudad Juárez, Mexico and graduated from Trevor Browne High School in Phoenix. “In the mornings, we set up specials to attract the older demographic. We put our older patient service reps up front, because that’s when the Baby Boomer crowd can feel less rushed. And they’ll reminisce about how they used to have to go to the south side and be hiding and looking over their shoulders whenever they used to buy pot. And the reps behind the counter will talk about going from being the black sheep in the family to actually finding an industry where they’re able to do something they like – and not be criticized and judged for it.”
The biggest change, of course, is that the Baby Boomers who once used recreational pot illegally are now using it legally for all kinds of legitimate ailments faced by older adults, from chronic back pain and severe nausea to hepatitis C, cancer and Alzheimer’s.
Older adults, by and large, are embracing cannabis as a safer and healthier alternative to prescription painkillers. A study presented in May at the annual meeting of the American Geriatrics Society in Orlando found that up to 65 percent of older adults who use medical marijuana significantly reduced their dependence on opioid painkillers while successfully alleviating their pain. That same study, drawn from a questionnaire of men and women between the ages 61 to 70 suffering from chronic pain who were given medical marijuana, reported 91 percent of those surveyed would recommend marijuana to others as pain medication.
As far as it’s come from the streets, however, buying medical marijuana is still a convoluted process, not covered by insurance and takes place, by design, outside the familiar realm of primary physicians.
That alone limits its acceptance. In a recent National Poll on Healthy Aging, the majority of the respondents, ages 50 to 80, said they believed medical marijuana was effective for pain relief, anxiety and other conditions. But 80 percent of them said they’d be more likely to use it if their doctor consented to a regimen, and a full 60 percent said they wouldn’t use medical marijuana without a doctor’s recommendation.
“It’s not like a traditional prescription world, where a doctor writes a specific prescription, the patient takes it to the pharmacy and a pharmacist who’s very well-versed in the regulations fills it,” says Elaine Burns, an Arizona-licensed and board-certified naturopathic medical doctor (NMD). “There’s a degree of confidence in that process, and it’s simplified to make getting the medication easy. Well, that doesn’t exist in the medical marijuana world.”
As medical director of Southwest Medical Marijuana Evaluation Center in Phoenix, Burns helps patients navigate the state’s certification process, which involves first being diagnosed with a qualifying medical condition (from severe and chronic pain to PTSD, glaucoma and HIV/AIDS) and collecting the required medical records, then becoming certified by a doctor qualified under the Arizona Medical Marijuana Program, and finally being issued a medical marijuana ID card – all processes that also require fees.
Even after going through all that, Burns says, older patients can be intimidated by going to the licensed dispensaries in the state, which she says are often not operated with the more mature adult in mind.
“The majority of certification centers just give you a piece of paper,” she says. “There’s no education, no dosing and treatment guidelines to follow. The centers and the physicians just leave it up to the dispensaries to figure that out for the patient. And there’s often a lot of recreational overtones at those. Patients will complain about the loud music playing, and having to listen to an 18- or 19-year-old ‘budtender’ talk to them about getting stoned. It’s an environment that can feel really disrespectful to the serious medical marijuana patient and devalues the program — which is already regarded by some legislators and senators as a Trojan Horse for recreational use, and those overtones just feed into their assumptions.”
Fortunately, that old model of the tie-dyed dispensary is rapidly disappearing in favor of clean, professional environments more like an Apple Store crossed with a doctor’s lobby, partially to cater to older users seeking serious pain relief.
“When you walk into our dispensary, it looks like a clinic,” says Molina of Mint’s new Tempe location. “There’s no marijuana leaves on the walls, there’s no Bob Marley playing on the speakers — nothing like that.” (Well, except for maybe that mural of the giant vault of weed.)
Molina says the people who snagged the first 100 licenses offered under the medical marijuana program tended to be stoners themselves. “It was the owner and a bunch of his friends getting high in the back and talking about how much money they were making,” he says. “Now it’s moving away from that. They’re all getting bought out, and the new owners are all businesspeople. It’s people who don’t smoke who are taking this on as a regular business and not a hangout.”
Molina’s reasons for catering to an older clientele are pure business, too. “To be honest with you, the kids will come in before the weekend and spend 30 bucks, whereas the older folks will come in and spend $150, $200, because they’re not looking to come in every other day,” he says, with a laugh. “They stock up!”
Will that be CBD or THC?
Along with tailoring the buying experience to better suit the older, more serious medicinal-use patients, today’s dispensaries – and their growers – are tinkering with the product to bring the offerings more in line with what that demographic is looking for.
Burns offers her own line of oils infused with cannabidiol, or CBD, the part of the plant that can alleviate inflammation and acute pain without the psychoactive effects produced by tetrahydrocannabinol, or THC, the plant’s more renowned property.
“Medical marijuana patients do not want to get high,” Burns insists in the press release for her Dr. Burns’ ReLeaf line, which includes an Opioid Recovery formula, a pain and migraine “ReLeafer” and a “GI Assist” formula for gastrointestinal ailments. “They just want to get better and feel better.”
Dan Kingston, marketing manager for AZmarijuana.com, a website that serves as an information clearinghouse for the state’s medical marijuana doctors, certifications and dispensaries, advises older users to steer away from the high-THC strains, even if they came of age during weed’s golden era.
“When you think back to the ‘60s and ‘70s, marijuana had well under 10 percent THC content,” he says. “These days it’s hard finding anything under 10 percent. So some dispensaries do carry lower-THC marijuana, and some of them do have some great high-CBD strains.”
Kingston says older users also are going for alternatives to smoking the flower, which these days can include cannabis-infused gummy bears, weed-vaping pens and cannabis tinctures, an extract made by soaking the dried flowers of the plant in ethanol and applying it to the skin or tongue.
“Consuming edibles or tinctures metabolizes the marijuana differently in the body than when you inhale it,” he explains, in budtender speak. “So it affects you a little bit differently, and takes longer for the effects to kick in. And they last longer as well.”
Former Scottsdale resident Bobbie Friedman, a physical therapist and dry needling acupuncturist now based in Las Vegas, swears by CBD, the wellness weed without the high that even young people are now using as a soothing remedy for high-stress lives.
“I contend everybody over 55 needs CBD regularly, just as they would take a Centrum multivitamin,” she says, enthusiastically. “Supplements are going to have CBD in them. CBD is already being used in face creams. There are CBD-infused craft beers, CBD-infused wines. Before Anthony Bourdain died, he did a whole show on infused-food restaurants in Washington State.”
While CBD promises the healing power of cannabis without the psychoactive effects, Molina advises his stores’ aging Baby Boomer shoppers to mix a little THC in there, too — just for good, therapeutic fun.
“First of all, anyone over 60 should be taking some CBD product just because it reinforces their immune system so they will live longer, and live a more enjoyable life,” he says. “But when you add in some of the THC, some of the psychedelic aspects of the marijuana, that can make them actually want to get out of their chair and go for a walk. All of a sudden they start getting more active. Because there’s still the cool part about it! Yes, they are feeling much better, they’re enjoying the later part of their lives much more. But beyond that, it’s making them feel funky!”
Molina laughs. “They’ll get with their old buddies and tell war stories for four hours! They’ll go to the park with the grandkids and play ball. It gives you a type of energy. And if you’ve been slowly deteriorating, closing in on yourself and feeling isolated, that’s healthy medicine in itself.”