Markita Wilburn says cannabis got her through pharmacy school.
“I was away at school, no family, no friends, in a doctoral program … It was a trying experience. There were times where I would just wake up just vomiting because I was so anxious and nervous and just stressed,” Wilburn said. “[Marijuana] really did help me. It allowed me to focus, it allowed me to be present, it allowed me to get through it all.”
Wilburn is the pharmacy manager at Maitri Medicinals, a cannabis dispensary in East Liberty. From the beginning, Wilburn knew she wanted to be a cannabis pharmacist, even though the field barely existed when she graduated in 2011.
Connecticut was the first state to require pharmacists in medical cannabis dispensaries, when it passed its law back in 2012. In Louisiana, the dispensaries are actually licensed as pharmacies. Minnesota and Arkansas also require pharmacists to be involved in some way, and five other states, including Pennsylvania, require either a pharmacist or physician to be on staff. Locally, many dispensaries opt for pharmacists over physicians, including Maitri.
“We were interested in bringing pharmacists on because of their knowledge of the pharmacology of marijuana in the body,” said Maitri CEO and co-founder Corinne Ogrodnik. “I'm not saying physicians don't know that, but pharmacists are trained to a deeper level to understand the action of the substance within the body.”
Wilburn now helps patients figure out what type of cannabis is right for them based on their symptoms. Do they want to alleviate pain, improve sleep, reduce inflammation?
“And if you are marijuana naïve, we kind of take it a little slower,” Wilburn said.
She also checks for interactions with any other drugs a patient might be taking. Certain pharmaceuticals can make cannabis less effective or cause it to build up in the body, and vice versa. Those results could be inconvenient, like if someone has to spend more money on cannabis to get the desired effect. Or they could be dangerous, like if the presence of cannabis causes a blood pressure medication to fail.
That’s the kind of information Jen Evashavik needed when she started buying cannabis for her 16-year-old son Luke, who has cerebral palsy, autism and a seizure disorder.
Luke is on a couple of medications for his complex health issues, so it was important for Evashavik to consult with a pharmacist before starting him on cannabis. In addition to anti-anxiety and anti-seizure medications, he takes an alcohol-based form of cannabis called a tincture, and a type of oil called an RSO.
With the right drug regimen, Evashavik said Luke is thriving. People underestimate children on the autism spectrum, she said, especially when they’re nonverbal like Luke. But he’s a speed reader, he’s starting algebra, and he loves doing yoga.
“He's pretty generally pretty happy all the time, except puberty has kind of thrown us for a loop actually,” Evashavik said, laughing.
When puberty hit, Luke started having what Evashavik calls meltdowns. “Hitting himself in the head, hitting his legs. Never towards me or anyone else, it was always self-injury out of frustration … he can't tell me what's wrong,” she said.
She took him to every medical doctor they could think of, ran all the tests, but everything came back perfectly normal. There was nothing the doctors could do for him. After doing some research online, she started purchasing CBD oil from a company in California, but found that she’d have to increase the dose every once in a while to stave off the meltdowns.
“It was getting expensive,” said Evashavik.
When Pennsylvania’s medical marijuana program went into effect last year, Luke was able to legally try THC – another compound in cannabis – in addition to CBD. It immediately started helping with both his seizures and his meltdowns. Still, every now and then, they have to tweak his drug regimen to keep his symptoms at bay.
“That's why you need the pharmacist, because they know … and they will just tell you what they think you should try,” Evashavik said. “And so, you know, we didn't know we had to add extra tincture in the morning until things just weren't really working out. And then we did it and it's been working out better.”
It can sometimes be tough for pharmacists to get the information they need to help patients. In Pennsylvania, they do take a 4-hour continuing education course in order to work in a dispensary, but most pharmacy schools still don’t currently teach much about the drug. That's beginning to change: The University of Pittsburgh School of Pharmacy is currently developing an entire course all about cannabis and how it works in the body. And they’re helping students get hands-on experience.
“We've opened up rotations, for example, in the last year of school, where they can go to local dispensaries and [shadow] a pharmacist there,” said Natalie Capozzolo, who works at both a local dispensary and Pitt’s pharmacy school, and is helping develop the new cannabis course.
Marijuana’s federal Schedule 1 drug status makes large scale studies next to impossible. But Melani Kane, co-founder of the International Society of Cannabis Pharmacists, said she doesn’t need more clinical evidence; she knows cannabis works.
“I think it's one of the best drugs we have. It's not perfect, but it's one of the medicines that can treat so many different ailments depression, anxiety, insomnia, pain, spasms,” Kane said. “You don't have this with other drugs.”
What’s needed, said Kane, is standardization of the types and forms of cannabis, education and certification of pharmacists, and destigmatization of cannabis once and for all.
“In my perfect world, it would be readily available in pharmacies and patients would have access to health care professionals that are knowledgeable about the plants and about the body,” Kane said.
Kane would like to see cannabis available to anyone behind the counter. That means people would have to consult with a pharmacist, but they wouldn’t need a prescription from a doctor. People are using it anyway, she says. They’re buying different forms of cannabis from pot dealers and gas stations. With pharmacists in the mix, people can be sure that their use is safe and effective, whether they’re trying to relieve pain, reduce seizures, or just unwind after work.
Find more stories in our series, The State of Cannabis.