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An interview with Debbie Churgai by Abby Stoddard, PharmD, MBA on behalf of The Client Centered Network.

Oregon is one of the few but growing number of states that have both a medical cannabis program and an adult use (recreational) program, and users of cannabis medicine can be found in either group. Enrolling in Oregon's medical marijuana program (OMMP) requires an application, physician and patient documentation, and a fee, but does have benefits. Patients in the OMMP program do not have to pay sales tax, are eligible to receive free product, and many dispensaries give OMMP members preference on things like delivery, parking, and in-store service. If you are considering applying to the OMMP program please check out our resource page, especially our cost calculator, to see if it might be a good fit for your situation.

Whether you enroll in the OMMP or not, I always encourage those using cannabis medicine to keep their health care providers in the loop - whether that's your naturopath, your therapist, your chiropractor or your primary care physician. Just like prescription medication, diet and exercise, cannabis can impact other therapies and treatments you may be using, so it's important to make sure whoever you're working with has the full picture and can monitor your progress or make adjustments if needed.

Of course having the conversation about cannabis can be complicated, intimidating and nerve racking. Medical cannabis has been legal in Oregon since 1998, but there can still be stigma, misinformation, and entrenched opinions on its use in the mainstream medical community. That is slowly but surely changing for the better, but in the mean time I wanted to speak to someone who knows the ins and outs of this dilemma and who can offer even more resources to empower users of cannabis medicine. I sat down (virtually of course) with Debbie Churgai, Executive Director of Americans for Safe Access to get some tips and talking points to help patients start this conversation. A big thank you to Debbie for her time and to ASA for all that they do. Read on for more on the free resources ASA provides to empower you to direct your cannabis care with your provider team.

CCN: Tell our readers a little bit about Americans for Safe Access and your role in the organization.

DC: ASA was founded in 2002 as a vehicle for patients to advocate for the acceptance of cannabis as medicine. ASA is the largest advocacy organization for legal medical cannabis use and research with over 100,000 supporters in all 50 states. ASA is well known in the medical cannabis community and is a strong influence on Capitol Hill and state legislatures across the country. We've helped to pass medical cannabis laws in 33 states and four U.S. territories. Recently, ASA was able to help keep cannabis businesses open during the COVID-19 shutdown. Currently, we are working to strengthen already existing state laws and regulations, and advocating for medical cannabis legalization at the federal and international level.

Despite the fact that 47 states, the District of Columbia, Guam, and Puerto Rico all have passed some kind of medical cannabis legislation, upwards of half or more of these populations are left out of the programs because of legislative and regulatory barriers. Creating safe and affordable access to patients everywhere, no matter what state they live in, what condition they have, where they work or live, or what socioeconomic status they are in, is our main goal.

ASA was founded by Steph Sherer, who remained the Executive Director until 2019, when she moved to President of the Board and I stepped into her role. ASA is proud to be one of the only "old-school" cannabis advocacy groups that has always been women-led.

CCN: ASA has been around for almost 20 years advocating for patient access to cannabis - have you seen attitudes change in the 'mainstream' health care community towards cannabis in that time? What do you think the driving forces behind the change are?

DC: When we began in 2002, there were only 11 medical cannabis dispensaries in the country—and all in California and all illegally run. Advocacy was focused on fighting DEA raids and police harassment surrounding medical cannabis. However, we soon realized that these battles would only take our mission so far, and the real key to changing minds was through education. ASA started advocating for medical cannabis laws at the state and federal levels, and helping legislators write medical cannabis legislation, many of which have become law in the U.S. We also started creating patient and doctor education through our Cannabis Care Certification (CCC) program and safety standards and training for the industry through our Patient Focused Certification (PFC) program.

It has taken many years, but programs like these have all helped to legitimize this medicine. 

CCN: In a state like Oregon, anyone over 21 can walk into a dispensary and buy cannabis, or they can get a medical card through the Oregon Medical Marijuana Program (OMMP). What's the difference? Why would someone still want an OMMP card?

DC: The layering on of the state-authorized adult-use access model led to an expansion of legal retail access facilities from which patients can secure medicine, which led to reduced attention to the state medical program by regulators, physicians and patients. However, we encourage patients to talk with their doctors about cannabis and believe that doctors, whether they agree with cannabis as a medicine or not, have a responsibility to assist patients seeking alternative treatments to those provided by the pharmaceutical industry. A few benefits of the Oregon medical cannabis program is that registered patients are shielded from state taxes on medical cannabis purchases. Registered patients can also participate in other state programs via reciprocity laws. Unfortunately, for many patients, the state medical program can be too expensive to participate in ($200/yr application fee). Regulators should do more to engage patients and physicians to solicit feedback on program operation, educate patient physicians on the utility of cannabis as a medicine and how to talk to patients about cannabis and engage with patients.

CCN: Many people might be intimidated to talk to their doctor about cannabis, I've heard some people say they're scared to get 'fired' by their doctor if they mention it. What should people know about their right to access cannabis in a state like Oregon with a medical and recreational program? 

DC: Yes, patients can just walk into an adult-use dispensary to secure legal access to cannabis, but without consulting with cannabis-educated doctors, patients are really left on their own to navigate treatment. This can be costly - e.g. having to buy products that may not treat a patient’s condition repeatedly via trial and error is more expensive than if a patient was able to secure a recommendation from a cannabis-educated doctor for the specific cannabis or cannabis product that will treat the patient’s condition, and find a local dispensary carrying that/those products. This can also be taxing on a patient with mobility issues, having to make repeated trips to dispensaries to hopefully secure the correct medicine and related dosage to treat the patient’s condition. 

We hear from patients all over the country that some doctors can be dismissive when they raise cannabis treatment as an option during a doctor visits. This is a stigma issue and is completely unacceptable in Oregon or any other state. There is a tremendous need in Oregon for physicians to become better educated on cannabis health applications, and patient engagement on the issue. This is why we created the Cannabis Care Certification (CCC) program. This program helps medical professionals, patients, and their caregivers better understand the endocannabinoid system and cannabis therapeutics. This program offers education for patients and caregivers, and Continuing Medical Education Credits (CME's) in cannabis-specific topics for medical professionals. 

CCN: Some people just need help kicking off the conversation. Do you have any helpful talking points patients can use with their doctor?

DC: Yes. ASA's website is full of educational resources for patients that are free to download. We encourage patients to take education with them to the doctor. This includes our ‘Talking to Your Doctor about Medical Cannabis’ guide. In it we acknowledge that doctors may be unaware or uncaring about state and local laws pertaining to cannabis policy reform, or be influenced by 80+ years of stigma that has been amplified across America. As such, patients must educate and prepare themselves for these conversations to be their own advocates. We suggests that patients familiarize themselves with the authorized conditions for which cannabis is permitted to be recommended in Oregon, and that patients bring along any information they can find about specific applications of cannabis to treat the condition they are discussing with their doctor.

CCN: If a doctor won't discuss cannabis with a patient, what should the patient do next? Are there any other resources, education sites, or support groups you recommend?

DC: It can be discouraging for patients to hear their doctors push back against cannabis as a treatment option, but ASA encourages patients to find alternative health resources. It is not uncommon to have to visit with several physicians before finding one that works for each patient. We recommend finding cannabis patient support groups in Oregon, where patients can discuss optimal treatment solutions and share information about qualified cannabis-literate doctors to help them navigate treatment.

CCN: If readers want to know more about your organization's history, mission and how they can get involved where should they go?

DC: Our website www.AmericansForSafeAccess.org offers a ton of free information for patients and we are always creating new reports that patients can share with their doctors or regulators. We are a member-based organization, and can only do the important work we do with support from our membership. So I would encourage people to become a member (for as little as $35 a year or $5 a month) or sign up for our monthly newsletters which includes information on what is going on around the country in regards to medical cannabis. You can also follow us on Facebook, Twitter, Instagram, or LinkedIn to learn more about what we are doing and ways you can help.

This blog can also be found on the Client Center Network blog page: https://www.clientcn.com/post/talking-to-your-doctor-about-cannabis