Susan Marks, RN, BSN, PHN, and a member of the American Cannabis Nurses Association
Susan Marks, RN, BSN, PHN, is a cannabis nurse and a member of the American Cannabis Nurses Association. She works with medical patients who want to include cannabis therapeutics in their health management program. With her website, DearNurseSusan.com, Susan educates and consults with clients on: The endocannabinoid system and how cannabis works in their body and is specific to their disease or issue, how to select safe and reliable products, the dosing process, the risks and benefits of cannabis, identifying drug interactions and avoiding unwanted side effects, understanding that cannabis is a treatment within a continuum of care which involves interacting components and being able to integrate cannabis with the client’s current treatment choices and lifestyle. With this knowledge, Susan Marks helps her clients make informed decisions about their cannabis regimen. We sat down with Susan to talk about the current state of the industry and how medical marijuana is benefiting people for a wide variety of reasons.
Marijuana Retail Report: Can you tell us a little bit about your background and how you decided to enter the medical cannabis field?
Susan Marks: I’ve been a nurse for more than 30 years, and several years ago my essential tremor, which is a neurological movement disorder, it’s a progressive kind of disorder, it got to the point where I needed to be taking antiseizure medicine and they were horrible. There are eight kids in my family, six of us have it, and my oldest brother, Jeff, has it the worst. Between the horrible effects of the antiseizure meds and the fate of my brother, I got desperate and just started researching, trying to find other things to slow down the disease. Cannabis was never a part of my life. When I started reading some of the medical research and just going on different sites on the internet I thought, “Well, it certainly worth the try, it doesn’t seem like it’s gonna be, you know, as toxic as the anti-convulsants.” So, I slowly was able to wean myself off of the antiseizure meds and I’m completely managing my tremor using cannabis. I have a high CBD, low THC regimen, and might use a little bit of raw cannabis as well. When I got such good results and felt so much better, I wanted everybody to know about this and that it’s available to them, and that it’s a lot safer and healthier than the typical western medicine treatment protocols. So I started educating, doing meetups, and anybody who wanted to learn about medical cannabis I was happy to share my knowledge with them. I started picking up clients, and I now spend most of my time working with individual medical patients who want to see if cannabis will be helpful in their disease management depending on what their situation is, what their goals are for cannabis therapy. I let them know which cannabinoids are the most important to deal with whatever issues they have, and what products contain that cannabinoid profile, or maybe we couple something together with a few different products. It keeps me busy. The rest of the time I write a column called Dear Nurse Susan. It’s Dear Abby but in the cannabis world. I take questions that I get and then I … “Dear Nurse Susan, I’ve been invited to a party then they’re gonna be serving edibles, and I’ve never tried marijuana. What do I do?”, then I answer and teach them about edibles, and what to watch for, and what kind of a dose to start at. You know, just that kind of stuff in addition to the medical side for example, somebody would write and say, “I have lupus and I heard that cannabis is good for lupus, is that true?”, then I’ll just answer, give information on the autoimmune system and how cannabis works to modulate that system. Anyway, it’s a lot of education, a lot of consulting and it’s the best job I’ve ever had. Seriously. I mean to be able to see people get a relief and nine times out of 10 they get the results that they’re looking for and they can’t hardly believe it.
Marijuana Retail Report: Can you speak a little bit about the endocannabinoid system, how it works with cannabis in a medically beneficial way?
Susan Marks: Sure. The reason I’m on a high CBD, low THC regimen is because CBD is more effective with tremors and movement disorder issues. Since I work all day I can’t be high so that’s where the low THC comes in and I usually take that at night so that I don’t have to any kind of impairment during the day. It’s funny, most of my clients don’t want to be high. That’s a common misconception with medical cannabis and that’s, “Okay, you know, this is just getting high and it’s not legit and all of that.” They’ve gotten so sophisticated now in the formulas in the genetics that have been developed with different cannabinoids being higher concentration than others. Anyway, I make sure that all of the products are safe so I see all of the lab results before I use anything and I teach everybody that they need to do that. They need to see lab reports so they know what the potency is and they know what the safety profile is in terms of the pesticides, and the molds, and the bacteria, and the solvents, et cetera. Once I’ve vetted the product then I start with the dosing of it. Generally it’s starting low and building up and incrementally adding different cannabinoids so that you can assess the effect that each additional cannabinoid is having. I finally, after doing a lot of experimentation with myself and often times I have to do the same with clients, it’s not immediate that you find the right regimen. After a lot of experimenting with myself, I came up with the protocol that is mostly CBD, then raw cannabis, the THCA and the CBDA because those are also effective with tremors, then the THC. I only use whole plant medicine, I don’t like using isolates because I think the entourage effect is very important. The selection of the product is important in terms of potency, and that it’s a whole plant and you’re going to get the entourage effect, and then just finding the right combination of cannabinoids that have scientifically been proven to be effective in certain areas. For example, THC is great when you have horrible nausea, pain, and vomiting, typically with chemotherapy or end-of-life issues. A lot of times people say, “Oh, THC is the fun one and CBD is the medical cannabinoid.” Actually, THC is very important to have, at least some of it in your regimen, not enough that you’ll feel the psychoactive effects per se, but it really is important to have the whole cannabinoid profile.
Marijuana Retail Report: Being a patient yourself, what are some issues that you’ve seen in the medical cannabis industry?
Susan Marks: Physicians don’t really like to talk about cannabis with their patients, I mean I had clients who were pulled back to me. They tried to tell their physician that they were starting this to see if it would help, and the physician like puts up his hands or her hands and says, “I don’t wanna hear about it because I don’t wanna have to document it” because they’re afraid that their DEA license will be jeopardy which is obviously what allows them to prescribe. It’s too big of a risk for most doctors. The only option that a patient has, unless they find somebody like me, is they go to a dispensary. Nine times out of 10, the budtenders don’t have any kind of medical education, or certification or anything like that, and they often times give the wrong recommendation. More often than not, they are recommending way too much THC and not enough of the other cannabinoids. If a patient has a bad experience with their first exposure to medical cannabis they’ll say, “Oh, this isn’t for me, you know, this doesn’t work, blah, blah, blah” when it really could be something fantastic for them. That’s probably the biggest issue. Next i’m worried that patients are going to be lost in the shuffle with adult use coming on in January. I just don’t want patients to be forgotten because they really need it, and they need it every single day. It’s not an option for them to, “Oh, do I wanna do it tonight or not?” Anyway, I think that those are my two concerns that people are being given the wrong information and have that experiences, and that with the adult use coming on in January that there’s going to be so much attention and activity in that segment that the needs of patients will get lost in the shuffle and maybe harder for them or more expensive for them to get the medication that they need. Actually, it just made me think of another issue on the patient side, and that’s that CBD, they pay the price on that. Most medical patients need CBD and it makes their medicine that much more expensive, and they don’t have insurance to cover it, or they have insurance but it won’t cover it. It makes access difficult.
Marijuana Retail Report: Do you see a potentiality for requirements for testing for budtenders on the medical side to be able to dispense proper information out? How important to you is education being taught in the dispensaries?
Susan Marks: I think it’s vital. In fact I spoke before the Santa Monica city council because they’re coming up with their regulations. I basically was there to advocate for patients and I said, “Listen, you need to make this as safe as you possibly can and I know that’s what your goal is, and you just need to understand that right now, patients are falling through the cracks, they’re giving the wrong information. But if budtenders had adequate education or certification to have a certain level of knowledge, if they’re gonna be interacting with the public, that would be part of public safety.” I also called the California Board of Education to ask them if they knew of any kind of certification that was coming down the pipe for budtender similar to like certified nurse’s aids. There was a time when pretty much anybody could be a nurse’s aid, and then it wasn’t until bad things started happening, but they changed it so that nurse’s aids needed to be certified, having a certain level of education and understanding. When I spoke with the Board of Education they said, “You know, either it’s gonna have to be regulated by the cannabis board or something really bad has to happen and then it will become a requirement that way.” I’m trying to affect the first one, and I’m talking to whoever is creating regulations for their area to include a requirement for minimal education of anybody interacting with the public and giving recommendations.
Marijuana Retail Report: We’ve seen a resurgence in the 50-year-old plus category in legalized markets, do you see that trend continuing?
Susan Marks: I think that as a demographic, the over 50 crowd is just going to get bigger and bigger. In fact, I believe it’s the fastest growing demographic. It totally makes sense because as you age you have more pain, you have more difficulty sleeping, a lot of ties there is an element of depression. In lieu of taking a pharmaceutical anti-depressant, and then another pharmaceutical sleep aid, and then narcotic analgesics, instead of having those three different drugs they are able to switch over to a plant medicine that has a far greater safety profile than the pharmaceutical drugs. What happens is by the time you’re over 50 you’re on at least two or three medications. There are some elderly patients that are on 12 to 15 different pharmaceutical medications and some of those usually are to manage the side effects from the other drugs. So it becomes like this vicious circle and it really impacts the quality of life for people who are 50 and older. To be able to have this kind of a safe alternative that improves their appetite, improves their nutrition, makes them sleep better which reduces their pain and depression, it all just kind of works together. I see that demographic definitely continuing to increase and adopt this as an alternative to pharmaceuticals. I could honestly get on a soapbox right now about the fact that the federal government and the Department of Health and Human Services has patents on cannabinoids as neuroprotectants and antioxidants that not only treat and help prevent Alzheimer’s, and Parkinson’s, and all of these things. On the other hand, it’s scheduled as a schedule one which means to the gov. there are no medical benefits and it’s highly addictive. Both things are completely untrue about cannabis. I’ll tell about politics and everything else as to why the situation is the way that it is. If we can just get the cannabis decriminalized on the federal level, then there’s all kind of education that will be available to patients, and much needed education. It’s not like you just read the thing on, instructions on the pill bottle, and the biggest worry is did I take that or not, did I forget to take it yesterday. With plant medicine, it just requires a little bit more self-reflection after you consume it to see how your body responds because everybody is different. It takes a little bit more effort to find the right dose for you and the right strains or products, but it’s certainly worth the effort. If you can find somebody to guide you through that process, it’s a lot faster and it’s a lot easier. They can’t keep it as a schedule 1 forever, there’s just too much of a groundswell of the public wanting this, and being able to end some suffering. The fact that the government is thinks that’s valuable enough to put a patent on it yet withholding it and throwing people in jail for using it, it’s just so hypocritical and immoral. I’ve seen so much suffering that could have been avoided. The government’s own words, it’s effective in the prophylaxis of all these diseases. Anyway, that gets me a little upset every time I think about it.
Marijuana Retail Report: If you can give our readers one tip on how to interact, engage, and better serve their medical patients, what would it be?
Susan Marks: I would say to have at least one person in a store at all times who knows medical whether it’s a nurse or whether it’s budtender who’s gone through some pretty rigorous education and training and passed an exam from a reputable location. Because when medical patients come in, they’re overwhelmed at the choices, I mean this is what I hear from my clients. They walk into a dispensary and they’re like, “Oh my god, what the hell am I supposed to do? I don’t know what to take, I don’t know how much to take. I don’t wanna make this worse, I don’t wanna get high.” They’ve got all of these things going on in their head when they come in for the first time. If there’s somebody there who not only understands the disease process but also understands the relevant issues by age then it makes the process easier. For example, your elderly client requires a lot less cannabis than a child, so it’s more about metabolism than it is about weight. A lot of times they’ll say the formula would be 5 milligrams per kilogram of the patient’s weight, but with cannabis it’s more about metabolism. A frail elderly person is going to need a tenth of what a five-year-old will need to control their seizures. That’s an important distinction to understand, and also what their challenges are. They need to be really good listeners, and not only know the medical stuff, but be able to work with whatever their age-related issues are. Whether it’s an elderly person and you have to deal with issues of forgetting, and safety, and teaching them about avoiding falls, all that kind of stuff. Those are issues that are commonly encountered with the elderly population. Then you have the parents who come in to buy it for their kids for seizure disorder or whatever. There you have a whole other set of issues of make sure that this is locked and in a safe place, and that the other kids can’t get to this, and the dog can’t get to this. It’s important for the budtenders to be able to understand and relate to the customers at the stage of life and the disease process that they’re currently in, then be able to make good recommendations so that the patient will start to have trust in that dispensary, that they have good products, that they have good recommendations, that they know what they’re doing, they aren’t just a bunch of stoners who are doing whatever. I think that will really significantly contribute to customer loyalty to that dispensary because most of these people don’t even want to go to a dispensary, they’re scared of them. If they’re going to go to a dispensary for their medicine, they’re going to equate that to going to a pharmacy. The more professional you can make your dispensary look, the more medicinal, the more it’s going to put that medical patient at ease. I think the adult user will walk in and recognize a good quality dispensary, but it’s the older demographic that really needs to be won over.
Marijuana Retail Report: How can patients reach you and what’s next for you in the industry?
Susan Marks: I have a website it’s called DearNurseSusan.com, and I am also putting on some online courses on my website for the public, for budtenders and for continuing education for nurses. Cannabis nursing is becoming a more popular area of specialty, so there’s a lot of education that has to go into being able to interact with the public on any one of those levels. They can reach me at my website, they can email me Hello@DearNurseSusan.com. They can call me. I’m pretty open. What’s next for me is I’m working on an app that will be for the end user. I originally started thinking I would make it solely for budtenders so that they could quickly look up disease states and the common symptoms in which cannabinoids and terpenes are best, et cetera. I thought, “You know what, the public could really, you know, use this directly.” The budtenders will want to use it too so that they’re giving the right advice to their patients though. I think the more that patients can feel in control through knowledge and through having an application to refer to will improve the results of individuals attempting to create their own cannabis therapeutic regimen.